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Home My Public Portal About9711 CRAIGLEE ST_Sewer__ 76A642061 AppL�OC�A�(MN FOR G�C�G�3�li/ �1f 76A642D ' COUNTY OF LOS ANGELES SEWER—SEWAGE MSPOS IQL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A, LAMBIE, County Enggineer ADDRESS WILLIAM A. JENSEN, Sup't of Buildiag LOCALITY r " NEAREST ' FOR APPLICANT TO IN CROSS ST. LEGAL OWNER DESCRIPTION LOT N0. - BLOCK TRACT MAIL ADDRESS N .OF BLDGS. SIZE OF LOT NO N LOT CITY TEL. N0. USE OF a DISTRICT NO. GROUP MAP P ESSED BY BUILDINGS BK P6 CONTRACTO " f. I J7 --- ADDRESS s' �� / CONNECTION DATA C ITY TEL.NO s 2� STATION DEPTH REGISTRATION N0. ��/. COUNTY MANHOLE REF :NCE UPPER NO. DESCRIPTIOF R FEE LOWER N HOUSE SEWER CONNECTING TO PUBLIC SEWER @ S3.00 TYPE OF CONN E ION LE NSdIH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.Y.TO P.L. PITS AND/OR DRAINFIELD @ S9.00 R�t##f#ELD ,: "a� CL fi�FTN..CESSPOOL.D;:Y��'RL @ $3�0� C HOUSE SEWER CONNECTING TO C.NO. O PRIVATE DISPOSAL SYSTEM @ BIceO CO.IMP. N0. JOB NO. U WORK ECT H ADDITIONALUSE . R LDG.OR @ S1 00 TRUNK PERMIT NOD PERMIT NO. w SEWER OR D SRO R A SYSTEM HOUSE @ $I 00 STATE ENCROACHMENT O PERMIT NO. u INDUSTRIAL a WASTE APPROVAL - to CHARGES ? OVVNERIS PERMIT $ 2 00 CONNECTIO CHARGE FEE A=ORIZATION TOTAL FEE i94:!P REIMBUR EMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- �� TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS D E INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER.. SIGNED THIS DAY OF 19— NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK 1 SEPTIC ADDRESS AND/ORD AIINFIELDPIT(S) I HEREBY ACKNOWLEDGE THAT I. HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY . CESSPOOL ❑ DRYWELL In !n /A, �(�J' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING '. ALTER,REPAIR,SEWER OR ` PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR " LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF HOUSE ABANDON DISCONNECT CTPLUG PLUGAND CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE r DEWER SCRIBED RESIDENT PROP Y. BACKFILL SEPTIC TANKS ❑ SIGNATURE . - SEEP.PIT(S ❑ CESSPOOLS OF PERMITTE VAIMATIOW----� ROBE=RT A. WOOD CK. 11.0. _ ��cAs:/ SUPERVISING MECHANICAL ENGINEER �kt d.� 4a JL1u _i_ 0 F f S'&E-668 17.55 APFUCATMN FOR PERMIT DIVISION OF BUILDING AND SAFETY SEWER—S tWAG E D O S POSH L Department of County Engineer County of Los-Angeles BUILDING J ADDRESS 71 / JOHN A. LAMBIE, COUNTY ENGINEER c T) CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY dr` f - __ _ �{'- /� yam/ FOR APPLICANT TO FILL IN NEAREST. ��,� `�� '� �7� LEGAL 'i DESCRIPTION .LOT NO. .. >> +J OWNER -BLOCK TRACT r.l!Z L•.L—4f MAIL ._ ADDRESS_ ' NO. OF BLDGS. CITY TEL, NO.SIZE OF LOT' NOW ON LOT _ _ kFIR USE OF �DISTRICT No. GROUP MAP' fil BUILDINGS - - - BK PG CONTRALTO �a4�"s •C' `'ff a +�` yy .ti ,a f CONNECTION DATA . ADDRESS ��/ �� t, j✓d^1'J-�✓ rr7 STATION DEPTH CITY �� 'a.�"TEL. NOj�G� t MANHOLE REFERENCE _. UPPER &]=`STATE COWER REGISTRATION N0. �-� 4% � ❑ COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CON CTION LE TH FROM --- PUBLIC SEWER @ $3.50 Y. CURB P.L. M TO P.L. SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR•DRAINFIELD @ $3.00 yOVERFLOW.SEEPAGE PIT, DRAINFIELD a; �� •P. C. NO. CX TN.,CES S.RO:-I,.,DRYW E L L,M A N H O LE @ $2.00 „} 4200 " CO. IMP. NO. OB N0. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO.. D PERMIT NO. . 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 - OWNER'S PERMIT $ 1 00' AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE �� a ••: ' I HAVE AT THIS DATE ACONTRACT WITH THE HEREIN NAMED CON- APPROVALSDATE INSPECTOR',S.SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. JEW HOUSE SEWER SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER OR. - BUILDING OR_WORK, ° OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)' -ADDRESS AND/OR DRAINFIELD - 1 HEREBY ACKN'OWLED GE THAT I HAVE READ THIS APPLICATION t. CESSPOO- DRYWELL❑ I D ✓ III 1 AND STATE THAT'THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR t v PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM. I" HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA O H6. ,)'.`F`fy�,,��iE-,LEG L OW T 06•Ti1�ABOVE — DESCRIBED RES BP N A 'I'uY�' BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS❑ OF PERMITTEE G - JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT.A. WOOD, CHIEF PLBG. INSPECTOR CK. Id. 0. CASH n�7 9 5. 4�' "* A. 3.0,0 WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, or 76A642D a certified copy thereof (Sec. 3800,'Lab C.) CE s8 08(REV.B/81) uP PU • TOMFOR PERM pM Policy No. Company ❑ Certified copy is hereby furnished. SEWERSEWAGE ®OSPOSAL ❑ Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. Date Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDINGJ I /•¢� STATION DEPTH COMPENSATION INSURANCE ADDRESS 9 7 C NA "(This section need not be completed if the work involved by the � � MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100)or less:) LOCALITY E/� L� [ LOWER NEAREST TYPE OF CONNECTION LENGTH FROM I certify that in the performance oY. CURB P.L. M.L.TO P.L. the work for which this CROSS ST. �G1 C I �� ' permit is issued, l shall not-employ any person in any manner P.C.NO. so as to become subject to the W kers'Compensation Laws. OWNER 11 /�!/S R /v CO.IMP.NO. JOB NO. cc 5 MAIL ADDRESS L TRUNK PERMIT NO. ROAD PERMIT NO. Date "'� 07 Applicant c.PPo_./ ,J�� -�� ' ��7 / Gad yet 1 8 AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR.NO. DATE NOTICE TO APPLICANT: If, after making. this Certificate of CITY /L e14 D/H TEL.No. . Exemption, you_ should become subject to the Workers' LEGAL Compensation provisions of-the Labor code, you must forthwith DESCRIPTION LOT NO. HWY.OR ST.WIDENING comply with such provisions o� this permit shall be deemed revoked. BLOCK , TRACT - STATE ENCROACHMENT ' LICENSED CONTRACTORS DECLARATION NO.of PERMIT No. LOT SIZE OF LOT NOW ON LOT I hereby affirm that I am licensed under provisions of.Chapter USE OF 9 (commencing with Section 7000) of Division 3 of the Busl- BUILDINGS ✓ S CHARGES ness and Professions Code, and my license is in full force and effect. CONTRACTOR 1 • CONNECTION CHARGE FEE L� ,�v �..U {� I'IIr ,v'�� License Number�J� /7 Lic.Class — Z' ADDRESS C PIS REIMBURSEMENT FEE u /dmf S / n.�t/, ` p ContraciOl✓ �L� Date � R+/V TEL.N .�Y'�7 7 3—&-J L q DISTRICT NO. GROUP .MAP P C SED BY CITY q �--• CL / n BK PG P LICENSE NO.: +J -3� CLASS C T Ov J/, O ❑ I am exempt under Sec. of the i.A.Co, STATE CL Z l ' lJ Plumbing Code and/or Sec. of the NO. DESCRIPTION OF WORK FEE FINAL u HOUSE SEWER CONNECTING TO - DATE VALIDATIO Imo. PUBLIC SEWER '�z/ y� B. 8 P. Code for the following reason SEPTIC TANK,SEEPAGE PIT OR FL PITS AND/OR DRAINFIELD - Date. - HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG.OR OWNER-BUILDER DECLARATION WORK To HOUSE SEWER r7 [� n 11 OVERFLOW SEEPAGE PIT,DRAINFIELD !r7 / 2 7 I hereby affirm that I am exempt from the Contractor's License EXTN.,CESSPOOL,DRYWELL,MANHOLE I JQQ Law for the following reason (Secton 7031.5, Bulsness and Pro- ALTER,REPAIR OR ABANDON HOUSE Mp p p p 0, fesslons Code): SEWER OR DISPOSAL SYSTEM - .- ❑ I,as owner of the property,or my employees with wages as c1,io,° 2 25 0 their sole compensation, will do the work and the structure o''a'o 2 2 5:0= is not intended or offered for sale (Section 7044, Business v and Professions Code). OWNER'S Permit. $ ❑ I, as owner of the property, am exclusively contracting with AUTHORIiATION TOTAL FEE 0 2 .b 8 7 licensed contractors to construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. . CONSTRUCTION LENDING AGENCY 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 OWNERS AGENT' issued (Sec. 3097, Civ. C.). ADDRESS - Lender's Name Lender's Address 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 ereby authorize representatives of this County to enter up the above-men . ned property for inspection purposes: . P,�Kazlu 7 2-f-S7 Signature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE