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HomeMy Public PortalAbout5807 ROSEMEAD BLVD_Sewer__ • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0010060002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL D: R / SEPTIC: S BUILDING ADDRESS: ON FILE EXIST OCC GRP: 5807 ROSEMEAD BL BLDGS. NOW ON LOT: TEMP CA 91780 ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 ORIGINATION: THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY LENGTH ML TO PL: STATION: DEPTH: TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON: 10/06/00 UT 04/05/01 COUNTY IMPROVEMENT NUMBER: OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE: CALAC INVESTMENT - JOB NUMBER: L 3709 TRUNK PERMIT NUMBER: [/< SAN DIEGO, CA9211137 ROAD PERMIT NUMBER: DESCRIPTION OF WORK AFFADAVIT: NO CAP 4 INCH SEWER PIPE (BREASE TRAP TO CATCH BASIN) WAIVER: NO APPLICANT: TEL. 0: EASEMENT: NO DART CONSTRUCTION CO (619) 561-0265- 9999 BLOSSOM VALLEY RECORD INSTRUMENT RECORD DATE: SPECIAL CONDITIONS: EL CAJON, CA HIGHWAY/STREE3;0-W E'3B. 1- � STATE ENC�1E,j� SER=�I ' CONTRACTOR: TEL. NO: �05 `" ErS_ yPA APPRO ALS DATE INSPECTOR SIGNATURE DENNIS DART DBA DART CONS. j.� 9999 BLOSSOM VALLEY RD. LIC. NO F ES ION• QUANTITY• OM': AMOUNT: EW HOUSE SEWER EL CAJON, CA 586402 B //01 P T I UA•0 FE, 27.75 CONNECT ADDITIONAL �R 00 EAC 30.45 BUILDING OR WORK ARCHITECT OR ENGINEER: E 0: 0 AL F� S 58.20 SEPTIC TANK, SEEPAGE PIT LIC. NO 1111111 AND/OR DRAIN FIELD DRYWELL SEWER MAP BOOK: PAGE: I TM(� n D ��C W O� ALTER, REPAIR, SEWER OR (l`%JJ MSEWAGE DISPOSAL SYSTEM LF ISCO NECT PLUG AND 0 ABANDON HOUSE SEWER ��_ISTBACKFILL SEPTIC TANKS O ElJ fSEEP. PIT _ CESSPOOL _ A ® ®5 GRAYWATER SYSTEM 46�• EloQ ie Service l'00' REPORT ID: DPR266 ROUTE TO BS0508 200055 DPW E89 WORKERS COMPENSATION DECLARATION of cons t6AG42D TION FOR PERMIT #)"nereby affirm that I hove a certificate of consent to self APPLICATION "insure, or a Ce,+i1!y°off(Sec 3800`l b Csotion Insurance, ar SEWER - SEWAGE DISPOSAL .'a certified COPY FMk� ,policy No ----��—_Componv ��?�`�� BUILDING AND SAFETY C Certified copy is hereby furnished. COUNTY OF LOS ANGELES a Is filed with the county building Inspectwn CONNECTION DATA (' Cert+fled COPY deQor+mern. FOR APPLICANT TO FILL IN DEPTH � i APPIIcant �: STATION NHO UPPER $a pore `� BUILDING tx owER t.,l ADDRESS J MANHOLE REFERENCE v CE IFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE - e TYPE CF CONNECT!UN LENGTH FROM .Air LOCALITY ' P L M L 70 P L (This seci,on need not be completed if the work involved 6y the Y Cuda NEAREST PC NO permit is for ane hundred dollars ($100)or less ) CROSS ST LOB NO cerci{y that in the performance of the work fer which this LEGAL o IMP No Pe in any manner DESCRIPTION LOT NO. ROAD PERMIT NO permit is issued. I shall not employ any P nsa tion Laws. TRUNK PERMIT NO SO as to become subject to the Workers' Compe BLOCK TRACT AFFIDAVIT WAIVER EASE MFNT RECORD INS?R NO DATE ASSESSOR PAGE PARCEL Date----Applicant_ MAPBOCH _ NO.OF BLDGS. Hwy OR ST WIDENING NOTICE TO APPLICANT: If, after making his heertifW©rkerrs' NOW ON LOT Exemption. YOU should become SUbjeCl 10 SIZE OF LCT c7ATE ENCROACHMENT Compensation provisions of the Labor code, you must forthwith usE OF PERMIT NO BUILDINGS comply with such provisions or this permit shall be deemed revoked .t C%NNER CHARGES LICENSED CONTRACTORS DECLARATION Os fMAIL I hereby affirm that I am licensed Under P ov's, 3 of the BUS` ADDRESS coNNECTION CHARGE FEE 9 (commencing with Section 7000) TEL No Hess and Professions Code, and m 1 license is .n full force and CITY RE MBURSEMENi FEE MAP PROCESSED BY y ROUP k effect `�1�C/ Gam- DIs?ac No By License Number G S��/S��__bc Class / CONTRACTOR �l 2 F Date--;� ADDRESS Contractorrl + "` TEL No VALIDATION O of the L.A.Co. CITY. L DATE I am exempt under Sec.______- STATE CLAS, DATE -J� +�y� Of the LICENSE NO U ✓ L /` ►— Plumbing Code and;or Sec._ OF WORK FEE NO. DESCRIPTION W a./ B. $, P Code for the following reason HOU`s.SEWER CONNECTING TO U) i P,;B;;C z SEWER Z Dale SEPTIC TANK SEEPAGE PIT OR _ PITS AND OR DRAINFIELD HOUSE SEWER CONNECTING?O SignaturePRIVATE D'SPOSAL SYSTEM OWNER-BUILDER DECLARATION CONNECT ADD TIONAL BLOC, OR WORK TO MOUSE SEWER I hereby affirm that I am exempt Pram the Contractor License OVERFLOW SEEPAGE PIT DRAfNFIE ID Low for the following reason (Secton 7031.5, Bvisness and Pro ex TN CESSPOOL ORIWELL,MANHOLE ALTER REPAIR OR ABANDON HOUSE feS5iOn5 Code)' r] I,as owner of the property,or my employees with wages as SEWER OR OIsPOSAL srsTEM their sole Compensation. will de the work and the structure r offered far sale (Section 7044, Business is not intended a and Professions Code) OWNER,$ Permit $ � r _ L] f,as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE licensed contractors to construct the project (SeciLon 7044, gU51ne5s and Profession' Code). ' AVE AT THIS DATE A CONTRACT W'TH .HE HEREIN NA PUBLIC EO SEWER TOR CONSTRUCTION LENDING AGENCY _0NNEC7 THE ABOVE O�EaCRIBED Ex'STING c W.nING o lending I hereby affirm that there is a construction agency SIGNET THIS DAY OF v for the performance of the work. for which this permit Is wNERrR issued (Sec 3047, Civ C i. nwNERs AGENT Lender'sLender's AddressAddress that— s— �— ta I certify that 1 have read III,_,a�ppfica+IOn and vv ht all Coutnty above Information is correct, I ree to comply ordinances and State laws regulating plumbing and Sewers, and hereby authorize representatives of this County to enter up�reof n the above-mentioned property for inspection purposes, , _ SEE REVERSE FOR EXPLANATORY IANGUAGE Date�,