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Home My Public Portal About9919 OLIVE ST_Sewer__ DEPARTMENT OF COUNTY ENGLNEER SEWER--SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION( COUNTY OF LOS ANGELES s WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS FOR APPLICANT TO FIL IN LOCALITY BUILDINGNEAREST ADDRESS G c CROSS ST. gr DISTRICT NO. SERIAL NO. j PERMIT NO. LOCALITY � yg;.,>3,.. �r:�-'4. a®�,J.-�, ;: S NEAREST CROSS ST. RECEIVED BY Ready for Inspection DATE ISSUED OWNER MAIL �' j "7— USE ZONE OCCUPANCY BK MAP PG AQORESS T r' CITY TELAO. CONTRACTOR CO.IMP.N0. ADORES S� JOB.NO. CITY TELAO. a TRUNK PERMIT NO. r7' REGISTRATION N0. STATE�X% COUNTY_ ROAD PERMIT NO. v. -DESCRIPTION LOT NO. STATE ENCROACHMENT _.- ------ PERMIT NO. BLOCK TRACT INDUSTRIAL WASTE APPROVAL SIZE OF LOT NO.OF BLDGS. CHARGES _ NOW ON LOT USE OF BUILDINGS .- -- CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO - -- �— PUBLIC_SEWER @ $ 3.50 RECEIPT NO. DATEi BY PHOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG .OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 — ALTER OR REPAIR EXISTING NO. DATE I BY SEWER OR DISPOSAL SYSTEM 1.00 + DISCONNECT AND ABANDON SEWER _ AND/OR DISPOSAL SYSTEM _ 1.00 + CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL -' SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE LOWER ITYPE OF CO NNECTIONLENGTH FROM OWNERS I _ PERMIT $ I I I 00 CURB P.L. M.L.TO P.L. AUTHORIZATION TOTAL FEE -- I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS.--... ......DAY OF._..../.L._— r-_.......19 NEW HOUSE SEWER J YJ d CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT... ' ` ' iSEPTIC TANK,SEEP.PIT(S) ADDRESS-:-.- . .... ._..1 AND/OR DRAINFIELD .—_ _. IT HERE ACKNOWLEDGE ATI HAVE READ THIS A?PLI- CESSPOOL C] DRYWELL 0 CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND DISCONNECT PLUG AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE RESCRIBED RESIDENTIAL PROPERTY. BACKFILLSEPTIC TANKS � SIGNATURE w SEEP.PIT(S)E] CESSPOOLS 0, PERMITTEE OF ✓ ' • - . '- .. - 76A642A 673 7/5 v& 3zt 1�Rs'CoMPE,NSATION DI t 14RA I ION CE$08°80) APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self SEWER-SEWAGE DISPOSAL insure, r_)r a certificate of Workers Compensation Insurance,or 'fl a certified copy thereof(Sec. 3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN CONNECTION DATA E3UILDItiG /yam STATION DEPTH ❑ ADDRE53 .' Certified copy is filed with the county building inspection - UPPER departrnent. LOCALITYMANHOLE REFERENCE LOWER Date_ Applicant licant NEAREST TYPE OF CONNECTION LENGTH FROM CLIkTiFICATE OF EXEMPTION FROM WORKERS' CROSS ST. f,. Y. CURB P.L. M.L. TO P.L. COMPENSATION INSURANCE �' P.C. NO. OWNER ir` .y 4'%fir CO. IMP, NO. JOB NO. MAIL (This section need not be completed if the work involved ADDRESS "� y TRUNK PERMIT NO. ROAD PERMIT NO. by the pctmit is for one hundred dollars ($100) or less.) C -4 4A.1ca y, ® P AFFIDAVIT WAIVER EASEMENT RECORD. INSTR.NO. DATE CITY Oy qs° T NO. L) I certify that in the performance of the work for which this LEGTtL permit is issued, I shall not ernploy any person in any manner DESCRIPTION LOT NO. L; HWY. OR 3T. WIDENING So sas to br;come subject to the Workers' Compensation Laws. � BLOCK TRACT STATE ENCROACHMENT Date Applicant NO. OF BLOGS, PERMIT NO. F SIZE OLOT NOW ON LOT NOTICE 'TO APPLICANT: If, after making this Certificate of SI � Exernption, you should become subject to the Workers* USE OF CHARGES BUILDINGS H' Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be CONTRACTOR -- CONNECTION CHARGE FEE deemed revoked. LICENSED CONTRACTORS DECLARATION ADDRESS:i REIMBURSEMENT FEE I hereby affirm that I it 171 licensed under prCTVE4fOIIS of Chapter r - D15TRtCT NO. GROuP MAI` PR OC' SSED BY conlmencin with Section 7000 of Division 3 of the Busi- ness CITYOf' " klTEL. No. `%� a ®K PG ness and Professions Code, and mylicenseis in full force and STATELIC. l y f LICENSE NO. e CLASS _ :P,<" ,°.y• 'Gi'. ^' - .. . effect. NO. DESCRIPTION F WORK FEE (/ HOUSE SEWER CONNECTING TO FINAL VALIDATION Lice,nse Number Lie.Class PUBLIC SEWER DATE SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR GRAINFIELD Contractor. Date _ FINAL HOUSE SEWER CONNECTING TO BY PRIVATE DISPOSAL SYSTEM I am exempt from the, licensing requirements as 1 am a CONNECT ADDITIONAL BLDG.OR licensed architect or a registered professional engineer WORK To HOUSE SEWER acting in my professional capacity (Section 7051, Bus- OVERT LOW SEEPAGE PIT, GRAINFIELD iness and Professions Code). E-'ITN„CESSPOOL,DRIWELL,MANHOLE ALTER,REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM Lic.or Reg.No. Date HOME OWNER-BUILDEIR DECLARATION I hereby affirm that I am exempt from the Contractor's OWNER`S �Pe,License Lave for the following reason (Section 7031.5, Susi- AUTI-IOF�IZATION nd Professions Code): I HAVE AT THIS OATS A CONTRACT WITH INE:HEREIN NAMEDCON- l'RACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I as owner of the property, will do the work and the TO THE PUBLIC SEWER. structure is not intended or offered for sale (Section SIGNED THIS DAY OF Is 7044,Business and Professions Code). OWNER OR "— OWNERS CONSTRUCTION LENDING AGENCY ADDRESS I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ-C.). 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 comply with all County ordinances and State laws regulating Plumbing and Sewers, and here authorize representatives x,t this County to enter upon the ove'rnentined pr I y for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Fzz Elf tiigna -re f Permittee Date WORKERS' COMPENSATION DECLARATION I hereby ?..ESfirYri that I have a certificate of consent to self 20-0,051 DPW 6189 msur,r, r,Ye a ceruf,cate of Workers' Compensation insur ince, or ICA64='� ;*6 certified copy thereof (Set 3800Lab APPLICATION FOR PERMIT Pcl,cy Cert;fled ropy is hereby furnished SEWER - SEWAGE DISPOSAL f.] Certified copy filed with the county building :aspect c COUNTY OF LOS ANGELES BUILDING AND SAFETY department. DateApplicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM 'WORKERS' BUILDING y �, !- r' �. �.E STATION DEPTH COMPENSATION INSURANCE aeo ess (This section need not be cornpleted if the work mvalved by tE,«> r MANHOLE REFERENCE hPPER LOWER permit is for one hundred dollars ($ip0; LOC'AL'rY : or 'es5.) ' certifythat in the performance of the work far which this NEAREST rr PE uF cCNNE 'o^� ENGTH FROM p C,90.,",- �`' C�JRB P L ML TOP L permit is Issued, i shall not employ any person in any manner -P. v LEC=A{. P, .JO so as to become subject I,) the War rs ,C-om P,,-w tion.Laws- DESCRiPrION LOi:NO. C0IMP NO 10B NO BLOCK TRACT TRUNK PERMIT 1:0 ROAD PERMIT NQ P.S&ESSOR �r AWDAVIT WAIVER EASEMENT RECORD INSTR NO, DATE NOTICE TO APPLICANT_ If, after making th s Certificate of mAP sooK PACE PARCE,. Exemption, you should become subject to the Workers' _e t`2 of BLDCs. Compensation provisions of the labor code, you must forthwith SIZE OF LOT '7 d. � NOW 0 EOr Hwv cR sr wiDENiNG comply with suet: provisions or this permit shall be deemed USE OF _ revoked. SUIL71NG5 -- }.qe6 - STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION PERMIT NO — 1 hereby affirm that I am licenseunder provisions of Chapter OWNER - 9 (commencing with Section 7GW. of Divis,on 3 of the Bust- Ualt. fjb '; HAar es Hess and Professions Cade, and and license is in full forte and aDDREss r'°, - effecf. Cir '" w " p ,r TEL Nr), ^5 2g G �� R CONNECTION CHARGE FEE License Number Lic.Class F1 REWBURSEMENT FEE —` C:OWTE9A(-TGF? .T ,p`',� :.„�,�T y'7C. �. Contractor Date DISTRICT NO GROUP h,`AP PROCESSED BV - —” ADDRESS L I am exempt under Sec. ____of the L.A. Co G _ } .� ,iG. /}t� -� = ! : mss ,. ' O IT-f TEL JO. (i'L Plurnbin.g Code and%or Sec. _ of the sTA:E �` V LII E.f`i5E IRCi. CLA WDAIE f1-A-TIA4TION z B. & P Code for the following reason No. DE.CRIPTION or tie PK FEE 4D'` 1 0 £ -PFR� NC ' f FINAL Gate i L SEWER ; {.� ,Z"•rte-Ge.iff':.*.r fly :.:`:u` f.a c --'._-_—..------- - W .fP l iAt K SEEPA'7f PI ;)R T }T, M rL Signature S At R C A NF1 iD �` �ignature _ HOUSE 9ERONNCTING TO DECLARATION PRIVATE �_ r�_-�AL I hereby affirm that i am exempt from the Contractor's License �r NNECT AD,I 13 AL BLhC; OR {� s.}}f� W09I TO SEWER •!'EEK :F !t•.� Law for the following reason !Becton 7031.5, Buisness and Pro- — fessians Code): OE2ROW SEEPAGE PITwDTAiNFIE.D DRY rtLrxN CEsr0i MANHOJ MARK a Ej I, as owner of the property,or my employees with wages as A'ER REP 7R A8 NDON HOu5E SEWEk OR ISPO.A!S,'STfM their sole Compensation,will do the work and the structure is net intended or offered for sale (Section 7044, Businessf'a j •"fit and Professions Code): 4I I'=, (1rLs r:, L I, as owner of the property, am exclusively contracting wit OWNER'S Permit $ � �� ; �?� � M licensed contractors to construct the project (Section 7044, Business and Professions Code', AUTHORIZATION CONSTRUCTION (ENDING AGENCY ',AVEA TRIS SATE a oNRA„TWITH Eery nAM�E "Kati R rD i - - ��ONNE-i'HE AB %F..ESC PiBEn r c S NC .W '4 T HE P„ - SEWER I hereby affirm that 'here Is a con5truttion lendin:a agent-, r., for the performance of the work for which this peirnit f? 7 „ slued {Sec 3097, Civ. C ). NED THIS AY( F �� —'v__ tie Lender's _. A„D E s y s -- lender`s Address—_ X Lender's certify that I have read this application and state thot +• - above infcrmation IS correct, I agree to comply with all Cciu l°., ordinances and E�S��tate laves regulon-.g Plumb ng and Sewe- , and hereby aut'stlj9ri7e repre Sentative a! this County t0 ntr*r upon e abav pPmT e4icined property fpr inspect on purFpose-, ^ _ p jtf Signature o e mif'ee _ -- ate SEE REVERSE FOR EXPLANATORY LANGUAGE I