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HomeMy Public PortalAbout10636 DAINES DR_Sewer__ ]6A660-OE80610,]4 APPLICATIO F®R LE�TRBCA PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ioe BUILDING AND SAFETY DIVISION ADDRESS / C� LOCALITY NEAREST / FOR APPLICANT TO FILL IN CROSS ST. OUTLETS NORECEP . EACX FEE GWNEROR Tyl ,)yG S S FIRM NAME [CJJ IV/CL/ ' LIGHT ._� TOTAL MAIL DD FIRST 20 25 ARESS LIGHT_ � •�a CITY TEL. SWITCH_ OVER 20 .10 PLAN CHECK LIGHTING TOTAL FIRST 20 25 APPLICANT FIXTURES 10 OVER 20 ADDRESS � RESIDENTIAL APPLIANCES CITY °TEELL..'NO.. RANGE DRYER PERIT WTR. HTR._ APPLICANT - 99�/+i F// ry�f/ 4C STA.,OOKOISP. F.A.U._ ADDRESS J� go lw ©/'✓ SPACE HTR. AIR COND. CITY TEL.�6 -14�y ORf CLOTHES WASH. DISHWASH. LICENSE REG. NUMBER�7 CLASS /o eC' FAN_OTHER 100 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY .MOTORS. TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. S12E & TYPE OVER TO HEREBY CERTIFY THAT AM PROPERLY REGISTERED AN RED ANO/OR O - 1 100 LICENSED AS REQUIRED A L05 NGELES COUNTY F THE ATE OF y CALIFORNIA OR THAI AM LEGAL OWNER OF THE ABOVE 4' 1 - 10 300 DES[RIPEO RES ID 1L pERTT. U PERMITEE 10 - 50 500SIGNATURE U 50 - 100 10.00 DISTRICT NO. ROCE ED BY W N 700 - 500 IDDO 1_1? - () O 0 SIGN, GAS SIGN AND ONE CIRCUIT 500 APPROVALS DATE INSPECTO'R'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 100 TEMP. POWER POLE SERVI CENOT OVER 600 VOLTS OR 200 AMP 3.00 UNDERSLAB WORK SERVICE OVER 600 VOLTS OR200AMP 1000 ROUGH CONDUIT TEMP SERVICE,POLE, 8:APPURTENANCES 5.00 . WIRING TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL PERMIT FEE (SUB TOTAL) NOTES: PLAN CHECK FEE PERMIT ISSUING FEE 300 5� TOTAL FEE 66 , PLAN CHECK VALIDATION DK. M.O. CASH PERMIT VALIDATION M.D. CASH SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 5&6-663.55 APPLICATION FOR PERMIT ✓ DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles Sul LDING WM. J. FOX. COUNTY ENGINEER ADDRESS ® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST lr3r CROSS ST. _ LEGAL DESCRIPTION LOT NO.. � OWNER Q x�'r BLOCK TRACT ^"{ MAIL rte. ADDRESS NO OF SLOGS. SIZE OF LOT / pv N01V ON LOT CITY w TEL. N0.USEO BUILDINGS '- �GEGa a4 L{ DISTRICT NO. GROJIP h1AP ,N BK I P`G ' CONTRACTOR ADDRESS / t�' CONNECTION DATA CITY TEL. NO. / STATION STATE MANHOLE REFERENCE t/ /'^/ ( ' UPPER REGISTRATION NO. /� D !A / ❑ COUNTY T J (o No. I DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO yl TYPE OF CON NECTIP.L, IALELGTH FROM 7 PUBLIC SEWER @ $ 3.501 V Y. CURB . . TO P.L. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG. OR YORK TO HOUSE SEWER 1.00 CO. [NIP. NO. JOB NO. ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 TR U NK.P M11A N0. ROAD PERMIT DISCONNECT AND ABANDON SEWER STATE ENC ACHMENT AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK, SEEPAGE PIT OR PITS AND/OR DRAINFIELD 3.00 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2.OD CHARGES OWNERS PERMIT s 00 CONNECTI01' ARGE FEE AUTHORIZATION TOTAL FEE REIMB RSEMENT FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER SIGNED THIDAY OF 1B NEW HOUSE SEWER S -A ' OWNER OR CONNECT ADDITIONAL x OWNERS AGENT. BUILDING OP. WORK SEPTIC TANK.SEEP. PIT(S) ADDRESS AND/OR GRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL ElDRYWELL C1AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR. SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY A STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT 1 AM THE LEGAL OWNER THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL PERTY. BACKFILL SEPTIC TANKS❑ SEEP. PIT(S) ❑ CESSPOOLS❑ SIGNATURE OF PERMITTE WILLIAM J.FOX. CouNZPtINICINEER ATION R.A./WOOD. CHIEF PLBG. INSPECTOR .; 6 ? G .50