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HomeMy Public PortalAbout5018-5026 ROSEMEAD BLVD_Sewer__ CE8082/70 PERMIT FOR SEWER 76A 642D COUNTY OF LOS ANGELES SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING (fj S ADDRES JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING y0. LOCALITY .�✓,L j,�r NEAREST FOR APPLICANT TO FILL IN CROSS ST. (PRINT OR TYPE ONLY) -."— --__--- LEGAL I DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT ADDRESS NO. OF OLDGS. SIZE OF LOT - NOW ON LOT CITY TEL. NO. USE OF - DISTRICT NO. GROUP CLASS 'AAP PROCESSED B,"BUILDINGS CONTRACTOR ADDRESS �� - - � CONNECTION DATA STATION DEPTH CITY NO - STATE LIC` MANHOLE REFERENCE - UPPER LICENSE NO. CLASS LOWER NO. DES•RIPT10N OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ S$.Do P.C.NO. SEPTIC TANK.SEEPAGE PIT OR PITS AND�OR DRAINFIELD Q 510.00 CO. IMP.NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. n' PRIVATE DISPOSAL SYSTEM @ S3.00 Q CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEM[NT RECORD.INSTR.NO. DATE U WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD • uJ J EXTN..CESSPOOL.DRY WELL.MANHOLE@ $5.00 - HWY.OR ST.WIDENING U' ALTER.REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ E3.00 _ STATE ENCROACHMENT >- PERMIT NO. Q INDUSTRIAL Cie WASTE APPROVAL O OWNERS PERMIT S '2 00 -- CHARGES < CONNECTION CHARGE FEE LLJ AUTHORIZATION TOTAL FEE _ I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING READ`CONDITIONS BELOW TO THE PUBLIC SEWER. SIGNED THIS DAY OF I9— THIS FORM WHEN PROPERLY MACHINE VALI- OWNER OR OWNERS AGENT DATED BELOW IS A PERMIT TO DO THE WORK ADDRESS DESCRIBED. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION Permittee is hereby authorized to install the work AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY as Shown, in accordance with provisions of Ordin- WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. once No. 2269 and related Ordinances. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR This permit becomes null and void if work is not cOm- LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF menced within 60 days from date of issuance, CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO OI if work is suspended at any time during con- RESIDE IN. THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. SIGNATURE Struction for a period of 120 days, or if any work is OF PERMrTTEE_ _ done on the said building Or Structure In violation Of the County Ordinances or State laws governing same. VALIDATION JACK R. ALLEN SUPERVISING MECHANICAL ENGINEER CK, M.O. CASH 2/70 76.A6A 642D APPLICATION FOR PERMIT 6 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION DING .�� / ® ^ JOHN A. LAMBIE, COUNTY ENGINEER r-7ESS ftiCOLEMAN W. JENKINS. SUPT. OF BUILDING /c el OCALITY G 0 FOR APPLICANT TO FILL IN CNEAREST ROSS ST. (PRINT OR TYPE ONLY) LEGAL DESCRIPTION LOT NO. .��J 4 (w� OWNER �'�/'" �- ' d /� BLOCK TRACT r/ �` f I TI '3 MAIL ADDRESS 50111-0 , L,,/ 1 7F it fF rj �© SP NO. OF BLDGS. SIZE OF LOT.J W ON LOT CITY TEL. NO. USE O BUILD NGS NGS DISTRICT NO. GROUP CLASS MAP BY DBKpS P�ROCES;kE CONTRACTOR �vdiivV �. c� ADDRESS CONNECTION DATA CIT STATION $'�!J f DEPTH ST TE IC UPP LICENSE NO; GLASS MANHOLE REFERENCE ""7 y�+) - LOWER NO. .DES ON OF WORK FEE TYPE OF CONNECTION, ` 9 •! LENGTH FROM ' HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWERS .0000 SEPTIC TANK.SEEPAGE PIT OR P.C.NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ S3.00 CLCL CONNECT ADDITIONAL BLDG.OR -'0}'� AF ,DAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE U WORK TO HOUSE SEWER @ $3.00 6V OVERFLOW SEEPAGE PIT.DRAINFIELD , ✓ 'v M I�'�v [_ EXTN..CESSPOOL.DRYWELL.MANHOLE @ $5.00 HWY.OR ST.WIDENING cALTER.REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM 53.00 STATE ENCROACHMENT iU PERMIT NO. Lu INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT s o0 AUTHORIZATION TOTAL FEE b CONNECTION CHARGE FEE 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 DAT INSPECT R'S SIGNATURE SIGNED THIS f DAY OF (2.e/{' 197 n /� OWNER OR NEW HOUSE SEWER t/ d..n— OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.PITS) I HEREBY 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 AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REO BY OS ANGLES COUNT AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR T AT I M H L OWNER O AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ROVE ES R NTIA ROPE RTY. ABANDON HOUSE SEWER SIGNATURE OF PERMffTEE Aq BACK ILL SEPTIC TANKS El Ell SEE P�T(SI ❑ CESSPOOLS VALIDATI NJACK R. ALLEN ° SUPERVISING MECHANICAL ENGINEER CC M.O. VC4SH l r a ? 5 OCT 1 1 ° 13.00- r 606 19-63 6A642D - APPLICATION FOR PERMIT 7 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL so DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 1 JOHN A. LAMBIE, County Engineer ADDREss �, WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO. OWNER Ile Aef _.t MAIL BLOCK TRACT L�� 'r-j,_=I3 ADDRESS NO. OF BLDGS. i SIZE OF LOT / NOW ON LOT CITY TEL. N USE OF BUILDI DISTRICT NO. GROUP MAP PROLE ED BY K PG CONTRACTOR /? �+ •� / ;� ADD s '/ JC.OL�NNECTIObN DATA CITY _ TEL. NO. /' �✓ / STATION Y Q DEPTH / w� /K� // ❑• STATE MANHOLE REFERENCE UPPER " REGISTRATION `� � ...! ❑ COUNTY a NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTIO LENGTHROM . HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO L. } PUBLIC SEWER @ S5.00 SEPTIC TANK.SEEPAGE PIT OR P C NO. O D�OR DRAINFIELD @ $10.00 CO. IMP. NO. JOB NO. PITS ANU HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ S3.00 ^ CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD. INSTR. NO. DATE 0 WORK TO HOUSE SEWER @ S3.00 SV• OVERFLOW SEEPAGE PIT.DRAINFIELD E XTN.,CESSPOOL,DRYWELL.MANHOLE @ S5.00 ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT z PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT S z 00 CHARGES AUTHORIZATION I TOTAL FEE B L CONNECTION CHARGE FEE '1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSP CTOR-S SIGNATURE SIGNED THIS DAY O 19_ OWNER OR NEW HOUSE SEWER •� �,� OWNERS AGENT • 11- Q CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) IHEREBY ACKNOW LE GE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE OVE IS CORRECT AN AGREE TO COMPLY WITH ALL COUNTY INANC ES AND STAT LAWS REGULATING PLUMBING AND SEW J$ CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIF �T AT I AM O ERL REGISTERED AND/OR ALTER.REPAIR,SEWER OR LICENSED AS REQ RE B LOS AN OUNTY AND STATE OF SEWAGEDISPOSAL SYSTEM CALIFORNIA OR T T A THE LEG ER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE O S RIB E NTI PROPERTY. ABANDON HOUSE SEWER SIGNATURE OF PERMITTBACKFILL SEPTIC ANKS ❑ E SEEP,PIT(S) El CESSPOOLS ❑ 1 I VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH 9 7 0- -;&n J 42 -; n Xe,;1d DEPANVAENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES r WILLIAM J. FOX, COUNTY ENGINEER f BUILDING �,,� ` r ADDRESS 1 1\10 . '-:f"tY�F'-c! FOR APPLICANT TO FILL IN LOCALITY �� BUILDING ADDRESS �-� a NEAREST Cp ,s ( � 1 CROSS ST. P(. LOCALITY -` DISTRICT NO. p A SERIAL NO. PERMIT NO. NEAREST r� 2-).4 — S CROSS ST. OWNER RECEIVED BY Ready for Inspection DATE ISSUED `t MAIL A-� ADDRESS USEZONE I OCCUPANCY BK MAP PG CITY TEL.NO. - _ I CONTRACTOR "`111 CO.IMP.N0. ADDRESS e JOB N0, CITY c TEL.NO. ,_l /�—1 TRUNK PERMIT N0. STATE REGISTRATIO NO. S` a El COUNTY ROAD PERMIT N0. LEGAL DESCRIPTION LOT NO. STATE ENCROACHMENT PERMIT NO. BLOCK TRACT INDUSTRIAL WASTE APPROVAL SIZE OF LOT NO.BF BLOGS. NOW ON LOT CHARGES USE OF BUILDINGS CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE PUBLIC SEWER c@ $ 3.50 RECEIPT NO. I DATE I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLD(I.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPA-1 If 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 CESSPOOL—DRYWELL STATION DEPTH SPECIAL CONDITIONS ONLY 1�,r1 ae.1 2.00 Z 0 G MANHOLE REFERENCE UPPER LOWER TYPE OF CONNECTIONLENGTH FROM OWNERS PERMIT $ I 00 Y. CURB P.L.- M.L.TO P.L. AUTHORIZATION I TOTAL FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE SIGNED THIS......-.............DAY OF........................................19-..,-,-- NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT----............-•........................................................... BUILDINGORWORK ADDRESS....................................... SEPTIC TANK,SEEP.PIT(S)- AND/OR DRAINF'ELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL 1 DRYWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR d + REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM _ 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG PLUGAND AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE VES RtBED ESIDEN 31AL PROPE TY. BACKFILL SEPTIC TANKS� SIGNATURE t�.,11 SEEP.PIT(S)� CESSPOOLS OF PERMITTEE- - - -- 76A642D 663 1/53 WORKERS'COMPENSATION DECLARATION I hereby affirm that ) have'a certificate of consent to self insure, OF•a t�ertificat6 of Workers'Compensation I'nsurante, or 76A642D a certified copy thereof (Sec. 3800, ab C.) 92-0002 DPW 6/88 APPLICATION FOR PERMIT Policy No TZ ompaIn ❑ Certified copy is hereby furnished. SEWER'- SEWAGE DISPOSAL Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY Datede artmennttt.. LLYY —q�l,y Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTI N FROM WORKERS' rRE ING COMPENSATION INSURANCE ESS/` STATION DEPTH (This section need not be completed if the work involved by the LITY P MANHOLE REFERENCE LUPPER OWER permit is for one hundred dollars ($100)or less.) I certify that in the performance Of the work for which this EST TYPE OF CONNECTION S ST. LENGTH FROM permit is issued, I shall not employ any person in any manner Y CURB P.L. M.L.TO P.L. so as to become subject to the Workers'Compensation Laws. P.C.NO. ER CO.IMP.NO. JOB NO. TRUNK PERMIT NO. ROAD PERMIT NO. Date Applicant ESS (n yYI",-,S NOTICE TO APPLICANT: If, after making this Certificate Of AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE S TEL.NO. Exemption, you should become subject to the Workers' ALCompensation provisions of the labor code, you must forthwith IPTION LOT NO. HWY.OR ST.WIDENING comply with such provisions or this permit shall be deemed revoked. K TRACT STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION NO.OF BLDGS. PERMIT NO. F LOT NOW ON LOT I hereby affirm that I am licensed under provisions of Chapter F9 (commencing with Section 7000) of Division 3 of the Busi- INGS CHARGES ness and Professions Code, and my license is in full force and effect. 2 //T 1 //1• /,, CONTRACTOR - o 1 Co CONNECTION CHARGE FEE License NumberC[C1 Lic.Clas4_-�� �l TT—/W ADDRESSREIMBURSEMENT FEE Contractor )J _Date V 1 () DISTRICT N GROUP MAP ROCESSE BY CITY \) YtCA TEL.NO. �S �� ❑ I am exempt under Sec. 5 of the L.A.CO. STATE No. 3 CLIL 4C U� �• BK PG n- NO. DESCRIPTION OF WORK FEE O Plumbing Code and/or Sec. of the \ FINAL U HOUSE SEWER CONNECTING TO DATE VAL1 ATIOQ Of B. & P. Code for the following reason PUBLIC SEWER SEPTIC TANK,SEEPAGE PIT OR O PITS AND/OR DRAINFIELD FINAL 14 1 Date OUSE SEWER CONNECTING TO BY LLJ � � PRIVATE DISPOSAL SYSTEM Sianatur_ A ,Q �lal�^!l l CONNECT ADDITIONAL BLDG.OR O NER-BUILDER DECLARATION WORK TO HOUSE SEWER z I hereby affirm that I am exempt from the Contractor's License EO TN.,CESSEPOEpOL,DRYGE WELRAIMAN OLE Law for the following reason (Secton 7031.5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE }j fessions Code): SEWER OR DISPOSAL SYSTEM .til ❑ I,as owner of the property,or my employees with wages as A :CT,g their sole compensation, will do the work and the structure I 33 is not intended or offered for sale (Section 7044, Business ,t �►7 ,ti4o and Professions Code). OWNERS Permit $ ITEMS ❑ 1,as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE ]TO y r/y�licensed COn1rOC10fS 10 construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAME TRACTI OTAL 34m50 Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. -yCONSTRUCTION LENDING AGENCY L•HECK ,�+i .501Ihereby affirm that there is a construction lending agency SIGNED OWNER ORHIS DAY OF 1 ® `.itAi€f c ol`I for the performance of the work for which this permit is OWNERS AGENT rTi�[t1JG issued (Sec. 3097, Civ. C.). A /D�C Lender's Name 'y G ADDRESS 0 0 1001 9+ 90 Lender's Address �} � (� e ;i 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 up above-mentioned property for inspection purposes. r Signehure of Perm ttee DateSEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'CQMPENSAJION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation InsuFance,^'or- 76A642D a certified 92-0002 DPW 6,66 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 3'a1-Gb Applicon FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING t COMPENSATION INSURANCE ADDRESS STATION DEPTH (This section need not be completed if the work involved by the LOCALITY MANHOLE REFERENCE UPPER OWER permit is for one hundred dollars ($100)or less.) I certify that In the performance of the work for which this NEAREST TYPE OF CONNECTION LENGTH FROM CROSS ST. permit is issued, I shall not.employ any person in any manner Y CURB P.L. M.L.TO P.L. so as to become subject to the Workers'Compensation LOWS. P.C.NO. OWNER CO.IMP.NO. JOB NO. MAIL Date Applicant ADDRESS TRUNK PERMIT NO. ROAD PERMIT NO. NOTICE TO APPLICANT: I_ g CITY TEL.NO.f, after making this Certificate of AFFIDAVIT [WAIVER EASEMENT 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 DECLARATION NO.OF BLDGS. PERMIT NO. I hereby affirm that I am licensed under prSIZE OF LOT NOW ON LOTovisions of Chapter USE 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• i �1�sq y CONTRACTOR �(' .t CONNECTION CHARGE FEE License Number Q71 ' Lic.Class--C 3lD -C-� C ( y� Q r� ADDRESS ��vL� v\1 REIMBURSEMENT FEE COnfraGiOi-•�'1'L Date --� oL•�� ly 4BY MAP PROC ED BY CITY Y�w /�iy TEL.NO.aI•O G J, `0 / B PG ❑ I am exempt under Sec. of the L.A.Co. STATELICENNO. t7�� ` qq.3 LIC.CLAG — NAL Plumbing Code and/or Sec. of the NO. DESCRIPTION OF WORK FEE FINAL HOUSE SEWER CONNECTING TO VALIDATI N Cn B. &P. Code for the following reason PUBLIC SEWER SEPTIC TANK,SEEPAGE PIT OR o PITS AND/OR DRAINFIELD Date HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG.OR - OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD 01 1 hereby affirm that I am exempt from the Contractor's License EXTN.,CESSPOOL,DRYWELL,MANHOLE Law for the following reason (Sectan 7031.5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE j,1) fessions Cade): SEWER OR DISPOSAL SYSTEM ❑ I,as owner of the property,or my employees with wages as ACCT A their sole compensation, will do the work and the structure 73:0.7 34.50 is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER'S Permit $dCONTRACTOR 1 ITEMS ❑ I,as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE TOTAL 34 . 2050 licensed contractors to construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED4.�Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUCHECK 34u50 CONSTRUCTION LENDING AGENCY �tI hereby affirm that there is a construction lending agency SIGNED THIS DAY OF CHANGE .00 for the performance of the work for which this permit is OWNER OR OWNERS AGENT issued (Sec. 3097, Civ. C.). ++�ryy�y ry �ry ADDRESS L•1000-0001 3/21/90 Lender's Name S: Lender's Address 9616 1 AM 8:2'3' 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 obo me ed property for inspection purposes. Signature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE