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Home My Public Portal About9132 EMPEROR AVE_Sewer__ LICATI �p 7/ 71 - ' - �. h� 1e,rc S&E-663 12.54 ��''°°'' ®� PERMIT 1 DIVISION OF BUILDING FIND SAFETY SEWER-SEWAGE DISPOSAL . Department of County Engineer BUILDING "` County of Los Angeles ADDRESS f� WM. J. FOX, COUNTY ENGINEERf CASSATT D. GRIFFIN, SUPT OF BUILDING MOM LOCALITY �✓ ® 0 NEAREST FOR APPLICANT TO FILL INceoss sr. LEGAL �D .J N'•_ G OWNER 0 .'-J /. DESCRIPTION LOT N0. C/ BLOCK TRACT /` MAIL O ADDRESS- � OF BLDGS, - SIZE OF LO (SOW ON LOT CITY TEL NO. USE OF BUILDINGS -`.., � ,� a DISTRICT NO. GROUP MAP h;..- BOK PG �.� CONTRACTOR ADDREs I � �✓t_ % CONNECTION DATA o M � EL. NO !�I t/ fL)� KIJ' i�: STATION.., DEPTH �a NOV ( � [t-STATE MANHOLE REFERENCE ' / REGISTRATION j� i Z", ❑ COUNTY UPPER (7-"I ) /J TYPE OF CONNECT) LENGTH FROM NO. DESCRIPTION OF WORK FEE Y. CURB ( P.t. M.L.TO P.L. 77 HOUSE SEWER CONNECTING TO PUBLIC SEWER a $ 3.50 HOUSE SEINER CONNECTING TO �� PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. VlORK TO HOUSE SEWER 1.00 JOB. NO. ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT _ AND/GR DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK, SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2.00 CHARGES CONNECTION CHARGE FEE OWNERS PERMIT 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE TRACTORHAVE T TO CON ECTHIS DATE ONTRTHEAABOVE DESCRIBED EXISCTED WITH THE TINGAMED DWELLING APPROVAL.C9. DATE INSPECTOR'S SIGNATURE 'a TO THE PUBLIC SEWER SIGNED THIS DAY OF9 NEW HOUSE SEWER 19y _/ l a`'rrfl/dr a OWNER ORI CONNECT ADDITIONAL OWNERS AGENT ti � `"� - t +-� BUILDING OR WORK ADDRESS SEPTIC TANK, SEEP, PIT(S) f �' - AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS Al PkICATION CESSPOOL[I DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE O COMPLY _ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 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 OR THAT I AM THE LEG L OWI±b R OF THE—ABO DESCRIBED NTIAL PROPERTY. 4 U BACKFILL SEPTIC TANKS❑ �.J jp /f �,/U SEEP. PIT(S) ❑ CESSPOOLS`�_y. 5�,� (51I&� -1 SIGNATURE OF PERMIT WILLIAM J. FOX, OUNTY ENG[ EER VALIDATION V �^5 6 3 J13L 14 4 4.50 '� BY SL1l) BY - DEPUTY DEPUTY BY BY ® DEPUTY V -M DEPUTY WORKERS' COMPENSATION DECLARATION {) 200051 DPW 6189 U •'I hereby affirm that I have a certificate of consent to self Insure, CC a certificate of Workers' Compensation I surance, or 76A6a2D o c ryifi d c py t er of o5mpan800, Lab C. APPLICATION .FOR PERMIT ❑ Certified copy is hereby furnished. CAus� SEWER - SEWAGE DISPOSAL ❑ Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. Date Applicant A dtl, Og'Z / FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING COMPENSATION INSURANCE ADDRESS Ll v STATION DEPTH (This section need not be completed if the work involved by the LOCALITY LOWER fJv�' 1 MANHOLE REFERENCE �—f (� LOWER permit is for one hundred dollars ($100)or less.) 1 certify that in the performance Of the work for which this NECROSS AREST TYPE OF CONNECTION LENGTH FROM ST. v CURB t M l TO P L permit is issued, 1 shall not employ any person in any manner LEGAL so as to become subject to the Workers' Compensation Lows. DESCRIPTION LOT NO. P C NO I P CO IMP NO JOB NO Date Applicant BLOCK TRACT TRUNK PERMIT NO ROAD PERMIT NO NOTICE TO APPLICANT: If, after makingthis Certificate Of ASSESSOR ,+ AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE MAP BOOK PAGE,/ J PARCE Exemption, you should become subject to 'the Workers' NO.OF BLDGS. Compensation provisions of the Labor code, you must forthwith SIZE OF LOT NOW ON LOT HWY OR ST WIDENING comply with such provisions or this permit shall be deemed USE OF revoked. BUILDINGS STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION PERMIT NO I hereby affirm that I am licensed under provisions of Chapter OWNER 9 (commencing with Section 7000) of Division 3 of the Busi- MAIL ADDRESS � jZ ` 'tp CHARGES ness and Professions Code, and mJ license is in full force and effect, CITY TEL.NO, CONNECTION CHARGE FEE License Number Lic. Class /t REIMBURSEMENT FEE L CONTRACTOR Ll �✓ Contractor ?N. a 1a)f8 / LDate�� DISTRICT NO GROUP MAP PROCESSED BV ADDRESS 1 j�(�► BK PG ❑ I am exempt under Sec. of the L.A.Co. C CITY > TEL.NO. Q D Q J 7 7 0- Plumbing Code and/or Sec. of the STATE LIC. pATEL VALIDATION Z LICENSE NQ CLASS B. 8 P. Code for the following reason NO. DE CRIPTION OF WORK FEE —a 0 HOUSE SEWER CONNECTING TO FINAL Date PUBLIC SEWER BY � }/ e SEPTIC TANK SEEPAGE PIT OR W /'�� Signature �/ g1T X r� PITS AND OR DRAINFIELD 0. HOUSE SEWER CONNECTING TO co OWNER-BUILDER DECLARATION PRIVATE DISPOSAL SYSTEM Z I hereby affirm that I am exempt from the Contractor's License CONNECT ADDITIONAL BLDG OR Low for the following reason (Secton 7031.5, Buisness and Pro- WORK To HOUSE SEWER OVERFLOW SEEPAGE PIT. DRAINFIELD -- feS5iOn5 Code): EXTN.CESSPOOL.DRYWELL.MANHOLE i'I:.•�_^ ❑ I,as Owner of the property, or my employees with wages as ALTER,REPAIR OR ABANDON HOUSE �f �j�� ........ T �� their sole compensation, will do the work and the structure SEWER OR DISPOSAL SYSTEM p� �J _-y is not intended or offered for sale (Section 7044, Business and Professions Code). _ ❑ I, as owner of the property, am exclusively contracting with OWNER'S Permit $ Q t- J t I+ licensed contractors to construct the project (Section 7044, G Business and Professions Code). AUTHORIZATION TOTAL FEE '- i- ' 3,; CONSTRUCTION LENDING AGENCY HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR ro , :`itiR'I' ! I hereby affirm that there is a construction lending agency CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER for the performance of.the work for which this permit Is issued (Sec. 3097, Civ. C/.,�). SIGNED THIS DAY OF 19_ ��-k'1 - OWNER OR .?LL:.I_' ..•»'ti ..-' i4 Lender's Name OWNERS AGENT Lender's Address FJ 3- .F�GE.r ?3AIa7d - ADDRESS #tea 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-mentioned property for inspection purposes. i--ti�a &W&-A �C—�— FF Signature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE DECLARATI . •fm that. ` I haveCOMPENSATION ate of consent to 76A3C6DPW9/89 APPLICATION FOR PERMIT LIME GREEN 76A364C I hereby affirm than I have a certificate of consent to self insure, ora certificate of Worker's Compensation I surance, or ertified HEATING-VENTILATING -AIR CONDITIONING copy thereof(Sec. 3800 Lab.C.) 1� Policy No. d4 6L Company 7 COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. Ce Ile copy Is ereby furnished. CEJ(, Sze F1ADCertified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDINGDRESS department. a c (PRINT OR TYPE ONLY) Jr , Date f 2 7 / /rJ Applicant J-4141Ja1 ��7^� NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. COMPENSATION INSURANCE ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed if the work involved by the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU per/ become subject to the Workers' Compensation Laws. Qp CiGwlrf-LCJ COMPRESSOR,BTU APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM pp NOTICE TO APPLICANT: If, after making this Certificate of ROUGH —p Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such FINAL provisions or this permit shall be teemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and HEATER: WALL Professions Code, and my license is in full force and effect. � c .Iles? C License Number , �(_—�_Lic.Class_� �Q V j I I n7 11 Contractor �� 0,1fu/u'lo Date 3 ❑ Plan check fee CHECK K i'1=�FI`U I am exempt under Sec. B.&P.C.for this reason PERMIT ISSUING FEE$ j� '• rlt3i ,I t1 f0 Date: TOTAL FEE U Signature al>.l. kfdJ/D� l'1� t 1'�Ii_Ii l-•.'_I ;%I �,'?'i r>_it d PLAN CHECK APPLICANTCn OWNER-BUILDER DECLARATION 7'75 t A`f"! In9F ° 1 hereby affirm that I am exempt from the Contractor's License Law NAME f for the following reason (Section 7031.5, Business and Professions ► Code): ADDRESS ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the CITY 4<4/EL. < - EL.NO. structure is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting MAIL with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CITY TEL.NO. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for NTRACTOR , the performance of the work for which this permit Is issued (Sec. 3097, Civ. C.). ADDRESS Lender's Name 0—6.114 1L tv 4,4 CITY TEL.NO. Lender's Address �.2 `°t 14.4? STATE LIC. I certify that I have read this application and state that the above LICENSE NO. CLASS information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APPLICANMR � AGENT DATE