The URL can be used to link to this page

Home My Public Portal About5627 ENCINITA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL DIVIS}ON OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FDX. COUNTY ENGINEER I BUILDING G/ ] , ADDRESS �J (7 L. /Y 7 FOR APPLICANT O FILL IN LOCALITY SS .� �U BUILDIA NEARE ADORE ST u CROSS ST. G /t LOCALITY DISTRICT NO. SERIAL NO. QPERMIT NO. NEAREST 7,6 `U /7 JRM2- 2_1 CROSS ST. / (1 RECEIVE BY Read for Inspection DATE SSUEDJ�. OWNER LE �2��7/� CDMAILy USEZON OCZCCUUUPANCYc BI�lY3YPG YRESS / r TELNO . 0 ' �� / .E� Ev / / /y2— CONTRACTOR ,/\� C•v CO.IMP.N0. (0 7 G ADDRESS y[ JOB NO. CITY TEL.NO. 'r" 1/�� I TRUNK PERMIT NO. STATE REGISTRATION NO. ® COUNTY ROAD PERMIT NO. LEGAL STATE ENCROACHMENT DESCRIPTION LOT N0. PERMIT NO. BLOCK TRACT (/ �' rr.. �fr INDUSTRIAL WASTE APPROVAL SIZE OF LOT 936 2OO NOW ON LOTS CHARGES USE OF BUILDINGS :e!5S CONNECTION CHARGE FE NO. DESC IPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER a $ 3.50 RECEIPT NO. I DATE IBP HOUSE SE WER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL SLOG.OR OO EX PTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO' DA E BY SEWER OR DISPOSAL SYSTEM 1.00 _ DISCONNECT AND ABANDON SEWER _ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PTS AND/OR GRAINFIELDIT OR 2.00 STATIONDEPTH CESSPOOL—DRYW ELL �� SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE UPPER [OWER _ TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT = I 00 v M.L.TaPL AUTHORIZATION I TOTAL FEE 2 00 IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS....................DAY OF----------......... . ... 19------ NEW HOUSE SEWER OWNER OR �I � CONNECT ADDITIONAL �[ OWNERS AGENT.- , _'t_Ic' ._._.& `• - BUILDING OR WORK OA ./• 1'IPR ee��J .. .t._-. ._.. .._//11 ADO RESS...��_..;3_(.----.n.._ _ .. . . .. ._ .$ter SEPTIC TANK. DftAINFIELD IT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOLEj 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 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND DISCONNECT PLUG AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSESAND AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- EWER ER OF THE ABOVE DESCRIBED RESIDENTIAL PR PERTY. BACKFILL SEPTIC TANKS SIONATUgE �. / SEEP.PIT(S)Q CESSPOOLS OF PERMITTE 76A642A 663 7/53 (WORKERS'COMPENSATION DECLARATION affirm that I have a certificate of consent to self �1 'inzwe, or wcertificate of Workers' Compensation Insurance, or 76A642D l�I��[T11'1MU a Eertified copy thereof (Sec. 3800, Lab C.) CE 8081RfV.11831 �aPPLOCA4p N FOR P15OT , Policy No. Company ❑certified copy whereby furnished. SEWER - SEWAGE DISPOSAL rtified copy is filed-with the county buildtio " g inspecn COUNTY OF LOS ANGELES BUILDING AND SAFETY Date / Police U� FOR APPLICANT TO FILL IN CONNECTION DATA CE I ICATE OF EXEMPTION FROM WORKERS' BUILDING /I COMPENSATION INSURANCE ADDRES r� STATION DEPTH (This section need not be completed if the Work involved by the MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100)or less.) LOCALITY TYPE OF CONNECTION LOWER , NEAREST LENGTH FROM certify that in the performance of the work for which this CRO$$sT. Y. CURB P.L. M.L.TO P.L. permit is issued, I shall not employ any person in any manner � p • 'yy�,,,.�� P.C.NO, so as to become subject to the Workers'Compensation LOWS. OWNER V� _ JG_7 CO.IMP.NO. JOB NO. ' MAIL / TRUNK PERMIT NO, ROAD PERMIT NO. Dale Applicant ADDRESS Sp NOTICE TO APPLICANT: If, after makin g this Certificate Of / AFFIDAVIT WAIVER EASEMENT RECORD.INS1R.NO. DALE CITY LEL.NO. N 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 No. LICENSED CONTRACTORS DECLARATION v NO.DF BLLO" PERMrt 512E OF LOT ,�p n NOw ON l0T 1 hereby affirm that I am licensed under provisions of Chaptei USE of 9 (commencing with Section 7000) of Division 3 of the Busi- BUILDINGS N CHARGES ness and Professions Code, onj my license is in full force and effect. 1 CONTRACTOR, \ CONNECTION CHARGE FEE license NuTmmbe�`^�O LIC.CIOs. ADDRESS�C/ � / REIMBURSEMENT FEE >,,, Caniratmr�/r ACTW�4' •Dat DISTRICT NO. GROUP MAP PROCESSED BY Is. CITY ,��+ TEL NO, 7!{/ BK PG U ❑ I am exempt Under Sec. of the L.A.Co. STATE No. or::3 Q ciA55 I �// NO. DESCRIPTION O ORK FEE O PlumbingCode and/or Sec. of the FINAL HOUSE SEWERR CONNECTING TO DATE / VALIDA ON V B. & P. Code for the following reason PUBLIC$EWEO W SEPTIC TANK,SEEPAGE PIT OR FINAL PITS AND/OR DRAINFIELD BY Us Date HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG.OR OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD I hereby affirm that I am exempt from the Contractor's License EXTN„CESSPOOL,DRYWELL MANHOLE LOW for the following reason (Sefton 7031.5, BUISness and Pro- ALTER,REPAIR OR ABANDON HOUSE O 11 fessions Cade): SEWER OR DISPOSAL SYSTEM (/ ❑ I, as owner of the property, or my employees with wages as R 4 2 3 b A their sole compensation, will do the work and the structure is not intended or offered for sole (Section 7044, Business e e o Q and Professions Code). OWNER'S Permit $ ❑ I,as owner of the property;am exclusively contracting with AUTHORIZATION TOTAL FEE .I ° ° 2 1,Jr licensed contractors 10 construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO p Bushes.and Professions Cade), CONNECT ME ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. e'e e 2 1.5 0 U CONSTRUCTION LENDING AGENCY Q � � (I_$b, 1 hereby affirm that there is a construction lending agency SIGNED THIS -DAY OF 19_ for the performance of the work for Which this permit is OWNER OR k �_T��„ „/ H�e�� issued (Sec.-3097, Civ. C.). OWNERS AGE^�vim==- I /J_ ADDRE85 Lender's Name - - - Lender's Address I certify that I ave 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 on rhe above=me Ion d rdperty for inspection Urposes. �...�, � Signature o PeimilteeSEE REVERSE FOR EXPLANATORY LANGUAGE 1 /'