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Home My Public Portal About9432 CAMINO REAL AVE_Sewer__ DFPATLTMENT OF (3OUNTY ENGffN CM SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUME)ING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGICT, 18 BUILDING WILLIAM J. FOX, COUNTY ENDIN¢[R I ADDRESS A AM FOR APPLC ,IOANT TO RLL IN LOCALITY BUILDINGNEAREST ADDRESS SI j `Q�j� CROSS ST. C L LOCALITY �`�y)I J j0 }!! DISTRICT NO. SERIAL Y0. /� PERMIT NO. NEAREST r 9�z jam' S A /, O S CROSS 8T. � ^- RECEIVED BY RmO fw Iupsatlem DATE ISSUED{ OWNER e, P ADDRESS AIL USE ZONE OCCUPANCY MAP BK yP9/ CITY TELNO. ,DO 4-1 ,97:f ooNTRAGT08 - .� - -IMP.NO. 3 — G ADDRESS ;, iL 4= •� 1^ JOB NO. CITY y.I, THLNO. c, ( TRUNK PERMIT NO. REGISTRATION N0. �� CJ� AD#T1 ROAD PERMIT N0. LEGAL STATE ENCROACHMENT DESCRIPTION LOT N0. �- PERMIT N0. BLOCK TRACT INDUSTRIAL r c WASTE APPROVAL SIZE OF LOT i NO.OF BLDQS- Y' NOW ON LOT CHARQES USE OF BUILDINGS '� -71 OOM OTION CHARD[FE[ NO. DESCRIPTION OFORK FEE _ REI�BUBS FEE OUSE SEWER OO N[OTIN TO ? PUBLIC SEWER • $ L" ! RECEIPT NO- DAT[ BY PRIVATE DISPOSAL SYSTEM I.00 OONNEOT AD ON 0ExcEpmo-m-leomED WORK TO HOUSE NEWER 100 ALTER OR REPAIR EXISYINdYU• DAT[ SEWER OR DISPOSAL SYSTEM IAO DISCONNECT AND ABANDON UVER AMD OR DISPOSAL SYSTEM 1.50 CONNECTION DATA SEPTIC TANKSEEPAGE PIT PITS AND OR�DRAINFIELD CQ LOO STATION � �� DEPTH LL SPECIAL OONDITIONS ONLY LOOL/ EFER[NCR A TMP[OF CONNECT 0 LENGTH FROM 0 OWNERS PERMIT ; I Y. CURB L M.L TO P.L AUTHORIZATION TOTAL FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPEOTOR'SSIGNATUR[ DATE DWELLING TO TH[ PUBUO SEWER n ' I SIGNED THI 2' AY OF 19 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT($) AND/OR DRA NFIELD I HEREBY ADKNOWLEDG[ THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL I] CATION AND STATE THAT THE ABOVE 1$CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANOn AND STATE LAW ALTER REPAIR j WER OR REGULATING PLUMBING AND SEWERS. gEWAdE DISPO LSYSTEM HEREBY CERTIFY THAT I AN ANSTERED D/OR LICENSED As QUI RED BYPLOS ANGELS$PERLY (COUNTY DIBCONN[CT PLUG AND AND STATE OF CALIFORNIA OR T�10HE LEGAL OWN- ABANDON NOUS[SEWER ER OF THE ABOVE DESCRIBED RPROPERTY. AM SIGNATURE SEEP.PITM l - OESSP00 'l ' , OF PERNITTV TEtlmL :: T/u a WORKERS'COMPENSATION DECLARATION {) I herby affirm that I have a certificate of consaN to salt ILIL Insure, or a certificate of Workers'Compensation Insurance, or 7°'b�' a certified copy thereof (Sec. 3800:LCb C.) CE"W''"1) APPLICATION FOR ERMIT . Policy No. Company �. ❑ Certified copy Is hereby f tr niched. SEWER - SEWAGE DISP SAL . ❑ Certified copy'ls'filed with the county building Inspection COUNTY OF LOS ANGELES dUI DING AND SAFETY department. Date Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMMON FROM WORKERS' } TPON TH COhkPLNSAT}ON INSURANCE ADDRESS J �� °® (This section need not be completed if the work Involved by the µ41.}00ULast permit II for one hundred dollars ($100)or less.) LOCAUTY NEAREST TYPE I certify that In the performance of the work for which thisrCY. OFP.L WL TCqNECT)ON LRTOO P LFROL}l per-mit is Issued, I shall not employ any person In any manner P c No to as to become subject to the Workers'Compensation Daws. —qR 4 CO 6 YP NO pg tp 0 ALC T"4K PMWT NO. ROAD PERµTT NO. Date 1-1;2Applicant MAIL ss / QC NOTICE TO APPLICANT: If, after Ing this Certificate of rte. a7-712S3 AFFlDAVTr wANE3! EAEMCfT RECORD.RrsTR No. DATE (O-, Exemption, you should become subject to the Workers' aT, ,' Compensatlon provisions of the Labor code, you must forthwith DF3CPTtON I,OTNO_ FrWY OR ST WEeANG comply with such provisions or this permit shall be deemed Z revoked. BLOCK TRACT STATE ENCROAC AI NT ' t PMW NO. LICENSED CONTRACTORS DECLARATION S1g OF Lar NgYv LOT I hereby affirm that I am licensed under provisions-of Chapter SOF 9 (corrtMencinq with Section 7000) 6f Division 3 of the Buil- CHARGES ness and Professions Code, and my license is In full force and effect. CONTRACTOR CONNECT10N CHARGE tE License Number Llc.Class ADDRESS R�ENT FEE Contractor Date D�tCT NO. GROUP MAP PROC�BY CITY TEL.NO. el( PG ❑ I am exempt under Sec. of the LA.t o. �GmtSE Nb. ,CL SS Plumbing Code and/or Seof the �' DES021 PTlOtJ OF WORK FEE Soc. PKI 4-10C HOUSE CQNECTING TO DATE VALIDATION PU MX SEWER B. 8 P. Code for the following reason TAN SEEPAGE PIT OR F1SEEPAGE P7T5 AND/OR DRAr>=taD Date' HOUSE SEINER CONNECTING TO Signature CONNECT ADD rrION44L MDG.OR OWNER-BUILDER DECLARATION WORK TO Hous SEWER I hereby affirm that I am exempt from the Contractors License ExiN. DALE Law for the following redson (Secton 7031.5, Bulsness and Pro- AVER REPAR OR ABA ON HOUSE fessions Code): =OR SYSTEM J2' 9Q 1,5A I as owner of the property,ar my employees with wages as • their sole compensation, will do the work and the structure Q • Is not Intended or offered for sale (Section 7044, Business o,0 0 1 PertTflt i and Professions Code). OWNEWS AUTHORIZATION 2 ° 215 Q ❑ I, as gwner of the property,am exclusively conttacting with YOTAL FEE licensed contractors to construct the protect (Section 7044, 1 FLAME AT THIS DATE A CONTRACT WrTH TFf FEREIN TO 0'0 0 2 1,5 Q 6 Buslneu and Professions Codq). CONNECT THE ABOVE DER3UBED DUSTR•10 DYAI WG TO THE PUBLIC CONSTRUCTION LENDING AGENCY �� 01- 12-83 T/f l%. , I hereby affirm that there Is a construction lending agency SI GNED TH IS - DAY� 19 { for the performance of the work for which ihls permit Is O'MFR OROWNIM AQEP�aa�o„-, Issued (Sec. 3097, civ. C.� Lenders Name Lender's Addreu I certify that I"have road this application and state that the above Informatlon Is correct. I agree to comply with all County ordinances and State laws regulating Plumbing and Sewers, and hereby authorize representatives 1pf this County to enter Upon the above-mentioned rty InspedIon purposes. `Sig re of Permittee Date f®FJVfi3fR POR EXPLANATORY LANGUAGE