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HomeMy Public PortalAbout6033 CAMELLIA AVE_Sewer__ APPLICATION FOR PERMIT COUrTY OF Los ANCWI B SEWER—SEWAGE DISPOSAL MARTNUM OF COUNTY ENS BUUXEfa AND SAFETY Dl MON 9mLD,NG DRESS JOEX L T 11B f+�r �� Ix a ma7m acyl of a L6cAurr Tem-ole City RLkRkVT FOR TO CaOSS ST Garibaldi LE 7 D" M' [o HLocK TRACT 6561 AD ams elly N0.or BLDM ^ mzx 0r 0x18 now on R USE OF DI Re idential BUILDINGS DISTRICT 10. GROUP SAP BK PG CONTRACTOR ! / ADDRnS CONIMMON DATA CITY TIL 110 STATION DEPTH STAREGISTRATION 110. cCOtJ TT XA)LH01X CIc. 6 [o IIS DESCRIPTION- gP�UpJ3&Bt �COOKME�CTIIRG TO $3.00 WAC bFiAIRFIILb �IT AAIR Imp T TYPE OF OR 0[ P.L. Lmqm 10 Pte[ I OVER" CESSPOOL D P [AIIHOI.!< 00 . HOUSE SEWER CONIIECTIRG TO 4 P.C.NO. PRIV1(A�TI DISPOSA�L�(STSTE[ I.DO CO.I[r NO JOB N0. ■oR TD�HOUSE S6WERBLDG.OR I.00 a; TRUNK PMEW[0. ROAD PERIIT[O. LTER.REP OR :9°U 1 Q0 STATE FACROACH[I[T �EE'1MfE�R ORD PER[R RO INDUST11ILL IS APPFATAL CHARGES . Q 'soo CORRICTIO[CHARGE FQ AUMOHIEATION rOT FEE 47-0 mmaa Raa[tfl1T FSS I HAVE AT THIS DATE A CONTRACT WITH THI HEREIN MANED COIL. APPHO� DATI iNSPECTOR'SSIGNAT4RE T;Ar-TOR TO CORRECT THY ABOTI DESC,RIBID ="G DWELLING TO THE PUBLIC SIGHED TH Y OF 1 NEW HOUSI SEWIR Of AER OR CONNECT ADDITIONAL OWNERS A BUILDING OR WORK ADD N o &.III@ onne C TAMC.SBEr•PITS) OR )W FIELD I BERIBT ACKNOWLEDGE THAT I HAT[ RIA.D THIS APPLICATI AND STATE THAT THE ABOVE IS CORRECT AND AG[IE TO CO[PLT CESSPOOL DRTWILL WITH ALL COU= ORDINANCES AND STATS LAWt REGULATING ALTER,iEPAla miWER oY PLU[DING AND SEVERS. SEWAGE EPAIR.A VIES OR 1 HEREBT CERTIFT THAT I " PROPIa1.T REEII'IWgZ AA QR SEWAGE DIS ECT PLUG AAft!� LICERM AS REOUIRID BT LOS ARGYLES COUNTY ' ST/♦TI Or ABANDON HOOSE SEWER CALIFORNIA OR THAT I A[ THE LEGAL OTM OF THY ABOVI DESCRIBED [ESII1 PRO PIT(,) C Tom❑ DESCRIIQKArBED 0% OF rBR>t 2 �+t YAUDATI� ROB�tT A WOOD XL IL Q. WJPSRVII;IMG MUNiMIICAL KKQL X12t WORKERS'COMPENSATION DECLARATION I hereby affirm that.I have, a wrt}flcate -of corment to self Insure, or a certificate of Workers'CompN»aribn Insurane, or 78A4M r certified copy thereof(Sec. 3900, e.) s-mmDPWVIN APPLICATION FOR-PERMIT . • Pollcic No. Company SEWER SEWAGE DNSPQSA4� , Certffled copy Is hereby furnished. ' Ceritfled copy is filed with t11e Ildl I COUNTY OF LOS ANdELFS WILDING AND SAFETY department. �-_' pP4ican1 FOR APPLICANT TO FILL IN CONNECTION DATA CERTlf�1CATE OF FROh1 VVORl�25' I NSU RANCE. ADOP2Sa STATOR D�rH (This sec4on need not be completed if thi work Involved by the t0�m wwsyott UPPER Permit is for one hundred dollars (;100)or'len.) NEAr�r of correcnar 1 certify that In the performance-of the work for which this C'* ST �TM P permit Is Issued, I shall not ep�b1'any person In any manner m y C8f�8 P.L hl4 to r.L so-as fobecome subject to the Worker'Compensation tows, ayr� P.C.NO. be No. f TauNse Pdb%%ff NO. Raw PERJWT NO. Appllc¢nt NO PPL TO AICANT: ft If,' after mat aking this Certifice of T�to w' eAsrArBJr RtcoRD' °A� Crry [Exemption, you should -become subject to the Workers' LEW Compiensc tion provlslons of the labor code, yon must forthwith #cRmic" tar.OR ST.wtDe47,4 .comply with ;uch provisloris.or this permit shall be deemed revoked. etooc Twcr STATE EN1rn0AC}urerr il¢-4SE13l,'CONTR4CTOR$DEC'I,ARA710N NO.or eLDcts. No. I hereby affirm that I-dm llnrwd under provisions of Cho ter OF[ oT taw tar 9 (com,mencIPg,with 'Section 7000) of Div(slon, asi 3 of the M - alARca noes dnd Profpseiotu Code, and my license Is In full fora and effect. CONliRACTOIR COr&4ECroN CHARGE t¢ le 41EML LlcenseNum U,Cbn A51 APDRIss Contractor /: DateDeanna N O. QQ0UP hw PMGkMM By CTTY TEL.NO. 11K PGf © 1 am exempt under Sec', of the LA.Co. STA NO. Plumbing Code and/xx Sec of the' NO. CONNOF YOM � nNAt Wousi!: eCT040 to DATE ( ) a)/J,�) - VALIDATION' B. b P. Code f6r_the following reason PuetrCaM� z_ Date PTra Arils DM aPrrn Oe HOuae ower ro Slgrwture ,worTtOMYVEM Ar NAt ELDO.OR OY^"-&U I LDER.DECLARATION WORK To ratrae sewer , I herby affirmm.that I am exempt from tho Controctoes License ExrNL Low for the following reoi,on (Sector 7031.3, BuNnees and Pro-- HOUR iQ fessions Code): �P�OR OWMAL SYSTEM El I,as owner of the property,or my employees with vfogq as their Bole Qormp+nsation;will do the,work and the structure ] 34.50 Is not Intended or offeted for•sole (Section 7.044, Bus]ness PerTr�lt i ] ITEMS and Professions Codek OWNIn ❑ I,as owner Qf then property,pm.excluslvely tontrocting with AUTHORIZATION TOTAL FEE Ilc.rsed aoriractors to cormitruet the project.(Setllon 7041, e I rv,VE AT THts DATE A Wr T MRM NAMED CONTRACT T�� :34,50 Business and Profbnions Code). CONNECT THE ADVA DG7CR 5 DvaTN(i�DYAIUNG TO n-e PUBDC SEWER_ .r CONSTRUCTION LENDING AGENCY �y_� I hereby afflrm that ►hire Is a. conatructlon lending agency SK3t�THts DAY iz 19 1417'ti7'Z'�y� , for the performance of the, work for which this permit is T - Isv4ed (Sec. 3097, Civ. C.). OWNERS AGeN benders Name ADoe:EM •'0010HQiD 1 4/1Y 9Cl Lenderr;Address ' 1, . AM10:32 I certify that I have read this appllrxrtlon and skate that the above Information Is correct. I agree to comply with all County ordinances and laws ulating Plumbing'and-Sewers, and a Ize taNves of this County to enter aPO entlo for Irspbcflon pu rb of Date- M E ffVMte KM lXN AMATORY PUKR A4#