The URL can be used to link to this page

Home My Public Portal About5758 GOLDEN WEST AVE_Sewer__ 1 WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Ihsuronce,or 76A642D a certified copy thereof (Sec. 3800, Lab C.) 92-0002 DPW 6/88 APPLICATION FOR PERMIT Policy No. Company ❑ 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 ��/ COMPENSATION INSURANCE ADDRESS6315-1 Gjp UL/-fak STATION DEPTH (This section need not be completed if the work involved by theLOCALITY a,R MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100)or less.) LOWER I certify that in the performance of the work for which this CROSSNEARESST. `-, V,–'M+A TYPE OF CONNECTION LENGTH FROM rvf��i�/I� Y. CURB P.L. MA.TO P.L. permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. P.C.NO. OWNER � � �Z.) CO.IMP.NO. JOB NO. _ Date Applicant ADDRESS S E� W r Sr` AVe TRUNK PERMIT NO. ROAD PERMIT NO. NOTICE TO APPLICANT: If, after makin this Certificate Of w G AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE g CITY I V TEL.NO. O L/rb VVDa Exemption, you should become subject to the Workers' LEGAL Compensation provisions of the Labor code, you must forthwith DESCRIPTION LOT NO. HWY.OR ST.WIDENING comply with such provisions or this permit shall be deemed revoked. BLOCK TRACT STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION / NO.OF BLDGS. PERMIT NO. SIZE OF LOT SD NOW ON LOT - I hereby affirm that I am licensed under provisions of Chapter TSE OF J 9 (commencing with Section 7000) of Division 3 of the Busi- BUILDINGS i.5 i L CHARGES ness and Professions Code, and my license is in full force and effect. CONTRACTOR CONNECTION CHARGE FEE License Number Lic.Class ADDRESS REIMBURSEMENT FEE Contractor Date DISTRICT NO. GROUP MAP ROC D BY z • CITY TEL.NO. ��JJJ'''��('J BK PG ///''' 0 STATE LIG. 1 ( 'J( A �I ❑ I am exempt under Sec. _of the L.A.Co. STATELICENNO. LIC.CLAe O '!F Plumbing Code and/or Sec. of the NO. DESCRIPTION OF WORK FEE FINAL / HOUSE SEWER CONNECTING TO DATE r VALIDATION U) B. 8 P. Code for the following reason PUBLIC SEWER SEPTIC TANK,SEEPAGE PIT OR FINAL PITS AND/OR DRAINFIELD Date HOUSE SEWER CONNECTING TO BY PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG.OR ® (- OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER — J . OVERFLOW SEEPAGE PIT,DRAINFIELD I hereby affirm that I am exempt from the Contractor's License EXTN.,CESSPOOL,DRYWELL,MANHOLE LOW f r the following reason (Secton 7031.$, Bulsness and Pro- ALTER,REPAIR OR ABANDON HOUSE fess• nS Code): SEWER OR DISPOSAL SYSTEM I,as owner of the property,or my employees with wages as �'C'�° their sole compensation, will do the work and the structure 3307 4.50 is not intended or offered for sale (Section 7044, Business and Professions Code). OWNERS Permit $ 1 1 TEM ❑ I,as owner of the property,am exclusively contracting.with AUTHORIZATION I TOTAL FEE TOTAL licensed contractors 10 construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. CHECK 50 CONSTRUCTION LENDING AGENCY L I hereby affirm that there is a construction lending agency SIGNED THIS DAY OF 19_ , �;rTAINGE .1141 for the performance of the work for which this permit is OWNER OR issued (Sec. 3097, Civ. C.). OWNERS AGENT Lender's Name ADDRESS 00130-1131301 7/31/91-1 Lender's Address 21344 1 A f t5 I certify that 1 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 authoriz epres atives of this my to enter U e b e-�ned perty for in on purposes. mil I nature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS- SE 0508 9706230007 BUILDING AND-SAFETY-/ LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: SEWER / SEPTIC: S BUILDING ADDRESS: TR: 6561 LT: 454 EXIST OCC GRP: 5758 GOLDEN WEST AV BLDGS. NOW ON LOT: TEMP CA 917802503 ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: 8587-028-013 ORIGINATION: THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY LENGTH ML TO PL: STATION: DEPTH: TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED N: PROCESSED BY: EXPIRES ON: 06/23/97 TC 06/23/98 COUNTY IMPROVEMENT NUMBER: OWNER: TEL. NO: PLAN CHECK NUMBER: . FINAL DATE FINAL CODE: RICHARDS STEPHEN B;CORRIE J (818) 500-6728- JOB NUMBER: ' 2- n " 5758 GOLDEN WEST AV TRUNK PERMIT NUMBER: TEMP 917802503 ROAD PERMIT NUMBER: DESCRIPTION OF WOR AFFADAVIT: NO - CONNECT SEWER TO REMODELING AND ADDTION WAIVER: NO APPLICANT: TEL. NO: EASEMENT: NO FRANK MARRONE."AND SONS, INC_ (818).444-2548- RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS: HIGHWAY/STREET-WIDENING-;1— STATE IGHWAY/STREETWIDENINGSTATE ENCROACHMENT "PERMIT NUMBERC'^1 CONTRACTOR: TEL. N0: FEES,'I D- APPROVALS DATE INSPECTOR SIGNATURE (RANK MARRQNE AND SONS, INC. (818) 444-2548- 9860 LOWER AZUSA ROAD LIC. NO FEE/,DESCRIPTION--, QUANTITY:'`UOM i AMOUNT: NEW HOUSE SEWER _ EL MONTE, CA 91731 C16/ * , !%�' %� - 01 PERMITASSUANCE FEES-. �� -%�•, 27.75 CONNECT ADDITIONAL 15;ALT/REP-HOUSE-, SEWER 1.00 EAC 30.30 BUILDING OR WORK ARCHITECT OR ENGINEER: TEL. N0: �' ,' ��. TOTALFEES ,� " .58.05 THE WREN GROUP. (818) 564-2650 SEPTIC TANK, SEEPAGE PIT 44 W. BELLUVUE DRIVE LIC. N0: AND/OR DRAIN FIELD SUITE 6 C21565 PASADENA, CA 91105 DRYWELL _ SEWER MAP BOOK: PAGE: ALTER, REPAIR, SEWER OR• SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND ABANDON HOUSE SEWER. BACKFILL SEPTIC TANKS SEEP. PIT _ CESSPOOL _ GRAYWATER SYSTEM * ADDITIONAL DATA ON FILE REPORT ID: DPR266 ROUTE TO BS0508