HomeMy Public PortalAbout10214 OLIVE ST_Sewer__ isA -663 f L85
E APPLICATION FOR PERMIT
4 zt E•66 -
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER _ADDRESS -
CASSATT D.GRIFFIN, SUF'T OF BUILDING ,_LOCALITY.
FOR APPLICANT TO FILL IN CROSSST,
LEGAL
yr
DESCRIPTION N LOT NG. .t - OWNER E y
MAIL
ADDRESS � .
BLOCK TRACT - _ A
`'� — ' —'�
j. N0.OF BLDGS. CITY
SIZE OF LOT NOW ON LOT V
USE OF
BUILDINGS�� a � ,J rzy� DISTRICT NO, I GROUPBK MAP PG
CONTRACTOR
ADDRESS -' _ CONNECTION DATA
CITY TEL. N0. _STATION .i-'�£.. 7"" >=.a 7 DEPTH
-- ----- ---- v ti� t _ MANHOLE REFERENCE — 1 &
(]Y STATE ._„'_ a-._ ,i.. �. .�'� .. „"�s' '.LOWER'
REGISTRATION N0. _ �' - / ❑ COUNTY
—,-
ND. J DESCRIPTION OF WORK --
HQUSE SFV ER CONNECTING TO J TYPE OF CONNECTI, P LENGTH FROM
PUBLICSEWER_._._ - _. — __-- � «_3.50._- s _ Y'-----CIJR6 -ycl PL M.L_.TOP.L, ''.-} �—
i SEPTIC TANK,SEEPAGE PIT OR jI(
I PITS ANGOR DRAINFIELD n $3.00
SSSS ---- -DIST
OVERFLOW SEEPAGE PIT,DRA- INFIELD _r ,bj P. C. N0.
F.XTN.,CESSPOOL,DRYNtLL,N.IANHOLE Try $ _.00T _ CO. IMP. N0. f r r _ 106 NO.
HOUSE SEWER CONNECTING TO - -- -
PRIVATE DISPOSAL SYSTEM $1.00 — .--TRUNK PERMIT NO, ROAD PERMIT NO.
SSSS-- SSSSSSSS--SSSS-- _.---SSSS-
CONNECT ADDITIONAL BLDG.OR--i---_—�-- -- STATE ENCROACHMENT
_I WORK TO HOUSE--SEW r R-- Cct� $1.00 I. PERMIT NO.
- -- - -- - SSSS DIST --._-__ ----------------------.—._,.------
ALTER,REPAIR OR ABANDON HOUSE ! INDUSTRIAL
SEWER CR DISPOSAL SYSTEM Cr R 1.00 I _ _ WASTE APPROVAL-- --- -- -._..
CHARGES
SSSS —
-----
--._-------- CONNECTION CHARGE FEE
�
OWNER'S PERMIT 1 00 - - -- ,- -.--SSSS----- - -
� ->
-- -_--`-- -- jSSSS-- -'
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE O C
APPROVALS DATE iINSPECTOWSS1GNATURE
I HAVE AT THIS DATE A CONTRACT S1IlT'H THE HEREIN NAMED CON- _-:__.._. ___-_ ___,_.DIST
TRACTOR TO CONNECT TRE ABOVE DESCRIBED EXISTING DWELLING '
,TO THE I UnLICEWE�2..a,,..y,3 NEW HOUSE SEWER
,/
SIGNED THIS _. D.A7` OF 79� CONNECT ADDITIONAL
DINNER OR �. . _ ..- --- BUILDING OR WORK... i
� �-� ---
UIINERS AGENT -AND
1'" _ IC TANK,SEEP, PIT(S)
_ /OR DRAINFIELD
1,�
HEREBY ACF OU/LEDGE THAT 7 HAVE READ THIS A-PPLICATION CESSPOOL LI DRYW ELL[] I
.AND STATE THAT THE ABOVE IS CORRECT AND AGREE 'TO COMPLY ------_-._ _.____-.--_-.--____---
Nrf'TH ALL COU TTY -ORDINANCES AND STATE LAWS REGULATING ALTER.,REPAIR,SEWER OR
PLUMBING =:ND SEWE=RS. --SEWAGE DISPOSAL SYSTEM
DISCOSSSS--SSSS- ----------------
I HERESY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED BY 7.OS ANGELES COUNTY AND STATE OF
CALIFORNIA 03 TKAT 1 AM THE LEGAL OWNER OF THE ABOVE A----SAtdDON HOUSE SEWER
---- -----
DESCRIGED RESIDENTIAL PROPERTY... BACKFILL SEPTIC TANK$Q i
SFFI'. FIT(S, i� CESSPOOLS,.."'
SIGNATURE
OF PERMITTEE - ,,'..o _ --^'
JOHN A. LAMBtE.COUNTY ENGINEER VALIDATIOD(�,' ROBERT A.WOOD, CHIEF Pt_ec. INSPECTOR
�-g
2 9
4
WORICE. S- COMPENSATION DECLARATION ]
i .yifirm that I have a certificate of consent to self
'6-6451 DPdNfii£19
;. in ure'or p certificate of VVurGers' Cornpe-nSa ;un li,7Lurcnce, or ''EiA£i42C7
Po r�1 ;. =� ` 38QQ, bC. y , ! APPLICATIONS FOR PERMIT
Certified copy is hereby furnished. SEWER - SEWAGE DISPOSAL
L Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY
de Sar In ent.
Date =��1?2:!_Applicant-/I—I e.p�. ' ''' FOR APPLICANT TO FILL IN CONNECTION DATA
CERTIFICATE OF EXEMPTION FROM WORKERS' ,till-Drt.; tit ,TATiZ;N DEPTH
COMPENSATION INSURANCE ADDaeS;
(This section need riot be completed if the work invoived by the MANHO,E R£FEREN:_E uPVER
permit is for one hundred dollars ]$100) or less.) LOCALI7 -fir" SOWER
NEAREST TYPE OF CONNECTION L-NGTH FROM
I certify that in the performance of the work for which this OROS'ST ,CEJ -7 et/ t� � CURS P L M L TO P t
permit is issued, 1 shall not employ any person in any manner L,[.GAL
PC' NO
so as to became subject to the Workers' Compensation Laws. DESCRIPTION (JT NO, C,,.) :MP NO JD6 NO
BI O.K TRACT ?Ru NK °FRMIT NO ROAD PERWt NQ
Date ----AppLcant------- --
NOTICE TtD APPLICANT lf, offer maktn f is CCT1iflCate 4f MAP,ASSESSOR AFFiDAV.T WAIVER EASEMENT REC)RO INS'R Nv '" DATE A t
g MAF SS�OR PACE PAaCE3-
Exemption, you should become subject to the WorkersNO O 81-DG!, -
Compensation provisions of the Labor code, you must forthwith SIZE OE LOT NOW on,L-OT HWY OR ST WIDENING
comply with such provisions or this permit shall be deemed USE OF
revoked. BUILDINcs 51ATE ENCROACHMENT
PERMIT NO
LICENSED CONTRACTORS DECLARATION ; ,
I hereby affirm that I am licensed under provisions of (Chapter
9 (commencing with Section 7000) of Division 3 of the Bus
l- nnlL s ,►�' / + HA GES
ness and Professions Code, and my license is in full force and ADDr+Las
effect. . e , c:rry f f L?l TEL NO o aNEc ON C ARGE FEE
%J � -'— - '
License Number I Lic Gass REIMBURSEMENT FEE,
ADN a:r..rOa r �
C OnPraGtOr Dote .�� DISTRICT NO GROUP MAP PROCESSFG`t3Y
SK PG
DRESS
I am exempt under Sec. of the L.A.Co. y + / 1�y� ! _ . '.
CITY "..� TEL..NO. �,..7 -j +-. c,�' '' l'.
PlumbingCode and:or Sec. of the SrATE FINAL
LICENSE NO. ,✓ 17 LESS ATE VALIDATION
Z
B & P. Code for the following reasonNO. DESCRIPTION OF WORK FEE
O
tO;SE SEWER CONNr NC; - f,NAI
Date —.. P IELI(E'SEWFR
SEPTIC TANK S:EP,4CE P:r OR
P rS ANI 0 DRA.N IE D
Signature ___—_ __ to
IAC
R,
OWNER-BUILDER DECLARATION F SEI ER u Nr T'NG rc g
R ATE D SaoSaL S s M
I hereby offirm that I am exempt from the Contractor's License r NEC Arr OVAL BLDG OR
Law for the following reason (Secton 7031.5, Buisness and Pro- WORK TO Hu.JSF,EWER
OVERF'Ov0 SEEPAGE"T DRAINF EL4
fe SSiOnS Code)' fXTN US`:POOI, DRY'WEU. MANHOLE _
I, as owner of the property, or ray employees with wages as Al"ER,^�RFPA R QR ABANDON I OUSE
SEvv OR DiSPOSAt SYSTEM
their sale-cimperisotion. will do the work and the structure r �is not intended or offered for sale (Section 7044, Business
and Professions Code). - -
i _l 1, as owner Of the property, am exclusively contracting with ....
S ,? .
licensed contractors to construct the project (Section 7044, OWNER'S Permit
Business and Professiors Code). AUTHORIZATION TOTAL FEE ,
CONSTRUCTION LENDING.AGENCY I HAVP AT TH ATE A ,CNrRA::T W H 111E IAERPINAME, zNTRA}Tc
I hereby affirm that there is a construction lending ae}ency _aNNEct THE AB VE ,ESCa I)(S7 tit .vE.�. r i+c :.FWEs
for the performance of the work for which this permit is
E.
S,CN€D THIS_DAY of llv:_
issued (Se[. 3097, Civ. C.1, v _
C vJ"VER OR
Lender's Name ;.a s Ar3E N'
Lender`s.Address _—
I certify that I have read this applicationand state that the
above information is correct. i agree to comply with all County'
ordinances and Mate lavas regulating Plumbing and Sewers,
and hereby authorize representatives of this C"ourity to enter
upon tthheo ove-mentioned property^r inspec ion purposes.
5 Apure of dee Date SEE REVERSE FOR EXPLANATORY IANGUAGE
s
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1207030004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: (SEWER / SEPTIC: SEWER I BUILDING ADDRESS: I
ITR: 10558 LT: 36 (EXIST OCC GRP: I 10214 OLIVE ST 1
I IBLDGS. NOW ON LOT: I TEMP CA 917803346 1
(ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: I NEAREST CROSS STREET: ARDEN I
18585-004-042 (ORIGINATION: i THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, Cl
I (LENGTH ML TO PL: STATION: DEPTH:
(TENANT: MANHOLE REFERENCE: UPPER/LOWER: "IISSUED ON: PROCESSED BY: I
I 107/03/12 SR I
ICOUNTY IMPROVEMENT NUMBER: I I
(OWNER: TEL. NO: 1PLAN CHECK NUMBER: IFINAL DATE FINAL BY: CODE: 1
1HUANG, XIAORONG (626) 698-2010- IJOB NUMBER: i r�
110214 OLIVE ST. 1TRUNK PERMIT NUMBER: -
TEMP 917803848 IROAD PERMIT NUMBER: [DESCRIPTION OF WORK
I IAFFADAVIT: NO IREPLACE SEWER LINE I
IWAIVER: NO I I
APPLICANT: TEL. NO: (EASEMENT: NO
IGUAN, SAMMY (626) 215-3100- I
462 W. WOODRUFF AVE IRECORD INSTRUMENT NBR: RECORD DATE: ISPECIAL CONDITIONS: 1
ARCADIA, CA 91006 (HIGHWAY/STREET WIDENING:
ISTATE ENCROACHMENT PERMIT NUMBER:
I 1
(CONTRACTOR: 1
TEL. NO: I FEES PAID (APPROVALS DATE INSPECTOR SIGNATURE
IGUAN'S CONSTRUCTION INC. (626) 968-2979- 1 1
115212 BERNARD COURT LIC. NO IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:(NEW HOUSE SEWER I I
1HACIENDA HEIGHTS, CA 91745 NONE
I 101 PERMIT ISSUANCE FEE 27.80 ICONNECT ADDITIONAL 1 I
I 115 ALT/REP HOUSE SEWER 1.00 EAC 30.50 IBUILDING OR WORK I I
(ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 58.30 1 I I
- I ISEPTIC TANK, SEEPAGE PITT I I
LIC. NO: I 1AND/OR DRAIN FIELD 1 I I
IDRYWELL
I I I I
SEWER MAP BOOK: PAGE: I IALTER, REPAIR, SEWER OR I I I
ISEWAGE DISPOSAL SYSTEM
I I I
I IDISCONNECT PLUG AND I I I
I (ABANDON HOUSE SEWER I I I
IBACKFILL SEPTIC TANKS I I I
1 i (SEEP. PIT _ CESSPOOL -i
IGRAYWATER SYSTEM 1
1 I I I I I
I I I I I I
I I I I
I
I
II I I I I
I
I I I I I
IREPORT ID: DPR266 ROUTE TO BS0508 I I I I
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