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Home My Public Portal About8802 GARIBALDI AVE_Sewer__ T�7 re F` 'ell 7& s A"2D-85 APPLICATION FOR PERMIT 76A 44u COUNTY OF LOS ANGM- SEWER-SEWAGE DISPOSAL Df PARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DrMION SUILDINo 2 ,4R1 13 to i JOHN A.LA-MBIE, Connt� Engineer A. Cf1 p COLEMAN W. J$NUNS,Sup t. of Building L LOCALfTY N EA RSET �/��•� FOR CANTTO FILL IN tROf. fT. /» D[DCRIPTION L0117414 0. OWNER MAIL BLOCK TRACT ADDRESS NO. OF BLOGS. SIZE OF LOT NOW ON LOT CITY TEL NO. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGSISK _ y� CONTRACTOR ��✓ ,jiL r ADDRESS r L . CONNECTION DATA CITY 'o TR. NO. 15 _t'y STATION _rVA A LICEM LICENSE r V ✓ UPP" NO. '� CLASS - 1r MANHOLE" C EFEREN [ LOWER -NO. IfDESCRIPTION OF WORK FEE TYPE OF CON ION LENGTH FROM HOUSE SEWER CONNECTINS TO Y. qB F.L M.L TO P.L PUBLIC SEWER • S 5.00 P.C.NO. .ITIC TANK, SEEPA41Z PIT W_ PITS AND/OR DRAINFIE. 4 $10.00 CO.IMF.NO. '0 JOS NO. HOUSE SEWER CONNECTINS TO TRUNK PERMIT NO. ROAD PERMrT NO. PRIVATE DISPOSAL SYSTEM ! $ 9.00 COWAFU AbDITLIONAL hLDG. OR AFFIDAVIT I 'All- LOIM'Irr "[CORD.INETR.NO, DAT[ WORT( TO HOUSE SEWER # $ 9.00 OHW Y.OR ST.WIDENING EXT N.,C ESD POOL, MANH LE S $ 5.00 STAT=ENCROACHMENT PERCOLATION TEST • $ 5.00 PERMIT NO. l INDUSTRIAL �FnT� p� WASTE APR O V A L OStlm s PERMIT ; 21 00 CHARGES AUMORIZATION1 TOTAL FEF O CONNECTION CHARGE FEE 'I HAVE AT THIS DAT[ A GONTRH "[IMBURSEMENT F[[ACf WITH T [ HEREIN NAMED CON- �r�� TRACTOR TO CONNE(,T THE ABOVE DESCRISFD LXIBTIHG DWLLLINO APPROVALS TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY .OR OWNER OR NEW HOUSE SEWER OWNS"AGENT CONNECT ADDITIONAL or BUILDING OR WORK ADDR[Bf SEPTIC TANK,SEEP,PIT(S) 1 HEREBYACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AHD/O"DRAINFI[LD AND STAT[ THAT THE ABOVE IS CORRECT AND AGR[[ TO COMPLY N WITH ALL COUNTY ORDIANCES AND BTAT[ LAWS REGULATING CESSPOOL ElD"YW[LL ❑ PLUMBING AND SEWERS. I HEREBY CERTIFY THAT I AM PROPERLY "EGIBTEIR[D AND/OR ALTER,R[PAi R,SEWER OR L IC[NSED AD REGUIR[D BY LOS ANQLES COUNTY AND STAT[ OF SEWAGE DISPOSAL SYSTEM LDE NIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND IN, TH[ VI D RI■ R[SID[NTIAL PROPERTY• ABANDON HOUSE S[WSR R[ dBACKFILLS[P�IC TANKSRYITT[E SEEP,PIT(a) u CW POOLB VALIDATION M.O. GASH j AjO2 2 4 0 a MAY 23 1 0 D 5.0 OMzzll 4 t yrA�� APPLICATION FOR PERMIT Ira 4�aDIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL 1 Dep-I>-nt rf C-2ty Eag ftp of Los Ama.>m FAIDR DING JOHN A. LAMBIE, COUNTY ENGINEER H3S0 CASSATT D. GRIFFIN• SUPT Of BUILDING LI7Y�— ST FOR CANT TO FIU-IN ST. LEGAL OWNER DESCRIPTION LO 0, v BLOCK - TRACT PAILADDRESS 0.OF SLOGS. CITY TEL. NO. SIZE 0 LOT Ow ON LOT USEOF DISTRICT NO.. GROUP YAP PG BUILDBK iAGa CONTRACT ADDREsSq� CONNECTION_77 Jr DATA . ��` STATION DEPTH f C TEL- NO.C,/ MANHOLE REFEAEIICE UPPER ,GESTATE r REGISTRATION NO. ❑ COUNTY No. DESCRIPTION OF WORK FEE TYPE OF ION LENGTH FROM HOUSE SEVER CONNECTING TO Y. P.L. Y.L.TO P.L. PUBLIC SEWER 9.50 SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD ® 3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD P. C. N0. i E7XYN.,CESSPOOL,DRYWELL,MANHOLE 2.00 CO. INP.N0. JOB NO. HOUSE SEVER CONNECTING TO PRIVATE DISPOSAL SYSTEM ® S 1.00 TRUNK PERMIT NO. 40AD PERMIT NO. COIINECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE 9EWE R ® f 1.00 PERMIT NO. ' ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEVER OR DISPOSAL SYSTEM Q 1.00 WASTE APPROVAL - CHARGES CONNECTION CHARGE FEE OWNERS POMT i 1 00 REIMBURSEMENT)<HE AUMQR=TION 'TOTAL FEE o ;Q I HAVE AT THIS DATE A CONTRACT'WITH THE HEREIN NAMED COX- APPROVAIZ DATE INSPECTOR'SSIGNATURE - TRACTOR TO CONNECT THE ABQyE DESCRIBED EXISTING AWELLING ` TO THE PUBLIC SEWER. NEW HOUSE SEWER SIGNED THIS OF 1715 19 CONNECT ADDITIONAL OWNER OH BUILDING OR WORK OWNERS AGRXT _ SEPTIC TANK,SEEP,PIT(3) ADDRH/ �' AND/OR DRAINFIELD ' 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ ANq MATE THAT THE ABOVE IS CORRECT Ally AGREE TO COMPLY WITH ALL COUNTY 0RDIXANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERI. SWAGE DISPOSAL SYSTEM L.ESCRIBED Y CKRTIFY THAT 1 AM PROPERLY REGISTERED AMD/0 DISCONNECT PLUG AND AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSES ER' A OR THAT I AN THE LEGAL OWNER OF THE ABOVE RESIDENTIAL PERTY. BACKlrILL CESSPOOLSITT£E JOHN A_ LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD,CHIEF PUBO. INSPECTOR CL L 0. /LATE+ '' trJL 4 Lj ,5 c� LWORl M'COMPENSATION DECIARATKDN I�hereby affirm that I have a certfflcate of consent to seff Insure, or a certtficah of Workers'Compensation Insurance, or copy thereof(Sec. 38 a certified 00, Lab G) 22- �DPW VW APPLICATION FOR PERMIT Policy No. Company SEWER SEWAGE DISPOSAL ❑ Certified copy Is hereby furnished. ❑ Certified copy Is filed Vblth the county building Inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. Date Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CUMIRCATE OF DTAWTION FROM WORi®2S' rq COMPENSATFON INSURANCE AmressVY STATION t DtPrr1 (Th Is Ion nned not be m to yf the work Involved by the �m e- MANHOLE REQ UPM permit oS )or ). TYPE OF CONNECTION -LB�QTH RIOM I certify that in the performance of,the.work for which this R. C Pry Y. CLORB P.L. MNL TO P.L. permit Is fsvied, I shall not emppNoy any person in any manner to as to become subject to the WorkW Compensation Laws. oyyr� P.c NO. '�. co.ww.No. roe No. MALO TRW(PERPAU NO. ROAD Pmma NO. Date Applkant AooR!!ti NUIICZ TO APPLICANT: If, after making thio Certtfkate of AP�AvrT wAner tASEAeear RECORD.MM Na DATE Exemption,. you should become subject to the Workers' C No } Compensatlon provWons of the Labor code,'you must fortirMth D raN LOT NO. FFWY.OR al'.V D9NLNo comply with such provialors or this permit aboll be deemed revoked. ikOou TRACT STATE R40bOACHNe ff LICENSED CONTRAICDECLARAATON NO.Or RLDf L �T Na TORS STM a LOT Now ON LOT I-hereby Affirm that I.am llgrsed Nndw provisions of,Chapter USE OF 9 (commencing with-Section 7000) of Division 3 of the Bust- CHAAGES nese and Prbfeeslors Code, and my Ilcerse U In full'force and ]rye pf fes, CONTRAIM COMECTICN C kPIM R4 Z Lk Kum Number LIc Clas ADORM6 Contractor Date Err TR.No. � PQ e DISTRICT NO. QAOIR MAP PROCESSEDY ❑ LLIC. E I am exempt underc Seof the LA Co. LICENSE Es!NO. CLASS VlumbIng Code and/or Sec of the NO. DEMOPTO OF YKW a FMM pwel aosaNV�TM To DATEVALDAT}ON cn B. d P. Code for the following reason PUINX r — Zt PIT OR _ PTTs ex CONNEc n () �° Nose sewEst aor•a�[tTrao m Signature CON,EC,AMGaNAL BLDG.OR Poo.OYV1J92$UILDER DECLARATION WORKTO MOUSE SEWER I hereby affirm that I am exempt from the Controgtor's License exTx MvelolF Law for the following reason (Becton 7031.5, Bulsrleu and Pro A< R �HOLM 1� feW one Code): OR DWOSAL • I, as owner of the property,or my employees with wages as ACCT.r I their sole compersatlon, will do the work and the structure Is not Intended or offered for sale (Section 7044, Buslnesp Permit = M7 27.03 and Professions code). AUTHOR En. 1 ITEM ❑ I,as owner of the property,am exclusively contracting with TOTAL FEE TOTAL ❑� llcensetrrs d conactoto construct the probed (Section 7044, 1 NAVE AT THts DATE A OONTRACr WITH THE FUMIJ NAME NT CORACTOR TO Business and Professions Code). CON•ECT THE AWYE DMOZEIm PLtSrM 1T49.LrN6 TO THE PUBLIC sEVA!3L CONSTRUCTION LENDING AGENCY cwcri 27.0[1 I hereby affirm thot there is a construction lending agency SIGMM THIS DAY OF 19_ f`or the performance 4f the OVIN work for which this permit Is toR •� wl•67s A,(`E•IT Issued (Sac. W97,-Civ. C. ADDRESS ryy� Lender's Name 0000-CMI' 2/- 7/91 Lenders Address 7L5 18 1 0 8:14 1 certify that I have read this appllcation and state that the above Information Is correct. L 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-Meentloned propper'ty four 'Ion purposes. r�r 7 Signature of Permittee Date is t1l4111IMfi FOR MPLANATORY LANGUAGE