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Home My Public Portal About5814 ENCINITA AVE_Sewer__ 7GA642D ae6066.69 APPLIC 10 OfSWEIR-SEWAGEFiINIIT COUNTY OF LOS ANGELES DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, Counl Evq�a6er ADDRESS CASSATT D. GRIFFIN, Sup? of Building LOCALITY REAREST FOR APPLICANT TO FILL IN c oss sr. [ADDRESS GAL OWNER 1 IPTION LOT NO. c TRACT 5 MAIL ADDRESS NO.OF BLDGS. F LOT NOW ON LOT i CITY TEL. NO. DISTRICT N0. GROUP I MAP I PROCESSED ' � INGS a T _ ACTOR �tL' - - �' v, 0 � • CONNECTION DATA / TEL.N0. STATION DEPTH STATE MANHOLE REFERENCE UPPER TRATION N0. J 1 COUNTY LOWER DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 TYPE OFCN' ION LENGTH FROM / SEPTIC TANK,SEEPAGE PIT OR Y. RB P.L. M.L.TO P.L. ITS AND/OR DRAINFIELD @ 53.00 OVERFLOW SEEPAGE PIT. DRAINFIELD EKTN..CESSPOOL.DRYWELL @ SZ.00 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. N0. JOB N0. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. WORK TO HOUSE SEWER @ SI.00 A LTE R,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT S EW ER OR DI SPOSAL SYSTEM @ $1.00 PERMIT NO, 114DUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE CON- TRACTOR TO THIS THE ABOVE DESCRIBED EXISTINGAMED DWELLIING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWS (� / ,r SIGNED THIS DAY OF ^+�--� 19� NEW HOUSE SEWER OWNER OR ,, CONNECT ADDITIONAL OWNERS AGENT Ar ✓ /-R-r�^ � ' BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD 1 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 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REOUIRBY LOS LE COUNTY AND STATE OF ABANDON HOUSE SEWE0. CALIFORNIA OR T A I AM T L G OWNER OF TH ABOVE // DESCRIBED RESID L PROPE Y. BACKSEEP.FILL PIT(SE CD TANKS Ll CESSPOOLS b-L SIGNATURE OF PER 2 ®rA'I'IOROBERT A. WOOD CR M.a. iiAsH SUPERVISING MECHANICAL ENGINEER L{C 1 9 9 42 J0 9 1 0 D 5.0 0 I WORKERS' COMPENSATION DECLARATION 94-0004 DPW 3/BJ �1 I hereby affirm that I have a certificate of consent to self ,cnanm fist insure, or a certificate of Workers'Compensation Insurance, or CE BDB a certified copy ther a Sec. 3800, Lab C.) APPLICATION FOR PERMIT Policy No. ❑ Certified copy is hereby furnished. V—/— f/2- SEWER - SEWAGE DISPOSAL Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. qq Date Applicant 1-• E • �I rn I(I— A'IU n7 FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING COMPENSATION INSURANCE ADDRESS L STATION DEPTH (This section need not be completedif the work involved by the LOCALITYST MANHOLE REFERENCE UPPER LOWER permit is for one hundred dollars ($100)or less.) TYPE OF CONNECTION LENGTH FROM NEARE I certify that in the performance of the work for which this CROSS ST. Y. CURB P.L. M.L.TO P.L. permit is issued, I shall not employ any person in any manner ///�`�, In L so as to become subject to the Workers'Compensation Laws. OWNER Ga 'LUrnQ A CO.IMP.NO. JOIN NO. Date Applicant ADDRESS /(J 1. 2eI Z2 r TRUNK PERMIT NO. ROAD PERMIT NO. NOTICE TO APPLICANT: If, after making this Certificate of CITY' AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE p Exemption, you should become subject to the Workers' LEGAA L° I TEL.NO. J L Compensation provisions of the Labor code, you must forthwith DESCRIPTION LOT N1, HWY.OR ST.WIDENING comply with such provisions or this permit shall be deemed revoked. BLOCK TRACT STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION SIZE Of LOT NONO.OFW ON LOT LOT PERMIT NO. 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 effect. n �J / CONTRACTOR {.-• L •Tyl• CONNECTION CHARGE FEE ' License Numberr 9/ Lic.Clasps ('Lf. L]N_ ADDRESS 197S (.i 6 n p REIMBURSEMENT FEE O Contractor L• 1- A J I rn(I� Date�I�J� � CITY TEL.NO. C/O -O&P � DISTRICT NO. GROUP MAP PROCESSED BY z m �/ /� BK PG Z ❑ am exempt under Sec. of the L.A.Co. LICENSE NO. 011-13.553 CLASS Plumbing Code and/or Sec. of the NO. DESCRIPTION OF WORK FEE FINAL U HOUSE SEWER CONNECTING TO DATEVALIDATION W / +' B. 8 PUBLIC SEWER a P. Code for the following reason ( N SEPTIC NANO,SEEPAGE PIT OR Dote FINAL /7 Z Plis AND/OR DRAINFIELD HOUSE SEWER CONNECTING TO eV PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG.OR OWNER-BUILDER DECLARATION WORK TO HOUSE SEWEROVERFLOW SEEPAGE PIT.DIA WIELD 1�I I hereby affirm that I am exempt from the Contractors License E%TN..CESSPOOL.DRYWELL.MANHOLE Law for the following reason (Secton 7031.5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE �a a fessions Code): SEWER OR DISPOSAL SYSTEM ' .7 r _ ❑ I,as owner of the property,or my employees with wages as 3707 1.75 their sole compensation, will do the Work and the structure 1 TT''_�IC is not intended or offered for sole (Section 7044, Business and Professions Code). OWNER'S Permit 4 iOTAL 5 ❑ I,as owner of theproperly, am exclusive) contracting with AUTHORIZATION TOTAL FEE Y 9 r r;r ,.r licensed contractors to construct the project (Section 7044, HAVE AT THIS DATE CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO �.rLr'�, Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER, r. 1 CONSTRUCTION LENDING AGENCY •:HAP,SE �Ip_j 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 (+�.4 ADDRESS Lender's Name Hifif,W Lender's Address I -Ed ave r 's application and state that the ab a informatio correct. I o e to comply with all County rdinances an tate WS regul ting Plumbing and Sewers, and hereb NZ r presence.ves of thi County to enter upon the o 'oned prop ty for in ction purposes. Si otur f Permi ee Date SEE REVERSE FOR EXPLANATORY LANGUAGE