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Home My Public Portal About9077 OLIVE ST_Sewer__ JI:-, 6A642D APPLICATION FOR PERMIT] COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL` �°A DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS _,__ JOHN A. LAMBIE, County Engineer 17 WILLIAM A. JENSEN, Supt of Building _L -A L'- -2_ '? OCALf7Y -NEAREST FOR APPLICANT TO FILL IN CROSS ST -",e�7 e LEGAL DES c P PTION LOT NO. OWNER MAIL S L OC K 'i RAC r ADDRESS NO, OF BLOGS, S !Z.E OF LOT NOW ON LOT ;r CITY TEL. USE OF I D DISTRICT NO. GROUP MAP ED BY --BU L INGS EK PG "R77 ty CONTRACTOR ADDRESS COECTION DATA STATION DEPTH -1 �Y TEL N 0' STATE I-ON NO. El COUNTY MANHOLE REFERENCE REGIS7RAT No. DESCRIPTION OF WORK FEE LENGTH --------- - ---- --- ----------------- I----- -- -- TYPE OFCO FROM HOUSE IrWIR CONN.CTfNG TO Y. L M.L.TO P.L. VW ER moo PUBLIC S 0 PC. NO- Isp $ID oo Hobk- 10- EFT CTkNK,SEE.PA1.E PIT OR PITS ANDOR DRAINFIELD CO.IMP. NO. SEWER CONNECI!NG To 'MIT NO. TRUNK PER ROAD PERMIT C(7,( PRWATE DISPOSAL SYSTEM 53.00 -/ Z-'- 0 I- � . ----- ONNFFTA60ITIONAL 1!LDGOR AFF� WAI" I DATE i7i WORK TO HOUSE SEWER @ $3 0 .0 - OVERFLOW SEEPA:GE PIT,DRAINF1 ELD FXTN.,C:FSSPOOL,DRYWE.LL.MANII.OLE @ $5— HWY.OR ST.WIDENING P ALTER.REPAIR OR ABANDON HOUSE i�iTE SEINER OR DISPOSAL SYSTEM @ $3.()0 C H PERMIT NO. INDUSTRIAL WASTE.APPROVAL CHARGES ONWERT— . D CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE L IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REM 7i ,31JRSEMENTFFL I F ACTOR TO CONNECT 14E ABOVE DESCRIBED FXISTI.NG DWELLING To THE PUBLIC T EWEI)W APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF—�_/ 1 96j ----—---- OWNER 01' NEW HOUSE SEWER ER5 A'GEN owN IV— CONNECT ADDITIONAL ADDRESS c BUILDING OR WORK TANK.SEEP,Plr{5) IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIFLO AND STATE THATT F ABOVE IS CORRECT AND AGREE 1*0 COMPLY WITH ALL COUN'T'Y ORDINANCES AND STATE: LAWS REGULATING FLU Me ING AND SEWERS. CESSPOOL, DRYWELL f HEREBY CERTIFY THAT IAM PROPERLY REGISTERED AND/OR ALYER, REPAIR.SEWER OR LI IRED BY OS ANGLES COUNTY AND STATE OF SCWAGF DISPOSAL SYSTEM CALIFORN 1CENSE:D AS REQtj L A OR THA'f I AM 7HE LEGAL OWNER OF, AND INTEND TO AND RES:DE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY- ABANDDISCONNECT PLUG ON HOUSE SEWER SIGNATLJRE IIA--KFILL SEPTIC TANKSS ❑ OF PERMITTEE, -0 4 SEEP,PIT(S) L7 CESSPOOLS E]! (CVALIDATION ROBERT A. WOOD K. M.O. CASH SUPERVISING FAECHANICAL ENGINEER X '6A 642D - CE808 - 9/73 APPLICA�N FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BU ILDINO�, S. 'U 09077 E. Olive St. ADDRESS LOCA LITS 0..R NEAREST C 05 FOR APPLICANT TO FILL IN '- S ST Sultails LEGAL _DESCRIPTION LOT NO. 20 OWNER Rolf L. Henriks L BLOCK D TRACT 11218 MAIL 9®77,E. Olive St. NO. OF�BLDGS. SIZE OF LOT 62xl86 NOW ON LOT 3 CITY TemT)l e CjtVTEL. NO. 285-8406 us' 'F ----[ BUILDINGS Residen.9e, Garage,---Storage DISTRICT NO, GROUP1 BK MAP Ps PROCESSED BY CONTRACTOR ADDRESS CONNECTION CITY TEL. NO. STATION DEPTH STATE LIC UPPER LICENSE NO,, CLASS MANHOLE REFERENCE LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER 0 $7.00 P.C.NO. SEPTIC TANK.SEEPAGE PIT OR PITS AN D/OR DRAINFIELD $10.00 CO.IMP,NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR @ $3-00 AFFIDAVIT 1 WAIVER EASEMENT RECORD.INSTR.NO, DATE WORK TO OL SEWER 5 V _H JSE --X f,?— -0-VERFLOW SEEPAGEPI-T.DRAINFIELD C--) EXTN..CESSPOOL,ORYWELL, $5.00C.> ALTER,REPAIR OR ABANDON HOUSE EWER OR DISPOSAL SYSTEM $3;00 HWY.OR ST.WIDENING'1�411(111 A STATE ENCROACHMENT ` MANHOLE $7.00 _PERMIT NO. 6�7 LU INDUSTRIAL a- WASTE APPROVAL v) CHARGES OWNER'S PERMIT $I ---- AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVEAT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACT CONNECT THE ABOVE DESCRIBED EXISTING DWELLING OR To Co' N TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS—DAY OF OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS-- BUILDING OR WORK SEPTIC TANK.SEEP,PITS) IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING ING AND SEWERS, CESSPOOL E3 DRYWELL E] IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFC,RNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO -DISCONNECT PLUG AND RESIDE IN. THE ABC0qDES fR!8ED RESIftp!5TIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE OF PEQMrT BACKFiLL5EPTIC TANKS SEEP.PIT(S) [I CESSPOOLS VALIDATION <-CK--- M,O. CASH 9 0 WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent'to- self- insure, or a certificate of Workers'Compensation Insurance, or aazD a certified copy thereof (Sec. 3800, Lab C. `8°s HEV „,,,, APPLICATION FOR PERMIT Policy No. Company ❑ Certified copy Is hereby furnished, SEWER - SEWAGE DISPOSAL ❑ Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. Date Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING - STATION DEPTH COMPENSATION INSURANCE ADDRESS `° J J ! (This section need not be completed if the work involved by the MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100)or less,) ocALlry 'J ,r` t l i LOWER NEAREST - TYPE OF CONNECTION LENGTH FROM I certify that in the performance of the work for which this CROSS ST `i '(� j,f. rtiJ t Y. CURB RL. M.L.TO P L. permit is issued, I shall not employ any person in any manner ��jj RC.No. so as to become subject to the Wgrkers'Compensation Laws. OWNER i tfii',�Lr l .. CO.IMP.NO, JOB NO. ,y MAIL ,1 j TRUNK PERMIT NO. ROAD PERMIT NO. '^:rte :' /..` _.;'_.�,,,,.�-•y ..,.�t.-r ADDRESS ` �' I / V t Gv I V'''::.. 1 ---"-note - Applicant s. _ AFFIDAVIT WAIVER EASEMENT RECORD.INSTR NO. DATE NOTICE TO APPLICANT: if, after making this Certificate of clTv Pr"'r< L 4 J ' TEL.No. _1z t" e Exemption, you should become subject to the Workers' AL I Compensation provisions of the Labor code, you must forthwith DESCRIPTIION LOT No. HWY.ORST WIDENING comply with such provisions or this permit shall be deemed / y revoked. BLOCK .0 TRACT STATE ENCROACHMENT OF BLDGS, PERMIT NO. LICENSED CONTRACTORS DECLARATION ✓ �/ tJO. j SIZE OF LOT jam. �, 7S. ;} _) NOW ON LOT .) I hereby affirm that I am licensed under provisions of Chapter USE OF :j = 9 (commencing with Section 7000) of Division 3 of the Busi- BUILDINGS CHARGES ness and Professions Code, and my license is in full force and effect. CONTRACTOR CONNECTION CHARGE FEE License Number LiC.Class ADDRESS REIMBURSEMENT FEE per, WSTRICT NO. GROUP MAP PR .SSED Y O Contractor Date CITY 7 TEL NO. BK PG V ❑ I am exempt under Sec. of the L.A.CO. STATE TICp� P LICENSE NO. CLASS Plumbing Code and/or Sec. of the No. DESCRIPTION OF WORK FEE FINAL . V -HOUSE SEWER CONNECTING TO DATE VALIDATION LU PUBLIC SEWER B. 6 P. Code for the following reason SEPTIC TANK,SEEPAGE PIT OR >� e � N PITS AND!OR DRAINFIELD FINAL g" Z Date HOUSE SEWER CONNECTING TO BY PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG ORICONTRACTOR OWNER-BUILDER DECLARATION WORK To HOUSE SEWEROVERFLOW 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- ALTER REPAIR OR ABANDON HOUSE fee-ssisions Code): SEWER OR DISPOSAL SYSTEM L1 ,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 sole (Section 7044, Business and Professions Code). OWNERS Permit❑ 1, as owner of the property, am exclusively contracting with AUTHORIZATION TOTAL FEElicensed contractors to construct the project (Section 7044, i HAVE AT THIS DATE A CONTRACT WITH THE HEREIBusiness and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TCONSTRUCTION LENDING AGENCY ►I hereby affirm that there is a construction lending agency SIGNED THISDAY OF for the performance of the work for which this permit is OWNER OR OWNERS AGENT issued (Sec. 3097, Civ. C.). ADDRESS Lender's Name Lender's Address I certify that I have read this application and state 'hat 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 upon-t a above-mentioned property for inspection purposes. Signature of Permittee Dat6-J Datil-JSEE REVERSE FOR EXPLANATORY LANGUAGE