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Home My Public Portal About9665 LONGDEN AVE_Sewer__ DEPA)VrMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY' PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING y/ t ADDRESS /7- ?" if dnngd,%nmtq- FOR APPLICANT TO FILL IN LOCALITY Temple City BUILDING NEAREST. ADORESS E. TiL23g'den AVO. CROSS ST. LOCALITY Temple City DISTRICT NO. SERIAL NO. PERMIT NO. NEAREST A S CROSS ST. — RECEIVED BY Ready for Inspection DATE ISSUED OWNER Don TR�,1 hardson MAIL ADDRESS 110 La Sierra Dr. USE ZONE OCCUPANCY MAP PG I BK PG CITY Arcadia, Calif. TEL.NO. DyD 0583 -CONTRACTOR A L. Cnme & Son CO.IMP.NO. ADDRESS 15008 E. Klondike Ave.. JOB NO. CITY Paramount, Calif TEL.NO. Me 36089 TRUNK PERMIT NO. STATE REGISTRATION NO. C. 42.111228 COUNTY ROAD PERMIT NO. LEGAL DESCRIPTION LOT NO.We8t 132 Ft. Of lot 8 STATE ENCROACHMENT PERMIT NO. BLOCK 1 TRACT Santa Anita Land Co. INDUSTRIAL SIZE OF LOT NO.OF BLDGS. 6 WASTE APPROVAL C NOW ON LOT CHARGES OF BUIL DINGS I)wellin g CONNECTION CHARGE FEE NO.I DESCRIPTION OF WORK FEE —`----------- - --- -- REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLICSEWER S 3.50 RECEIPT NO. DATE �BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO. DATE (BY 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 SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE UPPER LOWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT ; I 00 Y. CURB F.L. M.L.TO P.L. AUTHORIZATION I TOTAL FEE IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE SIGNED THIS---................DAY OF_..........._......_..................19..._. NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT.._._..._... BUILDING OR WORK ADDRESS---.•.......__......................................_--.-.--------_.._.._...._...__....._. SEPTIC TANK,SEEP.PIT(S)AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL CATION AND 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 I HEREBY CERTIFY THAT I AM 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 I 'r --- ---,----- SEEP.PIT(S)[] CESSPOOLS� OF PERMITTEE. ti .x- P_._4 4 ._.„ _W.___ I 76AG42D 663 1/53 WORKERS COMPENSATION DECLARATION I, hereby tffirni'"Ihat I have a certificate of consent to self J14sure, or a certifio'ate of Workers'Compensation Insurance, or 76A6420 _ a certifA copy thereof (Sec. 3800, Lab C) CE 800(REV.8/81) APPLICATION FOR PERMIT Policy No.' Company _ O)S ❑ 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' BWLDINGf' a STATION DEPTH COMPENSATION INSURANCE ADDREss (This section need not be completed if the work involved by the -- .4 ' MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100)or less.) LOCALITY f• ,,, ei<" LOWER I certifythat in the performance of the work for which this NEAREST ^" =, TYPE OF CONNECTION LENGTH FROM 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'Compgnsation Laws. ^` P C.No. p OWNER �, F �,. . CO.IMP.NO. J08 NO. ,,yy MAIL r"',Pr i s s TRUNK PERMIT NO. ROAD PERMIT NO. Date f F`-' Applicant "d: ADDRESS NOTICE TO APPLICANT: If aft ;(makin this Certificate of AFFIDAVIT WAIVER EASEMENT RECORD,INSTR.NO. DATE g CITY TEL.NO.& r - Exemption, you should becog 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. slzE 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 BUST- 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 O Contractor Date DISTRICT NO. G UP MAP ACESSED BY CITY TEL.NO, f�F BK PG z STATE ,y_.,_ LIC. 0 CLASS ❑ I am exempt under Sec. of the L.A.Co LICENSE NO. CLASS c NO. DESCRIPTION OF WORK FEE Plumbing Code and/or Sec. of the FINAL — LU HOUSE SEWER CONNECTING TO DATE VALIDA1J8N N PUBLIC SEWER Z B. & P. Code for the following reason SEPTIC TANK,SEEPAGE PIT OR PITS AND:OR DRAINFIELD FINAL Date HOUSE SEWER CONNECTING TO BY f, PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG.OR OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER w C� 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 (Secton 7031,5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE feSSions Code): SEWER OR DISPOSAL SYSTEM {{}} pp ryry I,as owner of the property,or my employees with wages as ® a s their sole compensation,will do the work and the structure is not intended or offered for sale (Section 7044, Business [ • n 2 t 5 0 and Professions Code). OWNER'S Permit $ AUTHORIZATION x ❑ I,as owner of the property,am exclusively contracting with TOTAL FEE %-� 9 � licensed contractors to construct theect j roSection 7044, P ( HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR i0 Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. CONSTRUCTION LENDING AGENCY , I hereby affirm that there is a construction lending agency SIGNED THIS DAY OF 19— for the performance of the work for which this permit is OWNER OR issued (Sec. 3097, Civ. C.). OWNERS AGENT ADDRESS Lender's Name 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 State laws regulating Plumbing and Sewers, and hereby authorize representatives of this County to enter upon the above-mentioned property for Inspection purposes. 5.1 ro( re of Permittee "Dote SEE REVERSE FOR EXPLANATORY LANGUAGE �,F