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Home My Public Portal About5703 ENCINITA AVE_Sewer__ 4465 NSERTS - CEBpB APPLICATION FOR PERMIT >age°:D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER t. .. - . BUILDING AND SAFETY DIVISION �ooaelssG7 10,EN &w 7r-A- JOHN A. LAMBIE. County Enyy'neor _ WILLIAM A. JENSEN. Sup't of Huildivg LOCALITY .:- ..-. NEAREST FOR APPLICANT TO FILL IN CROSS ST. csl. LEGAL DESCRIPTION LOT NOS OWNE v MAIL BLOCK TRACT , ✓ ADDRES p SIZE OF LOT I i� •�I NAW LOTS CIT SEL. N0. USE OF -_...,. , .. BUILDINGS �"'4-.Q,Q. 'DISTRICT NO. GROUP BK PG I /I lu_'fi-�,jMAP ��PPROCESSED BY ry I CONTRACTOR L/ _"L4� ADDRESS 0CTION DATA CITY /TEL.NO./_Q �//��sfQ STATIT 0 2 E I DEPTH O! REGISTRATION NO. / / y U STATE MANHOLE R FEflENCE OWER COUNTY NO. DESCRIPTION OF ORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 _J TYPE OF CONNECTION LENGTH FROM PETS AND/OR DRAINFPTIC TANK. GELDPIT OR @ S3.00 Y. CURB P.L. M.L.TO P.L. 024 OVERFLOW SEEPAGE PIT. DLR EXTN..CESSPOOL.ORYWELL @ $2.00 HOUSE SEWER CONNECTING TO CO. IMP. N0. 7 DOB N O PRIVATE DISPOSAL SYSTEM @ SI.00 CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. V WORK TO HOUSE SEWER @ SLGO 5 SEWER OR DAISPOSAL SYSTEM HOUSE @ $100 STATE ENCROACHMENT Pf PERMIT N0. O N INDUSTRIAL U - - WASTE APPROVAL 0. CHARGES LO OWNER'S PERMIT $ 200_ CONNECTION CHARGE FEE 6--u ✓ f7 AUTHORIZATION TOTAL FEE V REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS 16ATF/. IINSPECTOR'S'SIGNATURE TO THE PUBLIC SEWER. AI SIGNED THIS-C —DAY OF 19_ NEW HOUSE SEWER // G�UGI>%n OWNER OR /L(il,��/ CONNECT ADDITIONAL I / '✓-L/" OWNERSAGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT($) / AND/OR DRAINFIELD I �//) / I HEREBY ACKNOWLEDGE THAT 1 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 I 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 � 1 d ✓� CALIFORNIA OR THAT 1 AM HE LEGAL OWNER OF THE ABOVE gAC KFILL SEPTIC TANKS ❑ DESCRI BEO RESIDENTIA PR ERTY. SIGNATURE SEEP.PIT(S) Cl 2WPOOLS ❑ OF PERMITTE ®> VALIDATION,--, ROBERT A. WOOD CK. M.0. G°R SUPERVISING MECHANICAL ENGINEER I l 6 5 4 6 f ih7 t5 - D 5.00 .. A GE806e80APPLICATION FOR PERMIT TBABJIU COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL . �• DEPARTMENLAND COUNTY ENGINEER -- BUII.DINGSAFETY DIVISION BULDINGqg��nnADDRESS 4' v 7;g7"1-J WIOHN A. LAMBIE.LLIAM 001 ENCSupA 131E �!ofo uildiag LOCALITY44 17 NEAREST FOR APPLICANT TO FILL IN CROSS ST.DESCRIP ION LOT NO?'..�rJ. a( ! ..i' r l) OWNER '( / TBLOCK TRACT / ' MAIL. =�� L ._��4• 'u [ � ADDRESS e +r NO.OF.BLDGS. �• SIZE OF LOT rJ ..I n I ' NOW ON LOT L> _ CITY ! TEL. N0. USE OF - ,, _ BUILDINGS. C e��. �•�•�• DISTRICT NO GROUP MAP - PROCESSED BY SK PG ,{ CONTRACTOR '�. �,�I I r ` I 't r i• .-.' P.A 'S w. . - ADDRESS I�.�rrr. �- CONNECTION DATA CITY Y TEL.NO. STATION, • T * DEPTH .. STATE MANHOLEREFERENCE A UPPER - REGISTRATION N0. .�/:r �j ❑ COUNTY . j q r / LOWER NO. DESCRIPTION dF HOUSE SEWER CONNECTING TO , I PUBLIC SEWER @ $3.00 / •`� TYPE OF CONNECTION LENGTH FROM SEPTIC TANK.SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 W OVERFLOW SEEPAGE PIT,DRAINFIELD t ( y O EXTN..CESSPOOL. DRYWELL @ $2.00 V HOUSE SEWER CONNECTING TO P.C.NO. CO. IMP. N0. / JOB NO. PRIVATE DISPOSAL SYSTEM @ $1.00 W WORK TO HOOUSEISEWER BLDG.OR @ $1 00 TRUNK PERMIT'NO. ROAD PERMIT NO. ALTER. REPAIR OR ABANDON HOUSE STATE ENCROACHMENT - �-"� - m SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. O INDUSTRIAL 'WASTE APPROVAL A CHARGES M OWNER'S PERMIT S 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE' INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. ,/I �I /��\ � SIGNED THIS DAY OF 19 NEW HOUSE SEWER 1. 1 ) OWNER OR CONNECT ADDITIONAL OWNERS AGENT - BUILDING OR WORK SEPTIC TANK,SEEP. PIT(S) ADDRESS AND/OR DRAINFIELD ' I HEREBY ACKNOWLEDGE THAT 1 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 ' 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR - DISCONNECT PLUG AND LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL RO RTY. BACKFI LI SEPTIC TANKS ❑ SIGNATURE SEEP. PIT(S) [I CESSPOOLS ❑ " OF PERMITTE !'-- 11f ®r { VALIDATION,- ROBERT A.'WOOD - CK. M,0. /cxsH SUPERVISING MECHANICAL ENGINEER i 2 60 fNSE¢� CES08 6.60 >sneazn APPLICATION FOR PERMIT 1 COUNTY OF LOS ANGELES1'. SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER -. --. -= -. - -� - BUILDING AND SAFETY DIVISION ADORESSG 6 Ale IONN A. LAMBIE. County Engineer WILLIAM A. IENSEN. Supt of Building ,LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL 7K � F JQ .OWNER 5AlNrA J /4- c.oNtTGo' DESCRIPTION LOT NO. BLOCK TRACT MAIL P / W ADORES r /N 0.0 BLDGS, SIZE OF LOT �7 NOW ON L0T CITY TEL. N0. USE OFDI DISTRICT NO. GROUP MAP 9{POCESSED BY BUILDINGS '(�'/y'/ L BK P CONTRACTOR v G .2 �- ADDRESS 3 , �� f� C N CTION DATA CITY . TEL.NO. ��/.i(❑�p STATIONC" p DEPTH C' REGISTRATION N0. d ❑ COUNTY MANHOLE REFERENCE LOWER No. DESCRIPTION OF WORK FEE e1+n HOUSE SEWER CONNECTING TO I!I PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM PITS IAND/OR DRAC TANK, ENFGIELDPIT OR @ S3.G0 Y. CURB P.L. M.I.TO P.L. OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL DRYWELL @ 32.00 -- HOUSE SEWER CONNECTING TO PRIVATE D "Ac-40. CO. IMP, N0. ISPOSAL SYSTEM @ $1.°0 ' / ) 0. CONNECT ADDITIONAL BLDG:OR WORK C HOUSE SEWER $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. oC� U @ ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT IC S 'NEP OR DISPOSAL SYSTEM t n @ $1.00 PERM IT.NO. O INDUSTRIAL U WASTE APPROVAL W CHARGES OWNERS PERMIT $ 2 DD 1 CONNECTION CHARGE FEE AUTHORIZATION ITOTAL 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 SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS—DY OF 19— NEW HOUSE SEWER' I OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WOR% SEPTIC TANK,SEEP. PIT(S) 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 I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSES AND - - CALIFORNIA OR THAT 1 THE LEGAL OWNER OF THE ABOVE �'. ABANDON SEPTIC TANKS ❑ DESCRIBED RESIDENTI OPERTY. SIGNATURE SEEP. PIT(S) El CESSPOOLS ❑. - OF PERMITTE 0s VALIDATIOIP-- ROBERT A. WOOD CK. M.0. uSH J SUPERVISING MECHANICAL ENGINEER L P^D 0 5 4 7 1IV( b- _ 1 D25,00 :L r WO&KERS'COMPENSATION DECLARATION I hetebY:offiN% �.at I have a certificate of consent to self - "insore, or,a c1bri ficate•of Workers'Compensation Insurance, or Ranaaxo a certified copy thereof (Sec. 3800, Lab C.) BE BOB(REV.8/Bl) APPLICATION �Pp Ig� p gI®(,gyp I[®R PERMIT Policy No. company Os i"i SEWER -- OSEWuCAGIrE DISPOSALLO • ❑ Certified copy is hereby furnished. ' ❑ Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. Dote Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE COMPENSATIONON FROM INSURANCEWORKERS' nooaess,S7D3 E/YGi/Y/T STATION DEPTH UPPER (This section need not be completed if the work involved by the LOCALITTM �f /' MANHOLE REFERENCE LOWER permit is for one hundred dollars ($100)or less.) NEAREST G�// Li NEARESL 7-�• / TYPE OF CONNECTION LENGTH FROM I certify that in the performance of the work for which this [Ro555LL / 7` T. CURB P.L. M.I.TO P.L. permit.is issued, I shall not employ any person in any manner //'11 }7 P.C.NO. so as to become subject to the Workers'Compensation Laws, CO.IMP.NO, JOB NO, ••''�� d MAIL `! TRUNK PERMIT NO, ROAD PERMIT NO. Date—L I - pplicant:F(b/t ADDRESS_ z, /�/1 '/ _i /x I7 9 CITY /�(/�/ EL N0��7 �� AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE NOTICE TO APPLICANT: If, after making This Certificate of i Exemption, you should become subject to the Workers' LEGAL Compensation provisions of the Labor code, you must forthwith DEXRIPTION LOT NO. HWY.OR BE 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 o the Busi- BUILDINGS CHARGES ness and Professions Code, and my license is in full force and effect. CONTRACTOR CONNECTION CHARGE FEE T CL License Number Lic.(_lass ADDRESS REIMBURSEMENT FEE O DISTRICT NO. GROUP MAP PR Contractor Date ESSED BY V CITY EL No. BK PG Z ❑ O 7 - STATE LIG O am exempt under Sec. of the L.A.Co. LICENSE NO. CLASS `J L17 1— Plumbing Plumbing Code and/or Sec. of the NO. DESCRIPTION OF WORK FEE FINAL yuE HOUSE SEWER CONNECTING TO DATE L ATION d B. & P. Code for the following reason PUBLIC SEWER yF SEPTIC TANK,SEEPAGE PIT OR Z PITS AND/OR DRAINFIELD FINAL q Dote HOUSE SEWER CONNECTING TO BY LI ja 2 1.5 Q PRIVATE DISPOSAL SYSTEM /� Signature CONNECT ADDITIONAL BLDG.OR VO D C s 0 2 1,506 OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER hereby affirm that I am exempt from the Contractor's License OVERFLOW SEEPAGE PIT,GRAINFIELD E%TN„CESSPOOL.DRYWEU.MANHOLE p Law for the following reason (Secton 7031.5, Buisness and PFO- ALTER.REPAIR OR ABANDON HOUSE 0 U 1 4 18 6 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 is not intended or offered for sale (Section 7044, Business and Professions Code). OWNERS Permit S /0 ❑ I,as owner Of the property, am exclusively contracting with AUTHORIZATION TOTAL FEE '2�_ _ 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 D I 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 - issued (Sec. 3097, Civ. C.). OWNERS AGENT 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 Stole laws regulating Plumbing and Sewers, and hereby outhori sen a Iv f this County to enter upon we- enf )d p' petty for spectiin purposes. Signature a Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE