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Home My Public Portal About9215-9517-9519 LONGDEN AVE_Sewer__ -1 r PLICATION FOR PERMIT V, 1��-sl Cwln:.,�SATICIN DFCLARATION 76A6420 CE 808 (2 80) , ' c,,n that 1 have a (:Qrlificatt of ,n t to self SEWER-SEWAGE DISPOSAL Illsu're, 'Ir a cerflficate of Workers'Compensation Insurance,or �t COUNTY OF LOS ANGFLES BUILDING AND SAFETY 7 olk:y M-2777- 1, f FOR APPLICANT TO FILL IN CONNECTION DATA ��ertifi,�d copy IS,hereby _urni�;hed. UDEPTH Certified copy is filed%vith tile countv building inspection ADDRESS S UPPER epartl MANHOLE: REFERENCE 44 7 'C""49W ",)Applica TYPE OF CONNECTC LENGTH FROM CET-MVICA FOEXEMPTION IYOM INORK11"RS, C:A.�3S Ss77&— Y. CURB M.L. TO P L. F F COMPT',NSATION INS VRANCLP.C. NO. OWNER CO- IMP. NO. JOB No. MAIL (This section need not be completed if the work involved A DURESS TRUf'il< PERMIT NO. ROAD PERMIT NO. > by the permit is for one hundred dollars 0100) of less.) a- AFF A��JIT WAIVER EASEMENT RECORD. IN.TIR. NO. DATE C17 i TEL, NO. 0 1 certify that in tile performance of the work for which this LEGAL 0 J)etnkit is issued, I -shall not ernploy any Person in any manner DESCRIPTION LOT NO. HWY. OR ST. WIDENING so as to become subJect to the Workers' Compensation Laws. 0 BLOCK TRACT STATE ENCROACHMENT Date—?applicant NO. DV 13LDGS. PERMIT NO. t SIZE OF ON NOTICE FO APPLICANT: If, after waking'this Certificate of LOT NOW LOT Exemption, you should becosubject to the Workers' U S 0-6 ome, ISUILZCHARGES Z Compensation provision.,,,, of tile Labor Code, you must forth- with comply with such provisions or this permit shall bCONNECTION CHARGE FEEe CONTRACTO deemed revoked. REIMBURSEMENT FEE LICENSEM CONTRACTORS DECLARATION ADDRESS I hereby affirm that I am licensed under provisions of Chapter OIST-1-T N.. GROUP 'K MAP PG PRO—SE Y nmencing with Section '7000)of Division 3 of the, Busi- C I TEL. NO j54e 9 (coi ry ness and Professions Code, and my license is in full force and STATE LIC, CLASC LICVNSr- N6. Sr(' (-,3 4-: 3d 1, effect� F-_ -y—V_? I V DESCRIPTION OF WORK FEE. C6, .1,s'' — HOUSE SEWER CONNECTING TO FINAL VALIDATION Lic,��nse NurribcAl: Lie.Class— DATF 5EPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINrIELD FINAL .005. SEWER CONNECTING TO BY PRIVATE DISPOSAL SYSTEM I a4empt from the licensing requirements as I am a / --I...T---.T1-NAL-L---ON -7 licells-el architect of a registered professional engineer WORK 10 HOUSE Ewc. acting in my professional capacity (Section '7051, Bus- OVERFLOW SEEPAGE iness and Professions Code)., EAYN.,CE:5SPOOL,ORYWELL,MANHOLE ALTER, REPAIR OR ABANDON..USE J SEWER OR DISPOSAL SYSTEM Lie.or Reg-No.---Date— ——–------------ HOME OWNER-BUILDER DECLARATION I I hereby affirm that I am exempt from the Contractor's OWNER'S J Permit S License Law for the following reason (Section 7031.5. Busi- AUTHORIZATION TOTAL FEE nessand Prof,"- sions Code): I HAVE AT THIS DATE A CONTRACT WIT14 THE HERAN NAME. CON- YRACTOR 70 CONNECT�-ABOVE DESCRIBED EXISTING DWELLING El T. as owner of the property, will do the work and the TO THE 18LIC SEWER. structure is not intended or offered for sale (Section SIGNED THIS DAY OF-— Is Business and Professions Code). OWNLR .. +��a/I .. CONSTRucrICIN LENDING AGN ECY OWNERS AGENT ADnRe s_ I hereby affirm that there is a construction lending agency for tile performance of the work for which this permit is issued (See. 3097,Civ.C.). Lender's Name. Lender's Address I certify that I have read this application and state that the above information is correct, lagree to comply with all County ordinances and State laws regulating Plumbing and Sewers, and hereby authorize representatives of this County to enter �ha ,rnAmtioned Property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE A" Signature t Permittee 41'0RF,"tS'C0�1,lPl,_-NSNTION DTICLARA-140N 7A642D CE6808 (2-80) APPLICATION FOR PERMIT I hereby affirm ,�,'hat I hava certificat,� )f cone,t if) sAf A .. n SEWER-SEWGE DISPOSAL insure, or a certificate of Workers'Compensation lnsurallce,or a certified cop ,y thoTeof(Sec. 3800, Lab.c.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Certified copy is hereby furnished, FOR APPLICANT TO FILL INCONNECTION DATA S U I LD 1-4 G 2untt:_ APE_ ST4TION DEPTH __L_C UPPER Certified copy is filed with the county building inspecion ACORESS 94+5 LOCALITY MANHOLE REFERENCE LOWER -Te INEAREST TYPE OF CONNECTION LENGTH FROM CERTIVICAFE OF EXEMPTION FROM Wopv C L -ERS! ROSS ST. TO I. I. COMPE.NSATION INSURANCE OWNER Bowen Construction CO IMP. NO. JOB NO, (This section need not be completed if the work involved MAIL ADDRESS TRUNK PERMIT NO. ROAD PERMIT NO. req by the permit is for one hundred dollars ($100) or less.) CITY Ar_CqdiaZEL, NO, 445-1197 I certify that ill the performance of the work for which this LEGAL permit is issued. I shall not employ ally person in any manner DESCRIPTION LOT NO. HWY. OR ST. WIDENING -so as to become subject to the Workers' Compensation Laws. BLOCK TRACT STATE: ENCROACHMENT Date— Applicant NO. OF SLOGS. PERMIT NO. NOTICE TOP APLICANT: If, after making this Certificate of SIZE: OF LOT NOW ON LOT Fn xemptio , vou should become subject to the Workers' USE: OF NGS BUILD /CHARGES Compensation pr,visions of the Labor Code, you rnutq, forth- with comply with such provisions or this permCONNECTION CHARGE FEE it shall be CONTRACTOR Owen Bros. Flumbi Inc. deemed revoked� _q&l LICE,NSED CONTRACTORS DECLARATION ADDRESS 4265 N. BaldwinAve. REIMBURSEMENT FEE I hereby affirm that I amlicensed under provisions of Chapter CITY El Monte TEL. No. 443-0078 DISTRICT NO. GROUP MAP PR.CES5.r.0"I iK PG 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and STATE L c' effect. LICENSE NO� 231741 _-'LA-- C36-20 NO. DESCRIPTION OF WORK F F cl, License Number 23174 1 Lic.Class-- C36-20 HOUSE �EWER CONNECTING TO FINAL VALIDATION PUBLIC SEWER DATE SEPTIC �ANK,SEEPAGE PIT OR contrDwela_.Br_as_.,P_1bg_ Tme ® PITS ANO/OR DRAINFIELD FINAL El CONNECT SEWER CONN F.CTTNG TO BY PRIVATE E SY�TII I am exempt from the licensing requirements as I am A AOOITIONAL OLOG. OR K O . F licensed architect or a registered professional engineer WORT �OUSEWER acting in my professional capacity (Section 7051, Bus- URYWELL,MANHOLE ERF LOW SEEPAGE PlT DR AIN FIE L.D iness and Professions Code) EX-1 .!011 CE..-POOL., -- ALTER, REPAIR OR ARA ON"o—r. SEWER OR 0551105'.L SYS— Lic.or Reg,No.-----Date HOME'OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from OWNER'S the Contractor's Permit License Law for the following reason (Section 7031.5, Busi- AUTHORIZATION TOTAL FEE ness and Professions,Code): 1 HAVE AT THIS DATE A CONTRACT WITH THE,NER..N NAMED CON- IRACTOR TO CONNECT THE ABOVE U IL C -rWF 1, as ovmev of the property, will do the work and the TO THC P R. structure is not intended or offered for sale (Section SIGNED THIS DAYOF tg 7044, Business and Professions Code). 0-.. OR OWNERu FC ENT_ CONSTRUCTION LENDING AGENCY ,',,E I hereby affirm that there is a construction lending agency I for the performance of the work for which this permit is issued (Sec. 3(977,Civ.C,). Lender's Narne—_ Lender's Address-- I certify that I have read this aoplication and stat:: that the above information is correct. I agree to comply with ail County rdinances and State laws regulating PlUn,.bing and Sewers, and hereby authorize representatives of this County to Pnter ups 7 abo SEE REVERSE FOR EXPLANATORY LANGUAGE f Permittee