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Home My Public Portal About9860 ESTRELLA AVE_Sewer__ 7GA6420 APPLICATIOM FOR PERMIT S 8 E.663 12-54 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer cr / ,e -�- ,7 n County of Los Angeles ADDRESSG !S� ,N ` • �.�.-t AD XXL WM.J. FOX, COUNTY ENGINEER CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY e FOR APPLICANT TO FILL IN CROSS NEAREST ST. LEG DESCRIPTION LOT NO. OWNER ? (' MA IL BLOCK TRACT `4j 7 ADDRESS YVl C-1 l' k�O.I�DAV SIZE OF LOT t/.n -tt NO. OF NOW ON LOTS / A ,kms- CITY /p^•yVf[„rp L�(y,p TEL. NO. USE OF pp BUILDINGS ADISTRICT NO. V GROUP MAP ^ BK PG ^ CONTRACTOR (l l) Af i'. I\ /1 ^ i Pi 7 ADDRESS +� CONNECTION DATA 4 CITY TEL. NO. STATION /..f1 ,� DEPTH :! ❑ STATE // ! ll---lA, MANHOLE REFERENCE LOWER REGISTRATION NO. [I COUNTY •Y6) 1 TYPE OF CONNCT LENGTH FROM <� f NO. DESCRIPTION OF WORK FEE Y. CURB P.L. M.L.TO P.L. HOUSE SEWER CONNECTING TO PUBLIC SEWER Q $ 3.50 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEhj 1.00 _ WORK TO HOUSE SEWER CDG. OR 1.00 CO. IMP. NO. / :3-� 2 JO .,NO.y ALTER OR REPAIR EXISTING p 1 SEWER OR DISPOSAL SYSTEM I.DO TRUNK PERMIT NO. I ROAD PERMIT NO, J DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK, SEEPAGE PIT OR _ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2.00 CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 I HAVE DATE CON- TRACTORT TO CONNECT THEA CTED ABOVE DESCRIBED EXISTINGWITH THE HEREINAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE THE PUBLIC SEWER SI ^ SIGNED THIS DAY OF19 NEW HOUSE SEWER OWNER OR I / I CONNECT ADDITIONAL OWNERS AGENTlJ4nA Ak--h�—_,_,'U/'�� 'nnJ - `A U�-��"-y- BUILDING OR WORK ADDRESS G.flc,l Y.d�AI (V 1.1- .�--z'•"0' T•itt. SEPTIC TANK, SEEP, PIT(5) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION) CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE ICORRECT AND AGREE COMPLY WITH ALL COUNTY. ORDINANCES S AND STATE LAWS REGULATING ALTER, R OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM TEM I 'HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT-PLUG AND CALIFORNIA ORSI THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON SEPTI SEWER DESCRIBED RESIDENTIAL PROPERTY. - BAC p CKFILL SEPTIC TANKS❑ inn ,. / � �� ,�(�/ SEEP. PITS) ❑ CESSPOOLS ( alt (jYjV{'SC.(H.Cif SIGNATURE PERMITTEE I rte`' A G • ``�"^"'-+ WILLIAM J. FOX, COUNTY ENGINEER VALIDATION _ACo4 7 9T3' ' JUN16 4 4_ .50 .BY BY ,. a DEPUTYi -Jr/� -7�/ DEPUTY BY BY 111 ® DEPUTY DEPUTY L W-(JRK,€RS'COMIONSATION DECLARATION affirm that I'have a'certificate of consent to self TTS,,' or a certificate of Workers'Compensation Insurance, or 76Ae42D a,_ertified copy thereof (Sec. 3800, Lob C.) CE 808(REV.8/81) ��®{all ®� �� /Policy No. Company ®s u��I ❑ Certified copy is hereby furnished. SEWER - SEWAGE DISPOSAL ❑ Certified copy is fled 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 COMPENSATION INSURANCE ADDRESS STATION DEPTH (This section need not be completed if.the work involved by the .�.- MANHOLE REFERENCE permit is for one hundred dollars ($100)or less.) LOCALITY 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. M.L.TO P.L. _permit is issued, I shall not employ any person to any manner so as to become subject to the Workers'Compensation Laws. OWNER - CO.IMP.NO, P.C.NO Date O `x�k MAIL ADDRESS TRUNK PERMIT NO, ROAD PERMIT NO. �'�Applicon NOTICE TO APPLICANT: If, after making his Certi{i Of CITY TEL NO. AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE Exemption, you should become subject to the Wor s' LEGAL , Compensation provisions of the Labor code, you must forthwith' - DESCRIPTION LOT NO 0 HWY.OR Si.WIDENING comply with such provisions or this permit shall be deemed revoked. BLOCK TRACT STATE ENCROACHMENT No.oONf afo0s. PERMIT No, SIZE OF LOT 3 NOW Or LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 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 is full force and effect. CONTRACTOR CONNECTION CHARGE FEE License Numbe ff - _ Y Lic.Class- ADDRESS REIMBURSEMENT FEE a O Contfacfof Date NO��NLDISTRICT NO. GROUP MAP PROCESSED BY V CITY TEL NO. BK PG Z ❑ am exempt under Sec. of the L.A.Co. ueENSe NO cinss ,0 DESCRIPTION OF WORK FEE U Plumbing Code and/or Sec. of the NO. FINAL VALIDATION W HOUSE SEWER CONNECTING TO DATE B. 8 P. Code for the following reason PUBLIC SEWERSEPTIC TANK,SEEPAGE PIT OR —� -L PITS AND/OR DRAINFIELD FINAL Dote' HOUSE SEWER CONNECTING TO BY p PRIVATE DISPOSAL SYSTEM /� $Iga,f Uf ` CONNECT ADDITIONAL BLDG.OR pL 8 1 ,Q,y A OWNER-B IL ER DECLA N WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD I hereby affirm that I am exempt from the r octor's License ExTN.,CESSPOOL DRYWEU,MANHOLE - #,s e ee 11 O Law for the fallowing reason (Secton 7031.5, Buisness and Pro- ALTER,REPAIR OR ARAMBBNJ16uf,E- -' fessionsCode): SEWER OR DISPOSAL SYSTEM ❑ I, as owner of the property,or my employees with wages as al, e,e z.ti 5l0 .� their sole compensation, will do the work and the structure' 'e;e'e 2,1, 1j 0 U is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER'S Permit 5 ?1(„Q`l 4;t 8 7 ❑ I, as owner of the property, am exclusively contracting with AUTHORIZATION TOTAL FEE licensed contractors to construct the project (Section 7044, I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR i0 Business and Professions Code). CONNECT THE ABOVE DESCRIBED EX1571NG DWELLING TO THE PUBLIC SEWER. CONSTRUCTION LENDING AGENCY �yt� OAY OF D I hereby affirm that there is a construction lending agency SIGNED THIS �G\o�p QC” 197 for the performance of the work for which this permit is OWNER OR _["� ... issued (Sec. 3097, Civ. C.). OWNERSAGENT �'W\` .� r'• *3s�V•rc � Sym_—�-^-Zo Lender's Name ADDRES - - Lender's Address certify that I have read this application and state that the 1100 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 upon the abov -menti ned prop fy for inspection purposes. ' �ot�� ttee $Ignaturc*ofPermitfee Date SEE REVERSE FOR EXPLANATORY LANGUAGE