The URL can be used to link to this page

Home My Public Portal About9548 LIVE OAK AVE_Sewer__ D CE808-e•se APPLICATION FOR PERMIT - 7 eeoe• COUNTY OF LOS ANGELES y • 'SEW R-SEWAGE DISPOSAL . DEPARTMENT-OF COUNTY ENGINEER BUILDING AND SAFETY DMSION ADDRESS - �'7" • G / JOHN JL LAMBIE, County Engineer CASSAIT D. GRIFFIN, Supt of Building LOCALITY,/. 4/ 3 A, NEAREST` r FOR APPLIC&NT TO FILL IN CROSS ST. LEGAL Wo OWNER I' DESCRIPTION LO 0. MAIL BLOCK TRACT rG�V r ADDRESS / NO' B . � t SIZE OF LOT l� NOW 0 LD N LOT ' CITY ./ C.NO . ' - 3/ 3 USE OF BUILDINGS DISTRICT NO. GftO UPV MAP PROCESSED BY BK PG / CONTRACTOR ADDRESS .CONNECTION DATA I CITY 0.' STATION DEPTH STATE REGISTRATION NO B COUNTY MANHOLE REFERENC NO. DESCRIPTION OF WORK EE / LOWER 1 HOUSE SEWER CONNECTING TO I PUBLIC SEWER @ $3.00 SEPTIC TANK,SEEPAGE PIT OR TYPE OFC ION LENGTH FROM GI► PITS AND/OR DRAINFIELD @ $3.00 Y. UR P.L. M.L.TO P.L. oG OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2.00 HOUSE SEWER CONNECTING TO P.C.NO. PRIVATE DISPOSAL SYSTEM $1.00 CO.IMP. NO. JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK'PERMIT NO. ROAD PERMIT N0. WORK TO HOUSE SEWER @ $1.00 `ALTER, REPAIR OR ABANDON HOUSE - STATE ENCROACHMENT. SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PET $ 2 CC CONNECTION CHARGE FEE �7 AUTHORIZATION I TOTAL FEE REIIABURSEMENT FEE �y 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�SS �EER.�{{ C SIGNED THIS� CONNECT ADDITIONAL OWNERS AGENT DAY OF ' 1 g�9 NEW HOUSE SEWER r OWNER OR BUILDING OR WORK � SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ T IS APPLIC ON AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CO PLY CESSPOOL❑ DRYWELL❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR, SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM t HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES.COUNTY AND STATE OF CALIFORNIA OR THAT i AM THE- LEGAL"OWNER OF TH �ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDEN PROPER T)f� BACKFILL SEPTIC TANKS❑ SIGNATURE t' SEEP.PIT(S) EICESSPOOLS L/) l OF PERMITTEE ®► VALMATIO ROBERT"A.'WOOD CK. M.o. CASH SUPERVISING MECHANICAL ENGINEER �a 0 2 1 1 jUL7o A.76.0 w WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or d'certificate of Workers'Compensation Insurance, or 76A642D a certified cdpy thereof(Sec. 3800, Lab C.) 92-0002 DPW 6/88 APPLICATION FOR PERMIT Poliey No. Company ❑ Certified copy is hereby furnished. SEWER - SEWAGE DISPOSAL ❑ Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. Date Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDINGSTATION DEPTH COMPENSATION INSURANCE ADDRESS 917AA U' eJ (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 NEAREST a TYPE OF CONNECTION LENGTH FROM I certify that in the performance of the work for which this CROSS sr. o e v. 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. P.C.NO. OWNER CO.IMP.NO. JOB NO. MAILC4e — TRUNK PERMIT NO. ROAD PERMIT NO. Date Applicant ADDRESS41& t 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 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 effect. CONTRACTOR CONNECTION CHARGE FEE License Number Lic.Class ADDRESS REIMBURSEMENT FEE Contractor DateDISTRICT NO. GROUP MAP PROCESSED BY z CITY TEL.NO. BK PG 0 STATE LIC. /� O / ❑ I am exempt under Sec. of the L.A.Co. STATE No. CLALIC. C97 a NO. DESCRIPTION OF WORK FEE LtJ Plumbing Code and/or Sec. of the FINAL 13 HOUSE SEWER CONNECTING TO DATE PUBLIC SEWER ,` _ VALIDATION U) B. 8 P. Code for the following reason SEPTIC TANK,SEEPAGE PIT OR 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 Contractor's License OVERFLOW SEEPAGE PIT,DRAINFIELD Poo EXTN.,CESSPOOL,DRYWELL,MANHOLE _ Law for the following reason (Secton 7031.5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE y y v fessions Code): SEWER OR DISPOSAL SYSTEM OL / PC/ ❑ I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure u € is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER'S Permit $ _ ❑ I,as owner of the property, am exclusively contracting with AUTHORIZATION TOTAL FEE f 0i licensed contractors 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. , M = - CONSTRUCTION LENDING AGENCY _. ,:}t_: I hereby affirm that there is a construction lending agency SIGNED THIS DAY OF 19_ ® Iw>;;; _j for the performance of the work for which this permit is OWNER OR issued (Sec. 3097, Civ. C.). OWNERS AGENT ADDRESS - s !?:g:"�•: •j i-�j��r _ Lender's Name _�..._ _... _... ._.. L i;,_ Lender's Address `: •f t �" 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 ws regulating Plumbing and-Sewers, rize reps authosentatives of this County to enter therelby the abo -menti ed proper y for inspection purposes. Signature of Permittee Dote SEE REVERSE FOR EXPLANATORY LANGUAGE L