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Home My Public Portal About9415 LOWER AZUSA RD_Sewer__ 96A3420 APPLICATION FOR PERMIT 3&E-663 91.55 DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JC?HPl A. I_AMBIC, COUNTY ENGINEER -- +-- CASSATT E). GRIFFIN, SUPT OF BUILDING -LOCALi't'Y z...=;�e�L- x�`` NEAREST ,F FOR AIPPLICANT TO FILL IN CROSS ST. LEGAL �— DESCR9I C1UNLOT NO OWNER - -- BLOCK TRACT MAIL l B x�F� __--�`'- ---- ADDRESS • +�,, ,�,y �, NO.OF BLDGS. CITY SIZE OF LOT_.- "_:.,�1. a"�� "r NOW ON LOT - ----- �a'4,. - "!'I „o.... =.• USE OF �- DISTRICT NO. � GROUP MAP BUILDINGS -� '�^A'-- _✓� --_—..—_ �— K,,..,;_. i.e EIK PG CONTRACTOR ` �� f - - — CONNECTION DATA ADDRESS --- - / I STATION , -ft..d'm r=�s� DEPTH CITY `, t` L, ND, r;.:.m p _ - _... H�' MANHOL;^.REFERENCE -- [� STATE -- _- -----� -- LOWER R.EG9STRATION NO, -Q-CQUNTY - -- - NO CESC.'RIPT10t4 OFOFZK FEET - ----- ---- ---- -- HOUSc.SGVER COF`vECTING TO USEWER --_T -- -- - TYPE OF T�CTION LENGTH FROM � 4,`;'� j I BLIC 5E 4zP (m + -Y__---- CEPR P.L. M L.TO P,L. l SEPTIC TANK SEEPAGE PIT OR --- 3.5G I - -- 4 -- --__ PITS ANO/OR DRAINFIE1 D _ �2 $3.91 I _ --- -- - ----�'- ---_.. ----._.-i ' - P C. NO,OYERFC04 SEEPAGE PIT DRAINF9ELD znIN ,CErSPOOL,DRY ELLH.NHOLE 0,I 2.001 _30B NO.NO - ". HOUSE SEWER CONNECTING TO a' I PRIVATE DISPOSAL SYSTCM Cr 5 7.00 TRUNK PERMIT NO, ROAD PERMIT NO. J . CONNECT ADDITIONAL SLDG.OR STATE ENCROACHMENT WORK -�- WORK.TQ HOUSE SEWER (a 5.1.00 ', I PERMIT 1.40, ALYER,REPAIR OR ABANDON LOUSE --- _ .----- EWER ODISPOSAL SYSTEM f INDUSTRIAL R __---- _<S f.CC_i__---�- --- AIASTE APPROVAL _ CHARGES . ..--------------:_--_--- --..__--�__-_.-- CONNECTION CHARGE E'EE OWNER'S PERMIT S I i 00 - - ------- ----- -—--- —--- _-- --_- - -.- ___-- -- RL-iMBJR5EN:EN1'FEE AI9 THI OBIZA TION TOTAL FEE I ' I NSPECYOR's S Hklr AT .;HIS SATE A �09WITH7RAC9 W�1THE k.:.ReIN NAMED CON- APPROVALS DATE sIUNATURE _- -- -..-- _-- TRACTOR TO CONNECT. THE A3i VE D�,SCRIDFC iXiSTING DWELLING 'TO T14PU�L1C SF ,R, NEW HOUSE SL, ,R S1CJ'\`Fu T€aS___.�,L___DAY 'Z CONNECT ADT)Ir1 N-A—L_ � - -- OWNER O r BUILDING OR_WORK OWNERS AENT__ - �_ SEPTIC TANK,SELF.PIT 1,S) �----- I AND;ORR-,:..INE LL•..-- _-_. - I >ERE 1, AC fNIO -Eu E THAT 1 HAVE READ THIS APPLICATION CESSPOOLL! UP WELLO AND STATE T4 THE APOVF IS CORRECT AND AGREE ."O COMPLY W17R ALL CC UNTY ORDINANCES AND STATE LAWS REcWLATING ALTER,REPAIR,Se:'E.R OR PLUMBING AND SEWEP.S. SEWA'SE DISPOSAL SYSTEM LICENSED' c T P M PRO° RLY REGISTERED AND/SJR __- -r, S AN-ELES UNTY A,ND STATE CF D SCONNFCT PLJG k SID � CALIFORNIA OR�R}lU IF;E ANITHAT SfL�'HE LEGA OWNIR OF THE ABOVE ABANDON HOUSE SEWER i HERE-D,' _ DESL� sED RESIDENTIAL PROPERTY BEEP. PI E.7>71CT SEEP P 7(S) ��] CESSPOOLSJ GNATR OF .ERM!-rTEE- JOHN A.LAMBIE,CouNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBr. INSPECTOR R. j CASH ry A rt WORKERS'COM'_cNSA'i0N DECLARATION $. hereb",a,s�'r:r: inat ecce a certificate of consent to self 92-0002 DPW 307 76A642D nsure.oL<7 ert.f cot,. -fit WOrke s'Compensation Insurance, or CE 808 a certifies C h, rr �f; e�. Lab C.) APPLICATION FOR PERMIT Policy Na. Company _ CP)s [I 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' BUILDING ING COMPENSATION INSURANCE RADDRESSL94IJ 1 O� -�L STATION DEPTH (This section need not be completed if the work involved by the Y '' MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100)or less.) LOWER r^- TYPE OF CONNECTION LENGTH FROM I certify that in the performance of the work for which this Y. euRe P.L. M.L.TOP.L. permit is issued, I shall not employ any person in any annerso as to become subject to the Workers'Compensation aws. � L`- CO.IMP.NO. JOB NO. i TRUNK PERMIT NO. ROAD PERMIT NO. Date Applic t / �vT ANOTICE O PPLICANT: of e maks fi ate Of 1 _ r' AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE TEL.N Yal J-� Z"'�{ Exempti n, you should beco a suE 'ect t the Wor rs' LEGAL Compensation provisions of the Labor c de, y0 mUsi fort it DESCRIPTION LOT NO, HWY.OR ST.WIDENING comply with such provisions or this permit shall be deemed revoked. BLOCK TRACT STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION NO.OF BLDGS. PERMIT NO.SIZE OF LOT NOW ON LOT I hereby affirm that 1 am licensed under provisions of Chapter USE Or 9 (commencing with Section 7000) of Division 3 of the Busi- BUILDINGS CHARGES ness and Professions Code, and my license is in full force and effect. CONTRACTOR -1"' CONNECTION CHARGE FEE CL License Number Lic.Class ADDRESS REIMBURSEMENT FEE 0 Contractor Date. DISTRICT NO. GROUP MAP PROCESSED BY 0 CITY TE O. BK PG y. z F-1I am exempt under Sec. of the L.A.Co. LICENSE NO. CLASS l \ Q Plumbing Code and/or Sec. of the NO. DESCRIPTION OF WORK FEE FINAL Q HOUSE SEWER CONNECTING TO DATE VALIDAT LU B. & P. Code for the following reason PUBLIC SEWER u7 SEPTIC TANK,SEEPAGE PIT OR FINAL - z PITS AND,OR DRAINFIELD Date HOUSE SEWER CONNECTING TO BY PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG.OR OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER 1 hereby affirm That I am exempt from the Contractor's License OVERFLOW SEEPAGE PIT,DRAINFIELDEXTN.,CESSPOOL,DRYWELL,MANHOLE 7 Law for the following reason (Secton 7031.$, BUlsness and Pro- ALTER,REPAIR OR ABANDON HOUSE fessiotls Code): - SEWER OR DISPOSAL SYSTEM ® 1 C I,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 sole (Section 7044, Business t; r1 a and Professions Code). OWNER'S Permit .j O ❑ 1,as owner of the property, am exclusively contracting with AUTHORIZATION I TOTAL FEE_ I P, 8 licensed contractors to 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, CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency SIGNED THIS DAY F 19_ OWNER OR for the performance of the work for which this permit is OWNERS ADEN a issued (Set. 3097, Civ. C,). ADDRESS Lender's Named-�'�� Lender's Address CUA 1AA I fi'/llLJ ✓o- ' I certify that I hAe `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 re resentatives of this County to enter upon the above-mentio property for riinspection 0 rposes. Ig lure o Permittee 0 Date SEE REVERSE FOR EXPLANATORY LANGUAGE