The URL can be used to link to this page

Home My Public Portal About9415 GIDLEY ST_Sewer__ RS'CONAPEN.SATION DECLARATION - • Iyer �f#irr5i that I (nave a cbrtlficate of consent to self 'rfnwre, Dr'b ca2ffflcate of Workers'Compensatlon Insurance, or 700 e� p certiflab copy t" eof(Sec La 3900, b C.) cIam(RE`''8/81) APPLICATION FOR PERMIT Policy Nd._ Company Os ❑ certified copy I,,hareby fumished. SEWER - SEWAGE DISPOSAL ❑ Cert Hied copy is filed with the county bullding Inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. Dat. Appllcant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEAAPTION FROM WORKERS' Ducatq STATION DEPTHCOMPENSATION INSURANCE ADDRESS (This sectlon need not be completed If the work involved by the LovUTY MANFIOIE REEPIEN E UPPER permit Is for one hundred dollars ($1W)of less_) I certlfy that In the performance of the work for which thisY mar. - TYPE OF CONFE�7roN LENGTH FROM . CURD P.L. ML TO P.L.prinex printf Is 1lsued, I shall not employ any pson In any manner P G Na to as to become subject to the Workers'Compensation Laws.: ayytIER Hsu.NO roe NO / MAL TRUNK PERMIT NO. ROAD PstMlT NO. Date tArpllcant A,DOREss AFFVAVTt WA1VHt EA$EMiPJT REOORA INSfR.NO. DATE NOTtCf TO APPLICANT: If, after making this rttfi a of + TEL NO. Exemption, you should become subject to the Workers LEcan1 Compensation*vlslons of the Labor code, you must forthwith D"CRl PTION NO. HWY.OR ST WDE►e NO comply with such provisions or this permit shall be deemed revoked. kOCK TRACT STATE B4CROA0-We IT LICENSED CONTRACTORS DECLARATIONNo. No.of BLDas. PMW I hereby afflrm that I am licensed tinder proylsfons of Chapter O-O Lorsul i ( 9 (commencing with Section 7000) of Division 3 of the Busk LpRNps t } CHARM ness and Professlons Code, and my license Is in full force and effect. CONTRACTOR - OONF*C)ON CHA 43E FEE License Number Uc.Class kgs O Contractor Date• DiSTR NO. MAP PKXEMW BY V STATE DK 7- ❑ under Sec.am exempt unSec. of the LA_Co. �M'NO CLASS V�a� ] }cv O- c. Plumbing Cod*and/or Seof the NO, G IPT10N OF WORK FEE FINAL /` IiOIJEf,¢rust CCMrlCTeiG ro DATE W SPWER B. & P. Cods for the followlnor reason MT OR ALIpA N Pate PTs$ARD/ DRAAI$D Fs�A1 F HOUSE$EWER COPAECTtNG TO DY Slghgtun, CGt4 ECT ADDmo AL DLDO.OR ' OWNER-BUILDER DECIARATK N WORK TO HIOLtSE sEwst I h.rbby affirm that I am exempt from the Contractor's Lltertire OVERFLJNFELD D N. ow MA.NIHOLE Law for the following reason (Secton 71031.5, Bulsness and Pro- ALTER,REPAJR OR A AN ON House 1.7 6 9-0.A fesslons Code): SEWER 01 Rl I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure Is not Intended or offend for sale (Section 7044, Business and Profwlons Code). OWNER'S Permit $ $ '$ ❑ I,as owner of the property,am OXCIuSlvely contracting with AUTHORIZATION TOTAL FEE licensed contractors to construct the project (Section 7044, 4 HAVE AT THIS DATE A wrrH THE HERON NAMED TO Business and Profeesions Code. CONNECT THE ABOVE DE3C3t1BED DWLNO DWRUNC TO THE PUBLIC WMR . CONSTRUCTION LENDING AGENCY , I hereby affirm that there Is a construction lending agency SIONm THIS DAY OF 19_ for the performance of the work for which thls permit is OwriEk OR Issued (Set. 3087, CI-v. C_). OWNERS AQe f ADDRESS Lenders Name Lender's Address I certify that L have read this application and at" that the above Information Is correct. I agree to comply with 611 County ordinances and State rows regulating Plumbing and Sewers, and hereby authorize representatives of this County to enter Upon the a ve-mentioned property for Inspection purposes. Signature 6T Perms Date Sit RIVI M NOR EVI AMATORY LANGUAGN cmeof 4.59 APPLICATION FOR PERMIT COUNTY OF LOS AliGO se SEWER-SEWAGE DISP6SAL N:PABTIMfT OF COUNTY EXCIMM BUH.MG AND SAFETY DMMOX BUILDING L , Co�T_ ADDRp�l Ci�diT A Q�lLim& eQp'! LOCALITY MEMS APPUCAM TO 1CROSSLE O LEGAL DESCRIPTION LOT 110, OWARR BLOCK TRACT MAIL ADDRESS X6.OF BLD-GS. SIZE OF LOT now ON LOT USE OF BUI GD DISTRICT X0. GROU a" Cl BY BK t'G Cowm i J 7 ADDRESS COIMCnON DATJ CITY STATION DEPTH STATE MANHOLE REFEREXCE UPM RRGISTRATION no. COUNTY Xo D Rl O P'� @QUS[cEE11H3t CONNECTING To ruBLl f a I OF C011 011 IS T NK.SHBFAGE FIT OR T. CU P To P. PITS All OR DRAIXFIELD a 00 OVERFLOW SEEPAGE PDRAINFISLD 0 CONNB G E3 I'L TO P.C.NO. IVAW 713% CO.IMP.N0. JOS NO. CONNECT ADDITIONA&BLDG.OR TRUNK F[RMIT NO. ROAD P1 Rmrt M0. • Nw�uR¢XA?TOO HOAIUSE06Er fs X X HOUSE SATE EIiCROACHIIEXT 00 PERYIT N0. IXDUST.IAI WMTE APPROVAL, rc.n. CHARGES Rye S - O PEUCT p0 CONNECTION CHARGE FEE AUTE1013 ATIO14 TOTAL FEE REIMBURSEMENT PI!E 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 MY OF- i9_ HIM HOUSE SKWER OWNER OR CONNECT ADDITIONAL OWNERS AGK=? BUILDING OR WORK ADDRESS IETANK,SETiP.FITS) AN C R DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE !S CORRECT AND AGRfiE TO COMPLY CHSSF00L DRYrELL WITH ALL COUNTY ORDINANCES AXD STATE LAWS REGULATING AL REPA1ft Si7IR OR PLUMBING AND SEWERS. SBM DISPOSAL SYSTEM 1 HEREBY CERTIFT THAT 1 AM PROPERLY REGISTERED AND/OR LIDISCONNECT PLUG LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND AND STATE OF ABANDON HOUSE NEWER CALIFORNIA OR THAT I AM THE LE OF THE ABOVE DKSCRAED REJUD BgAACKFILL, C TANKD SIGNATURE SEIP.PITS CESeP00L6 El OF I'£R I 01, `/AI L 0. ROBERT A. WOOD tM<. L 0. - CAa BRJPLltVLGIHO HMrCk-ld►t11CAL lQ�IOLPiE�R 738OFv EV2610 D 5.00N 4 APPLICATION FOR PERMIT 1 D1VISION OF BUILDING AID SAFETY SEWER—SEWAGE DISPOSAL of C--fy Enghww Countr of Low Angeles BUILDTN RESS JOHN A. LAMBIE.COUNTY ENGINEER - F)LD CJaaATT D. GRIPTIN, BYP'T of BUILDI►I0 I,OCALITT EA AMMEST FOR APPLICANT TO IN CROs GT LE GAL 01•)! DESCRIPTION LOT NO. WAIL BLOCK TRACT ADDRESS 77 N0.O B GS. CITY �, TEL. N0. SIZE OF LOTIQ?k 14tX0W OX LOT USE BUILDINGS D ^� DISTRICT N0. GRdUP YAP �..�/ ` BK PG CONTRACTOR 2 a Co ON DATA . AD DCiES9 1� STATION DEPTH C1TY art/ TYL(XO / 0 MANHOLE RItFEll ENCE _ UPPER REGISTRATION NO. �+� ❑ STATE 1p of' LOWER No. DESCRIPTION OF WORK fEE ROUSE SEVER CONNECTING TO fyfEE f N GTH OY PUBLIC BER B 3.50 Y. CURB P.L. M,L.TO P.L. SEPTIC TANK,SEEPAGE PIT OR - - PITS AND/OR DRAINFIELD Q 3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. • i EXTX..CESSPOOL DRY LL YA HOLE S 2.00 CO. IMP. N0. JO i HOUSE-SEWER CONNECTIAG TO - i PRIVATE DISPOSAL SYSTEM ® S 1.00 TRUN[PERMIT NO. ROAD PYRMIT NO. F .COX ECT ADDITIONAL BLDG.OR _ STATE EXCROACHMEIIT WORK TO HOUSE SEWER Q S 1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DI POSAL SYSTEM .00 WASTE APPRwl< CHARGES CONNECTION CHARGE FEE - ovnm,S PENIN $ 1 00 AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE - I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN RAYED CON- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBE EXISTING DWELLING TO THE PUBLIC SEW R. .•� NEW HOUSE SEWER SIGNED THIS9 S o CONNECT ADDITIONAL ow OWNER OR BUILDING OR WORK N DWNEAS AGENT ' / . .- SEPTICTANI(,SEEP,PIT(3) ADDRESS- AND/OR DRAINFIELD ' 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPS TION CESSPOOL❑ DRY ❑ AND STATE THAT THE'ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTrLR,REPAIR,SEWN OR PLUMBING ANO SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LO¢ ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AY THE LEGAL OWNER OF THE ABOVE DESCRIBED RE111DENT1 PROPERTY. BACKFILL SEPTIC TANKS❑ SIGNATURE BEEP. PIT(8) ❑ CESJPOOLS❑ OF PERMITTEE JOHN A. LAMBIE, COUNTY ENGINEER VALIDATIO 0. /� N ROBERT A.WOOD.CHIEF Pu3G. INSPIECTOR u. jZ02 7 2 moi.-'JLL Zj-:. A Z.aQ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS 00 FOR APPLICANT TO FILL IN LOCALITY ADOREBU!LD �`� ��/,/LL y _ NEAREST CROSS ST. LOCALITY DISTRICT NO. )SERIIAIL NO. 9PEfRssMIT N0. C CROSS ST. r Ca V�AeL Y A NEAREST / / l / C' /� J y-/Tp ECfIIyVE Ready for Inspection DATE ISSUED OWNER � E � E� K7/�- 'L"(L. MAIL ADDRESS S/�/� -4 Y��T ( USE ZONE OCCUPANCY I MAP BK PG CITY EAD TEL.NO. CONTRAF6 /C= �t'l j9I'1}id �€Wg3' �„ct /�:.' CO.IMP.NO. ADDRESS-3}7 �lagP�T�Ave* JOB NO. ClAI}�A�® �9 T _,,a X4.8 TRUNK PERMIT NO. REGISTRATIO yp,� ^ ❑ STATE Nlt .4A5 S.„t F,] COUNTY ROAD PERMIT NO. 2- 4 3 'j 7 LEGAL STATE ENCROACHMENT DESCRIPTION LOT N0. l� PERMIT N0. BLOCK TRACT �� Cj 9 p� INDUSTRIAL 9 WASTE APPROVAL SIZE OF LOTi�X�Xy uh�N BF BL T / LJ7 NOW ON LOT ( CHARGES USE BUILDINGS BVIm(� E CONNECTION CHARGE FEE ,NO. DE:sr_fzIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE PUBLICSEWER @ $ 3.50 RECEIPT NO. DATE �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 EXISTING NO.. DATE I BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK.SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION 4 6 DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE UPPER i4YKGAy TYP OF CONNECTION LENGTH FROM OWNERS PERMIT $ I 00 CURB �,�_L. M.L.TO P.L. D AUTHORIZATION I TOTAL FEE 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO TH PUBLIC SEWER ,�j CC SIGNED THIS.___---------DAY OF___�..... .�_19..1 NEW HOUSE SEWER OWNER OR - // CONNECT ADDITIONAL OWNERS AGEN _ ..s_.. 1",(�....._.__ BUILDING OR WORK <SLrEy �, SEPTIC TANK,SEEP.PIT(S) ADDRESS..... _.- ............. I HEREBY ACKNOWLEDGE THAT I HAVE RLIAd THIS APPLI- CESSPOOL❑ DRYWELL❑ CATIONAND 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 1 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 DESCRI D RE IAL PROPERTY. BACKFILL SEPTIC TANKS SIGNATURE SEEP.PIT(S)[] CESSPOOLS E]�JJ OF PERMITTE , i 6A642D 663 1/53 - �_ I `1