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Home My Public Portal About10227 GREEN ST_Sewer__ DEPARTMENT OF COUNTY ENGLNTF.ER SEWER—SEWAGE DISPOSAL . ,DIVISION OF BUILDING AND SAFETY , PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING I ADDRESS FOR APPLICANT Tq FILL IN LOCALITY BUILDING �1 NEAREST r ADDRESS Id /2 ""Y rl,eFiK CROSS ST. LOCALITY DISTRICT NO. SERIAL NO. PERM TRD. NEAREST / _ CROSS ST. -j.��r�' �'I-�-� R IV Ready for Inspection DAXEISSU OWNER MAIL UgEZ OCCUPANCY AP ADDRESS BK PG��,`Q►•.J/ CITY TEL-NO. CONTRACTOR CO.IMP.NO. ADDRESS C. 11 JOB.N0. CITY ` TEL.NO. ld STATE TRUNK PERMIT N0. REGISTRATION NO. �� COUNTY ROAD PERMIT N0. LEGAL �-- STATE ENCROACHMENT DESCRIPTION LOT N0. PERMIT NO. BLOCK TRACT INDUSTRIAL WASTE APPROVAL SIZE OF LOT r 0.OF BLDG8. f �.7�OW ON LOT I C RGES USE OF CONNECTION CHARGE FEE BUILDINGS /C� C= �� NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO _ PUBLICSEWER $ 3.50 RECEIPT NO. TE BY HOUSE?SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EiCEPTION R CORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO. DA BY _SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND_ AND/OR DISPOSAL SYSTEMN SEWER 1.00 CON0IECTIOV DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOV REFERENCE -LOWER TYPE OF CONNECTIO UPPWLENGTH FROM Y. CURB P.L. M.L.TO P.L. OWNERS I PERMIT $ I 1 00 ' J AUTHORIZATION TOTAL FEE '-:o' I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTO 6SIGNATURE DATE DWELLING TO THE PUBLIC EWER SIGNED THIS..........._.......DAY F.-.- .__........._....I9-._-•- NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT................. - BUILDING OR WORK _. ---••- - - - - - - -._......_. SEPTIC TANK,SEEP.PIT(S) ADDRESS...............-..... .................- - - - _ -- - AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I AVE READ THIS APPLI- CESSPOOL DRYWELL CATION AND STATE THAT THE ABOVE S 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 DISCONNECT PLUG AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND AND STATE OF IFORNIA OR THAT I AM THE LEGAL OWN. ER OF THE A VE DESC WEP RESTP5NTIAL PROPBACKFILL SEPTIC TANKS �tof '` SEEP.PIT(S)[:] CESSPOOLS SIGNATURE OF PERMITTEE..._.... Lmililll� 04 76AG42A 663 7/53 vr eA&4ADeAly APPLICATION FOR PERMIT COUNTY OF LOS ANGEL SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER )MILDING AND SAFETY DMISION MUILDINu Offif A T 11)x. Com //r Abon[as ti JE!'f8F]f, bnp'f �h�l�q L 0CA L ITY N EAR fJrf . FOR APPLICANT TO FILL IN CROSS ST. EIGAL D[RCRIFTION LOT NO. OWNER BLOCK TRACEvyU■ NO, OK bLDGZ. ■IZA OF LOT NOW ON LOT CLiY TEL. NO_ .0/[ OF AUILDINGf DiStRICTAi ORO 44" PR BY i K CONTRACTo ADDRESI CONNECTION DATA STATION DEPTH CITY TEL NO_ IFTATI MANHOLE REFERENCE REbISTRATION + COUNTY No. I DESCRIPTION WORK FEE TYPE OF CONNECT]0 LENGTH F EER HOWSE SWCONNECTING TO o) L TD I•_ Y. CURB F.L Y. PUBLIC B[WER * 65.00 LJ� F.C_-NO. ■ PTIC TANK,SEEPAGE P OR P ITS ANp/OR DRAINFI[LD Q "..00 CO.IMF.NO. HOUfEBEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO_ - PRIVATE DISPOSAL SYSTEM 63.00 CONNECTADDITIONAL MDG.OR ATFIDAVIT ■�!�[■ WODiT RECORD.IN .NO. DATI WORK 70 HOU [■EWkR 63.04 _ OVERFLOW fEIlAGE PIT,DRAINFIKI D EXTN.,CE68POOL.DRYW[LL,MANHOLE 41 65.00 ALTER.IRRPAOR-AhANDOR HO - HWY_OR fT.-WID[NIHG BEWIR OR DIf PORAL SYSTEM [.00 STATE ENCROACHMENT F[Rl(IT NO. - INDUfTRIAL WASTE APPROVA� OWNE2VS �I�T ; 2 CO CHARGE■ �TM�+F� - CONNECTION CHARGE PE[ ' AIITHOHIZA�'ION TOTAL o XI. FSE I-HAVE AT THIS DATS A coNTRACT WITH TH[ Hx"IF4 GUM CON- RZIMBy"KM[NTF" TRACTOR TO CONNECT THE ABOVE DEfCRIR= LAISTINQ DWEL61NO �� TO THE PUBLIC SEWER. DATE INSP[GT-0R'2 SIGNATURE $IGNtD TttIS OAY CF- iD_ OWNER OR - - NEW HOUgR S[WSR -Dw N ERS A¢EN'T CONNECT ADDITIONAL - ADDRESS ■UILDING OR WORK SEPTIC TANK,STET,PIT(B) " I HER['Y ACKNOWLEDGE THAT J HAVE READ THIP APTLICATION AND/OR DAAINFI[LD . AND T STATE HAT THE ABOVE If CORRECT AND AGREE TO COMPLY WITH Ai-L COUNTY ORDINANCLB AND STATE LAWS R[GUL.ATIND POO(_ ❑ DRYW[LL ❑ PLUMBING AND BCWERS. CLI I HEREBY CERTIFY THAT I' AM PROPERLY RXWSTERID AND/OR ALTER,REPAIR,SEWER OR LICENSED A4 REQUIRED BY LOS ANGLIB'COUNTY AND STATE Or ■CWAG[DISPOSAL SYSTEM CALIFORNIA OR THAT M THE LEGAL OW [R OF, AND INTEND TO DISCONNECT PLUG AND SIGNA IN, THE A DEI3CRIfm FaDI I FJROT[NTY. ABANDON HOUSE/EWER UES ■10 NATU R[ �� BACI(FILL 1[FFJ_G TANKS ❑ /'+� OF P[RY S[V,PIT(f) IJ CESSPOOL) Y J VALIDATION ROBERT A. WOCb CK. M.o. cAaN 8WEBV181NG MECHANICAL ENGINEER O 9. 3 6 Z t3 .dZG'"�,• 7- 1 4 -7 Det" WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self 20-0061 DPW 6,059 J,nsure'o'"a certificate of W'brkers'Compensation Insurance, or �D a terrified copy thereof (Sec. 3800, Lab C-) - APPLICATION FOR PERMIT Policy Nb. Company ❑ Cattlfied copy is hereby furnished. SEINER - SEWAGE DISPOSAL ❑ Certified copy Is.fled with the county bulldlnq inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. _ �te � pllcant 1 fjy� FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE PTION FROM WORKERS' PtO COMPENSATION INSURANCE AADDo�FLESIB T. 4 , srArloN DEPTH (This section need not be completed if the work involved by the MANHOLE REFERENCE UPPER permit Is for one hundred dollars ($100)or less.) LOCAU-FY OM I certify that In the performance of the work for which this gT, r TYPE OF co CURB x�N M L TOP L ' CLJ.{� P L M L TOP L permit is issued, 1 shall not employ any person In any manner LEGAL so as to become ;ybject to the Workers'Com pensatlOn aWs. DEDCFJPT)ON LOT Flo, CO'IMP NO pe F O �', I,-,,V,6 ,, ,�` BLOCK �gACT TRUNK 6ERMfT NO ROAD PERMIT NO Date �--96 Applicant µ^K'U , p / ,.FFID,.,vu WArvER REeam IFSTR No DATE NOTICE TO APPLICANT: If, after making this CerWicate of A li! PAGE �r P�c�L G Exemption, you should become subject to the Workers' No.of ES i::V Compensation provisions of the Labor codb, you must forthwith 811E of LOT �d � HOW bN LOT � Hwr QR ST WIDENING comply with such provisions or this permit shall be deemed USE OF If revoked. BUILDINGS STATE 04CROACHM047 LICENSED CONTRACTORS DECLARATION / If PE RMT NO I hereby affirm that I am licensed under provisions of Chapter b+vF ER 9 (Commenting with Section 7000) oT Division 3 of the Susi- ADDRESS 0 �Z CRARGES nes.s and Professions Code, and mV license is in full force and effect. pT, ti— ex f TTZ No, CoraEcnoN CHARGE FET: License Number Lic. Class RE IMBURSEMENT FEE CONTwCroa Contractor Date O DISTRICT NGROUP MAP ESMD BY ADOFt£88 BK PG P{� ❑ I am exempt under Sec, of the L.A.Co. �j— f 3 CITY TE L NO. es p Plumbing Code and/or Sec. of the STATE NAL I ATION Z LICENSE NO. CU88 DATE B. 8 P. Code for the following reason No. DEBDtaar*NOFWOFM FTE 4-17-al( ■ O HOUSEDate �41C�p CONNECTING TO BYAI +7J1 IJ 57. SE IC TANK SEEPAGE PIT ORJ ITEMS Signature PITS ANO OR hFLELD 1 OWNER-BUIR QECLARATION �G TO , TOTAL 57 29 I hereby affirm that 1 am exempt from the Contractor's License CONNECT,..DDITx-NAL BLDG 7n Law for the following reason (Secton 7031.5, Buisness and Pro- WORK TO HOUSE SEWER+ f Ons Cod : OVERFLOW SEEPAGE RT.DRA D ExTN.CESSPOOL.DRriVELL. HOLE M�y_�1wLy1y2�� • mry� as owner of the property, or my employees with wages as kTER.REPAIR OR ABANDON HOUSE CHANGE ■00 SEWER OR DISPOSAL SYSTEM their tole compensation, w71 do the work and the structure Is not Intended or offered for yule (Section 7041, Business and Professions Code). 00 tt— N1 /27/96 ❑ 1,as owner of the property,am exclusively contracting with Permit 1 1 AI'I11��S licensed contractors to construct the project (Section 70", OWNER'S Business and Professions Code). AUTHORIZATION TOTAL FEE a CONSTRUCTION LENDING AGENCY I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON OR TO , I hereby affirm that there is a construction lending agency COF+4ECJ THE Ab"DESCRIBED EXISTING DWELLING TO THE PU LIC SEWER for the performance of the work for which thrz permit Is issued (Sec. 3097, Civ. C.). SIGNED THIS DAY OF 19_ OWNER OR Lender's Name OWNt;RS AGENT Lender's Address AZK)REss I certify that I have rood 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, arxf hereby authorize representatives of this Courlty to enter opon th above- ntloned pro rty for lospectian pu Signature of Permittee DcAe SEE RF.VIMSI�FOR EXP1IANAT0*Y LANGUAGE