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Home My Public Portal About5828 BURTON AVE_Sewer__ Sd 'oot- 'S,Iee ' o-,,zar%j9 >s �� ►0'�PLICATION FOR PERMITB 6DIVISION OF BUILDING ASAFETY SEWER ND —SEWAGE DISPOSAL Deportment of County Engineerun County of Los Angeles 1 3m LDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS ® CASSATT D. GRIFFIN, SUPT of BUILDING LOCALITY AP LICANT TO FILL IN / CROSS ST. � 7i - G GIi�FOR LO N0. 'I /-� OWNER RAIL G BLOCK i �iTRACT ADDRESSNO a rq / •V y /LG OW ON LOTS CITY t _ TEL. NO,47 SIZE OF LOT /l4-� N USE OF BUILDINGS G(.f:-{.L�-i G DISTRICT NO. GROUP MAP BK PG ' CONTRACTOR J CONNECTION DATA ADDRESS �st/�- /¢� �" ./iI �.�'{�. . CITY -�f (7 TEL. NO. STATION B DEPTH STATE // `� MANHOLE REFERENCE? �' _ _ 112:16 REGISTRATION NO. �' 9�7] COUNTY OWER NO. DESCRIPTION OF WORK FEET HOUSE SEWER CONNECTING TO TYPE O�iC9NN�(yTION LENGTH FROM.�D / .PUBLIC SEWER @ $3.50 Y. (( CURB/ P.L. M L 1.TOP L of SEPTIC TANK.SEEPAGE PIT OR PITS AND/OR GRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD /%l P. C. NO. EXTN.,CESSPOOL,DRYW ELL,M AN HOLE @ S 2.00 CO. IMP- NO, l C/ JOB NO. _ HOUSE SEWER CONNECTING TO I i PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. Z� ,J O CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1.00 PERMIT NO. ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $ 1.00 WASTE APPROVAL - CHARGES - CONNECTION CHARGE FEE OWNERS PERMIT S 1 DD —�� REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOWSSIGNATURE HAVE TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEVER_ ` NEW HOUSE SEWER Y SIGNED THISDAY OF �� 191' '1 - CONNECT ADDITIONAL OWNER OR b N t /, �� BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) ADDRESS q AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS EGULATING ALTER,REPAIR.SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT' 1 AM PROPERLY R 'TER AND/OR DISCONNECT PLUG AND LICENSED AS REO UIR ED BY LOS gNGEL C TY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT AM THE LEbA NER OF THE ABOVE DESCRIBED RESIDENT[ PROPERTY. ,- BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP.PIT(S) O CESSPOOLS❑ OF PERMITTEE e �"'Zt.�S/ JOHN A. LAMBIE.. Coll ENGINEERIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK., N.o. cAsx UEo 1.2 1 3 HAY 2 3 �4 A 4.50 M WORKERS'COMPENSATION DECLARATION - T hereby affirrp-that I have a certificate of conseht to self - insure%or acertificate of Workers'Compensation Insurance, or 7eA6410 - - a mwilied copy thereof (Sec. 3800, Lab C.) cE W8(REV.B/BI) . . APPLICATION FOR PERMIT Policy'Np. Company ®s - A ❑Certified copy is hereby furnished. - - SEWER. ' SEWAGE DISPOSAL ❑ Certified copy is filed with'the county building inspection COUNTY OF LOS ANGELES - BUILDING AND SAFETY department. Date Applicant FOR APPLICANT TO'FIU. IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING .504 Au�-f) siArloN DEPTH COMPENSATION INSURANCE ADDRESS O A A / O - (This section need not be completed if the work involved by the G46 zl/i t/ MANHOLE REFERENCE UPPER permit is for one hundred dollars,($100)or less.) t LOCALITY _ /t�uu�7/(C` 1. LOWER I certify that in the performance of the work for which t CRAREST /'T� uYL//�,J - TYPE OF CONNECTION LENGTH FROM Y. - CURB PA. ML TO P.L. permit is issued, I shall not employ any person in any man so as to become subject to the Workers'Compensation La s (� �1 P.C.NO OWNER . �J p• CO.IMP.NO. JOB NO. //��//� / �� [/�/l/ MAIL /(' .�./. TRUNK PERMIT NO. ROAD PERMIT NO. Do tE�/W'�r-_¢�.F.YApplicant ADDRESS &1 N lO Y7� NOf6'R/.-E TO APPLICANT: If, after makingthis Certificate o{ ,,LAFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE CITYS(711 /L LG.1 TEL.NO, Exemption, you should become subject the Workers' Compensation LEGAL - - Compensation provisions of the Labor code, you must forthwith DESCRIPTION LOT NO. HWY.OR ST_WIDENING comply with such provisions or this permit shall be deemed revoked. BLOCK -TRACT STATE ENCROACHMENT -t . . LICENSED CONTRACTORS DECLARATION NOOF BLDGSPERMIT NOL SIZE OF LOT NOW ON LOT I hereby affirm that I am licensed under provisions of Chapter f USE OF 9 (commencing with Section 7000) of Division 3 of the Busk USE CHARGES ness and Professions Code, and my license is in full force and effect. CONTRACTOR CONNECTION CHARGE FEE �. d License Number LIC.CIa55 ADDRESS REIMBURSEMENT FEE Q ContractorDate - DISTRICT NO. GROUP MAP ROCESSED BY V 1 CITY TEL.NO. q BK PG Z STATE LIC S Q ❑ am exempt under Sec. of the L.A.Co. .. LICENSE No. aAss r(� F Plumbing Code and/oNO.or OF WORK FEE rSec. ofthe HOUSE SEWER CONNECTING TO DAL EF VALIDATION. d B. 8 P. Code for the following reason PUBLIC SEWER yF SEPTIC TANK, .SEEPAGE PR OR FINAL ' PITS AND/OR GRAINFIELD Date HOUSE SEWER CONNECTING TO BY PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG.OR , OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER D 1{)t 1)0 hereby affirm that OVERFLOW SEEPAGE PIT,DRAINFIELD am exempt from the Contractor's License EXTN.,CESSPOOL;DRYWELL,MANHOLE - Law for the following reason (Secton 7031.5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE. fes as Code): - - SEWER OR DISPOSAL SYSTEM L r.l'•9 I,as owner of the property,or my employees with wages as 330I +��•�C' their sole compensation, will do the work and the structure 1 -i7c C is not intended or offered for sale (Section 7044, Business and Professions Code). OWNERS, Permit $ (J _ TOTAL 21 - 50 ❑ I,:as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE 2/ _ licensed contractors o ca the project ($aCfiOn 7044, HAVE AT THIS DATE CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO -CHECK '-1•cl_ - Business and Professions Cooddee).). CONNECT THE AeoveoEscRleEo EXISTING DweuwG To THE PUBLIC SEWER. L - CONSTRUCTION LENDING'AGENCY - - - - . . C�HANG- _ °�fFl I hereby affirm that there is a construction lending agency SIGNED THIS _ DAY OF 19_ for the performance of the work for which this permit:is OWNER OR issued (Sec. 3097, Civ. C.). =AGENT D - -" 00130-013016i/ 4/=;'U ADDRESS ,Lender's Name10137 i ANi[I. I. o Lender's Address I certify that I have 'read this application and state that the _ - above information is'correet. I agree to comply with oil County - - ordinances and State IOwS regulating Plumbing and Sewers, - and hereby out orize representatives of-this Countytoenter upon t e abov ntioneid property&r inspection purposes. Signature of Permittee (/Dote • SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION I hereby affirm that I hove a certificate of consent to self 20-0051 DPW 6109 761sure, or a certcate of Workers' Compensation Insurance, or indiG a ce^,fled cap, thereof-(Sea. 3800. Lab C.) APPLICATION FOR PERMIT Policy No. Company ❑ Certified copy is hereby furnished SEWER - SEWAGE DISPOSAL ❑ Certified copy is 6lefwim he County building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department Dote _ _Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING COMPENSATION INSURANCE ADDRESS - STATION DEPTH (This section need not be completed If the work Involved by the MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100) or less I LocaurY LOWER NEAREST TYPE OF CONNECTION LENGTH FROM certify that m the performance of the work for which this CROSS ST r CURB PL mL TO PL permit is Issued, I shall not employ any person In any monner LEGAL FIT NO so as to become subject to the Workers' Compensation Laws. DESCRIPTION LOT NO. CO IMP NO JOB NO BLOCK TRACT TRUNK PERMIT 10 ROAD PERMIT NO Date Applicant NOTICE TO APPLICANT: If, after making IfLS Certificate Of ASSESSOR AFFIDAVIT WAIVER EASEMENT RECORD INSiR NO GATE 9 MAP BOOK PAGE PARCEL Exemption, you should become subject to the Workers' NO.OF FLEXES. Compensation provisions of the Labor code, you must forthwith SIZE OF LOT NOW ON LOr oR ST WIDENINGcomply with such provisions or this permit shall be deemed USE OF Hwr revoked. BUILDINGS STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION PERMIT No I hereby affirm that I am licensed under provisions of Chapter OWNER 9 (commencing with Section, 7000) of Division 3 of the Busi MAIL —_ ness and Professions Code. and my'license is in full force and ADDRESS CHARGES effect CITY TEL NO CONNECTION CHARGE FEE License Number Lic. Class - REIMBURSEMENT FEE CONTRACTOR Contractor Date DISTRICT NO GROUP MAP PROCESSED BY ADDRESS BI FG ❑ I am exempt under Sec. of the L.A. Co. CITY TEL NO Plumbing Code ond'or Sec. ofthe STATE LICFINAL VALIDATION LICENSE NO CLASS DATE 8. 8 P. Code for the following reason NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO FINAL - Date PUBLIC SEWER BY Y. . .. _ SEPTIC TANK SEEPAGE PR OR Signature PTS AND OR CONNECTING _ MOUSE SEWER CO SYSTEMG TO OWNER-BUILDER DECLARATION PRIVATE DlsnosAL SYSTEM 3` 3 E- I hereby affirm that I Om exempt from the Contractor's License CONNECT ADDITIONAL BLDG OR < f"�L"M@'• Law for the following reason (Secton 7031.5, Buisness and Pro WORK TO HOUSE SEWER fesLans Code) OVERFLOW SEEPAGE PIT.DRAINFIELD '}-(5yy'LP�AL ��rr K- ExTN CESSPOOL DRYWELL MANHOLE /tf FEA. 3 0 ❑ I, as owner Of the property, or my employees with Wages as AI LER REPAIR OR ABANDON HOUSE y their sole compensation, will do rhe work and the structure SEWER OR DISPOSAL SYSTEM is not intended or offered for sale (Section 7044. Business and Professions Code). ❑ I, as owner of the property, am exclusively contracting with OWNER'S Permit $ �y�y� t�yst licensed contractors to construct the project (Section 7044, I"-Wo 31/7-1 Business and Professions Code). AUTHORIZATION TOTAL FEE 'olds+ A+ dq CONSTRUCTION LENDING AGENCY HAVE AT THIS DATE E CONTRACT EX1 WITH THE HEREIN THE PUBLIC QNT4AC10R 'C I hereby affirm that there Is a construction lending agency CONNED THE ABOVE DESCRIBED FxisriNG DWELLING TO THE PueL C scweR for the performance of the work for which this permit is issued (Sec 3097, CIv. C ). SIGNED THIS DAY OF Iv_ OWNER OR Lender's Name OWNERS AGENT Lender's Address ADDRE ss I certify that I have read this application and state that the above information Is correct. I agree to comply with all County ordinances and State laws regulating Plumbing and Sewers, and hereby authorize representatives of this County to enter upon the above-mentioned property for Inspection purposes. Signatm+e of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'[OMPENSATION DECLARATION I hereby affirm that I Kaye a certificate of consent to self 20.6661 DPW 6189 u insure, or a certi4 icate of Workees'Com ensot ion Insurance, o 76A642D - s!. T! a certified c ( 3800, a -) f APPLICATION FOR PERMIT PGLcy NO�� Ony ❑ Certified copy Is here/by furnished SEWER - SEWAGE DISPOSAL ElCertifiedcopy is filer with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY of tment 7 Date - Ayalimm FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM W BUILDING ✓7 7y" / �^ �/� �> FSTA11MON / /• 3 DEPTHCOMPENSATION INSU E ADDRESS�,J ',1 ✓�.(This section need not be completed if e work involved by the / ' REFERENCE UPPpermit is for one hundred dollars (SIDE) or less.) cocnuTv yJLoEI certify that in the performance of the work for which this GRESSEL PE OF CONNECTION LENGTH FROM CURB vl ML TOPL permit is Issued. I shall not employ any person in any manner LEGAL Pc No so as to become subject to the Workers' Compensation Laws. DESCRIPTION LOT NO. O JOB No DO ! PliCONBLOGK TRACT MIT NO - ROAD PERMIT NO NOTICE TO APPLICANT: f, afte makin this C IfiCa to O4 ASSESSOR AFFIDAVIT WANER EASEMENT RECORD INSTR NO DATE 9 MAPBOOK PAGE PARCEL - Exemption, you should become subject to e Workers• rvo.of eLOGi. Compensation provisions of the Labor code, you usl forthwith SIZE OF LOT NOW ON LOT HWY OR$T will comply with such provisions or this perm all be deemed USEOF revoked. 6u ILOINGS STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION �X c, PERMIT No I hereby affirm that'I am licensed under provisions of Chapter OWNER 9 (commencing with Section 7000) of Division 3 of the BUsi- ^^nu CHARGES ness and Professions Code, and my license is in full farce and ADDRESS effect. _ CONNECTION CHARGE FEE 611 CITY TEL.NO. License Number L.z�-/-`�'-(ZGLiI Class ' /� REIMBURSEMENT FEE Ci �� CONTRACTOR ��l L3� DRTRICT NO GRO P MAP PROCESSED BY Contractor �� Date. � (/J� .� —�- ADDRESS Bx / PG ❑ am exempt under Sec. of the L.A. Co. F 1H CITY �/ C No. p ^-��-J (/ J (O E� 1f45¢-e_1I a O . Plumbing Code and/or Sec. o4 the LSTATEICENSE CIO. FINAL V LICENSE NO. CLASS DATE VALIDATION z B. 8 P. Code for the following reason NO. DESCRIPTION OF WORK FEE O HOUSE SEWER CONNECTING TO By Date PUBLIC SEWER BY lir W VrTIC TANK SEEPAGE PIT OR Signature /� PITS AND OR DRAINFIELD -T-jpZ 73_C ER-BUILDERF ARATION HOUSE SEWER CONNECTING TO D 3303 3 �� PRIVATE DISPOSAL SYSTEM I hereby affirm that-I a�pT from the Contractor's License CONNECT ADD17IONAL BLDG OR 1 ITEMS Law for the following reason (Secton 7031,5, Buisness and Pro- WORK TO HOUSE SEWER - tL-y fessions Code)' OVERFLOW SEEPAGE PIT. DRAINFIELD 'TOTAL 73 Ile "5O EXTN.CESSPOOL.DRYWELL MANHOLE p LJ I,OS Owner of the property, or my employees XII ages as ALTER.REPAIR OR ABANDON HOUSE LM 73c�� SEWER OR DISPOSAL SYSTEM their sole compensation, will do the work the structure is not intended or offered for sale (Se an 1044, Business and Professions Code). ❑ I, as owner o4 the property, a exclusively contracting with licensed contractors to c truct the project (Section 7044, OWNERS Permit $ 0 0000_0001 8/22/95 Business and Professi Code). AUTHORIZATION TOTAL FEE s 197u`2 1 AM v�0�h CONST TION LENDING AGENCY _ I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED GNTRACIOR TO I hereby affirm t t there is a construction lending agency CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PU uC SEWER for the perfor once of the work for which this permit is issued (Sec 3097, Civ. C.). SIGNED THIS DAY OF 19_ OWNER OR Lender's Nome OWN EPS AGENT - Lender's Address ADDRESS I certify that I have read this application and state that the above information is correct. I agree to Comply with Of County ordinances and State IOwS regulating Plumbing and Sewers, and hereby authorize representatives Of this County to enter upon the above-menlio(�ged rJ�t$)P erty for inspection p�urpposes/�J� / 5ign Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE