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Home My Public Portal About8916 LONGDEN AVE_Sewer__ 2/70 76A 642D APPLICATION FOR PERMIT 76A 6 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING , �DillU� JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUP T OF BUILDING [LOCALITY nomoMm"WR APPLICANT TO FILL IN NEAREST (PRINT OR TYPE ONLY) LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT ADDRESS NO OF SLOGS 7 ( v SIZE OF LOT NOW ON LOT CITY TEL NO J IJ USE OF �f�� J �}�i/J �,,, DISTRICT NO GROUP CLASS MAP PROCESSED BY BUILDINGS a1 C� B K / p G CONTRACTOR L Z•iL (�//`l'`�✓ �t�.•V V�V �!� A[ �(L/ (✓'" - `"� ADDRESS �[ p e, K1�✓ �l�J�hr� CONNECTION DATA CITY )STATEZl%L'�-� TEL NO V2- �� j�� STATION /1�� `� DEPTH LICENSE NO 2 v � 6 LIC GLASS ` olZ- MANHOLE REFERENCE C� 0 LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FRCIM HOUSE SEWER CONNECTING TO A Y CURB L ML TO P L PUBLIC SEWER @ $5 00 u PC NO SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $1000 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ 53 00 G. CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER I EASENENT RECORD INSTR NO DATE Q WORK TO HOUSE SEWER @ $300 V OVERFLOW SEEPAGE PIT DRAINFIELD DL EXTN CESSPOOL DRY WELL MANHOLE @ $500 HWY OR ST WIDENING ALTER REPAIR OR ABANDON HOUSE 0 SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT V PERMIT NO W INDUSTRIAL CL Tn �y ��+ �i WASTE APPROVAL z OWNERS PERMIT S 00 CHARGES AUTHORIZATION TOTAL FEE 0Oh CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC 2r Ept APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAy OF ✓ 19�/ OWNER OR INEW HOUSE SEWER D X OWNERS AGENT CONNECT - 1 (' /y'�� "✓tJ!/ BUILDINGLDING OR WORK AL ADDRESS - J v "" SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR T AM THE LEGAL OWN OF AND INTE TO RESIDE IN TH ABOV DESCRIB RESID AL PROPERTY DISCONNECT PLUG AND ABANDON HOUSE SEWER SIGNATURE ❑ OF PERMTTT BACKFILL SEPTIC TANKS 1 SEEP PIT(S) ❑ CESSPO �O y7 AVDATION JACK R. ALLEN M O CASH SUPERVISING MECHANICAL ENGINEER CK f uwv 2 9 79 iLl 2 6 1 0 D 1 0.0 0 Q WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of.consent to self Insure, or a certificate of Workers'Compensation Insurance, or 76A642D copy ( ) 92-0002 DPW Qpp�p�Q��Cm FO[R F)ER 6,T a certifies co thereof Sec 380, Lab C o 0 Policy No Company 1Lpp SEWAGE I2 CC��+ cc�� pp ❑ Certified copy Is hereby furnished SEWER - SEWAGE D5SPQSALL` '•' ., � J,Certified copy is filed with the u ty building Inspect COUNTY OF LOS ANGELES BUILDIWG AND-SAFETY department QJ Date 4 /! Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING COMPENSATION INSURANCE ADDRESS Q�I STATION DEPTH (This section need not be completed If the work Involved by the U MANHOLE REFERENCE UPPER permit Is for one hundred dollars ($100)or less.) LOCALITY LOWER I certify`that in,the performance of the'work for which this ROSSSST TYPE OF CONNECTIONLENGTH Y CURBR8 P l MM LL TOOPP L L permit is Issued, I shall not employ any person in any manner No so as to become subject to the Workers'Compensation Laws OWNER P c CO IMP NO P C No MAIL [ �.y. TRUNK PERMIT NO ROAD PERMIT NO Date Applicant - ADDRESS vv�� AFFIDAVIT I WAIVER EASEMENT RECORD INSTR NO DATE NOTICE, TO.APPLICANT•_If, after making this Certificate of CITY � TEL NO —'p0 -3 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 LOT NO of PERMIT NO SIZE OF LOT• 11 Ov X� NOW ON LOT • "I hereby affirm that I am licensed under provisions of Chapter 9-,(commencing with,Section 7000) of Division 3 of the Busi- eun�iNGs CHARGES ness and Professions Code, and my license is in full force and �,,.Q effect // L CONTRACTOR �J.v!d CONNECTION CHARGE FEE ^ License Number O 1 ? Lic Class REIMBURSEMENT FEE (�)J ADDRESS 3 L _ Q/ CITY TEL NO O �. DISTRICT NO GROUP MAP PROCESSED BY Contractor l �` Date /f -3 El am exempt under Sec of the L A Co. LISK CENSE NO Z LIC ,�� r • UJI Plumbing Code and/or Sec of the NO DESCRIPTION OF WCIkK FEE FINAL in, HOUSE SEWER CONNECTING TO DATE VALIDATION fn B 8 P Code for the following reason PUBLIC SEWER / Z SEPTIC TANK,SEEPAGE PIT OR 2 'PITS AND/OR DRAINFIELD FINAL Date- HOUSE SEWER CONNECTING TO BY _ PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG OR OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER I hereby'affirm that I am exempt from the COntrOC OVERFLOW SEEPAGE PIT,DRAINFIELD 5 License EXTN,CESSPOOL DRYWELL,MANHOLE Law for the following reason (Secton 7031 5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE fessions Code)- SEWER OR DISPOSAL SYSTEM ) ❑ 1,as owner of the property,or my employees with wages as A;CT°s their sole compensation, will do the work and the structure ' Is not intended or offered for sale (Section 7044, Business (j ' and Professions Code) OWNER'S Permit $ � '-` r '="•'°= ❑ 1,as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE SD 1 1 I EM13 licensed contractors to construct the project (Section 7044, 1 HAVE AT-THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO TOTAL f � b "_3�� Business and Pfof@SSIOnS Cade) CONNECT THE ABOVE DESCRIBED EXISTING DWELLING T�PPUgLILIC SEWER CONSTRUCTION LENDING AGENCY CHECK' - 34.5(1 I hereby affirm that there is a 'construction lending agency SIGNED THIS OF 19 _ for the performance of the work for which,this permit Is OWNER OR �•�L Issued (Sec 3097, Civ C ). OWNERS AGENT r s. Lender's Name ' ADDRESS - Lender's Address �► CICI-€iCfU 4f` ' I certify that I have read this application and state that the ' EFdf_LK AN 'i X04 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 th tioned property for inspection purposes. Si6ndtur6 of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'COMPENSATION DECLARATION 1 hereby.affirm that I have a certificate of consent to self Insure, or a certificate of Workers'Compensation Insurance, or 76A6420 a certified copy thereof(Sec 3800, Lab C ) 92-0002 DPW 6/88 APPLOQUOON FOR PERMH Policy No Company ppp ❑ Certified copy Is hereby furnished SEWER e SEWAGE.", Certified copy is filed with the court building Inspection COUNTY OF LOS ANGELES r>;:•BUILDING.AND.SAFETY department- Date� Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' -" BUILDING COMPENSATION INSURANCE ADDRESS STATION DEPTH (This section need not be completed If the work Involved by the ^ren MANHOLE•REFERENCEUPPER permit is for-one hundred dollars ($100)or less ) LOCALITY LOWER RT I certify that In the performance of•,the work for which this CROSS ST TYPE OF CONNECTION ML LENGTH FROM permit is Issued, I shall not employ,any person in any'monner Y ctme P L M L ro P L so as to become subject to the Workers'Compensation Laws OWNER CO IMP NO JOB NO Date AI MAL pplicant ADDI RE SS l Zhu dh,—. TRUNK PERMIT NO ROAD PERMIT NO NOTICE, TO APPLICANT. If, after making this Certificate Of CITY TEL NO � jel AFFIDAVIT 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 SIZE OF LOT &)V /TC/ (�,7 NO of BLDG LOTS PERMIT NO 11 .• I hereby affirm that I am licensed under provisions of Chapter USE Now oN LOT ; S , 9 (commencing with Section 7000) of Division 3 of the-Buss- BUILDINGS _ -CHARGES ; ness and Professions Code, and my license Is In full force and I effect CONTRACTOR CONNECTION CHARGE FEE License Number 2 Lic.Class 9 ADDRESS 2 Tom, B REIMBURSEMENT FEE COntracto Date 2'�--f' , CITUTEL NO ifJ / CT�j' DISTRICT NO 'GROUP r BK MAP I PROCESSED BY 0 12 le❑ I am exempt under c of the L.A.Co PG LICENSE NO 6 cLCAss �d Plumbing Code and/or Sec. of the NO DESCRIPTION OF WORk FEE FINAL d PUBLIC HOUSE SEWER CONNECTING TO iJ/ DATE VALIDATIONfn B & P Code for the following reason SEPTIC TAN ,SEEPAGE PIT OR �E Z_ PITS AND/OR DRAINFIELD FINAL Dqte HOUSE SEWER CONNECTING TO BY T PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG OR OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER , I hereby affirm that I am exempt from the Cont tor'S License OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN,.CESSPOOL DRYWELL,MANHOLE Law for the following reason (Secton 7031.5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE 10 fessions Code)- SEWER OR DISPOSAL SYSTEM ❑ I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure ? ))7 34.50' is not Intended or offered for sale (Section 7044, Business and Professions Code), OWNER'S Permit $ 1,ITEM ❑ I,as owner of the property,am exclusively contracting with AUTHORIZATION FToTAL FEE TOTAL AL 34m5 licensed contractors to construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO C Business and Professions Code) CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER CHECK .tt/j•°i� CONSTRUCTION LENDING AGENCY i SIGNED THIS DAY OF ' 19' D CHANGE AGE I 0 I hereby affirm that there Is a construction lending agency ,_ If the performance of the work for which this permit is OWNER OWNERS AGENT Issued (Sec 3097, Civ C_) Lender's Name ADDRESS it 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 a or representatives of this County to enter upon ih endo d prCopAkirty for in ection purposes , Signature of Fermittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self Insure, or a certificate of /I Workers'Compensation Insurance, or 76A642D //77 PY 1 ) 92-0002 DPW 8/66 APri•,1(7 O/�7��0 Nn FOR 1�f7v Rr� U X11 a certified co thereof Sec 3800, Lab C a Ill�/II IS 1(V IUUAnuVVI FOR fUYJ IIS tU�lb7/Oltl I'ILJIII Policy No - Company (SEWER a SIEWAGE MSPOSA ❑ Certified copy is hereby furnished. .2�LSC7G CTC/ Certified copy-is filed with the coli ty building Inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department Date 2_q, Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS'V BUILDING COMPENSATION INSURANCE ADDRESS STATION DEPTH (This section need not be completed if the work Involved by the MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100)or less.) LOCALITY (OWER I certify that the performance of the.work for which this NEAREST,' TYPE OF CONNECTION CROSS ST LENGTH FROM m Y CURB PL ML TOPL 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 CO IMP NO JOB NO r MAIL TRUNK PERMIT NO ROAD PERMIT NO Date Applicant ADDRESS �Z Y � NOTICE TO APPLICANT- If, after makin this Certificate of AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE g CITY ( � _ TEL NO — Exemption, you should become subject to the Workers' Compensation provisions'-of the Labor code, you must forthwith DESCRIPTION LOT NO comply with such provisions or this permit shall beyd@em@d HWY OR ST WIDENING revoked BLOCK TRACT STATE ENCROACHMENT' i NO'OF BLDGS /' PERMIT NO ' LICENSED CONTRACTORS DECLARATION SIZE OF LOT D"b l NOW ON LOT 41 I hereby affirm that I am licensed under provisions of Chapter LJSEC� ('�� 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and 1 effect - Jh 3 CONTRACTOR CONNECTION CHARGE FEE� i License Number O/J-Z LIC CIa55 ADDRESS/ Z REIMBURSEMENT FEE l ' 1 .��q� t' Z _ —"/ 1 ,C.� ,TEL NO 0a<Z DISTRICT-NO GROUP.. MAP � ' I PROCESSED BY CO,niraClOrL�V V Date CITY I ❑ I am exempt under Sec of the H�'iCo. STATE p— LIC p r BK PG ' P v LICENSE NO 1!5D J CLASS _ t Plumbing Code and/or Sec of the NO DESCRIPTION OF WORK FEE FINAL Q. HOUSE SEWER CONNECTING TO A DATE VALIDATION to ",B & P Code for the following reason PUBLIC SEWER DC SEPTIC TANK,SEEPAGE PI r OR FINAL PITS AND/OR DRAINFIELD Dote HOUSE SEWER CONNECTING TO BY PRIVATE DISPOSAL SYSTEM Signature ef CONNECT ADDITIONAL BLDG OR 1 D OWNER-Bdll.Citk DECLARATION WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD I,hereby affirm that I am exempt from the Contractor's License EXTN,CESSPOOL DRYWELL,MANHOLE Law for the following reason (Secton 7031 5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE1 fessions Code)' SEWER OR DISPOSAL SYSTEM El 1,as owner of the property,or my employees with wages as ACCT.TIL their sole compensation, will do the work-and the structure is i, c Is not Intended or offered for sale (Section 7044, Business `''307 3,k.ii1 and Professions Code) OWNER'S Permit $ —' 1 ITEMS' ❑ 1,as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE �{ Y licensed Contractors to construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO 1 0 I As' 34 50 Business and Professions Code) CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER CONSTRUCTION LENDINCr'AGENCY AY ' y� �7 t HFC: 54.513 I herebyaffirm that there Is a construction lending agency F 19_[ o CII i g g Y SIGNED THIS OWNER OR .CHANGE for the performance of the work for which this permit is OWNERS AGENT � . Issued (Sec 3097, Civ. C ) ADDRESS �FZP 02!&J /U/}4Qt . �!' Lender's Name i�!!( 1,—ltllf 1 2! ¢,r'jj Lender's Address 511437 �(�14 I.-certify that I have-'read this application and state that the above Information Is Correct I bgree to comply with all County ordinances and State laws regulating Plumbing and Sewers,' and hereby authorize representatives of this County to enter upon the ab ve-mentioned property f r inspection purposes Ign ure of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE