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HomeMy Public PortalAbout8922 LONGDEN AVE_Sewer__ E-6° S& 63 12.54 APPLICATION FOR PERMIT 1 S E•6 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer �� County of LOS Angeles BUILDING �� l.. d'YtG L WM.J. FOX, COUNTY ENGINEER ADDRESS ` ovW CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY aM plr ('/7 V rAl— I F FOR APPLICANT TO FILL IN NEAREST CROSS ST. Rd S Ew F I \ EIDESCRPTION LOT N0. OWNERG D BLOCK TRACT 5In/0 MAIL C, 1 ADDRESS S ZG,�9-e SIZE OF LOT SO X 17G NO. OF BLOTS. G -r NOW ON LOT CITY � rI� Z S USE OF BUILDINGS DISTRICT NO. I GROUP I MAP BK PG CONTRACTOR --��-- ADDRESS A, L.�"i r CONNECTION DATA CITY TEL. NO. STAZION DEPTH ❑ STATE MANHOLE REFERENCE REGISTRATION NO. [3 COUNTY UPPER LOWER TYPE'dVCONNECTIONLENGTH FROM No. I DESCRIPTION OF WORK FEE Y. c P.L. M.L. TO P,L. -I HOUSE SEWER CONNECTING TO PUBLIC SEWER Qa $ 3.50 HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. �.f08. NO. WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. IIIERMIT N0. DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT ' AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK,SEEPAGE PIT OR --PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL CESSPOOL-DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2.00 CHARGES CONNEC N CHARGE FEE OWNERS PERMIT S I 1 00 AUTHORIZATION TOTAL FEE 4 I C c- RE BURSEMENT FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON--- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY 0 19- NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL _ t OWNERS AGENT 2_� � BUILDING OR WORK _ SEPTIC TANK, SEEP, PIS) ADDRESS z' Nom« T_AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL I--] DRYWELL[IAND 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 1 HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER 0 , THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ ,. 9 SEEP.PIT(S) [ICESSPOOLS❑ SIGNATURE '�. OF PERMITTEE ! WILLIAM J. FOX,COUNTY ENGINEER VALIDATION 5 4 3 5 JUL 4 2.0 0 n BY I Y DEPUTY ! C " DEPUTY BT BY ® DEPUTY DEPUTY D CES08- APPLICATION FOR PERMIT 1 anoe-e-sa COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING / ADDRESS JOHN A. LAMBIE, County Engineer CASSATT D. GRIFFIN, Supt of Building _LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. i k" DESCRIPTION LOT NO.&'"? 1 � ) —OWNER � � i_ / ✓ iL ll BLOCK TRACT k:ft)!.f' ADDRESS J NO.OF SLOGS. y SIZE OF LOT ,� ' NOW ON LOT CITY TEL.NO. USE OF r BUILDINGS " :;-'`i.'G- .. ,' ic: � ••�- DISTRICT N0. GROUP MAP PROCESSED BY BK PG CONTRACTOR­—i - - ,s J ADDRESS ,:t _ ,.- ��' . ,. � ,-__ CONNECTION DATA CITY �,AL.NO � �. - STATION l� � DEPTH ' STATE MANHOLE REFERENCE REGISTRATION N0. COUNTY , / NO. DESCRIPTION OF WORK' FEE — LEER.' HOUSE SEWER CONNECTING TO _ PUBLIC SEWER @ $3.00 i t. — SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM PITS AND/OR DRAINFIELD @ $3.00 —Y. CURB P.L. M.L.TO P.L. OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 HOUSE SEWER CONNECTING TO P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.N0. �_. 4y JOB N0. 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 @ $1.00 _PERMIT NO. INDUSTRIAL 'HASTE APPROVAL CHARGES OWNER'S PERMIT S 2 00 ;:ONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING _ TO THE PUBLIC SEWE& SIGNED THIS 1, DAY OF J J g_t% NEW HOUSE SEWER OWNER ' a �'ONNECT ADDITIONAL OWNERS AGENT__LLL- +-' % <t'�r l DUILDING OR WORK ADDRESS _AND/ORTANK,SEEP,PIT(S) L 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY '%ESSPOOL❑ DRYWELL❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR PLUMBING AND SEWERS. _SEWAGE DISPOSAL SYSTEM [ HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL, PROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP. PIT(S) E:1CESSPOOLS [3 OF PERMITTEE_�I ®R VALMATION ROBERT A.WOOD J X.p.. CASK SUPERVISING MECHANICAL ENGINEER 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 a certified copy thereof (Sec.3800, Lab C.) 92-0002 DPW 6/88 APPLICATION FOR PERMIT Policy No. Company ❑ Certified copy is hereby furnished. SEWER - SEWAGE DISPOSAL Certified copy is filed with the cou tub inspec on COUNTY OF LOS ANGELES BUILDING AND,SAFETY department. Date z' Applicant �/�� FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING. COMPENSATION INSURANCE ADDRESS ?-� e STATION DEPTH (This section need not be completed if the work involved by the LOCALITY C MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100)or less.) LOWER certifythat the performance Of the Work for Which this NEAREST TYPE OF CONNECTION LENGTH FROM In P CROSS ST. ! Y. CURB P.L. M.L.TO P.L. permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. l P.C.NO. OWNER CO.IMP.NO: JOB NO. Date Applicant ADD MAIRESSL ( TRUNK PERMIT NO. ROAD PERMIT NO. �2 NOTICE TO APPLICANT: If, after makingthis Certificate Of AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE CITY TEL.NO. Exemption, you should become subject to the Workers' LEGAL it V 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 BLDGS. /7 PERMIT NO. SIZEOF LOT ,0'0 X X76 NOW ON LOT O I hereby affirm that I am licensed under provisions of Chapter USE 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 effect, CONTRACTOR tJ I CONNECTION CHARGE FEE License Number ✓©/3^� LiC.Class -9 ADDRESS !2 REIMBURSEMENT FEE Contractor e — CITY TEL.NO. I'�T DISTRICT NO. GROUP MAP PROCESSED BY 0 ❑ I am exem t under Sec. of the L.A.CSTATE LIC. /? BK PG P o. LICENSE NO. �7C?pis CLASS J Plumbing Code and/or Sec. of the NO. DESCRIPTION OF WORK FEE FINAL HOUSE SEWER CONNECTING TO DATE VALIDATION 0 B. 8 P. Code for the following reason PUBLIC SEWER / SEPTIC TANK,SEEPAGE PIT OR FINAL _ PITS AND/OR DRAINFIELD ate HOUSE SEWER CONNECTING TO BY 1 PRIVATE DISPOSAL SYSTE Signature CONNECT ADDITIONAL BLDG.OR OW E - UIL ER DECLARATION WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD I hereby affirm that I am exempt from.the Contrac or'sb License EXTN.,CESSPOOL,DRYWELL,MANHOLE 4 Law for the following reason (Secton 7031.5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE fessions Code): SEWER OR DISPOSAL SYSTEM 8 f{CCT. v ❑ I,as owner of the property,or my employees with wages as ;7-L-; =j their sole compensation, will do the work and the structure -'=�`' 4`fl1 is not intended or offered for sale (Section 7044, Businesst I T=1,J LEN'; and Professions Code). OWNER'S Permit $ %g ❑ I,as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE "� TI.1TNL_ 34- m 50 licensed COn1raC10r5 to construct the project (Section 7044, I 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. CHECK t i _tie n•. CONSTRUCTION LENDING AGENCY ���'IANIGrE NEDTHIS DA I hereby affirm that there is a construction lending agency SIGIOF -gyp-+ 19 for the performance of the work for which this permit is OWNER OR - issued (Sec. 3097, CIV. C.). OWNERS AGENT Lender's Name ADDRESS I 13130,01-010-131 2/ +/91 Lender's Address c:35 1 AM 9:07 1 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 upo ove-mentioned pro y for inspection purposes. Signature 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 76A642D a certified copy thereof(Sec 3800, Lab C. sz-000zDPW siss APPLICATION FOR PERMIT - Policy No.—Company ❑ Certified copy is hereby furnished. SEWER - SEWAGE DISPOSAL. Certified copy is filed with rhe y b ing inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. Dare — Applica t FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING {1Q��� STATION DEPTH COMPENSATION INSURANCE ADDRESS U / (This section need not be completed if the work involved by the T 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 CROSSSST. TYPE OF CONNECTION LENGTH FROM permit is issued, I shall not employ any person in any manner Y CURB P.L. M.L.TO P.L. so as to become subject to the Workers'Compensation Laws. P.C.NO. OWNER Ws��"5 CO.IMP.NO. JOBB NO. MAIL L� TRUNK PERMIT NO. ROAD PERMIT NO. Date Applicant ADDRESS �l 7� F NOTICE TO APPLICANT: If, after making this Certificate of CITY ���-' ; TEL.No. WAIVER EASEMENT RECORD.INSTR.NO. DATE `->g� AFFIDAVIT Exemption, you should become subject to the Workers' LEGAL Compensation provisions of the Labor code, you must forthwith DESCRIPTION LOT NO. JRE Y.OR ST.WIDENING comply with such provisions or this permit shall be deemed revoked. BLOCK TRACT TE ENCROACHMENT LICENSED CONTRACTORS DECLARATION / NO.OF BLDGS. MIT NO. SIZE OF LOT l/J O X 1 7 6 NOW ON LOT I hereby affirm that I am licensed under provisions of Chapter USE of 9 (commencing with Section 7000) of Division 3 of the Busi- BUILDINGS ,L�e� � CHARGES ness and Professions Code, and my license is in full force and Q effect. / Sn CONTRACTOR GZf-e/� t NNECTION CHARGE FEE License Number ! : Z LIC.Class ��/ / ADDRESS _ MBURSEMENT FEE 8 Contracto I 2— T—37 .-�^ STRICT NO. GROUP MAP PROCESSED BY It.-�Y J�!-/ Date CITY i/n TEL.NO. �` O BK PG - ❑ I am exempt under Sec. of the L.A.Co. STATE ENSE NO. b� CLASSdPlumbing Code and/or Sec. ofthe NO. DESCRIPTION OF WORK FEEALHOUSE SEWER CONNECTING TO TE VALIDATIONB. & P. Code for the following reason PUBLIC SEWER SEPTIC TANK,SEEPAGE PIT ORALPITS AND/OR DRAINFIELD Date HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG.OR O N R- U L R DECLARATION s WORK TO HOUSE SEWER , OVERFLOW SEEPAGE PIT,DRAINFIELD I hereby affirm that I am exempt from the Contractor's License EXTN.,CESSPOOL,DRYWELL,MANHOLE 77 Law for the following reason (Secton 7031.5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE 9:) fessions Cade): SEWER OR DISPOSAL SYSTEM AM .T El 1,as owner of the property,or my employees with wages as fnt,,.1.j their sole compensation, will do the work and the structure 33,37 5'-` is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER'S Permit $ ` i i 3 E1` ❑ I,as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE �' 34- 50 licensed contractors to construct the project Section 7044, 101 AL- P I ( 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON RACTOR TO Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. i-_.-HECK �f 1{ CONSTRUCTION LENDING AGENCY � P/ _ I hereby affirm that there is a construction lending agency SIGNED THIS DAY OF _19./ I`.;-�A �d3rE for the performance of the work for which this permit is OWNER OR OWNERS AGENT 11_77&16 issued (Sec. 3097, Civ. C.). Lender's Name ADDRESS — q;'`j Lender's Address 54 1 Ar: 9�II� 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 a e- lentioned property for inspection purposes. Signature of Permittee Date l_ 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 Workers'Compensation Insurance, or 78A642D a certified copy thereof(Sec. 3800, Lab C.) 92-0002 DPW 6/88 APPLICATION FOR PERMIT Policy No. Company ❑ Certified copy is hereby furnished. SEWER - SEWAGE.DISPOSAL Certified copy is filed with the courAy building inspect' n COUNTY OF LOS ANGELES BUILDING AND SAFETY department. Date a-4' Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING COMPENSATION INSURANCE ADDRESS 2Z4 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 LOWER I certify that in the performance of the work for which this CROSSSST. TYPE OF CONNECTION LENGTH FROM Y. CURB P.L. M.L.TO P.L. permit is issued, I shall not employ any person in any manner P.C.No. so as to become subject to the Workers'Compensation Laws. OWNER CO.IMP.NO. JOB NO. MAIL TRUNK PERMIT NO. ROAD PERMIT NO. Date Applicant ADDRESS NOTICE TO APPLICANT: If, after makingthis Certificate of p AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE CITU ^r� TEL.NO. �O 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 BLDGS. PERMIT NO. SIZE OF LOT NOW ON LOT I hereby affirm that I am licensed under provisions of Chapter TSE 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 ���g� ` effect. CONTRACTOR CONNECTION CHARGE FEE License Number 6 .Z 7 Llc.Class ADDRESS J Z agcREIMBURSEMENT FEE _ �. Contractor We . DISTRICT NO. GROUP MAP ,PROCESSED BY CITY 1 i e TEL.NO. -Z /—7 BK PIS ❑ I am exempt under Sec. of the L.A.Co. ee /- STATE NO. FT��J � CtA55 Plumbing Code and/or Sec. of the NO. DESCRIPTION OF WORK FEE FINAL HOUSE SEWER CONNECTING TO �L/ DATE VALIDATION B. & P. Code for the following reason PUBLIC SEWER f.T SEPTIC TANK,SEEPAGE PIT OR FINAL o _ PITS AND/OR DRAINFIELD Date HOUSE SEWER CONNECTING TO BY PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG.OR­15 ► WNE -B DER DECD4076N I WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD I hereby affirm that I am exempt from the Contractors 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 f ❑ I,as owner of the property,or my employees with wages as A`--C'T.g their sole compensation, will do the work and the structure 7: i is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER'S Permit S T i7 •` ❑ I,as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE S� j licensed contractors to construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO TOTAL�AL 34 = 50 Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. i^�• C. CONSTRUCTION LENDING AGENCY [�7�,I� r' Q' CHECK I herebyaffirm that there is a construction lending age SIGNED THIS , '�- DAY OF 'e"b 19�/ { •LE I;;j . / L s01 g g y OWNER OR ^''� ' for the performance of the work for which this permit is OWNERS AGENT .� issued (Sec. 3097, Civ. C.). ADDRESS 44, Lender's Namel{ISI€j-1I[t i i fl t°j Lender's Address Kiri 9'.113 1 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 out orize representatives of this County to enter Uponth m tin=propertor inspection purposes. Signature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE