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Home My Public Portal About9925 LAS TUNAS DR_Sewer__ 0-63 76A642D APPLICATION FOR PERM I 6A642 - COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FNEAREST G �i JOHN A. LAMBIE, County Engineer S oC WILLIAM A. JENSEN, Sup't of Building Y FOR APPLICANT TO FILL IN ST G/n/ LEGAL If ' DESCRIPTION LOT NO OWNER -5 c (/ 1 MAIL BLOCK TRACT ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT _ CITY TEL NO USE OF �/} BUILDINGS I,/RY'JC `/ DISTRICT NO GROUP MAP PROCESSED BY BK PG CONTRACTOR';;5!/f-� �/�/J q'/j'/C-Q !9� l �• ✓ j ADDRESS �-1':?10 //Cf',.'6� CONNECTION DATA CITY / Y ` Q`ITEC NO 4C.e,5 f7 STATION DEPTH STATE MANHOLE REFERENCE UPPER REGISTRATION NO �V�C/ COUNTY L �OL�t$�G NO DESCRIPTION OF WORK FEE TYPE OF CO ION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L } PUBLIC SEWER $5 00 af/O P C NO d SEPTIC TANK,SEEPAGE PIT OR JOB NO O PITS AND/OR DRAINFIELD $10 00 CO IMP NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $300 a I= CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAIV ER EASEMENT RECORD INSTR NO DATE O WORK TO HOUSE SEWER @ 5300 V OVERFLOW SEEPAGE PIT DRAINFIELD W EXTN CESSPOOL,DRYWELL,MANHOLE @ $5 00 d ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING H SEWER OR DISPOSAL SYSTEM n8 $300 STATE ENCROACHMENT Z PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 AUTHORIZATION I TOTAL FEEGo CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - TO THE PUBLIC SEWE APPROVALS DATE INSPECTOR 5 SIGNATURE SIGNED THIS D Y OF 19 OWNER OR NEW HOUSE SEWER '' ' OWNERS AGENT CONNECT ADDITIONAL \ / - ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP PIT(S) I HERE CKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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 ❑ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE D ISPOSAL SYSTEM CALIFORNIA OR THAT I THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO" D CRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER /I„J SIGNATURE /��j// _ g f OF PERMITTEE V/�/ ) ��„/� BACKFILL SEPTIC TANKS ❑ W fp'Q /j�j �IJ SEEP PIT(5) ❑ CESSPOOL li fM!"b/V`Y ALIDATION ROBERT"A. WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH ,it�Q 2 4 7 6 JUN 9 1 0 D7,Q 0 VvoWERS'COMPENSATIQN DECLARATION � m•that I have a certificate of consent to self i certificate of Workers'Compensation InsJrpnce, or' 76A642D C c, copythereof�(Sec 3800, Lab CE 808(REV „a31 APPLICATION FOR PERMIT Ic:4'✓No Company ❑ Certified copy is hereby furnished SEWER - SEWAGE DISPOSAL ❑ Certified copy is filed with the county building Inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department Date Applicant FOR APPLICANT TO FILL IN �1 CONNECTION DATA CERTIFICATE OF•EXEMPTION FROM WORKERS' BUILDING ry� % iy� u f � STATION ��•Q g ' DEPTH 61 COMPENSATION INSURANCE ADDRESS T ��/�/J r (This section need not be completed If the work Involved by the LOCALITY `P' ( ` MANHOLE REFERENCE �� I r. UPPER permit is for'one hundred dollars ($100)or Tess ) c• OM I certify'that in the perform of the work for which this NEAREST TYPE OF CONN M L TOP L p CROSS ST -�j Y CURB P L M L TOP L permit is Issued, I shall not employ any person In any manner ,� / PC NO so as to become subject to the Workers'Compensation Laws OWNER ,�Q e 1'9e... CO IMP NO JOB NO ,. MAIL .� .y1 TRUNK PERMIT NO ROAD PERMIT NO DateApplicant_� may✓ ��/��'7" ADDRESS NOTICE TO APPLICANT If, after•making this Certificate of CITY TEL NO AFFIDAVIT I 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 PERMIT NO LOT SIZE OF LOT NOW ON LOT I hereby offirm'that I am licensed under provisions of Chapter USE OF 9 (commencing with Section 7000) of Division 3 of the Busl- BUILDINGS CHARGES ness and Professions Code, and my license Is in full force and 6.4; CONNECTION CHARGE FEE effect CONTRACTOR License NW=��te CIa55 /�� /y ADDRESS rf µ �� REIMBURSEMENT FEE Controcto `l /�� // CITY C,T TEL NO ' �e 71-3C? DISTRICT NO GROUP BK MAP PROCESSED BY 0 ❑ I am exempt under Sec T of the L A Co LICENSE NO 3 U �1Zk—STATE CLAss 3- 6-2— NO DESCRIPTION OF WORK FEE �� 0 • Plumbing Code and/or Sec of the FINAL HOUSE SEWER CONNECTING TO /'� DATE �.., c..�- VALIDATIO u B & P Code for the following reason PUBLIC SEWER V W SEPTIC TANK,SEEPAGE PIT OR d PITS AND/OR DRAINFIELD FI h Date HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG OR 1010OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD ;2 13 4 A I hereby affirm that I am exempt from the Contractor's License EXTN,CESSPOOL,DRYWELL MANHOLE Law for the following reason (Sectors 7031 5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE # 0'a o 0,1 0 fessions Code) SEWER OR DISPOSAL SYSTEM o o2 7.50 ❑ I,as owner of the property,or my employees with wages as their sole compensatio6, will do the work and the structure 16-1.8 2 7 5 O1„ is not Intended or offered for sale (Section 7044, Business 6-8 and Professions Code) i OWNERS I Permit $ ❑ I,as owner of the property,am exclusively contracting with AUTHORIZATION I TOTAL FEE 11 licensed contractors to Construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR T 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 hereby authorize representatives of this County to enter upon Bove-mentioned property for Inspection purposes ./ s� Signature of Permittee Uater SEE REVERSE FOR EXPLANATORY LANGUAGE - 1,