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Home My Public Portal About5203 FARAGO AVE_Sewer__ r ' a D99 APP I A:TIOI�I FOR PERMIT ('ae 08 8 7 COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL is DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING :PROCES.�119D ADDRESSJOHN A LAMBIE County En eer CASSATT D GRIFFIN Supt of Budd�nq LOCALITY NEAREST FOR APPLICAN TO FELL IN CROSS ST LEGAL DESCRIPTIO LOT NO OWNERBLOCK ,TRACT G MAIL ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS (�( � DISTRICT NO GROUP I MAP ]BI 0t BK PG I CONTRACTOR !' ADDRESS 6z24vCONNECTION DATA CITY TEL NO ),- ION ' DEPTH STATE MANHOLE REFERENCE ER REGISTRATION NO COUNTY N DESCRIPTION F WORK FEE j HOUSE SEWER CONNECTING TO ^� PUBLIC SEWER @ $3 00 16-t TYPE OF CONNECTION LENGTH FROM SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TO P L PITS AND/OR DRAINFIELD @ $3 001215 / OVERFLOW SEEPAGE PIT DRAINFIELD EXT N CESSPOOL DRYWELL @ $2 00 Loa HOUSE SEWER CONNECTING TOP C NO PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO CONNECT ADDITIONAL BLDG OR WORK TO HOUSE SEWER @ $100 TRUNK PERMIT NO ROAD PERMIT NO ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $100 PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNER S PERMIT $F-2 00 CONNECTION CHARGE FEE AUTHORIZATION I 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 SIGNED THISY OF 19OF J9_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT 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 HAT 1 PROPERLY EGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REOU ED BY LOS A LES CO NTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR AT I AM THE L AL 0 N OF THE ABOVE DESCRIBED REST L PROPERTY BACKFILL SEPTIC TANKS ❑ SIGNATURE SEE PITS ❑ CESSPOOLS OF PERMITTE Or —� ATION ROBERT A WOOD LS 0 GSH SUPERVISING MECHANICAL ENGINEER 0 500 I, t� I e � CE8062U..3 `y A PP LI I O N FOR E R INI eeos a se COUNTY OF LOS ANGELES SE EFi-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ,y ADDRESS � V JOHN A LAMBIE County En eer CASSATT D GRIFFIN Sup t of Building LOCALITY — NEAREST OCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL j DESCRIPTION LOT NO OWNER BLOCK TRACT MAIL ADDRESS NO OF B DG SIZE OF LOT NO ON LOT / CITY TEL NO USE OF DISTRICT NO GROUP MAP PROCE D BY BUILDINGS B PG CONTRACTOR ADDRESS / U 11 CONNECTION DATA CITY TEL NO,,6;7-1YJO1N Q DEPTH STATE MANHOLE REFERENC REGISTRATION NO COUNTY No I DESCRIPTION VORK —FEE 3 HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3 00 TYPE OF CONNECTION LENGTH FROM r SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TO P L PITS AND/OR DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL @ $2 00 HOUSE SEWER CONNECTING TOP C NO PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO WORK TOTHOUSEADDITISEWERRLDG OR @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT S W OR DISPOSAL SYSTEM @ $100 PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWAR.S I PERMIT $ CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE I tam 0r) 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 SIGNED THIS DAY F 9_. NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT 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 ABOVEIS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRY-WELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY T I AM P RLY REG TERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIR BY LOS ANGEL COUN AND STATE OF DISCONNECT ABANDON HOUSE SEWER CALIFORNIA OR THA 1 AM THE LEGA OWN OF THE ABOVE DESCRIBED RESIDEN OPERTY BACKFILL SEPTIC TANKS Cl SIGNATURE �L SEE PIT(S) ❑ CESSPOOLS OF PERMITTE ALIDATION ROBERT A WOOD �K m p CASH SUPERVISING MECHANICAL ENGINEER (1°tC 6 2 4 E SEP L I D - 5 t' O M J ��..WORKERS COMPENSATION DECLARATION A. `TereT'affirm that 1 have a certificate of consent to self Insure or a certificate of Workers Compensation Insurance or 92 0002 DP W5/87 a certified copy thereof(Sec 3800 Lab C ) 76A642D J APPLICATION FOR PEiZIIIIIT Policy No 1( %!533Company,5X9 /4 G�D�IJeNSA7Ilav (CE 808) (� ❑ Certified copy is hereby furnished ��7 r '( ` SEWER - SEWAGE DISPOSAL . µ ❑ Certified copy is filed with the county building Inspection COUNTY OF LOS'ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIVISION department Date 12-31--8? Applicant �i9c[ iQo 6 F�7�5 FOR APPLICANT TO FILL IN / CONNECTION DATA �` u CERTIFICATE OF EXEMPTION FROM WORKERS BUILDINGr� O _�g�A v STATION O w DEPTH COMPENSATION INSURANCE S ADDRESS V (This section need not be completed if the work Involved by the �� - MANHOLE REFERENCE § a LOWER permit Is for one hundred dollars ($100)or less j LOCALITY42 I certifythat In the performance of the work for which this NEAREST TYPE OF CONNECTION p CROSS ST Y CURB P L r LENGTH FROM, permit Is Issued I shall not employ any person in any manner J PC NO " so as to become subject to the Workers Compensation Laws OWNER ,S L/ 10V 7'Qe 11 Co IMP NO 4 JOB NO ' i bate—Applicant ADDITA RESS �s Q TRUNK PERMIT NO ROAD PERMIT NO NOTICE'TO APPLICANT If after making this Certificate of CITVt — AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE +' Exemption you should become subject to the Workers i LEGA rA TEL NO ` Compensation provisions of the Labor code you must forthwith DESCRIPTION LOT NO HWY OR ST WIDENING I comply with such provisions or`this,permit shall be deemed revoked BLOCK TRACT STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION NO of eL PERMIT No i dSIZE OF LOT NOW ON LOTOT j hereby affirm that I am licensed under provisions of Chapter USE of 9 (commencing with Section 7000) of Division 3 of the Busl BUILDINGS ��/ �E "(/C CHARGES ness and Professions Code and my license is In full force and effect ,� t/ �} CONTRACTOR � ��f�' CONNECTION CHARGE FEE License NumberV b // 9-3 J LIC CIOSS - / ADDRESS �£� v REIMBURSEMENT FEE 4 Contractor 'P/ Y l /S1k4&Date 3"/7—9� �J_D n n DISTRICT NO GROUP MAP PROCESSED BY CITY /� �' /yf�` TEL NO C3 /OS � BK PG ❑,I am exempt under Sec of the L A Co LICENSE NO �6//IQ ' LIC �02 V� � v Plumbing Code and/or Sec of the NO DESCRIPTION OF WORK FEE FINAL ��iii " W HOUSE SEWER CONNECTING TO DATE i VALIDATION 0 6 8 P Code for the following reason PUBLIC SEWERSEPTIC TANK SEEPAGE PIT OR FINAL M IBJ PITS AND/OR DRAINFIELD FI I Date HOUSE SEWER CONNECTING TO a /X PRIVATE DISPOSAL SYSTEMZ Signature CONNECT O K TO ADDITIONAL HOUSE SEWER DG OR r OWNER BUILDER DECLARATION OVERFLOW SEEPAGE PIT DRAINFIELD I hereby affirm that I am exempt from the Contractors License EXTN DRYWELL MANHOLE " Law for the following reason (Secton 7031 5 Buisness and Pro ALTER EPAI R ABANDON HOUSE 1L� fesslons Code) SEWER POSAL SYSTEM A(CT.s El .4I as owner of the property or my employees with wages as L t their sole compensation will do the work and the structure ° 3307 21.911 is not Intended or offered for sale (Section 7044 Business ` 1' and Professions Code) , OWNER'S Permit !CONTRACTOR o _ 1 IT , ❑ I as owner of the property am exclusively contracting with AUTHORIZATION TOTAL FEE J Q T licensed contractors to construct the project (Section 7044 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMETO OTAL .21.ry50 Business and Professions Code) CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE Pv Ll1Cf'7/ �CSe+4J CONSTRUCTION LENDING AGENCY IT�GG11..K 2 SIGNED THIS DAY OF 19_ f CHANGE V'1 I hereby affirm that there is a construction lending agency . for-the performance of the work for which this permit Is OWNER OR F Issued (Sec 3097 Civ C ) k OWNERS AGENT et 4 ADDRESS K ( 000�M01 C/l8/__ Lender s Name � r 1 �l Lender s Address v 3.2.3.00 1 AM11:05 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 a ' and eby authorize representatives of t Is County to enter u n e above mentioned property for pection purposes �� 4 � * r Signature of PeAlftDate + SEE REVERSE FOR EXPLANATORY LANGUAGE