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Home My Public Portal About10702 FREER ST_Sewer__ DEPAICUMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING I ADDRESS FOR APPLICANT TO FILL IN LOCALITY BUILDINGNEAREST i ADDRESS 10702 Freer St. CROSS ST. LOCALITY .1 Mnnte DISTRICT NO. SERIAL NO. PERMIT NO. c NEAREST 7{� ��CQ A �� j�S �ps CROSS ST. El Montle Ave* RECEIVED /RE�EIjBY Ready for Inspection �sDATE ISSUED OWNER P. L. MCNntt MAIL USEZONE OCCUPANCY MAP ADDRESS 272* San _CbriPl Rlyd. BK PG CITYSan Gabriel TEL.N0- . AT 94364 CONTRACTORT,`p• & BO CONWRlic"ODT Cao• CO.IMP.N0. ADDRESS 4Q8 Winthrop Dr JOB NO. �G'— CITY Alhambra TEL.NO.AT 48315 TRUNK PERMIT NO. CM STATE REGISTRATION NO. 113613-C-42 p COUNTY. ROAD PERMIT N0. LEGAL STATE ENCROACHMENT DESCRIPTION LOT NO. 6 PERMIT N0. BLOCK TRACT 17867 INDUSTRIAL WASTE APPROVAL '—'--- SIZE OF LOT NO.OF BLDGS. NOW ON LOT 2 \ CHARGES USE OF BUILDINGS 1 ReS• CONNECTION CHAR w EE NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE 1 PUBLICSEWER @ $ 3.50 RECEIPT NO. I DA I BY HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR "--EXCEPTION RECORDED WORK TO HOUSE SEWER • 1.00 ALTER OR REPAIR EXISTINGT NO- I DATE 1BY- 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 DRAINFIELD 2.00 STATION x'77 DEPTH CESSPOOL—DRYW ELL SPECIAL CONDITIONS ONLY 2.00M NHOLE REFERENCE /,(� � Q- UPPER TYPE OF CONNECTIONLENGTH FROM OWNERS PERMIT $ 1 11 00 -"Y-- 4"s P.L. -- M.L.TO P.L. AUTHORIZATION TOTAL FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED' CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING' APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER // SIGNED THIS....................DAY OF.......-...---....--__....-___.........19-.--.-- NEW HOUSE SEWERf' l�.3�`3 OWNER OR CONNECT ADDITIONAL OWNERS AGENT............................................................................... B U I L D I N G O R W O R K SEPTIC TANK,SEEP.PIT(S) ADDRESS-------------------------------------------------------------------------------------------- AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL E] DRYWELL I] CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE - TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED ESI ENTIAL PROPERTY. BACKFILL SEPTIC TANKS Ej SEEP.PIT(S) CESSPOOLS SIGNATURE OF PERMITTE � ❑ ❑ 76A642D 663 1/53 d WORKERS'COMPENSATION DECLARATION ` I hereby affirm that I have a certificate of consent to self insure, ot:a certificate of Workers'.Compensation Insurance, or 76A642D .certified copy thereof (Sec. 3800, Lob C.) 92-0002 DPW 6/88 " APPLICATION FOR PERMIT. PcNcy No. Company El'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' BUILDING "O `70 a STATION DEPTH COMPENSATION INSURANCE ADDRESS / �ee2 S f (This section need not be completed If the work involved by theMANHOLE REFERENCE UPPER permit Is for one-hundred dollars ($100)or less.) LOCALITY LOWER NEAREI certify.that in the performance of the work for which this CROSSSST G2 RJZ TYPE OF CONNECTION LENGTH FROM permit is issued, Y CURB P L M L,TO'PL I shall not employ any person in any manner n P c No so as ttoj become subject to the Workers'Compensation Laws. OWNER pd S lO=n (0,C- rCO IMP NO. JOB NO MAIL Date Applicant p� / ' �! ADDRESS /v •r f le e C/� 5 TRUNK PERMIT NO ROAD PERMIT NO NOTICE. TO APPLICANT: If, afte' making this Certificate Of CITY a AFFIDAVIT' WAIVER EASEMENT RECORD,INSTR NO DATE T TEL NO ? /p� U Exemption, you' should.become subject to the Workers' LEGAL Compensation,provisions of the Labor code, you must forthwith DESCRIPTION LOT NO HWY OR ST.WIDENING .comply with such provisions or this permit shall be deemed revoked. BLOCK TRACT STATE ENCROACHMENT • - LICENSED CONTRACTORS DECLARATION NO OF BLDGS PERMIT NOSIZE 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 of the Bust- BUILDINGS CHARGES ness and Professions Code, and my license is in full force and � ` �L effect. J� /� �{ CONTRACTOR ) /' (T'- CONNECTION CHARGE FEE LicenseNumber �/AS7 tic.Class ✓ � c� ADDRESS 1.241 J^ r i ene,)tc*— •ems REIMBURSEMENT FEE Contractor //e/A,7 / to Q rT -%Z CITY �� C.Qc!r✓1d C TEL NO DISTRICT NO GROUP BK MAP PG PROCESSED BY IOC ❑ I am exempt under Sec. of the L.A.Co. STATE LIC NO. SlB� �— CLASS Plumbing Code and/or Sec. of the NO. DESCRIPTION OF WORK FEE FINAL LLal' HOUSE SEWER CONNECTING TO DATE ) VALIDATION (n B. 8 P. Code for the following reason PUBLIC SEWER C � 66 p. SEPTIC TANK,SEEPAGE PIT OR FINAL_ Date .'� l TOS // PITS AND/OR CONDRAINECTING BY HOUSE SEWER CONNECTING TO ? PRIVATE DISPOSAL SYSTEM Signature .._J �� / CONNECT ADDITIONAL BLDG.OR OWN -BUILDER DECLARATION WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD I I hereby affirm that I am exempt from the Contractor's License EXTN,CESSPOOL,DRYWELL,MANHOLE Law for the following reason (Sefton 7031.5, Bulsness and Pro- ALTER,REPAIR OR ABANDON HOUSE i t fessions Code): SEWER OR DISPOSAL SYSTEM =L ❑ I,.as owner of the property,or my employees with wages as .117 their sole compensation, will do the work and the structure 7�� ? 27.rki is not intended or offered for sale (Section 7044, Business '�- and Professions Code). OWNER'S Permit ; 6 0T E=rte ❑ I,as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE OQ ,� licensed contractors to construct the project (Section 7044, 1 HAVE AT THIS DATE•A CONTRACT WITH THE HEREIN NAMED CON RACTOR TO t'4T1'4!- °'r– �, s 00 Business and Professions,Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER - CONSTRUCTION LENDING AGENCY Ci E E_' '''ry'IJ;t I hereby affirm that there Is a construction lending agency SIGNED THIS DAY OF 19_ Poo. }-(FNGLE p's 0 for the performance'of the work for whichOWNER OR t'0'• •'IL this permit i5 OWNERS AGENT issued (Sec. 3097, Civ. C ). ADDRESS Lender's Name01000-131001 2 ?l= Lender's Address 57 69 11 All 9--57' 1 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 upon the above-Mentioned property for inspection purposes. nature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE