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Home My Public Portal About6446 LIVIA AVE_Sewer__ A942D CEBOB 8-69 AP® BCAION F® PERMIT'RMIg ' ee�� COUNTY•OF LOS ANGELES SEWER-SEWAGE ®OSP®SAL DEPARTMENT OF COUNTY ENGINEER GM I BUILDING AND SAFETY DIVISION BUILDING JOHN A. LANZIE, County Engineer ADDRESS CASSAT! D. GRIFFIN, Supt of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN ceoss sT. [ARESS EGAL / OWNER RfPTION LOT NO. K. TRACT �O MAIL ADDRESS NO OF BLDGS. OF LOT - NOW ON LOT CITY TEL NO F DINGS DISTRICT N0. GROUP I MAP [,,PROCESSED BY BK P�/ RACTOR `�' O aJi Cv ' `V CO NECTION DATA it TEL N0. STATIONDEPTHSTRATIO 0 la TATE MANHOLE REFERENCE COUNTY No I DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO . Q PUBLIC SEWER @ $3.00 TYPE OF CONNEC _ LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN CESSPOOL DRYWELL @ $2 00 HOUSE SEWER CONNECTING TO l P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO. D JOB NO. CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO. 'ROAD PERMIT NO. WORK TO HOUSE SEWER @ $1 00 ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $100 PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ Z 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESIBED EXISTING DWELLING APPROVALS DATE d INSPECTOR'S SIGNATURE' TO THE PUBLICS W SIGNED THIS DAY OF I9 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT •`-'-'� BUILDING OR WORK \ SEPTIC TANK,SEEP.PIT(S) ADDRESS AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 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 PLUMBING AND SEWERS ALTER,REPAIR.SEWER OR SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT / LICENSED AS REQUIRED BY LOS AN EL CT PLUG AND COUNTY AND STATE OF ABANDON CTPLUGHOUSE D CALIFORNIA OR THA 1 AM E OWNER OF TH ABOVE DESCRIBED RESIDEA PROP TY. SEEP SEP❑C TANKS0❑LS 'Co OF PERMITTE SIGNATURE _ ALIDATION ROBERT A. WOOD CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER i �08 417 %0 Jul 12 0 0 5.0 0 WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self 6A642 DPW 6189 7 insure, or a certificate of Workers' Compensation Insurance, or 6Asa2D o Certified copy thereof (Sec 3800, Lab C ) v PPMEv"mom FOR PERM7 Policy No Company ❑ Certified copy is hereby furnished SEWER - SEWAGE DISPOSAL ❑ Certified copy-is filed with the county building Inspection COUNTY OF LOS ANGELES BUILDING ARID SAFETY department Date Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING / // COMPENSATION INSURANCE ADDRESS44 t L—I�// STATION DEPTH (This section need not be completed if the work Involved by the �^^/1 ITS MANHOLE REFERENCE ,-^UPPER permit Is for one hundred dollars ($100)or less ) LOCALITY C.�/_ a— l LOWER NEARESTn J TYPE OF CONNECTIO j -A',''• LENGTH FROM I certify that in the performance of the work for which this CROSS ST Z- aLK C OF 12,gj`,;MC/tp su, A] �.t/_'%W CUR P L," M L TO P L permit is Issued, I shall not employ any person In any manner LEGAL so as to become subject to the Workers' Compensation Laws DESCRIPTION LOT NO P c NO I P CO IMP NO JOB NO Date 13-93Applicant J� BLOCK TRACT TRUNK PERMIT NO ROAD PERMIT NO �J7��/r' NOTICE TO APPLICANT If, after /kin this Certificate Of ASSESSOR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE g MAP BOOK I PAGE PARCEL Exemption, you should become subject to the Workers' NO OFBLDGS 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 LICENSED CONTRACTORS DECLARATION PERMIT NO I hereby affirm that I am licensed under provisions of Chapter OWNER Q GC/1/)f}/✓ 9 (commencing with Section 7000) of Division 3 of the Busi- MAIL /� ADDRESS n 4� I CHARGES ness and Professions Code, and my license is in full force and I,( effect / (/ l/ CITY ( L C� TEL NO �{r7— /) CONNECTION CHARGE FEE r 9 `J License Numbe 1 K�� _� E LIC Class v � �- REIMBURSEMENT FEE L•` CONTRACTOR 0 / _ (/ COntractorLff W' Date J �J� DISTRICT NO GROUP MAP PROCESSED BY ADDRESS -1 fi EK / PG ❑ I am exempt under Sec of the L A Co CITY TEL NO 3 — Z a Plumbing Code and/or Sec of the STATE / LIC / FINAL O LICENSE NO / CLASS C tc DATE ' r, VALIDATION Z B•8 P Code for the following reason NO DESCRIPTION OF WORK FEE .5- Q HOUSE SEWER CONNECTING TO FINAL V Date PUBLIC SEWER BY ' SEPTIC TANK SEEPAGE PIT OR �,!1 d Signature P^—��"'T PITS AND OR DRAINFIEID HOUSE SEWER CONNECTING TO - OWNER-BUILDER DECLARATION PRIVATE DISPOSAL SYSTEM 13f_°:T1eg z I hereby affirm that I am exempt from the Contractor's License CONNECT ADDITIONAL BLDG OR !_� �'t Low for the following reason (Secton 7031 5, Buisness and Pro- WORK TO HOUSE SEWER 3M1 •!:r■,L fessions Code) OVERFLOW SEEPAGE PIT DRAINFIELD _ EXTN CESSPOOL DRYWELL MANHOLE - i !TENS S ❑ I, as owner of the property, or my employees with wages as ALTER REPAIR OR ABANDON HOUSE 1 1 -� SEWER OR DISPOSAL SYSTEM their sole compensation, will do the work and the structure TOTAL 53 is not Intended or offered for sale (Section 7044, Business i � � ail� and Professions Code) J ❑ I, as owner of the property, am exclusively contracting withu f t licensed contractors to construct the project (Section 7044, OWNER'S Permit $ C_Ht(+iVE •J- Business and Professions Code) AUTHORIZATION I TOTAL FEE ,1174P CONSTRUCTION LENDING AGENCY I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO Tt� 1 5/13i93 I hereby affirm that there Is a construction lending agency CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER D 1,`13OG-1�(�I�+ for the performance of the work for which this permit is -F AM �gW issued (Sec 3097, Civ C ) SIGNED THIS DAY OF 19_ fU OWNER OR Lender's Nome 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 upon the above-mentioned property for inspection purposes Signature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE