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Home My Public Portal About5949 ENCINITA AVE_Sewer__ OEPARTNIIENT OF COUNTY ENGLN-EFR SEWER-SEWAGE DISPOSAL ¶ DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION g COUNTY OF LOS ANGELES, WILLIAM J. FOX, COUNTY ENGINEER BUILDING AGGRESS FOR'7777771 APPLICANT TO FILL IN LOCALITY TCl BUILDING {-Q �/ -1 ,.p / NEAREST ADDRESS �J / /7 :�/y E�/y �r�'`! CROSS ST. ��n•�p�iq �/'� LOCALITY 7_1 ( DISTRICT NO. SERIAL NO. PERMIT NO. NEAREST _ _I A _Z..Z I �� S CROSS ST. !/'s IY�• RECEIVED BY Ready for Inspection DATE ISSUED OWNER fL 3• �� MAIL USE E OCCUPANCY MAP ADDRESS • I• IMI f BK PO CITY n TEL.NO. CONTRACTOR 'giol-eLl 4(1C CO.IMP.NO. J-_'S I ADDRESS -i�-� / , 108.N0. CITY _�� TELL , a 73i .r TRUNKPERMIT NO. /_ i/ A REGISTRATION N0. //O �Y(!/ COSTUNTTEY ROAD PERMIT N0. LEGAL /J STATE ENCROACHMENT DESCRIPTION LOT NO. -,,T 6 PERMIT NO, BLOCK TRACT J-4? Q INDUSTRIAL _ ) NOW ON LOT WASTE APPROVAL CHARGES Q K��3 NO.OF BLDG6. 2 SIZE OF LO jf USE DI �) ,e,�'_ CONNECTION CHARGE FEE '. BUILDINGS �jy•e LL//V Ami � �tLM�/�� NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEES PUBLIC SEWER $ 3.50 RECEIPT NO. ATE IBY HOUSE SEWER CONNECTING TO I/ PRIVATE DISPOSAL SYSTEM I.00 _ CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED .WORK TO HOUSE SEWER 1.00 / 00D ALTERORREPAIREXI8TING DATE IDV SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER _ _ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR /^ _ PITS AND/OR GRAINFIELD 2.00 STATION '3-�, Q DEPTH 1p CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 5 1 M EFERENCE 2q SD UPPER _ TYPE CTION LENGTH FROM am OWNERS PERMIT $ I I 00 CUR 8i4 M.L.TO P.L. 2d f AUTHORIZATION I TOTAL FEEIHAVE THS DATE CONTRACTOIR TO CONNECT THE ABOVE DESCRIBED EXISTED WITH THE HEREIN ING ED APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO T)EE PUBLIC YSEOlW%ER — INEW HOUSE SEWER - � r -6;7xSIGNED TWNERBUILDING OPIT(S)ORK OSS .. �- f ._�... AND/OR I HEREBY ACKNOWLEDGE THAT I HAVE REX6 THIS APPLI• CESSPOOL E] DRYWELL E] CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COURTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICEN6ED EQUIRED BY LOS ANGELES COUNTY AND STATE OF 0 IA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER ER OF THE ABOV GIBED RE DENTIAyPROPERLY. BACKFILL.SEPTIC TANKS Cc / SIGRATURE (/ SEEP.PIT(S)E] CESSPOOLS®- JCYIYOG .3'�1 � �S OFPERMITTEE..._..... ._.._.. .. _.........._.._......_.................._...... 76AG42A 663 7/53 Q i WORKERS'COMPENSATION DECLARATION ' SI sC hereby affirm that Lhave a certificate of consent to self - JISI inAuLe,'or a ceftificCIe of Workers'Compensation Insurance, or raAwsD a certified copy thereof (Sec..3800,.Lab C. CE BDe(REV.8i817 ,p PPp Og+ ,p•TION FOR P2RMff Policy No. Company 'ps F'Y IL ER - OCI IS 9H� ❑ Certified copy is hereby furnished. SEWER - SEWAGE DISPOSAL ❑ 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' B I'D NG 54�/ n/t°/Hi .r-9 � - STATION DEPTH '1 COMPENSATION INSURANCE ADDRESS This section need not be completed if the work involved b the 4 MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100)or less.) y NEARLOC�AEST �'�.<� L- L LOWER NEAREST TYPE OF CONNECTION LENGTH FROM I certify that in the performance of the work for which this CROSS sr. Y. CURB P.L. M.L.TO P.L. > permit is issued, I shall not employ any person in any manner 6 so as to become subject to the Workers' Compensation Laws, OWNER NO O ' '�j y. CO.IMP,NO. JOB NO. {.) )(NOTICE ADDRESS GN�/v�. TRUNK PERMIT NO, ROAD PERMIT NO. 0 x Date G Applicant / \NOTICE T APPLICANT: If er makingt s Certificate Of vv -46, `` p AFFIDAVIT WAIVER EASEMENT RECORD.INSiR.NO. DATE O CRY / EL.NO. �py''cr (� ~ Exemption, you should come subject to the Workers' LEGA Y Compensation provisions of the Labor code, you must forthwith DESCRIPTION LOT NO. yT d comply with such provisions or this permit Shall be deemed HWY.OR ST.WIDENING Y N revoked. BLOCK TRACT ✓ STATE ENCROACHMENT Z LICENSED CONTRACTORS DECLARATION NO.OF&OGS PERMIT NO. SIZE OF LOT -� g NOW ON LOT / - Ihereby affirm that I am licensed under provisions of Chapter USE of 9 (commencing with Section 7000) of Division 3 of the Busi- BUILDINGS CHARGES ness and Professions Code, and my license is in full force and effect. CONTRACTOR CONNECTION CHARGE FEE License Number Lic.Class ADDRESS REIMBURSEMENT FEE Contractor DoteDISTRICT NO. GROUP MAP SED BY CITY TEL NO. BK PG ❑ I am exempt under Sec. of the L.A.Co. STATE No. cross Plumbing Code and/or Sec. of the NO. DESCRIPTION OF WORK FEE FINAL HOUSE SEWER CONNECTING TO DATE �J �/ E VALIDATION B. 8 P. Code for the following reason PUBLIC SEWER i'r �'Y •�S SEPTIC TANK,SEEPAGE PIT OR FINAL Date PITS AND/OR DRAINFIELD HOUSE SEWER CONNECTING i0 BY PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG.OR D OWNER-BUILDER DECLARATION C WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD I hereby affirm that I am exempt from the Contractor's License EXTN.,CESSPOOL;DRYWELL MANHOLE Law for the following reason (Secton 7031.5, Bulsness and Pro- / _%BE$, ALTER,REPAIR OR ABANDON HOUSE fessi Code): SEWER OR DISPOSAL SYSTEM I as owner of the property, or my employees with wages as ( 2 0 9 2 0 A their sole compensation, will do the work and the structure f11 o e o o j 0 is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER'S Permit $ O ❑ I, as owner of the property, am exclusively contracting with AUTHORIZATION TOTAL FEE 'Z o - 21,50 licensed contractors to construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED ONTRAC70R TO IR a Ie 2 1.506 Business,and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWEUING TO THE PUBLIC SEWER. CONSTRUCTION LENDING AGENCY LGi 0 1 —8 3 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 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 State laws regulating Plumbing and Sewers, and hereby authorize representatives of this County to enter ,Ane above-mentioned pr erty for inspection purposes. Signature of Permj ee 1 45OH/ SEE REVERSE FOR EXPLANATORY LANGUAGE