HomeMy Public PortalAbout10512 LIVE OAK AVE_Sewer__ 3-6,
76A643-61
APPLICATION (SOP PERMIT
78A 64
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUMDING AND SAFETY DMSION BUILDING
JOHN A, LAMBIE. County Engineer ADDRESS
WILLIAM A. JENSEN. Supt of Building
_ LOCALITY
RAP LI ANT T CROSS QST. /f/
LEGAL OWNER �E
DESCRIPTI 0 NO
BLOCK TACT AIL ®�
DAESS
/ NO.OF BLDGS. —1164(�1 J�
SIZE OF LOT NOW ON LOT CITY TEL NO � T°t
USE OF
DI } DISTRICT N . GROUP MAP y CESSED BY
BUILDINGS / P
CONTACTOR B n J` /
ADDRESS CONNECTION DATA
CITY TEL.N0. ®�/ STATION DEPTH �a
+� TATE MANHOLE REFERENCE ,
REGISTRATION NO. / COUNTY WLOWER
NO. DESCRIPTION OF _WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ .00
TYP OF C N N LENGTH FROG!
SEPTIC TANK,SEEPAGE PIT OR Y. P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ S .00
OVERFLOW SEEPAGE PIT,DRAINFIELD a
EXTN. CESSPOOL DRYWELL S .00
HOUSE SEWER CONNECTING TO P.C.NO. O
PRIVATE DISPOSAL SYSTEM @ S.00 CO IMP. NO. JOB NO. U
CONNECT ADDITIONAL BLDG. TRUNK PERMIT N0. ROAD PERMIT N0. d'
WORK TO HOUSE SEWER $ 00
ALTER,REPAIR OR AB DO U STATE ENCROACHMENT O
SEWER R DISPOSAL ST @ $ 00 PERMIT NO V
INDUSTRIAL Lu
CL
WASTE APPROVAL N
CHARGES ?
OWNRWS° PMlWT $ CONNECTION CHARGE FEE
AUMOMATION TOTAL FEE REIMBURSEMENT FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEEINTRACTOR TO CONNECT THE ABOVE DESCRIBED EXIST NGAMED DWELLI G APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THI AY OF- 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDG I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I' HEREBY CERTIFY T I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REO ED \TYLO*-%NGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIAOR A WNER OF THE ABOVEDESCRIBED REST ENTI LRT BACKFILL SEPTIC TANKS ❑
SIGNATURE �,gryf SEEP.PIT(S) ❑ CESSPOOLS
OF PERMITTE ��"
VALIDATION ROBERT A. WOOD
cK
2.0. CASH SUPERVISING MECHANICAL ENGINEER
/ lel L
76AB642D 08 61 APB LSBCA Il MN FOR' PERMT
COUNTY OF LOS ANGELES SEWER SEWAGE ®BSPOSAL �J
DEPARTMENT OF COUNTY ENGINEER ,
BUILDING AND SAFETY DIVISION BUILDING o
JOHN A, LAMBIE, CouatY Enq�neer L 40E,
ADDRESS //
7 Al
WILLIAM A, JENSEN, Supt of Building LOCALITY 6
NEAREST
FO P C CROSS ST.
FBKC
AL OWNER
PTION LOT N .
AIL oo��
TRACT ADDRESS OGI
N0.OF BLDGS.
F LOT A� NOW ON LOT CIT TEL. NO
USE OF �I .4` -- - -
BUILDINGS (�� DISTRICT NO. GROUP MAP !3KESSED BY
3 BK 6�
CONTRACTORI E
ADDRESS 07— f T J CONNECTION DATA
CI /TEAL.N0. D��Z STATION -5' DEPTH
REGISTRATION NO. Ike; �d COUNTY nTE MANHOLE REFERENCE
LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO Aal
PUBLIC SEWER @ $100 V TYPE OF CON EC LENGTH FROM -15
I
PITS AND/OR DRAT FGELDT OR @ S .00 Y' P,L M.L.TO P.L. 4 J
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN. CESSPOOL DRYWELL @ .00 a
HOUSE SEWER CONNECTING TO P.C.NO. O
PRIVATE DISPOSAL SYSTEM @ 1.00 CO.IMP NO. JOB N0. V
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO
WORK TO HOUSE SEWER .00 d'
ALTER,REPAIR
DASPOSAL SYSTEM HOUSE @ 1 00 STATE ENCROACHMENT
,c PERMIT NOri
INDUSTRIAL CL
CL
WASTE APPROVAL
V)
CHARGES Z
OWM'S PERMT 51 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON.
' TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPRO\/AImS AT INSPECTOR'S SIGfIA� RE
TO THE PUBLIC SEWER.
SIGNED THIY OF 19— - NEW HOUSE SEWER A ,
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT 4 4 BUILDING OR WORK
ADDRES SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTE14
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRE BY%0SNGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR T I A AL OWNER OF THE ABOVE
DESCRIBED RES' EN 1 BACKFILL SEPTIC TA S ❑
SIGNATURE SEEP.PIT(S4 Q4 POOLS
OF PERMITTE
�AIMATION ROBERr A. WOOD
cR
12.0. CASH SUPERVISING MECHANICAL ENGINEER
X29 1 0 ® 7.00-
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self T DPW 6189
Insure, or a certificate of Workers' Compensation Insur*Zcb,'Or, 76A646A642D
o certified copy thereof (Sec 3800, Lob C ) APPUCATMN FOR PEURN7
Pole Cjipg,,
Elcer,Ifie copy IS ereby furnls ed SEWER - SEWAGE DISPOSAL
❑ Certified copy is filed with the county building Inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY
deportm nt
Dare 2� Applicant FOR APPLICANT TO FILL IN CONNECTION DATA
CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDINGf f
COMPENSATION INSURANCE ADDRESS 4C STATION —:5L
( y LOCALITY MANHOLE REFERENCE � DEPTH
This section need not be completed if the work Involved b the / UPPER
6 0V ,r��
permit Is for one hundred dollars ($100) or less ) ``
AREST
I certify that in the performance of the work for which this CFOSSST �_ TYPE OF CONNECTION LENGTH FROM
permit Is Issued, 1 shall not employ any person in any manner Y CURB P L M L ro P L
LEGAL PC NO
so as to become subject to the Workers' Compensation Lows DESCRIPTION LOT NO CO IMP NO JOB NO
Date Applicant BLOCK TRACT TRUNK PERMIT NO ROAD PERMIT NO
NOTICE TO APPLICANT If, after makingthis Certificate Of ASSESSOR AFFIDAVfT WAIVER EASEMENT RECORD INSTR NO DATE
MAP BOOK PAGE PARCEL
Exemption, you should become subject to the WorkersNO OF BLDGS
Compensation provisions of the Labor code, you must forthwith SIZE OF LOT 6 Nota ON LOT HWY OR ST WIDENING
comply with such provisions or this permit shall be deemed USE OF / �+
revoked BUILDINGS c— 1 STATE ENCROACHMENT
PERMIT NO
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter OWNER
9 (commencing with Section 7000) of Division 3 of the Busl- MAIL tf' [`�C/
ness and Professions Code, and my license is In full force and ADDRESS V V C C C— / CHARGES
effect CITY c TEL NOS ! CONNECTION CHARGE FEE
License er��3 f LIC Class G- 3 b .� S��_ REIMBURSEMENT FEE
Contractor Date A CONTRACTOR DISTRICT NO GROUPMAP PROCESSED BY
ADDRESS O BK PG
❑ I am exempt under Sec of the L A Co ,} ?/ B7 �! �O( �� A / }
CITY - ,�/ TEL NO L� O(O! ti /✓ a
Plumbing Code and/or Sec of the srnrE 3S� �� LIC
CAss ^ FINAL U
LICENSE NO DATE 11 A VALIDATION
B 8 P Code for the following reason NO DESCRIPTION OF WORK FEE r/_( O
HOUSE SEWER CONNECTING TO FINAL
Date PUBLIC SEWER BY (j
SEPTIC TANK SEEPAGE PIT OR LU
Signature PITS AND OR DRAWFIELD V CL
Z
PRIVATE DISPOSAL SYSTEM
I hereby affirm that I am exempt from the Contractor's License CONNECT ADDITIONAL BLDG OR
OWNER-BUILDER DECLARATION HOUSE SEWER CONNECTING TO
Law for the following reason (Secton 7031 5, Buisness and Pro- WORK TO HOUSE SEWER 11i
fessions Code OVERFLOW SEEPAGE PIT DRAINFIEW S
EXTN CESSPOOL DRYWELL MANHOLE
.ALTER REPAIR OR ABANDON HOUSE
i_ _
❑ I,as owner of the property, or my employees with wages as SEWER OR DISPOSAL SYSTEM 5
their sole compensation, will do the work and the structure =� t° '
Is not intended or offered for sale (Section 7044, Business q 'ff't��L_
I CENI
and Professions Code) C
❑ 1,as owner of the property am exclusively contracting with OWNER'S Permit $ � it'tr�? n 35
licensed contractors to construct the project (Section 7044, �_ �c
Business and Professions Code) AUTHORIZATION TOTAL FEE � � L',gECI'• C
CONSTRUCTION LENDING AGENCY i HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO CHANCE .011
I hereby affirm that there IS a construction lending agency CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THF PUBLIC SEWER
for the performance of the work for which this permit is
issued (Sec 3097, Civ C ) SIGNED THIS DAY OF 19_ -
OWNER OR 41
Lender's Name OWNERS AGENT
Lender's Address ADDRESS 7 ;tss�i
47E 1 L-t11i1
I certify that I hove 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 rept nt Ives of this County to enter
pn t Bove-mention r rty f Inspection purposes
nature er iitee Date SEE REVERSE FOR EXPLANATORY LANGUAGE
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERM�T
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS -SE-0508'-1403100003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID ISEWER / SEPTIC SEWER BUILDING ADDRESS
ON FILE 1EXIST OCC GRP: 10512 LIVE OAK AV E
IBLDGS NOW ON LOT ARCD CA 910078564
ASSESSOR INFORMATION NUMBER. ICONNECTION TYPE NEAREST CROSS STREET
18586-012-017 JORIGINATION THOMAS PAGE: 597 GRID D3 LOCALITY TEMPLE CITY CAI
I 1LENGTH ML TO PL STATION• DEPTH
TENANT. IMANHOLE REFERENCE UPPER/LOWER IISSU2D ON PROCESSED BY
1 1 103/10/14 SR
I ICOUNTY IMPROVEMENT NUMBER I
OWNER TEL NO IPLAN CHECK NUMBER IFINAL DATE FI CODE.
IWANG HERBERT H (626) 298-2476- IJOB NUMBER I
1525 WINNIE WA ITRUNK PERMIT NUMBER- _
(ARCD 910077961 IROAD PERMIT NUMBER: IbEC IPTIO OF WORK
!AFFADAVIT NO ISEWER LINE REPAIR 1
I IWAIVER NO 1 1
(APPLICANT: TEL. NO (EASEMENT- NO 1
IRIOS, RUDY (626) 858-9284- 1 I
1475 E ARROW HWY IRECORD INSTRUMENT NBR RECORD DATE ISPECIAL CONDITIONS
IAZUSA CA 91702 (HIGHWAY/STREET WIDENING I 1
I ISTATE ENCROACHMENT PERMIT NUMBER
6 6-1;10
1CONTRACTOR TEL NO FEES PAID JAPPROVAIS DATE INSPECTOR SIGNATURE 1
IRESCUE ROOTER (626) 858-9284- 1 1 1
1475 E ARROW HWY LIC NO IFEE DESCRIPTION QUANTITY UOM AMOUNT INEW HOUSE SEWER I I 1
IAZUSA CA 91702 765155 * I 1 1
101 PERMIT ISSUANCE FEE 27.80 (CONNECT ADDITIONAL I I I
1 X15 ALT/REP HOUSE SEWER 1.00 EAC 30 50 IBUILDING OR WORK I 1
(ARCHITECT OR ENGINEER TEL NO TOTAL FEES 58 30 1 I I
I - i ISEPTIC TANK, SEEPAGE PITI I 1
1 LIC NO: IAND/OR DRAIN FIELD I I I
I I I _ I I I
DRYWE,L�L
1 SEWER MAP BOOK PAGE ! JALTEk,_LEPAIR SEWER ORL 1 1
SEWAGE DISPOSAL SYSTEM
1 IDISCONNECT PLUG AND I I
I 1ABANDON HOUSE SEWER I I
I I I I I I
IBACKFTLL SEPTIC TANKS
I 1 ISEEP PIT _ CESSPOOL
I IGRAYWATER SYSTEM I I1
I I I I I I
I I I I I I
I I I I I I
I I
I I" ADDITIONAL DATA ON FILE I 1 1 1
I IREPORT ID DPR266 ROUTE TO BS0508 I 1 I
I I I I I I