The URL can be used to link to this page

Home My Public Portal About6223 RENO AVE_Sewer__ E808 12-68 6A 6420 �� vAPPLICATION Fd"pz_ COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION Bo'LDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY 4"' NEAREST 7 FOR APPLICANT TO FILL IN CROSS ST.,� LEGAL DESCRIPTION LOT NO. OWNER A rya MAIL BLOCK — TRACT NO. OF BL GS. ADDRESS j- D SIZE OF LOT NOW ON LOT CITY '.r NO. USE OF P 0 BY BUILDINGS DISTRICT NO. GROUP MAP -=pc S ,By HK PG CONTRACTOR--) ADDRESS jz� '�"-7' f-2 . ' CONNECTION DATA CITY S7 I STATION DEPTH STATE ✓ L,fc UPPER NO; CLASS MANHOLE REFERENCE LICENSE WE ----;WORK FEE NO. DESCRIPTION OF TYPE OF ICTION LENGTH FROM r I — NO. SEWER CONNECTING TO Yp jn� P.L. M.L.TO P.L. zo PUBLIC EWER SEPTIC TANK.SEEPAGE PIT OR I. PITS AND/OR DRAINFIELD @ $to No- I CO.IMP.No JOB No, HousSEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ S3.00 1 935-4,9 --l–CONNECT 0- ADDITio�i-A-L BCc5G.o-R-----T---- WAIVER IIAIEOINT RECORD.INS c:) ......4 WORK TO HOUSE,SEWER @ $3.00 TR,NQ. DATE I OVERFLOW EXTN-,CESSFOOLORYWELL.MANHOLE $5,00 I ALYER.REPAIR OR ABANDON HOUSEHWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM ENCROACHMENT ge PERMIT NO, cn INDUSTRIAL WASTE APPROVAL OWNER7S---T MIT 2i 00 CHARGES C AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED 'MED CON- REIMBURSEMENT FEE TRACTOR TO.CONNECT THE ABOVE DESCRIBED EXISTING DWELLING To THE PUBLIC SEWER. APPROVALS _DATE fill SF/ECT WASIGNATURE SIGNED THIS OWNER OR NEW HOUSE SEWER OWNERS AGENT I CONNECT ADDITIONAL .1 ADDRESS BUILDING OR WORK SEPTICTAN I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR D K.SEEP,PIT(S) AINFIELD AN STATE THAT THE ABOVE IS CORRECT AND AGREE To COMPLY ___R WITH ALL COUNTY ORDINANCESAND STATE LAWS REGULATING PLUMBING ING AND SEWERS.,- CESSPOOL 0 ORYWELL ❑ IHE REBY CERTIFY 4kAT J,'AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR LICr LICENSED ASlgV LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA M THE LEGAL OWNER/'6F. AND INTEND TO ITI,, DISCONNECT PLUG AND RESIDE IN, THE,,#BOVF DFSCRIBED;RESI/Dr-T�AV'PROPERTY. ABANDON HO USESEWER SIGNATURE ? OF PERMrTT BACKFILL SEPTIC TANKS SEEP.PIT(S) El CESSPOOL ,—rLMATION JACK R. ALLEN SUPERVISING MECHANICAL. ENGINEER (a�' Cl M.O. CASH c- 4 we 'ORKERS'COMPENSATION DECLARATION `" •( irm that I have a certificate of consent to self certificate of Workers'Compensation Insurance, or 7eA642D c certified copy thereof(Sec. 3800, Lab C.) CE 808(REV.8%81) APPLICATION FOR PERMIT Policy No.-Company� CJs ❑ 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' F BUILDING F'§ ', .; .�r.. .�. STATION ' " ,i> .� DEPTH 60 i COMPENSATION INSURANCE ADDRESS G (This section need not be completed if the work involved by the '�"' MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100)or less.) ocaurY `}`x` C ER NEAREST TYPE OF CONNECTION I certify that in the performance of the work for which this cRoss sr. �' '�'� � LENGTH FROM permit is issued, I shall not employ any person in any manner Y. UR P.L. M.L.TO P L. so as to become subject to the Workers'Compensation Laws. �. a - Y PC No OWNER b CO.IMP.NO. JOB NO. MAIL9 Date — � u __Applicant Y,`'T � �`�f�• S� �'�"`"' ADDRESS �h � ��,j TRUNK PERMIT NO ROAD PERMIT NO. NOTICE TO APPLICANT: if, afte making this Certificate of CITY ,. TEL.NO. � AFFIDAVIT WAIVER EAS8MEN1 RECORD.INSTR NO. DATE Exemption, you should become subject to the Workers' LEGAL Compensation provisions of the Labor code, you must forthwith DESCRIPTION LOT NO. HWY.OR ST.WIDENING comply with such provisions or this permit shall be deemed revoked. BLOCK TRACT STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATIONNO.OF BLDGS. PERMIT NO, C I hereby affirm that I am licensed under provisions of Chapter SIZE OF LOT NOW ON LOT GSE of 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 } a License Number Lic.Class ADDRESS REIMBURSEMENT FEE O Contractor Date CITY TEL.NO. DISTRICT NO. GROUP MAP ESSED BY U BK PG Z ❑ I am exempt under Sec. of the l.A.Co. STATE LIC. ✓ O p LICENSE NO. CLASS �/! _. ii' „ NO. DESCRIPTION OF WORK FEE PJ - V Plumbing Code and/or Sec. of the FINAL VALIDATION W. O HOUSE SEWER CONNECTING TO DATE - �. %. B. & P. Code for the following reason PUBLIC SEWER - / r ! Z SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD F1NA Le `% Date HOUSE SEWER CONNECTING TO fiY ,/! ,r� - ✓' /j PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG.OR - OWNER-BUILDER DECLARATION I WORK TO HOUSE SEWER OVERFLOW 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 fessions Code): SEWER OR DISPOSAL SYSTEM I, 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 and Professions Code). OWNERS Permit 11) AUTHORIZATION � 2 55 3 a 8 A ❑ I,as owner of the property,am exclusively contracting with TOTAL FEE licensed Contractors to construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO .a Business and Professions Cade). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency SIGNED THIS DAY OF 19_ for the performance of the work for which this permit is OWNER OR OWNERS AGENT 2 1, 5;C,' issued (Sec. 3097, Civ C. ADDRESS Lender's Name — "JAt _ Q U< F£ 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-mentioned;property for inspection purposes. SC dture of P6 mittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE