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Home My Public Portal About9014 PENTLAND ST_Sewer__ lDEPAlCrMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1 "DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J FOX, COUNTY ENGINEER BUILDING !'� / ADDRESS 9'y 6�� /"—�=.� 7L Ae.-rO FOR APPLICANT TO FILL IN LOCALITY T C_ BUILDI NO NEAREST ADDRESS �A/f/ f tNTX.drA/ Sr7`/ CROSS ST e� S LOCALITY Tl �� 52eZ- !NA lF DISTRICT NO SERIAL NO PERMIT NO NEAREST --�j�—� A 5 'S L S CROSS ST �mla.ri�iap ✓��N ��// RECEIVED BY ReAOyfarIeeOeotlao iAT ,77) OWNER �� MAIL USEZONE OCCUPANCY ADDRESS fj9jYf� MAP BK PG CITY TEL NO CONTRACTOR �� /�TTiNa�ioti CO IMP NO ADDRESS r JOB NO CITY22, A. r/✓ TEL NO {� ❑ TRUNK PERMIT NO REGISTRATION NO g/Q l7/ 1�-=VY ROAD PERMIT NO LEGAL DESCRIPTION LOT NO -7 STATE ENCROACHMENT �/y pp PERMIT NO BLOCK TRACT p� INDUSTRIAL WASTE APPROVAL SIZE OF LOT NO OF SLOGS _y /i0 NOW ON LOT '✓ CHARGES USE OF / / BUILDINGS I �j�,lAre CONNECTION CHARGE FEE NO DESCRIPTION OF W K EE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE PUBLICSEWER S SSO HOUSE SEWER CONNECTING TO RECEIPT NO DATE BY I PRIVATE DISPOSAL SYSTEM 1 GO CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED WORK TO HO USESEWE R 100 ALTER OR REPAIR EXISTING N0 I DATE BY SEWER OR DISPO SAL SYSTEM 100 DISCONNECT AND ARAN D ON SEWER AND/OR DISPOSAL SYSTEM 100 CONNECTION DATA SEPTICTANK SEEPAGE PIT OR PITS ANO/OR GRAINFIELD 200 STATION DEPTH CESSPOOL—DRYWELL BP ECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE UPPER LOWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT $ 1 1 00 Y CURB PL ML TOP L AUTHORIZATION TOTAL FEE 3 L7 0 I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE gSjBLIC SEWER OWNERTHIS .,t `C_• DAY OF 19.2 NEW HOUSE SEWER OWNER OR CONN ECT ADDITIONAL OWNERS AGENT �' _ BUILDING OR WORN ADDRESS /d� _ SEPTIC/OR GRA SEEP PIT(S) y AND/OR GRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL[:] DRYWELL 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 HEWERS SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RES ENTIAL ROPERTY BACKFILL SEPTIC TANKS SEEP PIT(S)[] CESSPOOLS SO F1 �R EELS✓.1 76AO42D 663 1153 WORKERS COMPENSATION DECLARATION I hereby, dffirm that I have a certificate of consent to self .sure or a certificate of Workers Compensation Insurance or 7sAa2D a certified copy thereof (Sec 3800, Lab C j CE Bae(REV B/BI) APPLICATION FOR PERMIT Poli y No Company @s ❑ Certified copy Is hereby furnished SEWER - SEWAGE DISPOSAL ❑ Certified copy Is filed with the county building Inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY deparfinen n /� ' Date Applicant//A'/ / n., C.dX/G FOR APPLICANT TO FILL IN CONNECTION DATA RTIFICATE OF EXEMPTION FROM WORKERS BUILwwG COMPENSATION INSURANCE ADDRESS Amy til .9.va STATION --3.6 DEPTH 16 This section need not be completed rf the work Involved b the y • UPPER ( P Y / MANHOLE REFERENCE 112 �/ permit a for one hundred dollar ($100)or less ) LocnuTr i Elf .(E I certify that In the performance of the work for which this CRO SST TYPE OF CONNECTION LENGTH FROM v cuae PL ML TO PI permit Is issued I shall not employ any person In any manner so as to become subject to the Workers Compensation Lows OWNER J� L c0 IMP NO p2Q� JOB No w�� /�'C ADD a TRUNK PERMIT NO ROAD PERMIT NO Date / � Applicant �[�>'y�Q( ADDRESS lr i" dRb NOTIC TO APPLICANT If offer making this Certificate of CITY Oj TEL NO Zf�� y2) 3G 7)i AFFIDAVITWANER EA4MENi RECORD INSTR NO DATE Exemption you should become subject to the Workers LEGAi Compensation provisions of the Labor code you must forthwith DESCRIPTION LOT NO Hwy MST WIDENING comply with such provisions or this permit shall be deemed r O _ aJ—� revoked BLOCK TRACT M EJ STATE ENCROACHMEM OF&� PERMIT NO wKy LICENSED CONTRACTORS DECLARATION SIZE OF LOT Now ON LOT I hereby affirm that I am licensed under provisions of Chapter SSSS OF 63 O 9 (commencing with Section 7000) of Division 3 of the Busl BUILDINGS 111.e J CHARGES ness and Professions Code and my license Is In full force and effect CONTRACTOR �/¢!i� .( ��` CONNECTION CHARGE FEE T A'r/6r1� �- V"r License Nummbbe�r,,Owo / LIC Class ADDRESS /r}6/ /�'X (� f'f�� REIMBURSEMENT FEE Q Controcta//J--'�///��9 --"Dat. /~ �>� 5 CITY ,�//R��IF��TEI NO '7 rC714 DISTRICT NO GROUP MAP SSED BY V PG Z ❑ am exempt under Sec of the L A Co LICENSE NO CQ ^Q dj 9S O r NO DESCRIPTION OF WORK HE V Plumbing Code and/or Sec ohhe FINAL /�� VALIDATION d HOUSE SEWER CONNECTING i0 DATE PUBLIC SEWER B 8 P Coda for the following lBOSan SEPTIC TANK SEEPAGE RT OR N PITS AND/OR DRAINFIELD FIN Date HOUSE SEWER CONM{TING TO BY PRNATE DISPOSAL SYSTEM Signature WORK LO HOUR SEWER W OR A 6 0 8 5 A , OWNER-BUILDER DECLARATION OVERFLOW SEEPAGE PIT DRAINFIELD NH I hereby affirm that I am exempt from the Contractors License E%TN CESSPOOL oRvwEu MANHOLE - - # . �•� � � 0 Law for the following reason (Secton 7031 5 Buisness and Pro- ALTER REPAIR M AawDON HOUSE fessions Code) SEWER OR DL5POSAL SYSTEM I - - 27.50 ❑ I as owner of e property or my employees with wages as O Q 7 n their sole compensation will do the work and the structure 9 L tj Is not Intended or offered for sale (Section 7044 Business and Professions Code) OWNERS Perrnit E - ❑ j as owner of the property am exclusively contracting with AUTHORIZATION I TOTAL FEE licensed contractors to construct the project (Section 7044 I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO Business and Professions Code) CONNECT THE ABOVE EXISTING DIMMING TO THE PUBLIC SEWER CONSTRUCTION LENDING AGENCY pL ' I hereby affirm that there Is a construction lending agency SIGNED THIS DAY OF r CYl for the performance of the work for which this permit is NER A /9 ' Issued (Sec 3097 Civ C ) OWNERS GENT^ -- ADDRESS 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 hereby authorize representatives of this County to enter upon the above vaned prop ty for Inspection purposes Signature of Perm l free Dote v7— SEE REVERSE FOR EXPLANATORY LANGUAGE