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Home My Public Portal About6244 GOLDEN WEST AVE_Sewer__ DFPARTDVIE+NT OF COUNTY F-NGEKEER DIVISION OF BUILDING AND SAFETY L - SE�/Eli—SEiiVJ4►GE DISPOSAL PERMIT APPLICATION COUNTY OF LOS ANGELES /J WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS 2 44 �'.GO f L/�//�l� Y/Q s 7' FOR APPLICANT T FILL'" N LOCALITY " ADDREBUILDSNG S (� p<� L y+Q Ae_ GROSS ST. GG) LOCALITY DISTFRU NO. SERIAL NO. PERMIT NO. NEAREST A 5.5-9119- J CROSS ST. , _ ECEIVED BY Ready for Inspection DATEISSUE¢ OWNERMAIL J -� �' USE ZONE OCCUPANCY MAP ADDRESS BK PG CITY TELAO.Q�C 7 S'7S6 e ® L 70 . -- CONTRACTOR CO.IMP.NO.,� ADDRESS 3 � I JOB.N0. CITY TEE-Li.N /�- TRUNK PERMIT NO. �] REGISTRATION NO. /l J `f7 q� COUNTY ROAD PERMIT NO. 2LEGAL �7 DESCRIPTION LOT NO. D - / ►��, p STATE ENCROACHMENT PERMIT N0. BLOCK TRACT I INDUSTRIAL WASTE APPROVAL SIZE OF LOT 7/ /570 NO.OF BLDGS. CHARGES NOW ON LOT USE OF BUILDINGS i 4- C.1 Y'd.Pa C ECTION CHARGE FEE NO. DESCR PTION OF WORK FEET HOUSE SEWER CONNECTING TO REIMBURS NT FEE PUBLIC SEWER @ $ 3.50 _� RECEIPT NO. DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXC 0 ECORDED _WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING DATE BY 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 �® ¢' . ® DEPTH CESSP00 L—DRYW ELL SPECIAL CONDITIONS ONLY 2.00e3 M UPPER FERENCE TYPE OF CONNEC 10 LENGTH FROM S ,O Y. CURB P.L. M.L.TO P.L. OWNERS PERMIT ; I 1 00 AUTHORIZATION TOTAL FEE I S� CONTRACTORHAVE TO CONNECT THDATE E AED BOVE D SCRIBEDWITH THE I EXISTING ED APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS____.. rDAY bF_..._...._ _:_. _.___...Y _19 NEW HOUSE SEWER �� L CONNECT ADDITIONAL Y OWNER OR BUILDING OR WORK OWNERS AGENT ... . .LA `_,n--._.._.._..-----.._.._..�.___..._ SEPTIC TANK,SEEP.PIT(S) ADDRESS- -•-.--•�-•--.--.--•-_= -•-,_.. .----_--_......__.........-..__!-- AND/OR DRAINFIELD I HEREBY ACKNOWLEDG HAT I HAVE READ THIS APPLI• CESSPOOL[3 DRYWELL I] CATION AND STATE THAT 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 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUG AND AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- WER ER OF THE ABOVE DESCRIBED RESIDENTIAL PR ERTY. BACKFILL SEPTIC TANKS ZSEEP.P]T(S)[-] CESSPOOLS.O SIGNATURE OF PERMITTEE r�� ...�-........ _. ...... ..... 76A642A 063 7/53 7GA6420 ■/gyp_A, 5&E-663 3= APPLICATION ® 66 I"'11 0 P LI`3 T I O N FOR PERMIT DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL. Deportment of County Engineer BUILDING // A V� County of Las WM.J. FOX, COUNTY ENGINEER 4 ADDRESS ® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY ;. C t FOR APPLICANT TO FILL IN C OSS s. LSele i LEGAL g/ .�}r /J OWNER DESCRIPTION LOT NO. fl11 /`�-'°'f.{ (L *�! Al L , BLOCK TRACT rt A DRESS P) N0. OF BLDGS. SIZE OF LOT 2� B Sw NOW ON LOT CITY n .. TEL. NO. USE OF pp BUILDINGS �. J' .�- t./.�A....P`A.d.. DISTRICT NO. GROUP MAP BK PG CONTRACTOR rE. vZa�' �,,J ,�/ � ADDRESS CONNECTION DATA CITY TEL. NO. STATION DEPTH ❑ STATE MANHOLE REFERENCE UPPER REGISTRATION NO. ❑ COUNTY LOWER NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM Y. CURB P.L. M.L. TO P.L. PUBLIC SEWER @ $ 3.50 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 _ CONNECT ADDITIONAL BLDG. OR q P. C. NO. \YORK TO HOUSE SEWER 1.00 /! CO. IMP. NO. JOB NO. ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 / D"(/ TRUNK PERMIT NO. ROAD PERMIT NO. DISCONNECT AND ABANDON SEWER "iff--- STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK, SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL CESSPOOL- DRYW ELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2.00 CHARGES CONNECTION CHARGE FEE OWNERS PERMIT i; 1. 00 AUTHOI REIMBURSEMENT FEE TRACTORHAVE TTOS CONNECTDATE ONTRTHEA ABOVE DESCRIBED EXCTED WITH THE ISTINGNAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS -DAY OF 19- NEW HOUSE SEWER a2g'� ► E OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTIC TANK, SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ SIGNATURE _SEEP. PIT(s) El CESSPOOLS C1! 4�r �s OF PERMITTEE rp - WILLIAM J. FOX, COUNTY NGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR ;(� 4 6 6 OCT'2`7 A } In WORKERS'COMPENSATION DECLARATION 2Go"l DPW NICO �I h.hereby affirm that I have a certificate of consent to self u insure, or q�ertiflcate of Workers'Compensation Insurance, or 7BA842D atIn coec. 38M APPLICATION FOR PERMIT ❑ Certified copy is hereby furnished. x/ /93 SEWER - SEWAGE DISPOSAL �2brtified copy is filed with t county building inspection COUNTY OF LOS ANGELES BUILDIPI AND SAFETY cl rt Date- Appllcdnt / )C1 IJP OR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' F;1 QCOMPENSATION INSURANCE STArtoN / - DEPTH(This section need not be completed if the work lnvolved by the MAN Hoof RETE RE Nia 22 permit Is for one hundred dollars (5100)or less.) CAI NEAREST I TYPE OF COMECTION LENGTH FROMf.5—/ I certify thpt In the performance of the work for which this OFLO88 St. r C&" PL M L TO Pr ,hJ permit Is issued, 1 shall not employ any person in any manner ma PC No so as to become subject to the Workers' Compensation Laws. DE8CR1PTtON LOT NO. CO IMP No roe NO Date Applicant Ek� TRACT TRUNK PER/NT NO ROAD PERM NO NOTICE TO APPLICANT: If, after making thts Certificate of MAP BOO PAGE PARCE1 ArstoAvr wATVER EASEAhR1T RECORD N5T{j NO DATE Exemption, you should become subject to the Workerttp of BWOG� Compensation provisions of the Labor code, you must forthwith SOF LOT NOW ON LOT HWY OR ST WIDENING comply with such provislons or this permit shall be deemed USE OlF revoked. BUILDINGS STATE kOACJ'LVz NT LICENSED CONTRACTORS DECLARATION KZWT No I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of thb Busi- M'IL o1ARGE5 ness and Professions Code, and my license is In full force and ADD F1 E55-effect.. N CONt•[cnOrd CHARGE FEE License Nu r II&llc.Class cON7RAcr CO nhact0 Date DLSTT2 R-T/•NO (''ROUP MAP PROCESSED 6r ADORE:SS (/� PJ( PG ❑ I amexempt Under Sec. of the L.A,Co. W14— ;7ZNo Plumbing Code and/or Sec. of rhe STA u�� 12 93t Nat 8 RAT VALIDATION Z B. b P. Code for-the following reason No. RXn') NOF WORK FEE ��CL' p SE SEWER CONNECTING TO F1KAL Dat! PLMLK SEWER BY y>� SEPTIC TAW SEEPAGE PIT OR a Signature PITS AND OR DRAIWIELD 0- OWNER-BUILDER DECLARATION HOSEWER WER CONEC NTING TO pop- PR A I hereby affirm that I am exempt from the Contractor's License CONNECT ADofT BLDG ort 10 Law for the followln9 reason (Secton 703T.5, Buisness and Pro- WORK to HOUSE SEWER dJERow � I JL Code): OVERFLOW SEEPAGE pRyVFLE LT ❑ I, as owner of thb r0 ALTER REPAIR OR AMMON HOUSE r � properly, or my employees with woges as SEWER OR DISPOSAL SYSTEM � p7. their sole compensetlori, will do the work and the structure 3307 30 Is not Intended or offered foF sale (Section 7041, Business 1 ITCJ R and Professions Code). ❑ I, as owner of the property, am exclusively conrrocting with OWNER'S Permit s Y TOTAIL. 59 -30 licensed contractors to construct the project (Section 7041, z4 f ' g. l Business and Professions Code). AUTHORIZATION TOTAL FEE L1L CONSTRUCTION LENDING AGENCY I HAVE AT THIS DATE A CONTRACT MTH THE PAREIN NAMED CONTRACTOR TO , OWE .00 W I hereby affirm that there Is a construction lending agency COt,"CT THE ABOVE DESCRIBED ExrSTING DWELLING TO THE PUELK SEWER for the performance of the work for which this permlt is issued (Spc. 3097, Civ. C.), SIGr*DTHIS DAY OF 19_ ��yy'yy-��yy��(ryyyy�'� 7/{r�/p OWNER OR t10IA-LLJV 1 JJ 1V!7J Lender's Name OWNERS AGE NU p��y�y �yF ,L <ab-Zv�e Address ADDRESS 8600 1 M11:45 fy shot I'have rood this p kation and state that the Information is correct. I e to comply with all County and State laws re lating Plumbing and Sewers, and here uthorize repre tatives of this County to en-ter rj,�bo mentioned pr a fpr�yoection urposes, na of PermitteeC/J/Date SEE REVEIKE FOR EX"PLATORYlANIGUAGE