The URL can be used to link to this page

Home My Public Portal About8856 ELM AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER. SEWER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER I BUILDING �� ADDRESS ��6 �� FOR APPLICANT TO FILL IN LOCALITY BUILDING /+ NEARESTq _ADDRESS� &rJ% ��(2Gf�n�� c�� CROSS ST. �same" �'V(� LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. y� NEAREST /,`/-�"� 0 d tJ A/ CROSS ST.4 IFAOA,OA,I "_'z" / q ,n RECEIVED BY Ready for Inspection DATE ISSUED OWNER MAIL ADDRESS K ��` '� n„�® /�� USE ZONE OCCUPANCY MAP l� /� p p� I �i BK PG CITY. TEL.NO. �4- ?6,Pg. v CONTRACTOR , �,�, r/ `p ,,.� �,.ad,-� CO.IMP.N0. ADDRESS '�'/� GL/�� @J•Al1 er JI CITY I ON � � TEL.N0.1/�(U o. fj'l TRUAPTI' RRiTT' ` ❑ STATE REGISTRATION N0. ❑ COUNTY LEGL DESCRIPTION LOT NO. 74 S I 6' 9 P� ��A ENT A �A /0'0 PERMIT N0. BLOCK TRACT,< Ns� *Y /0'0 1 IAL WASTE PRDVAL'' SIZE OF LOT ae N0.OF BLDGS. NOW ON LOT CHARGES .USE OF BUILDINGS CONN ECTI HARGEFEE NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEM NT F PUBLIC SEWER j 3.50 RECEIPT 0. AT (BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OREXCEP ON RE ED WORK TO HOUSE SEWER 1.00 N0. I BY ALTER OR REPAIR EXISTING DAT SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION �� DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 1Zd� ANHOLE REFERENCE G46 W � 7 t SR 4Z::�o LOWE TYPE CTION LENGTH FROM Y. zfC CURB P.L. M.L.TO P.L. OWNERS PERMIT $ I 1 00 AUTHORIZATION TOTAL FEE I - 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER �` - �oZ �--p`� '-'�, NEWHOUSESEWER .�( 1 J SIGNED THIS_-------••-�----DAY OF---••--=---�----•-------...--•-----.19� OWNER OR _ CONNECT ADDITIONAL OWNERS AGENTx -/ `...............'Gsi.t�s..T BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS------------------------------......-•--------------_....................-_...•---•-... AND/ORDRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL[:] DRYWELL I] 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 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED R PLUG AND DISCONNECT AND/OLICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS J SIGNATURE �-1 Y SEEP.PIT(S)E] CESSPOOLS [' / :- >r�^-moi ✓. `"a'l� - ` OF PERMITTEE - V 76A642D 663 1/53 DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES _ WILLIAMFOX, COUNTY ENGINEER I BUILDING �jn �//� CASSATT D.. PE GRIFFIN, SUPT DF BUILDING ADDRESS !rJ `/�i� (� FOR APPLICANT TO FILL IN LOCALITY Q,1 i BUILDING • ; NEAREST ADDRESS � '. !` / n J� � CROSS ST. LOCALITY by h:z-p �� 0 DISTRICT NO. A SERIAL NO. PERMIT NO. NEAREST /tl�.T �r•!Q�-(0 6�CT � A /O � I S CROSS ST. J .��ss t URI/IS.S- RECEIVED Y Ready for Inspection DATE ISSUED OWNER /:si/Ff �Y• 4�yT �� jO MAIL USEZONE OCCUPANCY MAP ADDRESS l�w'�Y✓ �/�. ��^ v I � BK PG CITY 7924YEL L tt�y TEL.NO.#r CONTRACTORr CHARGES REIMBURSEMENT FEE �' �+ ADDRESS ,/01--Xl fd/ ,y / NOTlTMUfRED^ -___ CITY p, J TEL.NO. dam/ 0, JOB NO. �+jn' CONNECTION CHARGE FEE STATE CO.IMP. NO. REGISTRATION NO. COUNTY LEGAL ?! 76 ('/Y .!;o` � RECEIPT N0. I DATE I BY DESCRIPTION LOT N0. ` 7 a BLOCK TRACTx 6X3, AJ, `IJ WAIVER FOR RECORDING SIZE OF LOT 0 NOW NO.OF ON BLOT LDGS. J RECEIPT NO. DATE BY (Z�f USE OF BUILDINGS , O NO. DESCRIPTLON OF WORK FEE p + HOUSE SEWER CONNECTING TO ROAD PERMIT NO. PUBLIC SEWER @ $ 3.50 HOUSE SEWER CONNECTING TO g SFEEa1GfiQAGWwtFUT PRIVATE DISPOSAL SYSTEM 1.00 PERMIT N0. CONNECT ADDITIONAL-BLDG.ORI I/ii LN0SiUE ALA.L WORK TO HOUSE SEWER 1.00 �7 NTICSTPPROVAL��1 ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 I STATION DEPTH SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 I MANHOLE REFERENCE CESSPOOL—DRYWELL U�PR �"--+-_�LOWER SPECIAL CONDITIONS ONLY 2.00 I TYPE OF CONNECTION LENOTH..FROM Y. CURB P.L. M.L.TO P.L." OWNERS PERMIT $ I 1 00 — U AUTHORIZATION I TOTAL FEE-HAVE THIS DATE WITH THE f� NAED CONTRACTOR TO CONNECT THTE ED ABOVE D SCRIBED(EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS--------------------DAY OF---------------------------------------- 19-------- NEW HOUSE SEWER OWNER OR CONNECT BULDING OR WORK -7- ) .- � 57-7-63 OWNERSAGENT------------------...........--------------------------------------.-....._ R� SEPTIC TANK,SEEP.PIT(S) ADDRESS---..........-----------..................................................................... AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ DRYWE.LL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND AND/OR DISCONNECT PLUGUSE'S ALICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUG ND AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ER ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFI LL SEPTIC TANKS E:] /7 SEEP.PIT(S)E] CESSPOOLSa- SIGNATURE OF PERMITTEE. - - --04'- - ---------I------------ 76A642D 663 12/52 :WORKERS'COMPENSATION DECLARATION I hereb0-y affirm that I have a certificate of consent to self insure, or a certificate of.Workers'Compensation Insurance,'or -76A642D . CE 808(REV.B/81) APPMC�Ga�' N FOR pEL N'T b certified co�f (Sec. 3800 ) .}—' '. p o o CAMN 0 0 Policy No. Company . rn app p EJ Certified copy is hereby f is ed. SEWER e SEWA E MSPOSALL ❑ Certified copy is filed wit co b ding ', ection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. � Date �C!1pplicant. ) - FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXE PTI N FROM WORKERS' BUILDING 9 COMPENSA 10 INSURANCE ADDRESS STATION DEPTH ' (This section need not be com eteld if the work involved by the p Q MANHOLE REFERENCE` (((/7ig SV �� UPP permit is for one hundred dollars ($100)or less.) LocnurY C C� r LowER I certifythat In the performance of the work for which this NEAREST TYPE OF CON ON LENGTH FROM . P CROSS ST. _ Y. CURB' P.L. M.L.TO P.L. permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation LOWS. OWNER CO.IMP.NO. JOB NO. MAIL Date Applicant ADDRESS TRUNK PERMIT NO. ROAD PERMIT NO. ° ' ' AFFIDAVIT WAIVER EASEMENT RECORD.INSTR,NO. DATE NOTICE TO APPLICANT: If, after making this Certificate of CITY L.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 or this permit shall'be deemed :revoked. .BLOCK TRACT STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION NO.OF BLDGS. PERMIT NO.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 Bus'- BUILDINGS CHARGES ness and Professions Code, and my license is in full force and effect. CONTRACTOR CON NECTION.CHARGE FEE License Number Lic.Class ADDRESS i l REIMBURSEMENT FEE O Contractor DateCITYmdei TEL.NO.' •ra DISTRICT NO. GROUP MAP PROCE ED BY V ❑ I am exempt under See. of the L.A.Co. STATE Uc t /1 K PG O P LICENSE NO. CLASS �L-' f�!) Q�. z 3 4,g Plumbing Code and/or Sec. of the NO. DESCRIPTION OF WORK FEE' FINAL U OUSE SEWER CONNECTING TO DATE W B. & P. Code for the following reason PUBLIC SEWER VALID LT I@ °'� H0 SEPTIC TANK,SEEPAGE PIT OR - FIN L \•., •I i;° 21,5 O PITS AND/OR DRAINFIELD Date HOUSE SEWER CONNECTING TO BY �, O U PRIVATE DISPOSAL SYSTEM a 0.6 Signature CONNECT ADDITIONAL BLDG.OR- ' OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER SEEPAGE INFIELD I hereby affirm that I am exempt from the Contractor's License EOXTN.,CESSPOOL,DRYWDRAMANHOLE I �,'� 2$8 7 Law for the following reason (Secton 7031.$,:.BUisness and Pro- ALTER,REPAIR OR ABANDON HOUSE fessions Code): SEWER OR DISPOSAL SYSTEM ❑ I,as owner of the property,or my employees with wages as — their sole compensation, will do the work and the structure ow at is not intended or offered for sale (Section 7044, Business and Professions Code). OWNERS Permjt $ ❑ I, as owner of the property,am exclusively contracting with AUTIiORIZATION TAL FEE Licensed contractors to.consiruct the project (Section 7044, I HAVE AT HI DATE A C TRACT ITH:THE HEREIN NAMED CONTRACTOR TO Business and Professions Code). CONNECT T ABOVE DESC IBED EXIS NG DWELLING HE PUBLIC SEWER. CONSTRUCTION LENDING AGENCY. D I hereby affirm that there is a construction lending agency SIGNED THIS DA F 1 for the performance of the work for which this permit 's OWNER OR issued (Sec. 3097, Civ. C.). OWNERS AGE ADDRESS— Lender's DDRESS Lender's Name Lender's Address I certify that I have read this application and state that the above inf r ion is correct. I agree to comply with all County ordinan s an State aws regulating Plumbing and Sewers, rl�ancl h eby a hart rRee tatives of s County to enter upon t e e entioperty f ns ection purposes. k-tignature of Permitte iDate SEE REVERSE FOR EXPLANATORY LANGUAGE