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Home My Public Portal About4917 ENCINITA AVE_Sewer__ f -0, 76A6423-01 APPLICATION! FOR PERMIT 8A642 COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY D n SION ABUILDING DDRESS _ G WILLIAM OH �A JENBSENIE , Sup ofn9,Urnq LOCALITY NEAREST FADDR OR APPLICANT TO FML IN CROSS ST L� C� L - OWNER TION- F LOT NO TRACT MAIL ADDRESS NO OFBLDGS LOT NOW ON LOT b CITY L L NO DISTRICT NO ROUP MAP PROCESSED BY OF GS BK PO TOR �Y 42 W 9 CONNECTION DATA TEL NO 1� 9' STATION DEPTH STATE MANHOLEREFERE CE UPPER ATION NO COUNTY LOWER No I DESCRIPTION OF WOM FEE PUBLIC SEWER CONNECTING TO @ $3 00 SEPTIC TANK SEEPAGE PIT OR TYP 0 CONNECTION L GTO FROM PITS AND/OR DRAINFIELD $g Op Y CURB P L M L TO P L OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL @ $2 00 d HOUSE SEWER CONNECTING TO P C N0. O PRIVATE DISPOSAL SYSTEM @ S1 00 CO IMP NO JOB N V CONNECT ADDITIONAL BLDG OR .-�^ TRUNK PERMIT NOD PERMIT NO WORK TO HOUSE SEWER @ S1 00 0 SEWER It ISPOSALSYSTEM IR OR ABANDON HOUSE @ $I 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL W WASTE APPROV h CHARGES z OWNER'S PERMIT E 21 OO CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR S`SI6NATURE TO THE PUBLIC SEWER SIGNED THIS DAY OR i9_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL � ' v OWNERS AGENT BUILDING OR WORK SEPTIC TANK SEEP PIT(S) 1 ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP PIT S ❑ CESSPOOLS OF PERMITTEE VALROBERT WOOD 111 0 YYY cs ■ 0 astl SUPERVISING MECHANICAL ENGINEER �.3 0 2 6 7 �4i1dR 3 C p 3 .0 0 ; ��G DF.PARTV ENT OF COUNTY ENGINEFR SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGFT.ES WILLIAM J. FOX. COUNTY ENGINEER I BUILDING ADDRESSBUILDING/ FOB. APPLICANTLOCALITY TO FILL IN - 44 NEAREST ADDRESS CROSS ST �� d:0119/ LOCALITY T [� DISTRICT NO A SERIAL NO " PERMIT NO e C NEAREST G�� ' ' �� ~ /FS5 0 J ROSSST tY�`�"` RECEIVY Ready for Inspection A� E ISSLTE OWNER jr,/ �fs d ADDRESS !� 7 / ,�i MAIL USE ZONE I 0 I CCUPANCY � BK PG A�l�l CITY TEL NO. -� CONTRACTOR ? CO.IMP NO. -13 77 3 -4 ADDRESS v / JOB.NO. - CITY - TEL NO. d(p (17bC,5"*' TRUNK PERMIT NO STATE REGISTRATION NOyy//f3` y0 5 el wgCOUNTY ROAD PERMIT-NO <Vl6f 406-1%, LEGAL DESCRIPTION LOT NO /►/a �V �d �+® STATE ENCROACHMENT PERMIT NO BLOCK TRACT' `� INDUSTRIAL - _ WASTE APPROVAL SIZE OF LOT OF LDGS CHARGES OW ON LOT USE OF BUILDINGS CONNECTION CHARGE�,EE NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO �j y� PUBLIGSEWER @ $ 350 .,.7i J1�6� RECEIPT NO DATE I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1 00 CONNECT ADDITIONAL BLDG OR XCEPTION R CORDED WORK TO HOUSE SEWER 1 00 0 ALTER OR REPAIR EXISTING I 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 AHD/OR DRAINFIELD 200 STATION 7 s DEPTH CESSPOOL—DRYWELL P SPECIAL CONDITIONS ONLY 200 MAN�'� 8' 2pLEFERENCPEfj0 � t9WER TYPE OF-C ECTION LENGTH FROM OWNERS PERMIT $ I 1 00 ,CURW ML TO P L e? 0 AUTHORIZATION I TOTAL FEE S40 N NAED CONTRACTOIR TO CONNECT THE ABOVE DESCRIBED S DATE CONTRACTED WITH THE I EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE`P�U LIC SEWER SIGNED THIS DAY OF —__�L_�____— 193 NEW HOUSE SEWERy,,, OWNER OR �'� f�� r' n � ��Svr CONNECT ADDITIONAL OWNERS AGENT_._ /+�L__ N __ BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL E]CATIONAND 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 IAM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE D SCRIBED RESIDENTIAL PROPERTY y os- BACKFILL SEPTIC TANKS El SIGNATURE' j I SEEP PIT(S)E] CESSPOOLS yy OF PERMITTEE _ �X 765AG42A 663 7/5 O li WORKERS' COMPENSATIONpDECLARATION t I h4;6by�6ff4'm that I have a certificate of consent to self insure, Cra certificate of Workers'Compensation Insurance, or 76A642D U a certified copy thereof (Sec 3800, Lab C > CE808(REV 1/83) APPLICATION FOR PERMIT Policy No Company ❑ SEWER - SEWAGE DISPOSAL Certified copy is hereby furnished ❑ 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' BUILDING STATION DEPTH COMPENSATION INSURANCE ADDRESS (This section need not be completed If the work Involved by the MANHOLE REFERENCE LOWER LOCALpermit is for one hundred dollars ($100)or less ) NEAREST LOWER NEAREST TYPE OF CONNECTION LENGTH FROM I certify that in the performance of the work for which this CROSS ST Y CURB P L ML TOP L -permit Is Issued, I shall no mploy any person Ina y manner so as to become subject to` Workers' Com ens on Laws OWNER Co IMP NO JOB NO MAILv� TRUNK PERMIT NO ROAD PERMIT NO Date Applic ADDRES AFFIDAVIT I WAIVER EASEMENT RECORD INSTR NO DATE 15 7 NOTICE TO APPLICANT f, ter making Certificate of CITY L NO Exemption, you should ome subject to the Workers' LEGAL Compensation provisions of theLabor code, you must forthwith DESCRIPTION LOT NO HWY OR ST WIDENING comply with such provisions c,r this permit, shall be deemed revoked BLOCK TRACT STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION SIZE OF LOSS�`X No of / PERMIT NO � D 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 Busi- BUILDINGS CHARGES ness and Professions Code, and my license Is in full force and CONNECTION CHARGE FEE effect CONTRACTOR License Number LIc Class ADDRESS REIMBURSEMENT FEE Contractor Daf@ DISTRICT NO GROUP MAP PROC SSED BY CITY TEL NO BK PG V El am exempt under Sec of the L A Co STATE LIC 5;O p LICENSE NO CLASS 5A-) Plumbing Code and/or Sec of the NO DESCRIPTION OF WORK FEE FINAL OTS HOUSE SEWER CONNECTING TO DAT VALIDA N B 8 P Code for the following reason PUBLIC SEWER W SEPTIC TANK SEEPAGE PIT OR �o PITS AND/OR DRAINFIELD FINN Date- - HOUSE SEWER CONNECTING TO - BY _ ;2 3 2Q 2 A Z _ PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG OR OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER D , o # 0 0 0 0 1 Q OVERFLOW SEEPAGE PIT DRAINFIELD I hereby affirm that I am exempt from the Contractor's License EXTN CESSPOOL DRYWELL MANHOLE Law for the following reason (Secton 7031 5, Buisness and Pro- ALTER REPAIR OR ABANDON HOUSE I O o21.50 fes ions Code) SEWER OR DISPOSAL SYSTEM 10 2 I,as owner of the property,or my employees with wages as a 1'5 r, 9their sole compensation, will do the work and the structure Q is not intended or offered for sale (Section 7044, Business and Professions Code) OWNERS Permit $ ❑ I,as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE S 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 19OWNER _ for the performance of the work for which this permit is OWNERSOAGENT 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, land hereby authorize repres olives of this County to enter on the above-me oned r rty for in Do n purposes Signature of Per it a Date SEE REVERSE FOR EXPLANATORY LANGUAGE u r