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Home My Public Portal About9835 GARIBALDI AVE_Sewer__ 246210 "°" '° FOR PERMIT APPLICATION O comm OF MM ANoIMES SEW E"EWAG E DISPOSAL DEPAETMM OF COUNTY E DOM - m I ' BUII.DINC} AND SAFETY D#VIffiON BUl ING ADOREU OHZf A. r ivnrc `� LOCALITT EAAFST F)-- FOE ANT TOTILL Rose li arra ION LOT N0. -21 TRACT !W L l+4 ADDASdY NO.OF B GS. OT NOW ON LAT C �� DISTRICT NO. GROUP MAP Di PG R �2 CONNEQIIOIfLDATA TEL No. �O (f (�O DIQT9 � STATE ,oA11HOLI R[FQtEII REGISTRATION N0. G COUNTY - NO: I DESCRIPTION OF WOR FILE J i HOU9ECSE�Ffi_cONNECTING TO Q ' r SF�PTIC TANK,SEEPAGE PIT OR TYPE OF COHNHCTION LENGTH ■ D/ T. CURB P ■. To P. PI AN OR DRAINFIELD OVERFLOW SEEPAGE PIT DRAIXFIELD HOOSA.ES E�C0NNE I G TD P.C-No. n�YVX�NE /gyp T pNA� 9 S1,00 CO.Imp.No. Z3 �f JOB N0. wcooU T tTT..11R �2RBLDG.OR 0 SIM TRUNK PERMIT NO. ROAD PJWMIT N0. A 0 BANDON HOUSE I FE, ENCROACHMENT 9YST 'PERMIT NO. INDUSTRIAL W APPROYA 9HARGES 0MUM R► PE)ESUT 00 CONNECTION CHARGI PTL[ AUTHOR=TION I TOTAL FEE kiUMBURSEMENT Pis I HATH AT THIS DATE A CONTRACT WITH THE HEtEIlI NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EIISTING DWELl,lNQ APPROVALS TE INSPER'S 314NArax TO THE PUBLIC SEWER. SIGNED THIS nAY OF 12- NEW HOUSE SEWER A-? O"ER OR COX ECT ADDITIONAL OWNERS AGENT BUILDING OR WORT( ADDREn IC TI�NK.SEEP.PIT(S) MD/OR DRAIXFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT TH ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL DRTWELL El WITH ALL COUNTY RDINAMCEZ AHD' STATY LAWS REGULATING PLUMBING AMD SEWERS. ALTER,REPAIR,SEWER OR 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND 'STATE OF AbAND DISCONNECTPLUGAMD CALIFORN OR THAT I AM THE LEGAL OWNER OF THE ABOVI ASAXDON HOUSE SEWER DESCRIBE RESID IA PROPERTY. BACKFILL SEC TANKS SIGNATUR$ Sd8 PIT S CHII8P00 OF PERYI Ci. L 0. (Jl{M [} 0 0 is c', 5Z;J AUG I D D 5.0 0. 32� 24630 WflTf `_°°°' A APPLICATION FOR PERMIT 7/A/4sD COUNTY OF LOS ANaEL.E$ SEWER--SEWAGE DISPOSAI* DEPARTMENT OF COUNTY ENS �[ ' BUMDING AND SAFETY DViMON AnnRExa wmluT c= LOCA LITT e— NEAREST FOR APPLICANT TO FILL IN J, i CROSS Sr LEGAL DESCRIPTION LAT 110. OWNER RML BLACK TRACT V ADDRESS N0.OF BLDGS. BIZKOF LAT Now ON LOT CTITV USE OF DISTRICT■O. GROUP BUI INGd n CONTRACTOR , -a 2 ADDRESS S' CONMCtOb CITY TSL X0.j, �q;/./ L/ O 0 DVITH STATE / AEGIBYRATiON X0. 0 / COUNTY Yk)1d0 QRFxRRMCI . No. CR IO R FEE ATE ODUCsaE►F COXXECTIXG TO 7TP5 OFCONNECTION LENGTH FRO■ SEPTIC7/1iK,SEEPAGE PIT OR T. CURB F. N.L.To P PITS ANDD//0R DRAINFIELD OVERFLOW SEEPAG PIT DRAIN-RELD OUSE ER CONNECT G TO P.C.110' CCp nn A p n/�L CO.IEP. NO. .)OE YO_ 1�ORK C HOUSE B XAL BL.DQ.OR TRUNK PERMIT K0. ROAD PS3LIIT N0. 8 09 �fiA R OREIAYBE'ARX X HOUSE STATE E!!((CROACdYS1LT �r pul "gum $1.00PERMIT M0. INDUSTRIAL APPROY ;HARGIS OWNEWSPEMMT s , CONNECTION CHARGE FYI AUTHOR A71ON TOTAL FEE vv REABURSI XCKPI'T-FU I HAVE AT THIS DATE A CONTRACT WITH THE HERKIN HAZED COX, _ TRACTOR 7O CONNECT THE ABOVE DESGRI�ED MISTING D1►$L,WNG APPROVALS bATE INDPYCTOR'SSI7MTURI TO THE PUBLIC SEWFJL SIGNED THIS SAY OF t0_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIOXAI OWNERS AGKN•T � /'��r � BUILDING oR WORK ADDRaav SEPTIC TANK SEEP.PIT(11) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IR CORRECT AND AGREE TO COYPU CESSPOOL DRTWl LL El WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING A T1;R,REPAIR,SEWER Op _ PLUMBING ApD SEfBRD. B�AGE DISPOSAL SYSTEM 1 HEREBY CERTIFT THAT I Al PROF2RLT REGISTERED AND/OR DISCONNECT PLUG AND LIC AS REOUIRED BT LOS ANGELS COUNTY AND ATE OF ABANDON ROUSE BE CALIFORNIA OR THAT A■ THE LEGAL Owm OF T ABOVE DESCRIBED REBID PROPIRTT. BACKFILL SEPTIC TAX SIGNATURE SEEP.PIT 1 CESS OF PERYI mr VAL L 0. /'a- SINGROBKZF A WObD Q L 0. hlfi H4)P43VID1N0 HECHAHIC:ALiiI'1dI7O317K Lk .oaae aur 1 z d 2 5,0 0 WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent/to self ' Insure,,or a certificate of Worker'Compensationnsurotics, or I7��' a certifled cppy thereof (Sec.3800, Lab C,) CE Ks(RE".8/°I) , APPLICATION FOR PERMIT Policy No. Company 01 ❑ Certlfled copy Is hereby fumished. SEWER - SEWAGE DISPOSAL ❑ Certified copy Is filed with the county building Inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY _ department. Date _Appllcant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BusD+NG G , I COMPENSATION INSURANCE ADDRESS n H STAB °EFrH (This sectlon need not be completed If the work Involved by the {C. L - C' MANHOLE Rte UFPM permit Is for one hundred dollars (V00)or less.) NEAREEr J,�.dd TYPE OFOor4NECTloN LENGTH I certlfy that In the performance of the work for which this cess sT. u� Y. CURB P.L WL TO P.L permit Is Jssudd, I shall not employ any person In any manner P_C.NO. so as to become subject to the Workers'Comperuatlon Laws. ayr� figLA�///,J/ Q CO•LMP.NO. JOB NO. 0 Date_ AppNcant TRUNK PERWT NO. ROAD PBMAFT NO. � ADor�s `� NOTICE'TO APPLICANT: If, after making this .Certificate of �y • � �0-7 AJ�vrr WAN" EASeMetT IPlSI R. DATE Exemption, you should become subject to the Workers Lam' W Compensation provisions of The Lpbor code, you must forthwith DESCRIPTION LOT-NO, HWY.OR ST.WDE3RgG CL N comply with such provisions or this permlt shall be deemed revoked. tlLOOC TRACT STATE Z LICENSED CONTRACTORS DECLARATIONNo.OF NDvs IHLWT No. S@ OF LOT NOW ON LOT L hereby affirm that I am Ilcensed under provisions of Chapter USE Or 9 (commencing with Section 7000) of Division 3 of the Bull- BUILDINGS Vylf/G 47, CHARGES nets and Professlons Code, and my license Is In full force and dIARC�e effect. CONTRACTOR FEF License Number LI c.Class RR"URMNANT.FEE Contractor Date CITY ra.NO. DESTRIcr NO. GROUP MAP PG PROCESS®BY El am exempt under Sec of the LA Co. �UBtSENO. aA.ss Plumbing Code and/pr Sec. of the NO. DESCRIPUON OF WORK FEE RNAL HXtSE SEWER cONNECnNG TO DATE � VALIDATION B. A P. Code for the following reason PLRWJC T SAGE PIT OR FNAL ' Dare PITS ATA DRAT NFHD SEWER TO BY 4T . Signature = CONrECT ADDLTONA,L BLDG.OR OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER I hereby affirm that I am exempt from the Contractor's License Extx MAae MANN1012 Law for the following reason (Se-don 7031.5, Bulsness and Pro- ALTEiL REPAnt OR AaunoN IKouSE fesslons Code): SEWa)OR DMPOsu SYSTEM, ar ' fl 5 9.4. I,as owner of the property,or my employees with wages as their sole compensation, will do the'work and the structure # 0 0 0 0 1 0 Is not Intended or offered for sale (Settldn 7041, BUslneu and Professlom Code). OWNER'S Permit $ 2 ° 0 2 1.50 ❑ I,as ownsr of the property, am exclusively contmcting with AUTHORIZATION TOTAL FEE c L.b ensed contractors to construct the project (Section 704", 1 HAVE AT THLS DATE A CONTRACT WITH THE HI3tE➢t NAI-® ro °,' ° 1'`�0 siness and Professions Code). CONNECT THE ABOVE Df3Qt1�DUSTING DWE LLNG TO THE PUBLIC SEWER 11.04—83 CONSTRUCTION LENDING AGENCY , by affirm that there is a construction lending agency SIGNM THIS DAY OF 19_ e performance of the work for which this permit Is OWNER OR Aid (Sec. 3097, Clv. C). ADDRESS rs Name r's Address fy that I have read tfiN application and state that the Information Is correct. (corse to Comply with all County nces and State laws regulating Piumbing and Sewers, ereby authorize representatives of this County to enter the above-mentioned pr for Inspection purposes. nature of Permittee Date sae RIVEM FOR IM ANATORY LAYOGUAGe