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Home My Public Portal About6039 HART AVE_Sewer__ /� �p246550-INSERTS' 1�n�,,1 76A642.60 APPUCU`UTMN FOR PERMIT �8T , �sAsazn COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. County Engineer WILLIAM A. JENSEN, Supt of Building LOCALITY �,, ,,....- NEAREST - - FOR APPLICANT TO FILL IN CROSS ST. LEGAL / AI—� ,�Y DESCRIPTION LOT N0. / ( �•6� OWNER BLOCK TRACT �"� ,. MAIL ADDRESS NO.OFF BLDGS. +. SIZE OF LOT NOW ON LOT .CITY TEL..NO. USE DISTRICT O. GROUP• MAP <P k SSB BUILDINGS DIIN NGS I EDY- A/1}� �K PG o CONTRALTO �;. (,.j, k4tr� i ADDRESS .CONNECTION DATA CITY .� TEL.NO. `�' l67 (4 STATION DEPTH /� R STATE MANHOLE FERENCE PP R REGISTRATION NOJ!j 226 1 e!4� COUNTY {� NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 TYPE OF TION LENGTH FROM . SEPTIC TANK,SEEPAGE PIT OR Y. URB` P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD ` EXTN..CESSPOOL, DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO i' P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB N0. y, CONNECT ADDITIONAL BLDG.OR v TRUNK PERMIT O ROAD PERMIT N0. WORK TO HOUSE SEWER @ $1.00 N0. 0 , ALTER, REPAIR OR ABANDON HOUSESTATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.OA _PERMIT NO. ZZ 11p INDUSTRIAL U WASTE APPROVAL W P. 'CHARGES OWNERS PERMIT $ 21 0A0. CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE y 4/t REIMBURSEMENT FEE NAMED CON- TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXDATE A CONTRAWITH THE IISTI�ING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19— NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT�A aQgty.t;,®�! - BUILDING OR WORK '. ADDRESS SEPTIC TANK,SEEP. PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I -HAVE READ THIS APPLICATION - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY o CESSPOOL ❑ DRYWELL ❑ ' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR - PLUMBING AND SEWERS. SEWAGE REPAIR, DISPOSSEWER EM . I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND �J LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER nA CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE > DESCRIBED RESIDE IAL PROP TY. BACKFILL SEPTIC TANKS ❑ / /� _ // �( ' SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS ❑ / ` sr,}-�G21lQ.v'�.a. --a- OF PERMITTE OF VALIDATIO)R----) ROBERT A. WOOD CK. M.0. CASH ` SUPERVISING MECHANICAL ENGINEER moi✓ WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self " insur0, or a certificate of Workers'Compensation Insurance, or 76A642D //LOQ\I��JIr��tl�� (p//U�\ M �r�b �{/�� ^o oCoSe 00x1 "k 92-0002 DPW [rUllc�U2pLSp��r``7[/-11Y�POppUV�oFOR PLSc�UV1MOU R+P Y� J –yw JISVCYISR e�JISVGG�I�IS ®OSP®c�JALS ❑ r -N d cop is hereby furnished. El Certified copy is filed with the count build g inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY departure t. Dot plicaM FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICA OF EXEMPTION FROM WORKERS' ' BUILDING TATION )) ,�+ DEP.TH COMPENSATION INSURANCE ADDRESS Y •—7 . (This section need not be completed if the work involved by the LOCALITY .�f MANHOLE REFERENCE V nt i PPE . permit is for one hundred dollars ($100)or less.) 1 certify that in the performance of the work for which this CROSSSST. TYPE OFCNEAR ON LENGTH FROM permit is issued, I shall not employ any person in any manner Y. CURB P L M L TO P.L. so as to become subject to the Workers'Compensation, IMP, P.C.NO. IOWNE / CO. .NO. JOB NO. MAIL U TRUNK PERMIT NO. ROAD PERMIT NO. Date Applicant .ADDRESS - vV NOTICE TO APPLICANT: If, after making this Certificate of L NO ' AFFIDAVIT WAIVER EASEMENT RECORD,INSTR.NO. DATE 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. - 1.hereby affirm that I am licensed under prSIZE OF LOT NOW ON LOT ovisions of Chapter USE OF 9 (commencing with Section 7000) of Division 3 of-the Busi- BUILDINGS CHARGES ness and Professions Code, and my license is in full force and effect. 22 ^ CONTRACTOR CO EC ON CHARGE FEE Licens NU er✓ Lic.Class (� A DRES ENT FEE, f/�– � ' , COnlraCiof w a Q.�/ DISTRICT NO, GROUP MAP 'PROCESSED BY CI E /7STATE `�)' BK PG I r LIC ❑ I am exempt under Sec. _of the L.A.Co. LICENSE NO. CL �/j D� �� . CL . C IPTION Plumbing Code and/or Sec. of the NO. E- OF WORK FEE 'FINAL � U HOUSE SEWER CONNECTING TO DATE VALIDATION ' O' _ B. 8 P. Code for the following reason ' PUBLIC SEWERSEPTIC TANK,SEEPAGE PIT OR FINAL O PITS AND/OR DRAINFIELD Date HOUSE SEWER CONNECTING TO BY W PRIVATE DISPOSAL SYSTEM _ Signature �� --mss —^ CONNECT ADDITIONAL.BLDG.OR D- - OWNER-BUILDER ECLARATION WORK TO HOUSE SEWER z NFIELD I hereby affirm that I am exempt from the Contractor's License EO TN.,CESSOOLGDRYWEDLRLAIMANHOLE Law for the following reason (Secton 7031.5, Bulsness and Pro- ALTER,REPAIR OR ABANDON HOUSE i� { C11 fessions Code): SEWER OR DISPOSAL SYSTEM: i' �:1 Ji 1 0•. ❑ I,as owner of the property,or my employees with wages as* ITEMS Gt 13 their sole compensation, will do the work and the structure is not intended or offered for sale (Section 7044, Business TOTAL 1021.50 and Professions Code). OWNER'S Permit $ CHECK 2105 ❑ I,as owner of the property, am exclusively contracting with AUTHORIZATION TOTAL FEE {� n licensed contractors to construct the project (Section 7044, I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO f;tlE V' 1UQV nOU Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. - - L r1 i CONSTRUCTION LENDING AGENCY ;� �jE o[ ! , I hereby affirm that there is a construction lendirig agency SIGNED THIS DAY OF 19_ for the performance of the work for which this permit is OWNER OR issued (Sec. 3097, Civ. C.). °p"` E TiS1Q p- Q01 1 11/89 Lender's Name .O r*T � ''` ern. 6167 1 AM 10:00 Lender's Address Lw I certify that I 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, P•� and hereby authorize representatives of this County to enter ►+ uponthe above-mentioned�roperty for 'nspectio purposes. Signature of P mitt ee ate (DE REV29E FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE'CITY. # 0508 SEWER PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0403290005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID• SEWER / SEPTIC: SEWER BUILDING ADDRESS: TR: 5904 LT: 322 EXIST OCC GRP: 6039 HART AV BLDGS. NOW ON LOT: TEMP CA 917801915 ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: GARIBALDI 5384-015-018 ORIGINATION: THOMAS PAGE: 596 GRID:'H3 LOCALITY: TEMPLE'CITY LENGTH ML TO PL: STATION: DEPTH: TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON: 03/29/04 VG 09/25/04 COUNTY IMPROVEMENT NUMBER: OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL ATE FINAL BY: CODE: CAI, SHENG HONG, QIAN, HUIMING (626) 287-7859- JOB NUMBER: 6039 HART AV TRUNK PERMIT NUMBER: TEMP 917801915 ROAD PERMIT NUMBER: DES R ON OF WORK AFFADAVIT: NO CONNECT LAUNDRY IN G AGE TO EXISTING SEWER LINE WAIVER: NO APPLICANT: TEL. NO: EASEMENT: NO PA LAM CONSTRUCTION CO. (626) 293-1612- RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS: HIGHWAY/STREET WIDENING: STATE ENCROACHMENT PERMIT NUMBER: ` CONTRACTOR: TEL. NO: FEES PAID APPROVALS DATE INSPECTOR SIGNATURE PA LAM CONSTRUCTION CO. (626) 695-3439- • 819 N. GARFIELD AVE. LIC. NO FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER ALHAMBRA, CA 91801 809418 B 01_PERMIT_ISSUANCE-FEE---- 27."75- CONNECT ADDITIONAL -- 13 WORK TO HOUSE SEWER 1.00 EAC 30.45 BUILDING OR WORK ARCHITECT OR ENGINEER: TEL. NO: TOTAL FEES 58.20 - - SEPTIC TANK, SEEPAGE PIT LIC. NO: AND/OR DRAIN FIELD 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 REPORT ID: DPR266 ROUTE TO BS0508