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Home My Public Portal About5829 ROSEMEAD BLVD_Sewer__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS �8568-9804Z4UOO BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL D: SEE / SEPTIC: TR: 3623 LT: 105 EXIST OCC GRP: 5829 BLDGS. NOW ON LOT: TEMP CA 917801832 ASSESSOR INFORMATION B CONNECTION TYPE: NEAREST CROSS STREET: HERMOSA 5387-012-018 ORIGINATION: THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY LENGTH ML TO PL: STATION: DEPTH: TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: -PROCESSED 8 EXPIRES ON: PEPE'S RESTAURANT 04/24/98 UT 04/24/99 COUNTY IMPROVEMENT NUMBER: OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL B CODE: RUSSI, JOE (626) 286-3055- JOB NUMBER: 5829 ROSEMEAD BLVD. TRUNK PERMIT NUMBER: ' TEMPLE CITY ROAD PERMIT NUMBER: AF FADAV I T: NO ;ti :P Tr,` -1`,r,«r,twNi - . EW R WAIVER: NO APPLICANT: TEL.-NO: EASEMENT: NO SAME AS OWNER RECORD INSTRUMENT_NBR.:- RECORD DATE: SPECIAL CONDITIONS: HIGHWAY/STREET.-WIDENING:=-_ :' ', STATE ENCROACHMENT;PERMIT�-NUMBER:.-:-� CONTRACTOR: TEL. NO: ;� F E5,'.PAI,D•�. APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO FEE•DESCRIPTION: QUANTITY: UOM: `''�° AMOUNT: NEW 0 SE SEWER 01'PERMIT ISSUANCE FEE r' `�'� 27.75 CONNECT ADDITIONA 03 CONN TO PUBLIC SEWER 1.00 CON �` 46.95 BUILDING OR WORK ARCHITECTOR ENGIN R: EL. NO: TOTAL FEES 0 74.70 THE GUTIERREZ PARTNERSHIP (714) 598-1518- - SEPTIC TANK, SEEPAGE PIT 404 LEMON AVE #7 LIC. NO: - AND/OR DRAIN FIELD WALNUT, CA 91789 C-15523 RYWEL SEWER MAP BOOK: PAGE: ALTER, REPAIR, SEWER OR SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND ABANDON HOUSE SEWER BACKFILL SEPC TAN5 SEEP. PIT CESSPOOL GRA WATER SYSTEM REPORT ID:-MZ66 --- `ROUTE Tbf: SS0508 WORKERS'COMPENSATION DECLARATION " I f ereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, or 76n642D a certified copy thereof(Sec. 3800, Lab C.) 92-0002 DPW Was APPLICATION FOR PERMIT Policy Ncv._Compony ❑ 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 TP FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING STATION DEPTH COMPENSATION INSURANCE ADDRESS ( p e work involved by MANHOLE REFERENCE This section need not be completed if the the LOCALITY UPPER LOWER permit is for one hundred dollars ($100)or less.) - NEARE I certify that in the performance of the work for which this ROSS ST TYPE OF CONNECTION LENGTH FROM permit is issued, I shall not employ any person in any manner Y arae P,I. M.L.TO P.L. " P.C.NO, so as to become subject to the Workers'Compensation Laws. OWNER CO.IMP.NO. JOB NO. MAIL TRUNK PERMIT NO. ROAD PERMIT NO. Dat Z>I� Applicant y trzarlx /�r r�,m; ADDRESS AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL.NO. Exemption, you should become subject to the Workers` Compensation provisions of the Labor code, you must forthwith DESCRIPTION LOT NO. comply with such provisions or this permit shall be deemed HWY.OR ST.WIDENING revoked. BLOCK TRACT STATE ENCROACHMENT / LICENSED CONTRACTORS DECLARATION NO.OF BLDG5. PERMIT NO, SIZE OF LOT NOW ON LOT I hereby affirm that I am licensed under provisions 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 �s effect. - CONNECTION CHARGE FEE �;, ,.�, CONTRACTOR'� � , 3 V �License Number C 0d55 /J� L' ' T<' ADDRESS -, d //t ' REIMBURSEMENT FEE ' C aM11raYTd7� CITY ys TEL.NO. DISTRICT NO. GROUP MAP PROCESSED BY BK PG ❑ i am exempt under Sec. —of the L.A.Co. STATE LICENSE No. /y aASs !� �' �� „ _� LQ Plumbing Code and/or Sec. of the NO. DECRIPTION OF WORK FEE FINAL f HOUSE SEWER CONNECTING TO DATE \ VALIDATION (A PUBLIC SEWER ✓' B. 8 P. Code for the following reason SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD FINAL �—...� .... Date n HOUSE SEWER CONNECTING TOPRIVATE BY L SYSTEM Signg7ur,, �✓ = CONNECT ADDITIONAL LDG.OR \/ OWNER-BUIU6ERVtLARATION WORK TO HOUSE SEWER I hereby affirm that i am exempt from the Contractor's License OVERFLOW ELDRAI ETNCESSPO ,DRYGE WELMANHOLE Law for the following reason (Secton 7031.5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE fession.S Code): SEWER OR DISPOSAL SYSTEM - ❑ 1,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure t b sr is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER'S Permit $ 00 ❑ 1,as owner of the property, am exclusively contracting with AUTHORIZATION TOTAL FEE �, v licensed contractors to construct the project (Section 7044, HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONT ACTOR TO Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency SIGNED THIS DAY OF 19_ ► Y{i ii;". : ; ; for the performance of the work for which this permit is OWNEROWNERS AGENT issued (Sec. 3097, Civ. C.). ADDRESS Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. 1 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 inspecttion/purposes. -51y Signature of Permrtt Dote SEE REVERSE FOR EXPLANATORY LANGUAGE