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Home My Public Portal About5708 MUSCATEL AVE_Sewer__ 76A642D .E9081REV.6/781 k)s APPLICATION FORIPERMIT SEWER - SEWAGE DISPOSAL COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN DISTRICT NO. I CROUP I MAP PR CESSED BY �.� .f BK PG BUILDING 708 N. Muscatel i, ADDRESS 5( -..,/'*(�`.f R -!9 .117"'�''Ir/7 ;LOCALITY Temple City CONNECTION DATA r NEAREST STATION -2 �:! ,,' DEPTH CROSS ST. UPPER MANHOLE REFERENCE OWNER Dr. Bevli LL -' TYPE OF CONNECTION LENGTH FROM MAIL Y. CURB ('�-�'•L._, M.L.TO P.L. ��y ADDRESS same CO.IMP.NO. f JOB NO. CITY TEL.NO. 285_7�C�J � -�` LEGAL -,. TRUNK PERMIT NO. ROAD PERMIT NO. 'DESCRIPTION LOT NO. AFFIDAVIT I WAIVER I EASEMENT RECORD.INSTR.NO. DATE (BLOCK TRACT NO.OF BLDGS. SIZE OF LOT NOW ON LOT HWY.OR ST.WIDENING USEOF 'BUILDINGS school STATE ENCROACHMENT PERMIT NO. INDUSTRIAL CONTRACTOR Universal WASTE APPROVAL ADDRESS 2631 Lee Ave CHARGES CITYSe• El Mohte TEL.NO. 575--3460 CONNECTION CHARGE FEE STATEQ[[[[ p LIC. !r p� REIMBURSEMENT FEE 8668 ' LICENSE NO. CLASS C 60.20 O NO, DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE V HOUSE SEWER CONNECTING TO PUBLIC SEWER SEPTIC TANK,SEEPAGE PIT OR NEW HOUSE SEWER PITS AND/OR DRAINFIELD CONNECT ADDITIONAL HOUSE SEWER CONNECTING TO BUILDING OR WORK PRIVATE DISPOSAL SYSTEM SEPTIC TANK,SEEP, PIT(S) CONNECT ADDITIONAL BLDG.OR AND/OR DRAINFIELD WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL ❑ DRYWELL❑ E)CTN.,CESSPOOL,DRYWELL,MANHOLE ALTER,REPAIR OR ABANDON HOUSE ALTER,REPAIR,SEWER OR SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS❑ SEEP,PIT(S)❑ CESSPOOLS OWNER'S Permit s - 00 AUTHORIZATION TOTAL FEE VALIDATION I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN 14AMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ OWNER OR OWNERS AGENT ADDRESS I HEREBY ACKNOWLEDGE.THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED V .E,LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM'ti•HE LEGAL OWI� OF,AND INTEND TO RE- SIDE IN,THE ABOVE DESORIBED RESIDEI�T1 PROPERTY. SIGNATURE _ a OF PERMITTEH- W0RKFRS'COJMPENSA'l ION DECLARATION 76A642D CE 908 (2-80) APPLICATIO� FOR PERMIT I hereby affirm that I have a certificate of consent to self SEWER—SEW GE DISPOSAL inswc, or a ecrtificate of Workers'Compensation Insurance.or I cel-ii'-'ied ,-opy.thereof(Sec. 3800,Lab, C.) COUNTY OF LOS ANGELE BUILDING AND SAFETY PN olicy o___Company____ ---------- ......... Certifi,-�d copy is hereby fumished. FOR APPLICANT TO FILL IN CONNECTI-ON DATA BUILDING STA* -L.9, %`, '0' DEPTH Certified cow, is filed wn with the county building inspection _L_ RES,- PER— department. M- A-1JqOLE R FERENC LOC ALITY LOWER P E_0F CONNECT LENGTH FROM !)are— Applicarit-__ _ NEAREST CER111FICATE OF EXEMPTIONT FROM WORKERS' CROSS ST.—L, Y� CURB . TO P.L. P.C. O. COMPENSATION INSURANCE 1..�Na. MAIL (This section need. not be completed if the work involved ADORE:SS TH64K PERMIT No. ROAD PERMIT NO. by the permit is for one hundred dollars ($100) or less-) CITY 7F-�,"VIT �WAIVEF. E�ASEMVW�RFCORD.�INSIR. Nb.1 A TC TEL. NO. I certify that in the performance of the ,vork for which this LEGAL permit is issued, I shall not emnioy any person in any manner DESCRIPTION LOT V"t' . 44INY, OR ST. WIDENING so as t,, become subeci to the Vorkers, C p2nsa wri L ill avvs. 1) 1�'_ SLOCK TRACY'�) STATE ENCROACHMENT PERMIT NO. Appheant ✓zLn �e -- Datc & ant NO. OF SLOGS. SIZE F LOT NO'A'2�N LOT NOTICF, TO APPLICANT: If, ft.e.r Inak-Ing this wla_;��f Exemption, you should become subject to the Workers' USF OF eUILDINGS CHARGES Compensation provisions of the Labor Code, you must forth- with Comply with such provisions orhis permit shall be CONTRACTORk, CONNECTION CHARGE FEE deemed revoked, LICENSED CONTRACTOCL RS DEARATION REIMBURSEMENT FEE MAP FR CESSED Btl I hereby affirm that I am liceosed under provisions of Chapter 1.11R11T NO. —L,1 C ITY L TEL. NO. 261�5; 9 (cominencing with Section 70009 of Division 3 of the Bust- A/ -ofessions Code, all STATE LIC, 0 ness and P7 NO, S LICENSE CLAS effect. CI rny'license is in full force and NO DESCRIPTION OF WORK FEE T-) y 1� FINAL I ) 7 015r SE-11 IINNIIT�1� 11 VALIDATI N License Number Class _PU.1IC S—R DATE SEPTIC T.—,SEC TITS AN -IE-L P.T-R U;-.1...IN F1114AL HOUSI. SE-111S. C.NN��C,I.G 19 PRIVATE DISPOSAL SVSTl By. crit exempt frorn the licensing requirements is I am �) -.- - ._____________ 11 IIECT-10111111L 1--1R licensed architect or a registered professional engineer WORI TO HOUSE SEWLR Ei_ , acting in my professional capacity (Section 1051, Bus- E.11— PITDVA�.T vi L 6 iness and Professions Code)� x,N-CESSPOOL,ORYWELL, MANHOLE AL.TCR, 'PAIR OR ...HOUSE SEWER OR OMPOSAL SVSTF. I ic.or Reg.N..-3— Zz Date_. HOEVIE OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's OWN E R'S Permit S Licen,qe Law for the following reason (Section 7031.5, Busi- AUTHORIZATION[ TOTAL FEE gu ness and Professions Code): I— t HAVE_ AT THFS DATE A CONTRACT ON RACT WITH TIfERaIN NAMED CON- '1 "0 CONNECT T- ABOVE 1, as owner of the property, will do the work and the To r.. PUD SE-' structure is not intendcd or offered for sale (Section SIGNED T DAY 14 7044, Rusiness and Professions Code). OWNER OR O—E.. CONSTRUCTION L1,1NDING AGENCY -1 hereby affirm that Mere is, a const I ruction lending ageric for the performance of the work for which this permit is issued (Sec. 3097,('iv.C.). Lender j Lender's Address I certify that I have redd this -,application acid state that o above information is Correct,I agree to COMPlyWith all C(_)LUi(,' ordinances and State laws regulating Plumbing and Semc,,, -)n ,�!,�e y au"tilorizo represL d I b 11tativos o this County to ew_,r upon ab., fllentiQned prt perty for jf'�- n sP0,Cti0n purpose,,, SEl_' REVERSE FOR EXPLANATORY LANGUAGE Pe ate