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Home My Public Portal About5302 NOEL DR_Sewer_7/5/1985_ CESOB 9 62 TBA842D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER �y r BUILDING AND SAFETY DIVISION F G JOHN A LAMBIE COUNTY ENGINEER S COLEMAN W JENKINS SUP T OF BUILDING Y l TFOR APPLICANT TO FILL INsT LEGAL •" DESCRIPTION LOT NO /2— OWNER MAIL BLOCK TRACT of ADDRESS L, l NO OF BLDGb '�� SIZE OF LOT NOW ON LOT CITY ` .G.. - TEL NO r USE OF DISTRICT NO GROUP MAP BK PG BUILDINGS :76SED BY 00 CONTRACTOR AD ESs / S' u CTION DATA TEL STATION DEPTH CI Y 5 2 !!!! LICENSE Q� ✓ CLASS SC MANHOLE REFERENCE �j�s ` LOWER NO I f/,,RIPTION OF WORK FEE TYPE OFC ION (l LENGTH FROM/Co / } HOUSE SEWER CONNECTING TO /' Y CUR P L' ML TOP d PUBLIC SEWER 0 $5 00 V SEPTIC TANK SEEPAGE PIT OR J C NO PITS AND/OR DRAINFIELD 0 510 00 CO IMP NO OB NO /� V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT N /yTO �I O PRIVATE DISPOSAL SYSTEM ! $300 VLA CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMERT RECORD INSTR NO DATE WORK TO HOUSE SEWER 0 $300 W OVERFLOW SEEPAGE PIT DRAINFIELD IL EXT N CESSPOOL DRYWELL MANHOLE! $5 00 to ALTER REPAIR OR ABANDON HOUSE HWY OR 3T WIDENING Z SEWER OR DISPOSAL SYSTEM S300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT S 00 AUTHORIZATION TOTAL FEE O 0 CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER DATE INSPE OR S SIG ATU RE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANKSEEP PITS) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR - LICENSED AS REQUIRED BY LOS LES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE GA OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRI ED S ENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS [30 F PERMITTEE SEEP PIT(S) ❑ CESSPOO L-S-E3 S III VALIDATION JACK R ALLEN CK M O CASH SUPERVISING MECHANICAL ENGINEER 0 5 IS 10 1) 10.00- WORKERS COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self 1n r ora rteflcate of Workers Compensation Insurance or 76A644D `p Yfl y the a (S c Lab_C� _ _ _ CE808(REV 1/83) APPLICATION FOR PERMIT ❑/ C.'r't.-ff ied co 1s hereb f noshed— SEWER - SEWAGE DISPOSAL PY Y d py Is filed with the cou ty building ysp ion COUNTY OF LOS ANGELES BUILDING AND SAFETY tm �+ Dar AppII FOR APPLICANT TO FILL IN CONNECTION DATA RTIFICATE OF EXEMPTION FROM WORKERS BUILDING COMPENSATION INSURANCE ADDRES STATION iIF3 '5DEPTH 6 (This section need not be completed of the work Involved by the r MANHOLE REFERENCE U permit is for one hundred dollars($100)or less) LOCALITY LENGTH FROM ' I certify that in the performance of the work for which this ROSRST TY S • Y PE c0 CURB P L LEL TOP t permit is issued I shall not employ any person In any manner PC NO so as to become subject to the Workers Compensation Laws OWNER CO IMP NO JOB NO MAI T U PERMIT NO ROAD PERMIT NO Date Applicant ADD NOTICE TO APPLICANT If after making this Certificate of c1Tv L NO AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE Exemption you should become 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 DECLARATIONNO OF BLDGS 01 PERMIT NO SIZE OF L �O I hereby affirm that I am licensed under provisions of Chapter 115E • NOW ON LOT S 9 (commencing with Section 7000) of Division 3 of the Busi B CHARGES ness and Professions Code on y license is In full force and ;;�Z_ effect CONTRA Lice OW- ` �_ CONNECTION CHARGE FEE s er� ec Class L III ADDR * REIMBURSEMENT FEE /�ptr Date 'W/ I i'7 DISTRICT NO GROUP MAP PROCESSED BY O ✓✓✓ _T � ❑ I am exem t under ec of the L A Co HATE LIC 5-, 2 SK P; V P LICENSE NO CLA /,d 19 J 'q'Ml Fj of NO DE I ON OF WORK FEE O Plumbing Code and/or Sec of the FINAL HOUSE SEWER CONNECTING TO i1 DATE ...i VALIDA ON 13 E SE WR (f B 8 P Code for the following reason PUBLICW SEPTIC TANK SEEPAGE PIT OR FINAL PITS AND/OR DRAINFIELD H Dat HOUSE SEWER CONNECTING TO BY Z PRIVATE DISPOSAL SYSTEM Signa f r CONNECT ADDITIONAL BLDG OR OWNS UI DER DECLARATION WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT DRAINFIELD I hereby affirm that m exempt from the Co ractor s License EXTN CESSPOOL DRYWELL MANHOLE 12 3 7 4 A Law for the follows g reason (Secton 7031 5 Buisness and Pro- ALTER REPAIR OR ABANDON HOUSE fessions Code) SEWER OR DISPOSAL SYSTEM # • • • • 1 Q ❑ I as owner of the property or my employees with wages as their sole compensation will do the work and the structure ( • * 2750 is not intended or offered for sale (Section 7044 Business and Professions Code) OWNER'S Permit $ • • • 2 7 5 0 5: ❑ I as owner of the property am exclusively contracting with AUTHORIZATION TOTAL FEE IQ licensed contractors to construct the project (Section 7044 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO 0 071 -85 Business and Professions Code) CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER CONSTRUCTION LENDING AGENCY Poo hereby affirm that there Is a construction lending agency SIGNED THIS DAY 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 comp with all County or' es and State laws regulate g PILI. Ing and Sewers an ereby authorize r rese III es of t es Cou to ter iMabo;ment p y for 1 pectin pur s Slgnatur f Permittee Dat SEE REVERSE FOR EXPLANATORY LANGUAGE