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Home My Public Portal About9810 HOWLAND DR_Sewer__ JSA42D E.G. 11-SS APPLICATION FOR PERMIT 1 S S 0 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING /� JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS ��/(/ (g_.r, ® CASSATT D. GRIFFIN. SUr'T OF BUILDING LOCALITY '!r .,. p y4) P l _ LEGAL FOR APPLICANT TO FILL IN CROSS yI . o ] / -DESCRIPTION LOTNO. iL 2 OWNER yv / • i n.' .//�t�.Y 7q�.Tl da�yJ BLOCK TRACT // Nd-OF SLOGS. CITY �FP�TEL. NO, p` SIZE OF LOT J NOW ON LOT .r/J./.:t.is," i i:• �a .� Q USE OF Y BUILDINGS d DISTRICT N0. VGROUP MAP BK PG CONTRACTOR,/ ADDRESS ! ' 7 '� CONNECTION DATA �/'''/"'I TATION y l� klfl A_R 7 N:rI DEPTH CITY TEL. Ci MANHOLE REFERENCE r... " ❑ STATE 7 REGISTRATION N ( ( ❑ COUNTY NO. DESCRIPTION OF WORR PtE TYPE OF CONNECTIO LENGTH FROM HOUSE SEWER CONNECTING TO P PUBLIC SEWER @ S 3.50 Y. CURB .L. ,SEPTIC TANK.SEEPAGE PIT OR PITS AND/OR DRAINFIELD Q $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELDp P. C. NO. + EXTN.,CESSPOOL,DRYWELL,M AN HOLE Q $2.00 CO. IMP. NO. /. Ov JOB NO. ' HOUSE SEWER CONNECTING TO //�� PRIVATE DISPOSAL SYSTEM Q $1.00 TRUNK PERMIT N0. ROAD PERMIT N0. 0 CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT �— WORK TO HOUSE SEWEN Q $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM Q' $ 1.D0 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ 1 00 AUTHORIZATION TOTAL FEE "TN. REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED N- APPROVALS DATE INSPEC OR SSIGNATURE HAVE TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER, t✓!- NEW HOUSE SEWER C )'/ ��"( 4J SIGNED THIS DAY OF. �*'•' +� 19as_ CONNECT ADDITIONAL OWNER OR 'q/1 -1 /l A BUILDING OR WORK OWNERS AGENT�LLp -• �_I ��A 1'�✓ 1 - �$ PTIC TANK.SEEP, PIT(S) ADDRESS '>' � AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICAT16 CESSPOOL❑ DRYWELL❑" AND STATE THAT THE ABOVE IS CORRECT Al AGREE i0 COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSALS STEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT AM THE LE WNER OF HE ABOVE DESCRIBED RESIDEN L. ROP RT BACKFILL SEPTIC TANKS SIGNATURE ' SEEP. PITS) ❑ CES SP00 5❑ OF PERMITTEE 1 4 JOHN A. LAMBIE, COUN ry ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR CK. M.0. CASH t ` 1 5 8 0�;. AUGZ 64 4 5 0 0 WORKERS' COMPENSATION DECLARATION 0051- DPW 6189 A I fAere'by of{irm that I have a certificate of consent to self ZD 200051D Insure. or a cernbcote of Workers'Compensation Insuronce. of o cey'No. copy -hereof (Sec. ny Lab C.) APPLICATION FOR PERMIT ElCY Na. company SEWER - SEWAGE DISPOSAL ' ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. Dote Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' eunowG COMPENSATION INSURANCE ADOREsSIQ L STATION I ,f''T DEPTH This section need not be completed if the work involved b theREFERENCEz O' uPPf4 ( P y �� MANHOLE O permit is for one hundred dollars ($IOO) or less.) Locnury I certify TYPE OF CONNLENGTH FROM fy shot in the performance of the work for which this CROSS ST. C5/ 2 permit is Issued, I shall not employ any person In any manner Cil PL ML TO LEGAL v P C NO so as to become subject to the Workers' Compensation Laws. DESCRIPTION Lor No. �0 Co IMP NO toe No Date Applicam BLOCK TRACT T4UNS PERMIT NO ROAD PERMIT NO NOTICE TO APPLICANT; If, after making this Certificate Of ASSESSOR O AFFIDAVIT WAIVER EASEMENT RECORD IN5TR NO DATE 9 MAP BOOK(f PAGE(•/ PARCEL Exemption, you should become subject to the Workers' q NO.OF 0LDG5. Compensation provisions of the Labor code. you must forthwith SIZE OF LOT 1/ 07 NOW ON LOi Hwy OR Si WIDENING comply with such provisions or this permit sholl be deemed USE OF revoked. BUILDINGS STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION PERMIT NO I hereby affirm Thal I am licensed under provisions of Chapter OWNER 9 (commencing with Section 7000) of Division 3 of The Busi- MAIL ness and Professions Code, and my' license is in full force and ADDRESS (/E CHARGES effect. CITY TEL.NO. CONNECTION CHARGE FEE License Number LIC.Class C CONTRACTOR REIMBURSEMENT FEE sG L� Contractor Date DI5141C1 NO GROUP MAP PROCESSED BY ADDRESS BK PG ❑ Iam exempt under Sec.—of The L.A.Co. �s O -� GI/ ^�^ > ary TEL.No. ✓ ICO Y'-- a Plumbing Code and/or Sec. oflhe STATE uc. FINAL 0 ucErvsE No. CLASS DATEyy qq �Z VALIDATION B. 8 P. Code for the following reason NO. DESCRIPTION OF WORK FEE d—L / 0 HOUSE SEWER CONNECTING TO FINAL F Dale PUBLIC SEWER BY (l SEPTIC TANK SEEPAGE PIT OR Signature PITS AND OR DRAINFIE to a HOUSE SEWER CONNECTING TO N OWNER-BUILDER DECLARATION PRIVATE DISPOSAL SYSTEM , I hereby affirm that I am exempt from the Contractors License CONNECT ADDITIONAL SIDI OR Law for the following reason (Secton 7031.5, Buisness and Pro- WORK TO HOUSE SEWER O D fessions Code): OVERFLOW SEEPAGE PIT GRAINFIELD ExTN CESSPOOL DRYWEII MANHOLE I, as owner of the property,or my employees with wages as ALTER REPAIR OR ABANDON HOUSE - their sole compensation, will do the work and the structure SEWER OR DISPOSAL SYSTEM is not Intended or offered for sale (Section 7044, Business and Professions Code). ❑ 1, as owner of the property, am exclusively contracting with OWNER'S Permit $ - _ c licensed contractors to construct the project (Section 7044, ' Business and Professions Code)- AUTHORIZATION FTOTAL FEE 1.51 17 – 1 CONSTRUCTION LENDING AGENCY 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO I hereby affirm that there is a Constru Clion lending agency CONNECT THE ABOVE DE5CPIBED EXISTING D'YEIIING TO THE PUBLIC SEWER for the performance of the work for which this permit Is _- Issued (Sec. 3097, Civ. C.). SIGNED THIS DAY OF 19_ _ OWNEPOR Lender's Nome OWNERS AGENT "I Lender's Address ADDRESS I cerlify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and Slate jaws regulating Plumbing and Sewers. , and hereby authorize representatives of this County to enter upon Ih above-mentioned property for inspection purposes. � R•r_ifs_—.i1�LL.w ,.:-y;.J.n�— /014.?Jq gnalure of Perm e _ Date r—r SEE REVERSE FOR EXPLANATORY LANGUAGE