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Home My Public Portal About6012 KAUFFMAN AVE_Sewer__ SINE-6 911-se. APPLICATION "FOR PERMIT DIVLSION OF BUILDING AND SAFETY SEWER—SEWAGE DIS_ POSAL Department of County Engineer ` County'of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS- ® CASSATT D GRIFFIN, SUPT OF BUILDING - LOCALITY ` FOR APPLIC NT TO FILL IN NEAREST LEGAL DESCRIPTION LOT N0. .e,J'�f�D 7 OWNER• -" MAIL` BLOCK TRACT j- ADDRESS NO. OF BLDGS. CITY TEL. NO. SIZE OF LOT NOW ON LOT USE OF � DISTRICG ,- I MAP BUILDINGS ' 1 BK PG CONTRACTOR �' /� CONNECTION DATA ADDRESS STATION OZ DEPTH C "Y N0. - MANHOLE REFERENCE ❑" STATE LOWER REGISTRATI N NO. "( 0' ( ❑ COUNTY NO.' DESCRIPTION OF WORK FEE 1 HOUSE SEWER CONNECTING TO TYPE OF CD � ION LENGTH FROM ` 61 PUBLIC SEWER @ $3.50 CURB_ R�IstY M.L. TO P.L. Jr .SEPTIC TANK,SEEPAGE PIT OR " ` PITS-AND/OR DRAINFIELD @ $3.00 - OVERFLOW SEEPAGE PIT, DRAINFIELD ��®/ P. C. NO. - EXTN.,CESSPOOL,DRYW EL L,MANHOLE @ $2.00 CO. IMP. NO. (,�, JOB NO. i HOUSE'SEWER•CONNECTING TO '��s��' PRIVATE"DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR STATE'ENCROACHMENT WORK TO'HOUSE SEWER @ $1.00 PERMIT NO. , ALTER,REPAIR OR'ABANDON HOUSE INDUSTRIAL , .SEWER OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL ' L -CHARGES CONNECTION CHARGE'FEE - OWNERS PERMIT g 1 00 AUTHORIZATION, TOTAL FEE REIMBURSEMENT FEE I HAVE AT•TWS DATE A CONTRACT WITH THE HEREIN AMED CON- APPROVALS" DATE INSPECTOR'S SIGNATURE 'TRACTOR TO" CONNECT,THE,ABOVE DESC IBEDEXISTING DWELLING TO.THE PUBLIC S� R. _ � NEW HOUSE SEWER SIGNED THIS" ✓ _„cDAY OF CONNECT ADDITIONAL OWNER OR ` „!`�— BUILDING OR WORK •- OWNERS AGENT 11 SEPTIC TANK,SEEP,PIT(S) .ADDRESS AND/OR DRAINFIELD - ' I•HEREBY ACKNOWLEDGE,THAT I 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 ' IHEREBY 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 I AM.-THE LEG OWNER OF THE ABOVE _ - r DESCRIBED RESIDENTIA ROPERTY. BACKFILL SEPTIC TANKS❑ '` y� SIGNATURE _ _ SEEP.PIT(S).❑ CESSPOOLS Q u OF PERMITTEE- JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION RORER A. WOOD, CHIEF PLBG. INSPECTOR CK. CASH d.1. 4 8�0�R JAN -4 4 4.5 C� -� WORKERS' COMPENSATION DECLARATION 20-0051 DPW 6/89 I hereby affirm that 1 have a certificate of consent to self Im;ore, or a certificate of Workers' Compensation Insurance, or 76A6a2D• c ylfN copy thereof (S Policy m pane 6n� � ►Z4 APPLICATION FOR PERMIT �❑�/•Certified copy Is hereby furnished SEWER - SEWAGE DISPOSAL l—T Certified copy is filed with#the' Iy buildingInspection COUNTY OF LOS ANGELES BUILDING AND SAFETYde artment Date ";S'13Apphcant FOR APPLICANTTO FILL IN CONNECTION DATA CERTIFICATE OF EXEMM WORKERS' BUILDING' �j COMPENSATION INSURANCE ADDRESS. D/fT. � � STATION � DEPTH (This section need not be completed If the work Involved by the MANHOLE REFERENCE W ` ,(`/ � R pernrilt,is for.one hundred dollars ($100)or less ) LOCALITY t ON / �r OWER NEAREST TYPE OF CONN ION LENGTH FROM f I certify that In the performahce,of the work for which this CROSS ST Y P L M L TO P L p?� permit Is Issued, I shall not employ any person In any manner LEGAL PC NO so as to become subject to the Workers' Compensatl on Laws DESCRIPTION. LOT NO Co IMP No JOB NO n BLOCK TRACT TRUNK PERMIT NO ROAD PERMIT NO Date Applicant ASSESSOR AFFIDAVIT WAVER EASEMENT RECORD INSTR NO DATE NOTICE TO APPLICANT If, after malO'ng this Certificate of MAP BOOK PAGE - PARCEL Exemption, you should become„subject to the Workers' No of BLDGS Compensation provisions of the Labor code, you must forthwith SIZE OF LOT NOW ON LOT HWY OR ST WIDENING comply with such provisions or this permit shall be deemed USE OF revoked BUILDINGS STATE ENCROACHMENT PERMIT NO LICENSED CONTRACTORS DECLARATIONOWNER I hereby affirm that I am licensed under provisions of Chapter MAIL 9 (commencing with Section 7000) of Division 3 of the Busi- MAIL ADDRESS CHARGES ness and Professions Code, and my license is In full force and effect CITY TEL NO CONNECTION CHARGE FEE License Number 3 +(, LIC ClaSS C— 3 Y ^ REIMBURSEMENT FEE ContractorlPIC*X40 Date -- 2 3 CONTRACTOR �I� �� DISTRICT NO GROUP MAP PROCESSED BY ADDRESS ''II__ / t r y BK gPGp' - ❑ I am exempt under Sec of the L A Co CITY P Y'V� li0Ut� TEL No a 4 �Y-r—o21�/ J'�� ` -1 , lg, c - a O Plumbing Code and/or,Sec of the STATE 2 LIC / FINAL "U • LICENSE NO 3s`�' CLASS ( 3 DATE VALIDATION B & P Code for,the following reason No DESCRIPTION OF WORK FEE Z O HOUSE SEWER CONNECTING TO FINAL li-I Date PUBLIC SEWER - BY ,EU LJ SEPTIC TANK SEEPAGE PIT OR Slgnafule PITS AND OR DRAINFIELD D ER- UILDER LARATION HOUSE SEWER SAL SYSTEM To ® Z . PRIVATE DISPOSAL SYSTEM - r•r•�{{ g I hereby affirm that I am exempt from the Contractor's License CONNECT ADDITIONAL BLDG OR - _ ACCT air _ WORK TO HOUSE SEWER Law for-the following reason (Becton 7031 5, Bulsness and Pro- ;'D3 rc -C fe Ssions Code OVERFLOW SEEPAGE PIT DRAINFIELD _ _„yli_ :L:lati':I ' L, PIT MANHOLE El1, as owner of the property, or my employees with wages a5 ALTER,REPAIR R ABANDON HOUSE S• SAL SYSTEM 1TE '.r their sole compensation, will do the work and the structure - 5.�._ •• 5 is not Intended or offered for sole (Section 7044, Business 1 13'f�L 5=a--e ao '� and Professions Code) 4, ❑ 1, as owner of the property, am exclusively,contracting with L•Pt� �� 55.75:r� licensed contractors to construct'the project (Section 7044, OWNERS Permit , $ -- • ' CHANGE a1131_1 Business and Professions Code) AUTHORIZATION TOTAL FEE •• CONSTRUCTION LENDING AGENCY I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMEIC.NTIAIT,.- - I hereby affirm that there Is a construction lending agency CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUf.. 1-_ 7 12 j`.;-�for the performance of the work for which this permit is C09 ' `3'•fIssued Sec 3097, Civ C SIGNED THIS DAY OF " " t-9�j7 i ��r({ .i ( ) OWNER OR - 03 �` 1 A i1Va ILL Lender's Name OWNERS AGENT Lender's Address 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'hereby authorize representatives of this County to enter up o t e a ave-men e perry for Inspection purposes nature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE