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HomeMy Public PortalAbout6113 IVAR AVE_Sewer__ 7-TA 642D•- CE808 - 9/73 APII UCA II'O®N FOR PERMO 1' ' I COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL. ILJI DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION7+.OW ING SS �+(,7;lL•/" 1 e� ITY jfL' •C_ C�.� ST FOR APPLICA TO FILL IN ST. � �✓'LG LEGALj �L DESCRIPTION LOT NO. / 1 J-- MAIL �a BLOCK TRACT •� ADDRESS '�� L �ZG-C!i✓� 1� NO. OF BL GS. SIZE OF LOT J 0 NOW ON LOT CITY `c/L:�(i � TEL. NO. USE OF /� " . DISTRICT NO. GROUP MAP OCESS ED BY BUILDINGS R 1'�f /yAA►, /nBK (,//�JpS 60NTRACTO f,E/`..[ ) f Af� r- I , . rJ ADDRESS - dn.„ CONNECTION DATA CITY TE/L. NO. ` QrF STATION ) 0, fZDEPTH RER' STATE Lic SS HOLE REFERENCE I - _ LICENSE NO., CLAMAN S NO. DESCRIPTION OF WORK FEETYPE OFC CTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CUR •P.L. M.L.TO P.L. PUBLIC SEWER Q $7.00 SEPTIC TANK.SEEPAGE PIT OR P.C.NO. PITS AND/OR DRAINFIELD Q $10.00 CO.IMP.NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. - PRIVATE DISPOSAL SYSTEM Q $3.001. ' CONNECT ADDITIONAL BLDG.OR AFFIDAVIT W�IVEL ELLLNL NT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER Q $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD U EXTN.,CESSPOOL.DRYW ELL. Q $5.00 ArreR-A4PAfR'OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR4"SPe'3AL SYSTEM Q $3.00 STATE ENCROACHMENT O� MANHOLE Q $7.00 PERMIT NO. LU INDUSTRIAL a WASTE APPROVAL - Ln OWNER'S PERMIT g 0 CHARGES Z AUTHORIZATIONTOTAL FEE o CONNECTION CHARGE FEE IHAVE AT THIS-DATE A CONTRACT WITH THE HEREIN NAMED CON. 14EIMBURSEMENTyFyERE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY*OF - 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL - BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) - 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE.TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL Cl DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 'ALTER.REPAIR,SEWER OR LICENSED AS RE BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFC67NIA /THAT AM E LE AL W OF, AND INTEND TO RESIDE IN E ABO D RI BE R ALK IAL PROPERTY. DISCONNECT PLUG AND 1`` 91► ABANDON HOUSE SEWER -/I / SIG NATO E � ❑ ' OF PE4{ ITT �'C- 't-C BACKFILL SEPTIC TANKS SEEP.PIT(S) ❑�E-AlSl LS ❑ V ALED CK. M.0. CASH f 9 2 6*-,qE'P -10 1 a o 9,0 Q Asa 76A 6420-CE808-10-71 pp I�1�pp C,/� pp Npp I� I�Mpp W lf-Ir l��`>d{'���®Irl FOR If-�IfY ptl11 0 ' COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER --- BUILDING AND SAFETY-DIVISION BUILDING ADDRESS 61.1.3 N. IVar AVE . STI /Y LOCALITY yelp le Celt .... NEAREST FOR APPLICANT TO FILL IN CROSS ST. Garibaldi LEGAL DESCRIPTION LOT NO. OWNER Richard Bowen MAIL BLOCK TRACT ADDRESS 1,620 Melanie Ln. NO. OF BLDGS. SIZE OF LOT S� NOW ON LOT CITY Arcadia TEL. NO. USE OF BUILDINGS Res . DISTRICTNO. GROUP MAP CESSED BY BK PG CONTRACTOR Square Deal Sewer Service 70 .0 r m _ ADDRESS 2933 Maxson Rd. CO ECTION DATA CITY El Monte TEL. NO. 444-2020 STATION / O L DEPTH STATE 88LIC 1 LICENSE NO:; 2(�v70 GLA55 //�Zy C-42 MANHOLE REFERENCE i�6-I LOW ER NO. •DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO �yl� Y. CURB p,L; M.L.TO P.L. 1. PUBLIC SEWER @ $7.00 a(/ SEPTIC TANK.SEEPAGE PIT OR P.C.NO. MPNOv JOB NO. PITS AND/OR DRAINFIELD @ $10.00 CO.. . . } HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. d PRIVATE DISPOSAL SYSTEM Q° $3.00 CONNECT ADDITIONAL B 0 DG.OR gFFIDAVIT wAIVEN ERSEME NT RECORD.INSTR.NO. DATE 0 WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD CL EXTN..CESSPOOL.DRYWELL. @ $5.00 HWY.OR ST.WIDENING' O ALTER.REPAIR OR ABANDON HOUSE (— SEWER OR DISP OSAL SYSTEM @ $3.00STATE'ENCROACHMENT W MANHOLE Q $7.00 PERMIT NO. G. INDUSTRIAL N WASTE APPROVAL OWNERCHARGESS PERMIT s �"a� AUTHORIZATION I TOTAL FEE 1.5 00 CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER 17,4- OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SEEP,PIT(S) AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REOUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER O AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIA PROPERTY. ABANDON HOUSE SEWER SIGNATURE OF PERMI`TTE _ BACKFILL SEPTIC TANKS E3SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION CK. M.O. CASH 088 ncf 2 u 1 5.00 WORKERS'COMPENSATION DECLARATION ' I hereby affirm that I have a certificate of consentto self e• insurts, or a certificate of Workers'Compensation Insurance, or Z.6A642D ^^p , a certified copy thereof (Sec. 3800, Lab C.) CE 808(REV.B/81) /U%I�IJII �chug011 V FOR �.LSnUG v Policy No. Company ©s (l 1111 fill IS �V�J_!/l1 ll. app pp ❑ Certified copy is hereby furnished. SEWER -.SEWAGE MSPOSALS ❑ 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 /// STATION DEPTH COMPENSATION INSURANCE ADDRESS (This section need not be completed If the work Involved by theMANHOLE REFERENCE UPPER permit is for one-hundred dollars ($100)or IesS.) LOCALITY LOWER NEAREST a TYPE OF CONNECTION LENGTH FROM I certify that in The performance of the work for which this CROSS ST. Y. CURB P.L. M.I.TO P.L. permit is issued, I shall not employ any person in any manner P.C.NO. so as to become subject to the W erS'COmpenSaflOn LAWS. OWNER CO.IMP.NO. JOB NO. MAIL / GU TRUNK PERMIT NO. ROAD PERMIT NO. Date9-//-83 Applicant � P�G�L 9�".E30l�. /�• ADDRESS / Im g ,i ¢ AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE �+_ NOTICE TO APPLICANT: If, after makin this Certificate of CITY TEL.NO. A `7 0 Exemption, you should become subject to the Workers' LEGAL LU 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 an revoked. BLOCK - TRACT STATE ENCROACHMENT Z LICENSED CONTRACTORS DECLARATION No.OF BLDGS. PERMIT NO. I hereby affirm that I am licensed under provisions of Chapter SIZE OF LOT NOW ON LOT usE OF 9 (commencing with Section 7000) of Division 3 of the Busi- BUILDINGS CHARGES tress and Professions Code, and my license is in full force and 421 effect. / CONTRACTOR CONNECTION CHARGE FEE License N be�442 0 1!O LIC.Class C —3 REIMBURSEMENT FEE j ADDRESS Contrac ate —II c�3 CITY TEL.N 3— eG91– LIC. 1 DISTRICT NO. GROUP MAP AE�SSED BY a BK, PG El I dm exempt Under Sec. _ Of the L.A.Co. LICENSE NO.3 412–6417,C> CLASS G-3 6 Plumbing Code and/or Sec. of the NO. DESCRIPTION OF WORK FEE FINAL ' HOUSE SEWER CONNECTING TO DATE -..B ,. VALIDATION B. & P. Code for the following reason PUBLIC SEWER l SEPTIC TANK;SEEPAGE PIT OR �fJ�.•,�� �3 PITS AND/OR DRAINFIELD FINAL J Date - HOUSE SEWER CONNECTING TO - BY �.,. PRIVATE DISPOSAL SYSTEM Signature � CONNECT ADDITIONAL BLDG.OR OWNER-BOILDER DECLARATION r A WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD D I hereby affirm that I am exempt from the Contractor's License- EXTN.,CESSPOOL,DRYWELL,MANHOLE Low for the following reason (Secton 7031.5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE # 0.4-45 3 A' . fessions Code): SEWER OR DISPOSAL SYSTEM {. _ • ❑ I,as owner of the property,or my employees with wages as _ ,oO o) ,° 1 Q their sole compensation, will do the work and the structure is not intended or offered for sale (Section 7044, Business ,2'° ° 2 1,5 0 . and Professions Code). OWNER'S Permit $ I El 1, as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE ° ° ° 2 1,Jr 7:v licensed contractors to construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED ON RAC RTO 0, 1 .1 J=8 3 Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. - - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency SIGNED THIS DAY OF 19_ for the performance of the work for which this permit is OWNER OR issued (Sec. 3097, Civ. C.). OWNERS AGENT _ ADDRESS Lender's Name Lender's Address 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, and y authorize representatives of this County to enter u n the bbve-mentioned.pro rty /�nspection purposes. G sr 3 gnature of Per iitee Date SEE REVERSE FOR EXPLANATORY LANGUAGE • '} -. .' \• �• r .a +may - __ I�.,:�, ay a • . 1 �� V 7�'e�T IO� �{�i•P.� b�`-j� •y Yf'� [ [' h' yy...,. _ c 71 No .• : rs• • It L ..y �Wr�rrirLil•1_ - r.7� �.^- by ( IY.. 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