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Home My Public Portal About5616 NOEL DR_Sewer__ DEPARTD�NT OF OOUNW ENGII�EIEB SEWER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION 1r OOUBM OF X09 "GRIM BUILDING 5-4 � WILLIAM J FOX, COUNTY ENOINEER ADDRESS _ (o FOR APPLICANT TO FILL IN LOCALITY BUILDIUS NEAREST ADDRESS I CROSS ST LOCALITY 7"eM b t e C j y DISTRICT NO SERIAL NO PERMIT NO NEAREST 1 A 7 S CROSS 8T Ready for InspeoNoo DATE ISSUED OWNER -14 -Sn MAIL ADDRESS 2 I a• USE 20NEPANCY BK MAP PO CITY TEL NO Z A CONTRACTOR a y CO IMP NO ,( ADDRESS T T /P y foye V Mo ApTe JOB NO 34/y4 — CITY TEL NO /-Q• 6 �d TRUNK PERMIT NO p TATE REGISTRATION NO Al J� g��/0 LINTY ROAD PERMIT NO DESCRIPTION LOT NO — PERMIT ENCROACHMENT BLOCK y 2 TRACT/(. // INDUSTRIAL WASTE APPROVAL CHARGES 812E OF LOT 3 X Q NO OF SLD LOT GS USE NO W ON BUILDINGS J CONNECTION CHARGE FEE NO DESCRIPTION OiPWORK FEE _ REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER ! = Sao 56 RECEIPT NO 10ATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED WORK TO HOUSE SEWER 100 NO ALTER OR REPAIR EXISTING DATE BY SEWER OR DISPOSAL SYSTEM 100 AND/OR DISPOSAL SYSTEM SEWER too CONNECTION DATA SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD 200 STATION S� (p, DEPTH CESSPOOL—DRYW ELL SPECIAL CONDITIONS ONLY 200 I � UPPER M EFERENCE TbR TYPE OF CONNECTIO LENGTH FROM C) OWNERS PERMIT I 00 *v` SIB PL M L TO P L AUTHORIZATION TOTAL FEE '-s-0 IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE AB E DES IBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS L& DAM OF _ NEW HOUSE SEWER 00 CONNECT ADDITIONAL OWNER OR t OWNERS A NT - i BUILDING OR WORK S D SEPTIC TANK SEEP PIT(S) ADORES 1 AND/OR DRAINFIELD 1 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALTER REPAIR SEWER OR ALL COUNTY ORDINANCES AND STATE LAWS t , REGULATING PLUMBING AND SEWERS SEWAGE DISPOMLSYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND AND STATE OFBED CALIFORNIAUI ED ByOR THAT 1 AM THE ANGELEGALOOWN. ABANDON HOUSE SEWER 1 ER OF THE ABOV 8CRIB REBIDENTI PROPERTY BACKFILL SEPTIC TAN � SIGNATURE KS — -- BEEP PIT(S) CE88POOLSO OF PERMITTEE 7OA842D 063 1/58 j WORKERS COMPENSATION DECLARATION 200051 DPW 6188 'l l I hereby affirm that I have a certificate of consent to self 20 MAS1D U Insure or a certificate of Workers Compensation Insurance or a ce tit ds�py��s�y ` ' APPLICATION FOR PERMIT Polls %(Ob ❑ Certified copy is hereby furnishedff SEWER - SEWAGE DISPOSAL ❑ Certified copy is filed with the c my bull in sp ctlon COUNTY OF LOS ANGELES BUILDING AND SAFETY department / %V Date—&Zf Appllco .� rA,SSESSOR FOR APPLICANT TO FILL IN CO ECTION DATA CERTIFICATE OF EXEMPTION FROM WORAK ING / / COMPENSATION INSURANCE ESS (/ STATION 4. D DEPTH CD (This section need not be completed If the work Involved by the ITY MANHOLE REFERENCE Q -4Q5, UPPER permit Is for one hundred dollars ($100)or less ) LO R I certify that In the performance of the work for which this EST TYPE OF CONNECTION ' LENGTH FROM S ST V CURB P M l TO P L permit Is Issued 1 shall not employ any person in any manner GAL PC No so as to become subject to the Workers Compensation Laws IPTION LOT NO ' CO IMP NO JOB NO Dot@ Applicant TRACT TRUNK PERMIT NO ROAD PERMIT NO NOTICE TO APPLICANT If after making this Certificate Of SOR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE 9 OOK PAGE PARCEL Exemption you should become subject to the WorkersNO OF BLDGS Compensation provisions of the Labor code you must forthwith F LOT NOW ON LOT HWY OR ST WIDENING comply with such provisions or this permit shall be deemed Frevoked INGS STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION PERMIT NO I hereby affirm that I am licensed under provisions of Chapter R S 9 (commencing with Section 7000) of Division 3 of the Busi MAIL �-y nese and Professions Code and my license is In full force and ADDRESS tp I CHARGES effect �� CITvr T TEL NO CONNECTION CHARGE FEE //tIcense Numbe►cT�gL7J/20 LIC Class �s'C(�/�j REIMBURSEMENT FEE Cont►acto7�Date CONTRACTOR � laO ��• '�� DISTRICT NO GROUP MAP PROCESSED BY ADDRESS BK PG ❑ I am exempt under Sec of the L A Co CITY TEL No Plumbing Code and/or Sec of the STATE uCF,NpI V LICENSE NO CLASS DATE / /__ VALIDATION Z B 8 P Code for the following reason NO DESCRIPTION OF WORK FEE T 0 HOUSE SEWERCONNECTING TO FINAL 115 e2 4Ppse Z PUBLIC SEWER By tL SEPTIC TANK SEEPAGE PIT OR SlgnafureA - I PITS AND OR DRAINFIELD N HOUSE SEWER CONNECTING TO OWNER BUILDER DE ATION PRIVATE DISPOSAL SYSTEM Z 1 hereby affirm that I am exempt from the Contractors License CONNECT ADDITIONAL BLDG OR Low for the following reason (Secton 7031 5 Buisness and Pro WORK TO HOUSE SEWER fessions Code) OVERFLOW SEEPAGE PIT DRAINFIELD - 1 ITEMS REPAIR OR ABANDON HOUSE E%TN CESSPOOL DRYWELL MANHOLE 1 as owner of the property or my employees with wages as SEWER OR DISPOSAL SYSTEM their sole compensation will do the work and the structure TOTAL 55.35 is not intended or offered for sale (Section 7044 Business and Professions Code) CHECK 55.71 ❑ I as owner of the property am exclusively contracting with OWNERS Permit S Q ("GE 01) licensed contractors to construct the project (Section 7044 Business and Professions Code) AUTHORIZATION TOTAL FEE CONSTRUCTION LENDING AGENCY I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO 00000—Ml I/ig// 9 I hereby affirm that there Is a construction lending agency CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER for the performance of the work for which this permit Is issued (Sec 3097 Civ C ) SIGNED THIS DAY OF 19_ 34a2 1 AM11.• 11 OWNER OR Lender s Name OWNERS AGENT Lender s Address ADDRESS — I certify that I have read this application and state that the above information Is correct I agree to comply with oil County ordinances and State lows regulating Plumbing and Sewers and hereby authoriz repre nt tives of this County to enter upon the O Is on r erty r inspection purposes Signature of Permitte Date SEE REVERSE FOR EXPLANATORY LANGUAGE