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Home My Public Portal About9904 LAS TUNAS DR_Sewer__ 8&E-6893 11-SS _ APPLICATION FOR PERMIT - - 8&E•8I - 1 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE D ISPOSAL 1 Department of County Engineer County of Los Angeles BUILDING JOHN A LAMBIE, COUNTY ENGINEER ADDRESS ® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS ST. LEGAL ' DESCRIPTION LOT NO 1..�� i OWNER f MAIL BLOCK TRACT !Y l ADDRESS NO. OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF DISTRICT NO GROUP I MAP BUILDINGS BK PG CONTRACTOR Zi- CONNECTION DATA ADDRESSIJA STATION T /j DEPTH CITY - TEL. N0. MANHOLE REFERENCE, (((�jppp/' UPPE ❑ STATE =V LOWER REGISTRATION NO. ❑ COUNTY NO DESCRIPTION OF WORK 'FEE TYPE OCTION LENGTH.FROM F HOUSE SEWER CONNECTING TO /' Y. URB P L M L TO P L es 3 PUBLIC SEWER @ $3 50 SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD • Q $3 00 A. OVERFLOW SEEPAGE PIT,DRAINFIELD i 3 /1 /• _ P C. NO , EXTN.,CESSPOOL,DRYWELL,MAN HOLE Q $2 00 CO IMP. NO. / (/t'f JOB NO HOUSE SEER PR VATE DISPOSAL SYSTEMG TO Q $1 00 TRUNK PERMIT NO ROAD PERMIT NO.'?JS'7.S— CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT ' WORK TO HOUSE SEWER Q $1 00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL - CHARGES CONNECTION CHARGE FEE t , OWNER'S PERMIT $ 1 00 . REIMBURSEMENT FEE - AUTHORIZATION TOTAL FEE 40 ics-113 I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'SSIGN TURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. - NEW HOUSE SEWER SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER OR - BUILDING OR WORK OWNERS AGENT- 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 _ I 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 T E LE AL OWNER OF THE ABOVE DESCRIBED RESIDENT ROPE Y w - BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP PIT(S) ❑'CESSPOOLS OF PERMITTEE - JOHN A. LAMBIE, COUNTY ENGINEER ALIDATION ROBERT A. WOOD, CHIEF PL.BG INSPECTOR CK. m O, CASH , EACO 4 5 9 7 NOU 2 6,' 4 - 4.5 0 F, VORKERS'COMPENSATION DECLARATION 92-0002 DPW 3/87 - irm that I have a certificate of consent to self r a certificate of Workers'Compensation Insurance, or 76A642D ed c qy 7 (Sec 3800, Lab C CE 808 APPLICATION FOR PERMIT I No Y� �t a pony �i U 1 l/�� ®s ; rtified copy is Fi y furnished SEWER - SEWAGE DISPOSAL Certified copy Is filed with the county building Inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department Dare Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING `nn f I COMPENSATION INSURANCE ADDRESS 1V STATION Ci r 5 DEPTH I,`l V � (This section need not be completed if the work Involved by the MANHOLE REFERENCE • C✓ da UPPER permit Is for one hundred dollars ($100)or less ) LOCALITY r LOWER NEAREST TYPE OF CO N LENGTH FROM I certify that in the performance of the work for which this CROSS ST Y CUl�B P L ML TOP L permit is Issued, I shall not employ any person in any manner PC NO so as to become sublect to the Workers' Compensation Laws OWNER /`�► r e,'4 CO IMP NO JOB NO MAIL TRUNK PERMIT NO ROAD PERMIT NO Date Applicant ADDRESS D AFFIDAVIT I WAIVER EASEMENT RECORD INSTR NO DATE NOTICE TO-APPLICANT If, after making this Certificate of CITY Exemption, ,you should become subject to the Workers' LEGAL Ae Compensation provisions of the Labor code, you must forthwith DESCRIPTION LOT NO 'L HWY ORST WIDENING comply with such provisions or this permit shall be deemed revoked - BLOCK TRACT Q STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION NO OF BLDGS PERMIT NOSIZE OF LOT NOW ON LOT I hereby affirm that I am licensed under provisions of Chapter U 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 effectCONTRACTOR CONNECTION CHARGE FEE License Numbe H 34"'31 Lic Class (eJC'N-` 3y i ADDRESJS /-� 2y REIMBURSEMENT-FEE O Contractor �a�4 Date I — 1 V CRY Cr& v TEL NO l DISTRICT NO GROUP MAP PROCESSED BY L) !J BK PG z ❑ I am exempt under Sec of the L A Co SCENSE NO '1 CLASS 3 U ✓rU� Plumbing Code and/or Sec of the NO DESCRIPTION OF WORK FEE FINAL W HOUSE SEWER CONNECTING TO DATE VALIDATION B & P Code for the following reason PUBLIC SEWER / Cl) -, SEPTIC TANK,SEEPAGE PIT OR 309 FINAL 1 9PITS AND/OR DRAINFIELD 1114 Date HOUSE SEWER CONNECTING TO BY PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG OR _I �1 OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD D,� r b I hereby affirm that I,am exempt from the Contractor's License EXTN,CESSPOOL,DRYWELL,MANHOLE ' B= Law for the following reason (Secton 7031 5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE I 1 fessions Code) SEWER OR DISPOSAL SYSTEM o a e U ❑ I,as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure O O G 8 8 is not Intended or offered for sale (Section 7044, Business and Professions Code) OWNER'S Permit $ A0 _1�'a ❑ 1,as owner of the property,am exclusively contracting with AUTHORIZATION I TOTAL FEE 2 Z IL , licensed contractors to construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO 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 �- Poo 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 : abeheove-men ion Is correct I agree to comply with all County ordState law re ulating Plumbing and Sewers, and Litho r rese Tatives of this County To enter upoto ed operty for inspect/n pur oses Ig ature of Per Tee Dat SEE REVERSE FOR EXPLANATORY LANGUAGE