Loading...
HomeMy Public PortalAbout10521 OLIVE ST_Sewer__ YYVKr,[KJ 1-1-NV\rr-J^II%JIN 920002 DPW 3 87 1 hereby 7ffirm that I have a certificate of consent to self 76A642D insure, or,-certificate of Workers'Compensation Insurance, or CF Bae a certifi.34 copy thereof (Sec. 3800, Lab C.) APPLICATION FOR PERMIT Policy No Compony .t�,Q._C�,. .- �s SEWER - SEWAGE DISPOSAL ❑ Certified copy is hereby furnished. Q Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. -- Date,--APplicont FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING 1OS1� Olive �C. STATION / _ 1 DEPTH COMPENSATION INSURANCE — ----- U- PPE (This section need not be completed if the work involved by the LOCALITY r #e! MANHOLE REFERENCE t LOWER permit is for one hundred dollars ($100)or less.) �City TYPE OF CONNECTION LENGTH FROM I certify that in the performance of the work for which this CROSS ST Y CURB P1. M!, TOP IL permit is issued, I shall not employ any person in any manner PC NO so as to become subject to the Workers'Compensation laws. OWNER CO.IMP,NO JOB NO. MAIL 203 SRUNK PERMIT NO ROAD PERMI7 NO Date Applicant ADDRESS — L S. HyTt 1! Ave.Ave. AFFIDAVIT I WAIVER rSEW=.NO DATE NOTICE TO APPLICANT: If, after making this Certificate of CITY UnnCOVIS TEL.NO 359-37 Exemption, you should become subject to the Workers' LEGAL Compensation provisions of the Labor code, you must forthwith DESCRIPTION LOT NO. — 11WY OR ST WIDENING comply with such provisions or this permit shall be deemed STATE ENCROACHMENT revoked. BLOCK TRACT ! NO.OF BLDGS PFRMIT NO, LICENSED CONTRACTORS DECLARATION SIZE OF LOT NOW ON LOT 1 .. I hereby affirm that I am licensed under provisions of Chapter usE OF 9 (commencing with Section 7000) of Division 3 of the Busl- BUILDINGS _ CHARGES ness and Professions Code, and my license is in full force and CONNECTION CHARGE FEE effect. ` CONTRACTORS. Pluabialt. Irk license Number�1$ 741 LIC,CIOSS Cab-2o ADDRESS 4265 11. BaldA��• REIMBURSEMENT FEE Contractor OM �. �6 Dale 1-5-90 DISTRICT NO GROUP MAP PROCESSED BY !` CITY iEi NO BK PG STATE ❑ I am exempt under Sec. of the L.A.Co. LICENSE NO 231 7§1 LASS C3 — �i .y. NO. DESCRIPTION OF WORK FEE FINAL L Plumbing Code and/or Sec. of the HOUSE SEWER CONNECTING TO DATE VALIDATION PUBLICSEWER B. 8 P. Code for the following reason SEPTIC EP71C TANK,SEEPAGE PIT OR FINAL _ PITS AND/OR DRAINFIELD BY r Date HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG OR , OWNER-BUILDER DECLARATION WORK HOUSE SEWER OVERFLOO W SEEPAGE PIT,DRAINFIELD I hereby affirm that I am exempt from the Contractor's License EXTN,CESSPOOL,DRYWELL,MANHOLE Law for the following reason (Secton 7031.5, Buisness and Pro- $EWER REPAIR DISPOSALORBANDO HOUSE 4 fessions Code): Y ❑ 1,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 sale (Section 7044, Business t, and Professions Code). OWNER'S Permit $ ❑ I,as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE c' licensed contractors to construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO IS Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER CONSTRUCTION LENDING AGENCY SIGNED THIS DAY OF 19— I hereby affirm that there is a construction lending agency OR for the performance of the work for which this OWNER permit is A p OWNERS AGENT issued (Sec. 3097, Civ. C.). ADDRESS Lender's Name Lender's Address 1 certify that I have 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 representatives of this County to enter upon4he obgv entignedVJ, erty for inspection purposes����� .EI-.�-� Ai 1-5-90 Signature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE " CORKERS'COMPENSATION DECLARATION 92-W02 DPW 3/87 �I ,r! H,et:eef.? affirmthat I have a certificate of consent to self .insure; or a certiflaatexf WOfk'grs'COrTip�rrsation:Insurance.,or j 76A�n2� �+p j� a cer�iNd cop0. ry then"eof,'($ec:,.3t3t)I�r1;eCiL); ., ,C .. APPLIC �'1 H u. 4 PERMIT .Policy.No..1.Q-CY fi9h0!ryompony - .C)VA- Ins.. _s Is hereb furnished. I SEWER - SEWAGE DISPOSAL ❑ certified:copy' y , [#Certified.copy is:filed with,the.county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department.. Date1.-5^'90 Applicant Owen.Bros: Mg. FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM.WORKERS' B.l11LD.ING. 1 i STATION 'DEPTH: COMPENSATIOM INSURANCE AL}DRESS 10.5'2;1, Olive St.: '(This section n.eed:.not be completed if the work involved by the' UPPER. MANHOLE REFERENCE. .permit is for one:hundred dollars($100)or less.:) LOCALITY Te[n.'.1e' City 8 (OWER NEAREST TYPE OF CONNECTION 'LENGTH FROM I certify that inthe performance of the work for which this " CROSS ST. Y. ARB P.L. M.1.TO PA,is issued,:I shall not employ any person in.any manner so as to become subject to the Workers'Compensation Laws. P.C.NO. OWNER Omen -D.e ve.l. . - ... CO.IMP,NO'. . .. JOB NO., :Date. Applicant oILRESS 20'3'5 .S: .M. rtle Ave:. NOTICE TO. APPL'ICANTi If, -after Makin ibis• Certificate. of Monrovia 359.—''3211 AFFIDAVIT. , A ME EO. STR.NO. DA TRUNK PERMIT NOL ROAD PERMIT.NO 'W WAIVER EASEMENT. RE ORM IN TE - - 9 ctTY TEG.NCI. E:xemption, you should. become subject to the, Workers' LEGAL Compensation provisions of the'Labor code,.you must forthwith DESCPTTFTION LOT NO. HWY-OR V.WIDENING comply with :such..provisions or this permit shall be deemed revoked. ! %OCK, TRACT NATE ENCROACHMENT .. - .L PERMIT'NO.. LICENSED CONTRACTORS DECLARATION. NO..Olt DGS. S[ZE QF LOT NOW.ON'LOT I hereby affirm that I'am'licensed under provisions of Chapter USE OF 3 . 777 . '- 9 (commencing with Section 7000) of Division' 3 of the Busk BUiLDINO- CHARGES 11 Hess.and Professions Cade:,,and my license is in full for.0 effect. CON.TRNACIOR ' - CONNECTIOF4 C14ARGE'FEE LicenseNumEier1 L+1 Lit, 7f1 OWe BC S:: 1 'Tri REIMBURSEMENT.FEE Q-' 7 C35 �I ADDRESS 4265 N.. Baldwin Ave.::. o Contractor Owen .Bros. Pih Rate. 1=5-90 7 El MOnte 443'-0.078 DISTRJCT NO. GROUP MAP P SEED BY O '. ,i 'CIT`( TEL,NO: SK _ PG .. - :STATE.. LIC. ��ti/) ❑ I am exempf under Sec. of the.L.A.Co. LICENSE No. .23.1 741 C4ASS — �4), t .-2� 1. ' NO. DESCRIPT:ION.OF WORK FEE:' k t?lumbirrg•Code.andlor$ec'... of.the FINAL cU HOUSE SEWER CONNECTING T© •:^7.'. ATE. � LUVALIDATION B', &P.:.Code for the foflowing reason II PUBLIC SEWER a• . ... 5EP1'JC.TANK,.SEEPAL"2E.`;PIT OR �� L r; � VNIA ., 1j � RITS'ANDJORDRAINP. BY .Dwe HOIJSESEWERCONNECT.ING:TO d' ' •.PRIVATE DISPOSAL SYSTEM - Signature I CONNECT ADDITIONAL BLDG,OR OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER OVERFLOW SE%ALG'.PR,DR.AINPIELD 1 /r I herebyoff that.I am exem t.fr..onm the Contractor's.License t1CTN„CESBPOOi,DRYWELL, . MONHQLii: - law for the..fol;low.%ng,reason(Becton 703'1..5,,Bulsness and Pro= �, ALTER,.REPAIR.OR.ABANDON HOUSE , SEWER OR DISROSAL,:51"ST# fessio.ns Coale): �� - ,: .�.0 Ti ❑. I,as Owner of the property;.or my employees with wdges�as: R t their.ole Compensation,will do the work and..'the structure �l l� ,•I;,„.,;tit Is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER'S Permit $ ?. A € AUTHORIZATION TOTAL FEE ''�� ❑ i,.as owner of the property.,am'exclusively confrpcfitig with TO t,Il„ 33.5-10 licensed.eo.n•tra.ct.ors.to construct the project (Section.7044,. I mAw AT THIS DATE A.CONTRACT WITH THE'HEREIN NAMED:CONTRACTOR TO B.Lis1ness and'Pr6fessio.ns Code). CIONNEVrHE ABOvEEIESCRIBED.E21tS71NG:DYJELCIIVGTOT'0 PUBl1C 5EY�2. CHI��' ' "li_'>=f' CONStRlJCT10N LENDING..AGENCY l hereby- affirm that there, is o construction' Iendin d enc I SIGNED.THIS DAY OF g y OWNER'O.R for the performance of the work for which this permit is + ?:••! ,r; ,..,I 'OWNERS AGENT {: 9 issued (Sec. 3097, Civ. C..). Y 1ADDRESS -T1. •4:: y - ;- �� 1/ .5/c?,- Lender's 1 "/Y Lender's Name .... . . ' 3 {{ Lender's Address j d t I G S.01 v 4 CH+ : 9.a—A i:carts#y. tfiot I have read this bP{til'icgtiott :aiTd. state that the _ s�I above..i.nformat+ots is correct. I agree.to comply wi'tFL all Count: 'L-a 9 Y ii F.l� C,:9 Wr inances.and State laws regul.ot.ing Plumbing anal. Sewets; and heseby guthorize represpntgtiveS Of this County to enter I u 9n�1'i.8 abov -tne.ritiorye)d property for inspection purposes. �= ^. F•! .% I ri pig• r. lett' b. 1=.5=90:. S'ignaf.'yre•af.Perhiit ee Date': I SEE REVME-FOR EXPLAN:AT 011V LANGUq F( 4A .` `y .5 r" J -