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Home My Public Portal About9224 LONGDEN AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION { COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS FOR APPLICANT TO FILL IN LOCALITY �c•�� 'T ... BUILDING NEAREST ADDRESS CROSS ST. LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. NEAREST A S CROSS ST. � ( j I f RECEIVE Y Ready for Inspection DATE ISSUED OWNER 1tI MAIL �JII ADDRESS USE ZONE OCCUPANCY BK MAP PG CITY TEL.NO. c CONTRACTOR CO.IMP.NO. ADDRESS f / JOB.NO. CITY TEL.NO. TRUNK PERMIT NO. REGISTRATION N0. 1 j K STATE COUNTY ROAD PERMIT NO. LEGAL DESCRIPTION LOT NO. STATE ENCROACHMENTPERMIT NO. " BLOCK -�';.. TRACT INDUSTRIAL WASTE APPROVAL SIZE OF LOT NO.OF BLDGS. NOW ON LOT CHARGES USE OF BUILDINGS CONNECTION CHARGE FEE no. OE'-iCRIPTION 13F WORK FEE REIMBURSEMENT FEE _.... SEWER CONNECTING 70 _ P '+ v SEWER @ $ 3.50 p� RECEIPT NO. I DATE (BY SEWER CONNECTING TO w vATE DISPOSAL SYSTEM 1.00 -- --- 6644ECT AIIDITIO-NAL BLDG OR EXCEPTION RECORD WOPK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING �' NO. DATE i BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER I AND/OR DISPOSAL SYSTEM 1.00 1 CONNECTION DATA SEPTIC TANK,SEEPAGEPIT OR _PITS AND/OR DRAINFIE_LD 2.00 STATIONDEPTH SPECIAL CONDI-ONS ONLY 2.00 MANN E REFERENCE LOWER TYPE 6F CONNECTION LENGTH FROM CURB �. M.L.T I P-L. [� OWNERS PERMIT $ I ! oo AUTHORIZATION TOTAL FEE vj L' 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 i SIGNED THIS--------------------DAY OF......-.-...............................19.--_--- NEW HOUSE SEWER i OWNER OR CONNECT ADDITIONAL OWNERS AGENT----.... '.......-.....................,... ....... BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS.... ......--..................................... _.......-........................... AND/ORDRAINFIELD CAITHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL E] DRYWELL I] IONAND STATE THAT THE ABOVE IS CORRECT AND AGREE _ TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT IAM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS SIGNATURE - SEEP.PIT(S)(E' CESSPOOLS❑ � OF PERMITTEEV4_14--l- 'r.. .--.---. 46A6421) 663 1/53 WORKERS'COMPENSATION DFCLAlZ..%TI,0N 764A642D CE 808 (2-80) APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self SEWER-SEWAGE DISPOSAL insure, or a certificate olWorkers'Compensation insurance,or ,i certified copy thereof(Sec. 3800, Lab,C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No_ Company—____ Certified copy is hereby furnished FOR APPLICANT TO FILL. IN CONNECTION DATA a MLDINC,, , 1�2 L _ STATION DEPTH Certified copy is filed with the county building inspection ADDRESS' ls�V�11 ,11 1 t_"I ...I UPPER department. _16 MANHOLE REFERENCE LOCALITY I V,,- 11 (, LOWER VY- Date_____ Applicant— Nl:'AREST' �_ ___ 'TYPE OF CONNECTION LENGTH PROM CROSS ST Y. CURB P.L. M.L. TO P.L. CI:RTIIAC,ATF 0P EXEmp,rION FROM WORKERS' COMPENSATION INSURANCEP.C. NO. OWNER 4 CO. IMP. NO. JOB NO. MAIL (This section need not be completed if the work involved ADDRESS R ESS TRUNK PERMIT NO, ROAD PERMIT NO. 0 by the permit is for one hundred dollars ($100) or less.) —. - I-VF" EASEMENT RECORD, 1N:STR. NU. DATE 0 CITY T r L. NO , I certify that in the performance of the work for which this LEGAL SCRIP 0 permit is issued, I shall not ernploy any person in manner D E TION LOT NO. HWY. OR ST. WIDENING so as to become subject to the Workers' Compensation Laws. IJ BLOCK TRACT STATE ENCROACHMENT Data • -Applicadi 1� I I I PE NO. 4JA 3 NO. OF BLDGS. _.RMIT J SIZE OF LOT NOW ON LOT No CE 10 API LICAN T: If, after making this Certificate of 1�.,.Xemptinn - USE or-, you should become subject to the Workers' CHARGES Compensation provisions of the Labor Cu Code, you rast forth- ... ...... w)th comply with such provisions or this permit shall be R CONNECTION CHARGE' FEE CONTRACTO deemed revoked. LICNSED co!\!,rRACT0Ps mcLARATION ADDRESS, �J RE:IMSURSEME!�T PEE E I hereby affirm that I am licensed under provisions of Chapter Sy.ICT NO. GROUP Al PROCESSED BY CITY T E L. N 0., t�^ BK PG 9 (commencing with Section 7000) of Division 3 of the Busi- ofes,jons Code, LIC,SS ness find Pr, and my license is in full force and LICENSE CLA effect. _ `NQ._T__ DESCRIPTION OF WORK FEE , HOUSE SEWER CONNECTING TO FINAL VALIDATION License Number1WC1!21_ l'ic.class— SEWER DATE —.1TIC TANK,SE 'PAGE PIT R _"TS AND/OR FINAL Date HO JSE SEWER ION.CCTII.10 I— PRIVATE' JSPO1.L SYSTEM BY I am exempt Trona tile. licensing requirements as I arn a CONNECT ACDT-O—L BLDG,OR 114.k,nsed architect or a registered professional engineer WORK TO HOUSE SEWER _i acting in my profe-,Aon3l capacity (Section 7051, Bus- O�V RFTOW.E�AGT?T_x,DRA14FI LD iness and Professions Code). Ex TN CESSPOOL,DRYWELL,MANHOLE .ITLR, RE—IR OR......11..Use. SEWC.— OR DISPOSAL SYSTEM Lic-or Reg. No___Date HUME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's OWNER'S Permit License Law for the following reason (Section '1031.5, Busi AUTHORIZATION TOTAL FEE I x/ ness and Professions Code): I HAVE AT T-S OATL A CONTRACT WITH THE HEREIN NAME CC— TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGOWELL;NG I, a-, owner of the property, will tic) the work and the TO THE P U BL I C SEWER. structure is not intended or offered for sale (Section SIGNED THIS DAY OF 7044, Business and Professions Code). OWNER OR OWNERS GENT CONSTRUCTION LENDING AGENCY ADDRESS I hereby affirm that there is a construction lending agency for the pterfornrance of the work for which this permit is issued (See, 3097,Civ.C.), Lender's Narne_______._________ 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' Star-, laws regulating Plumbing and Sewers, ,_A41A hereby authorize representatives of this County to enter up6p the above-mentioned property for inspection purposes. -)R EXPI 'AGE SEE REVERSE FC _-ANATORY LANGUAGE: L Signature of Permittee Date