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Home My Public Portal About6149 RENO AVE_Sewer__ 1808 5-65 6A642D APPLICATION FOR PERMIt COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 101IN A. LAMPIE, County Engineer ADDRESS -b no COLEMAN W� JLNKINS,Supt. of Building ADDRESS R E LOCAL:T E, NEAREST CR�Sdi. CSO SS ST. FOR APPLICANT TO FILL IN DESCRIPTION LOT OWNER J, h e el MAIL BLOCK TRACT ADDRESS Q BLO GS, SIZE OF LOT NOW ON LOT CITY Tora��jl,e i TEL. N USE OF .y DiSTRIC NO. Gj MAP PROjjESSED BY BUILDINGS-- SK PG CONTRACTOR a CONNECTION DATA ADDRESS 293�i �E.S_..BY CITY STATION TEL. NO. 444-2020 2-Q LICENSE CJJ It LOWER -'"70 LASS -'j-q,4, NO. MANHOLE REFERENCE NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTI4 FROM 1 SEWER CONNECTING TO Y. P.L. M.L.TO P.L- ; aa $ 5.001 IC SEWER. P.C.NO. 1 SEP(i�TANK SEEPAGE PIT OR JOB NO. 1 PiTS ANDOR DRA!NFIELD $10.000-------I CO. IMP. NO. 0 HOIUSE SEWER CONNECTING TO l TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISP05AL SYSTEM $ 3.00� CONNECT ADDITIONAL BLDC3. OR WAIVER EASEMENT RECORD, IN5TR.NO, 0 WORK TO HOUSE SEWER $ 3,00� -X ---T`A1-rTA7-R EpW—OR—ASAq-DON HOUSE SEWER OR DISPOSAL. SYSTEM F1 $ 3,00 U HWY.OR ST.WIDENING 14.11 LLX=,CESSPOOL, 1AAN!jCL.E -"Ooi Q. STATE ENCROACHMENT $ 5.OG PERMIT NO. z I PERCOLATION TEST INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT $ 2 00 0 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I -- I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON, REIMBURSEMENT FEE TRACTOR. TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER, APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS—DAY OF—_—, __19 OWNER OR NEW HOUSE SEWER II N OWNERS AGENT .CONNECT ADDITIONAL SU I LDI NG OR WORK ADDRE5S--�_ == SEPTIC TANK.SEEP,PIT(S) H I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND ND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD WITH ALL. COUNTY ORDINANCES AND STATE LAWS REGULATING CESSPOOL DRYWELLPLUMBING AND SEWERS. [ 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 CALIFORNIA OR ZTHAT I AM T HE LEGAL OW E R0 F AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE ABOVE DESCRIBED RE�'. NTIALr ROPERTY, ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS EOF PERMITTEE SEEP.PIT(S) [I CESSPOOLS C] C�VALIDATION K ' M.O. CASH :5 7EI-0 A,B27 -1- 7.0 rj'- WORKERS' COMPENSATION DECLARATION ti 1 hereby affirm that I have a certificate of consent to self 20-0051 DPW 6/69 insure, or'a teNif,i!ate of Workers' Compensation Insurance, or 76A642D a certified copy thereof ISec 3800, Lob C.) APPLICATION FOR PERMIT Policy -Cornpany.-,----____ Certified copy I% hereby furnished. SEWER - SEWAGE DISPOSAL Certified copy is filed with the county building Inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. Date Appi co nt FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' -TATION ,I/1/-3 1� RT,E-C,NG ;6 DEPTH COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved by the MANHOLE REFERENCE permit is for one hundred dollars I$1001 or less.) LOCALITY LOWER I certify that in the performance of the work for which th NEAREST TYPE OF CCN-NtCjIPN LENGTH FROM is CROSS ST, f• CUP" P L M I TOPL permit is issued, I shalt not employ any person in any manner LECA] P NO so as'a become subject to the Workers'Compensation Laws. IDESCRIPTION LOT NO CO POP NO JOB NO Date—Applicant.._ BLOCK TRACT TRUNK PERMIT NO ROAD PERMIT NO ASSESSOR AFF EASEMENT RECORD IN$TR NO DATE NOTICE TO APPLICANT: if, offer making t�;s Certificate of MAP BOOK =1AGI PARCEL Exemption, on, you should become subject to the Workers' NO.OF B;-DGS, Compensation provisions of Ihe Labor code, you must forthwith SIZE OF LOT NOW ON LOT HWY OR ST WIDENING comply with such provisions or this permit shall be deemed USE OF revoked. BUILDINGS STATE ENCPOACHMENT PERMIT NO LICENSED CONTRACTORS DECLARATION _ I hereby affirm that I am licensed under provisions of Chapter OWNER 9 (commencing with Section 7000) of Division 3 of the Busi- MAIL Z/7 ness and Professions Code, and m)!license is in full force and ADDRESS CHARGE,) 6.'-3� ��ONNECTION CHARGE FEE effect. CITY TEL NO License Number —0c, Class— REIMBURSEMENT FEE CONTRAC11ORDISTRICT NO GROUP VAP PRC<"ESSED f,�,r Contractor Date ADDRESS BK PG El I am exempt under Sec. of the L.A.Co. CL CITY TEL_NO -Z L" 0 Plumbing Code and/or Sec. of the STATE LJC frIAL 0 ]LICENSE Na, CLASS CoATIF VALIDATION Z B. & P. Code for the fohowing reason NO. DESCRIPTION OF WORK FEE f 0 HOUSE SEWER�'QNNECIING TO `�NAL l'- Dote, PUNIC SEWER BYQ SE PTIC TANK SEEPAGE PIT OR UJI Signature-- P TS AND OR DQAINFIELD CL OWNER BUILDER DECLARATION HOUH SEWER'ONNE(-PNG TG —...-PRIVA"DISPOSAL SYSTEMz � I hereby affirm that 1 am exempt from the Contractor's License �:ONNFCT ADr1J!CNAi B(C)C, OP N111. Low for the following reason (Secton 7031 5, Buisness and Pro- WORK TO HOLE SEWER fessions CodeDRASNfIftC )� C-XIN" '01 EI.i. MANHOLE ALTER!RE AIR OR ABANDON HOJSE as owner of the property, or my employees with wage-,ci�s Y OR - - 3 their sole compensation, will do the work and the structure is not intended or offered for sole (Section 7044, Business and Professions Code). I,as owner of the property, am exclusively contracting with $ OWNER'S hCen5ed Contras ars to construct the project (SeChon 7044, 1 Permit $ Business and Professions Code). AUTHORIZATION I TOTAL FEE 11'CONTRA I I CONSTRUCTION LENDING AGENCY I HAVI A' TH ss `ATE A CONRACWITH THE HEREN NAMED r-CONTPACTTOR TU-� P I'i�I I hereby affirm that there is a const!'LiChOn lending agency CONNECT rH1 ABOVE DFSCP1EED EX;ST:NGi)%AEL0t.G TO THF PUBU( SEWER for the performance of the work to, which this perrria 1- 7 issued (Sec. 3097, Civ. C.) SIGNED THIS '9 OWNER OR __DAV(-)F 19 Lender's 0 WNERS AGE NT—___ ADDRESS Lender's Address--- — I certify that I hove 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-mentioned property for Inspection purpose,,,, Signature of Per y t Date A SEE REVERSE FOR EXPLANATORY LANGUAGE