The URL can be used to link to this page

Home My Public Portal About9307 DAINES DR_Sewer__ 76A 642D • CE808 - 9/73 APPLICATIO OR PE MIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONBUILDING /J w •L-s K.9j i LOCALITY _ FBLOCK R APPLICANT TO FILL IN NEAREST iL CROSS ST. cjL OY r?/@' LOT NO. ��J v OWNER ` / MAIL TRACT � jof T '0�Wr'C ADDRESS �13o7 D4 �(f --Q 3 J� V NOWOON LOTS �/ to 6 TEL. NO. 2 CITY DISTRICT NO. GROUP MAP ESSED BY q BK PG CONTRACTOR * ��/ - ^ /� �K VV�_ ADDRESS U I A.'i�J // ` V L/ CONNECTION DATA CIT TEL. NO.1, ' 'f 6 y 0 STATION DEPTH STATE LIC UPPER LICENSE NO: CLASS MANHOLE REFERENCE LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER Q $7.00 P.C.NO. SEPTIC TANK.SEEPAGE PIT OR JOB NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM $3.00 CONNECT ADDITIONAL AFFIDAVIT I WAM [AS NT RECORD,INSTR,NO. I DATE WORK TO HOUSE SEWER ® $3.00 t� d OVERFLOW SEEPAGE PIT.DRAINFIELD V EXTN..CESSPOOL.DRYWELL. $5.00 /- 7375 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING -/ / SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT c:) H MANHOLE $7.00 PERMIT NO. W INDUSTRIAL a WASTE APPROVAL N CHARGES — OWNER'S PERMIT s CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE U[) I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED El STING DWELLING TO THE PUBLIC SEWS APPROVALS DATE INS CTOR'S SIGNATURE SIGN�61R DAY OF OW NENEW HOUSE SEWER OWt�- T CONNECT ADDITIONAL ADDRESS BUILDING OR WORK -- SEPTIC TANK.SEEP.PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR ` LICENSED ED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFC A OR T IAM THE LEGAL OWN OF, AND INTEND TO DISCONNECT PLUG AND RESID IN, A OVE DESCRI ED RESID T/AL PROPERTY. ABANDON HOUSE SEWER 51 N PER MTTT �r sL ��' BACKFILL SEPTIC TA' **T SEEP.PIT(SI ❑ SS O S ❑ VALIDATION CK. M.O. CASH A 8x2 ®r- 1t710U 9.0Q DEPAIVrMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER I BUILDING ADDRESS < _' FOR APP CANT TO FILL LOCALITY _ BUILDINNEAREST y� r ADDRESSc+kar.S�q Fes` CROSS ST. LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. NEAREST CROSS ST. .—�� P — RECEIVED BY Ready for Inspection DATE ISSUED OWNER MAIL ADDRESSJL USEZONE I OCCUPANCY MAP r n; BK PG CITY z----- TEL.NO. CONTRACTOR&(; P CO.IMP.NO. ADDRESS iA JOB NO. ) CITY TEL.N0. L" TRUNK PERMIT NO. f ATE REGISTRATI N NO. ��121-1 ❑ COUNTY_ ROAD PERMIT NO. LEGAL DESCRIPTION LOT NO. 5 r LZ C 7® STATE ENCROACH NT PERMIT N0. BLOCK TRACT '-r INDUSTRIAL WASTE APPROVAL SIZE OF LOT (y �/ ' NO.OF BLDGS. (j 7t ! NOW ON LOT CHARGES - USE OF BUILDINGS AA CONNECTION CHARGE FEE ' NO. DESCRIPTION OF K FEE HOUSE SEWER C40NNECTIN T y!p.- REIMBURSEMENT FEE PUBLICSEWER @ ; 3.50 V_ RECEIPT NO. i DATE (BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 _ CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING - NO DATE I BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/ORDRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 _ MANHOLE REFERENCE - UPPER TYPE OF CONNECTION^ LENGTH FROM OWNERS PERMIT ; I 00 Y. CURB P.L. M.L.TO P.L. AUTHORIZATION TOTAL FEE C: I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRTO CONNECT HE PUBLIC TSEWER VE DESCRIBED EXISTING APPROVALS INS PECITOR'SSIGNATURE DATE SIGNED THIS.----1L--Z-1---DAY OF_ "-fru ................19. -� NEW HOUSE SEWER OWNER OR L.I ^�� -/i� CONNECT ADDITIONAL OWNERS GENJT_.-_`: _j_.._. _. _ ..�_ _ /.ryj�_ BUILDING OR WORK ADDRESS idol_. a ... ._ � r__- SEPTIC TANK,SEEP.PITS) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL❑ DRYWELL❑ CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTEREII DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR TH I AM THE LEGAL OWN- ER OF THE ANEZESG�JQ60 q 6IDENTIAI,-PROPERTY. BACKFILL SEP TANKS❑ SIGNATURE s Ela € � L.y�., SEEP.PIT(S) CESSPOOLS❑ j4lik OF PERMITTEE - - -. ... ---•-•--- .......-..... 76A642D 663 I/ -1 ,WORKERS'COMPENSATION DECLARATI( 1r CE 808 808 Er,(2-$fl; i APPLICATION FOR PERMIT - :- CE I hereby affirm that I have a certificate of consent-to self- SEWER—SEW? A�E DISPOSAL insure, or a certificate of Workers'Compensation Insurance,or �,'� a certifie py t r Sec. 3800,Lab. ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No, 9tMyxmpany Repub�,ie Indemnity ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN CONNECTION DATA ....._. -. BUILDING _ STATION DEPTH ® Certified copy is filed with the county building inspection ADOREss 9307 Dai nes Dr. UPPER ` /`�r�ll $11 J & D PlumbingCo* MANHOLE REFERENCE Date Applicant LOC ALITV Temple City LOWER ;NEAREST TYPE OF CONNECTION LENGTH FROM CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. Hilton Y. CURB P.L. M.L. TO P.L. COMPENSATION INSURANCE �� P.C. NO. '�lJ.L OWNER lI1!'r el Pedrini CO. IMP. NO. JOB NO. MAIL Tp (This section need not be completed if the work involved ADDRESS 9307 Daines D • TRUNK PERMIT NO. ROAD PERMIT NO. } by the permit is for one hundred dollars ($100) or less.) AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR. NO. DATE .0- CITY aCITY Tem le Cit-.V NO. O I certify that in the performance of the work for which this LEGAL permit is issued, I shall not employ any person in any manner DESCRIPTION LOT NO. HWY. OR ST. WIDENING tr so as to become subject to the Workers' Compensation Laws. O II�7/��,,�.� /� ii (� ��, y BLOCK TRACT STATE ENCROACHMENT Date 7/14/ J & D Plurlbin PERMIT NO. (� NO. OF BLDGS. � SIZE OF LOT NOW ON LOT NOTICE TO APPLICANT: If, after making this Certificate of a Exemption, you should become subject to the Workers' BUILDINGS OF CHARGES to Compensation provisions of the Labor Code, you must forth- BUILDINGS PLesidence CONNECTION CHARGE FEE with comply with such provisions or this permit shall be CONTRACTOR J D lunibinCo. deemed revoked. 1' LICENSED CONTRACTORS DECLARATION ADDRESS 414 S. San Gabriel--Blvd. REIMBURSEMENT FEE I hereby affirm that I am licensed under provisions of Chapter DISTRICT NO. GROUP MAP PROCE ED BY 9 (commencing with Section 7000) of Division 3 of the BUsi- CITY San Gabriel TEL. NO. 287-05,79 B „PG ness and Professions Cade, and my license is in full force and srwrE Llc. /�\/✓J�effect. NO.LICENSE NO. 0 66 CLASSC- 6 l NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO FINAL ,� VALIDATION License Number 307766 Lic.Class C-36 PUBLIC SEWER DATE � e4 7/14/81 SEPTIC TANK,SEEPAGE PIT OR � �' Contractor-J & D Plumbingate PITS AND/OR DRAINFIELD FINAL HOUSE SEWER CONNECTING TO BY ( >k4 ay ❑ PRIVATE DISPOSAL SYSTEM I am exempt from the licensing requirements as I am a CONNECT ADDITIONAL BLDG.OR licensed architect or a registered professional engineer 1 WORK TO HOUSE SEWER f acting in my professional capacity (Section 7051, Bus- OVERFLOW SEEPAGE PIT, DRAINFIELD In CSS and PIOfeSSIOnS Code). EXT..,CESSPOOL,DRYWELL, MANHOLE LL`SYYY CX-V f ALTER,REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM z 0 3 3..5 A Lic.or Reg.No. Date # O'O.O O 1,0 HOME OWNER-BUILDER DECLARATION , ' ' • I hereby affirm' that I am exempt from the Contractor's OWNER'S Permit s 2:°ti° 1 4,0 0 License Law for the following reason (Section 7031.5, Busi- AUTHORIZATION TOTAL FEE D`o 0 1 41,0 0 50 ness and Professions Code): I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- ❑ - TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING O'�/, 1 �4'-8 1 I, as owner of the property, will do the work and the TO THE PUBLIC SEWER. structure is not intended or offered for sale (Section SIGNED THIS DAY OF 19 7044,Business and Professions Code). OWNER OR OWNERS AGENT CONSTRUCTION LENDING AGENCY ADDRESS I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). 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 hereby authorize representatives of this County to enter upon the above-me oned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 7/111/81 Signature of Permittee Date