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Home My Public Portal About9075 LONGDEN AVE_Sewer__ DEPARTMENT OF COUNTY ENGLYEERr DIVISION OF BUILDING AND SAFETY SE�/ER�-SEWAGE ®1$P®S�►6 PERMIT APPLICATION COUNTY OF LOB ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING �y//J� I /� ADDRESS I R APPLICA TO FILL IN LOCALITY .1J� BUILDING NEAREST U U ADDRESS O CROSS ST. LOCALITY DISTR ICT NO SERIAL NO. �/{� PERMIT NO. NEAREST �I� A V O 9 3? S CROSS ST. RECEIVED BY Ready for Inspection DATE ISSUED OWNER ► ) ' l ^X* MAIL USEZONE OCCUPANCY MAP ADDRESS .jy I BK PG' CITY TEL.NO.j+f:Z�-?<f®Qf CONTRACT01M, C. Nottlrlgharh rn of Tamplg f i* — CO.IMP.NO. ADDRESS 5933 N. CLOVERLY AVE, SOB.NO. CITY if-MME QRLYN&ALIF TRUNK PERMIT N0. STATE REGISTRATION NO. 8 COUNTY ROAD PERMIT NO. LEGAL DESCRIPTION LOT NO. STATE ENCROACHMENT PERMIT NO. BLOCK TRACT INDUSTRIAL WASTE APPROVAL SIZE OF LOT NO.OF SLOGS. NOW ON LOT CHARGES USE OF BUILDINGS 'CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLICSEWER 11 $ 3.50 RECEIPT NO. I DATE IBY HOUSE SEWER CONNECTING TOQ 0 PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 N0. DATE IBY ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER __AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL U SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE UPPER LOWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT $ 1 00 Y. CURB P.L. M.L.TO P.L. � AUTHORIZATION TOTAL FEE ' d 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS.--__._.__DAY OF.-----.--19_._..- NEW HOUSE SEWER (NMMD OWNER OR CONNECT ADDITIONAL OWNERS AGENT.-.-._.-..._......_. BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS...............-......-----•--.............................................. AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-' CESSPOOL DRYWELL E]CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,RE AI ,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG PLUGAND AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ER OF THE ABOVE n DESCCRR-IpBEDnuRESSIDENTIA P P � BACKFILL SEPTIC TANKS(] SIGNATURE m' C• N iAG" , Co' Soy '-' SEEP.PIT(S)� CESSPOOLS (aw) OF PERMITTEE ...... - ......------...... ........... To 76A642A 663 7/53 % /� J 5&E--88669 I1-99 EAPPLICATION FOR PERMIT 8& DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING O JOHN A LAMBIE, COUNTY ENGINEER ADDRESS ® CASSATT D GRIFFIN SUPT OF BUILDING LOCALITY '�'yyl ,L FOR APPLICANT TO FILL IN CROSS ST. p r. 4 '1 LEGAL DESCRIPTION LOT NO .+- `� Z OWNER MAIL �� 1 BLOCK TRACT / Z• 1 1 ADDRESS %r N0. OF BLDGS CITY TEL NO ( j SIZE OF LOT (/ NOW ON LOT USE OF DISTRICT NO GROUP BK MAP BUILDINGS L P CONTRACTOR fQ ADDRESS "/ y W�/11 y 7_ r p{/{- CONNECTION DATA STATION Q DEPTH UPPER CITY -�,t Q rl Y TEL. NO. � - MANHOLE REFERENCE [3 MANHOLE REGISTRATION NO ❑ COUNTY NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM Y. CURB L- M.L. TO P L. PUBLIC SEWER @ $3 50 SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD Q $3 00 OVERFLOW SEEPAGE PIT, DRAINFIELD P C. N0. EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2 00 CO IMP, NO D� JOB NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO. ROAD PERMIT NO CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1 00 PERMIT NO - ALTER,REPAIR OR ABANDON HOUSE (J INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL - CHARGES CONNECTION CHARGE.FEE _ OWNERS PERMIT $ 1 00 AUTHORIZATION TOTAL FEE rN- REIMBURSEMENT FEES 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING P TO THE PUBLIC SEWER, NEW HOUSE SEWER p SIGNED THIS _1 2 DAY OF �4 r- ig � CONNECT ADDITIONAL /� ��-,l F� l OWNER OR LBUILDING OR WORK OWNERS AGENT - oe xm SEPTIC TANK,SEEP,PITS) ADDRESS-U2-r& - AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THYT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND 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 _ I 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 1 AM THE LEGAL ;OWER OF THE ABOVE DESCRIBED RESIDENTIA PROPERTY BACKFILL SEPTIC TANKS❑ SIGNATURE �' SEEP. PIT(S) ❑ CESSPOOLS OF PERMITTEE JOHN A. LAMBIE, COUNTY ENGINEER VALIDATIO ROBERT WOOD, CHIEF PLBG. INSPECTOR CK. M 0. CASH -� [go2 0 KNR 17 4 A 550 - m v W.QRKERS',COMPENSATION DECLARATION :1 hereby�offirmL-thcq'I have°a certificate of consent to self irisLafe, or a cRrhficate of•Workers"Compensation Insurance or 76A642D a certified copy thereof (Sec 3800( I�b'C cEaoBIREv 1iB31 APPA 0CAVI®N FOR PERMOU Policy No �/ �C�o��mpany V(f � lb fieri! 9019'9 11 ❑ Cert, le"d7cs/►tereby furnished - SE1f�Elt SEWAGE DISPOSAL ❑ Certified copy is filed with th c un ilding Inspection COUNTY OF LOS ANGELES BUILDING ARID SAFETY department Date Applic FOR APPLICANT TO FI IN CONNECTION DATA CERTIFICATE OF EXE P 10 RCWW RKERS' BUILDING J COMPENSATI N INSURANCE ADDRESS STATION [O�. Ur DEPTH (This section need not be co I ted if the work Involved by the MANHOLE REFERENCE 1 u permit is for one hundred do rs ($100)or less ) LocauTv LowER that in the erformance of the work for which this NEAREST TYPE OF CONNECTION LENGTH FROM I certif y p CROSS ST Y CURB P L M L TO P L permit is issued, I shall not employ any person In any manner PC so as to become subject to the Workers'Compensation Laws OWNER CO IMP NO JOB NO MAIL TRUNK PERMIT NO ROAD PERMIT NO ADDRESS Date- Applicant AFFIDAVIT I WAIVER EASEMENT RECORD INSTR NO DATE NOTICE TO APPLICANT If, after making this Certificate of CITY TEL No Exemption, you should become subject to the Workers' LEGAL Comperisation 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 a 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 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 CONNECTION CHARGE FEE License Num LIC CI cis 5 & ADDRESS REIMBURSEMENT FEE ��r�•. BK PG DISTRICT NO GROUP MAP PROCESSED BY 00 Contract CITY TELLO G/✓ STATE El I am exempt rider Sec of the L A Co LICENSE NO CLASS v►�/ 6� = Plumbing Code and/or Sec of the NO D SCRIPTION Or WORK FEE FINAL PUBLIC SSEWER EWER CONNECTING TO DATE VALIDA N B & P Code for the following reason y SEPTIC TANK,SEEPAGE PIT OR NAL ' Date PITS AND/OR DRAINFIELD FINAL HOUSE SEWER CONNECTING TO BY PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG OR OWNER-BUILDER 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 (S@Cion 7031 S, Bulsness and Pro- ALTER,REPAIR OR ABANDON HOUSE' fessions Code) SEWER OR DISPOSAL SYSTEM B� El 1,as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure Is not intended or offered for sale*(Section 7044, Business Permit $ O c - 21,50 and Professions Code) OWNER'S ❑ 1,as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE 0'a .2 1,5 Q to licensed Contractors 10 Construct the project (Section 7044, 1 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 o O 2 O y O 5 CONSTRUCTION LENDING AGENCYSIGNE ® Q G V 1 hereby affirm that there is a construction lending agency : OWNER THIS DAY OF 19_ for the performance of the work for which this permit is OWNER OWNERS AGENT Issued (Sec 3097;Civ C ) ADDRESS , Lender's Name Lender's Address I certify that I have read this application and state that the above inf rmation Is correct I agree to comply with all County ordinanc a State laws regulating Plumbing and Sewers, and her thorize representatives of this County to enter upon t / o e-mentioned property for inspe tion furposes ig oture of Permittee Dae SEE REVERSE FOR EXPLANATORY LANGUAGE _ lI