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Home My Public Portal About6142 ROSEMEAD BLVD_Sewer__ 3a E-663 - 6 APPLICATION FOR PERMIT 1 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER _ADDRESS i� -- CASSATT D. GRIFFIN. SUPT oP BUILDING LOCALITY CIL FOR APPLICANT TO FILL IN NEAREST GROSS ST_ �y;��' LEGAL DESCRIPTION LOT NOIC OWNER BLOCK TRACT +y..�y', �/} - MAIL ADDRESSNO - f- 1 +y NOWOONBLOTS - ----- I' SIZE OF LOT a'k, S- CITY P� TEL. ' -6-UEILDINGS '� .DISTRICT NO. j GROUP MAP eK PG CONTRACTOR CONNECTION DATA CITY ADDRESS�, .. 7E._ v ,^=jL,y• ------ ---- ---- ---. _ STATION " DEPTH vc,� L. NO, MANHOLE REF'ERENCEy ----_ .-------UPPER` — TATE REGISTRATION N0. f '�' 0 _ L COUNTY NO._!_ D ESC Ii-I P ION OF Nf� FEE - -- -------- -- --- '- - -- --'---- --'— - TYPE OFC CTION LENGTH FROM I HOUSE SEWER CONNECTING TO - -- -__. PUBLIC �$_0 _SEWER--- ----._ _ I pis' --- C ,�r7-----N.L.TO P.L. _ Lam_ - --- SEPTIC TANK SEEPAGE PIT OR _ PITS AND/OR DRAINFIELD_ _ (0-D $3.00_I_ OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO, EXTN.,CESSPOOL.DRYWELL.MANHOLE fn, $2.00 i CO. imp. I'40.�I�.. � .JOB NO. - -- - --- ---- - ._.— --- _ - I kOUSE SEWEP CONNECTING-TO ...• . �PR VATE DISPOSAL SYSTEM r $1.00 TRUNK PERt,�T7 NO. _ --_ ROAD PERMIT NO..<.� I CONNE11 CT ADDITIONAL BLDG.OR �.j WORK TO HOUSE ER r. I TATE EN CROA+'HMLtvT __ $9_CO PERMIT NO _ l AL ER,REPAIR OR ABANDON HOUSEINDUSTRIAL -------� - -------- SEWER OR DISPOSAL SYSTEM Q $1.00 � --_--_� -. --- WASTE APPROVAL �^- CHARGES CONNECTION CHARGE FEE- OWNER'S PERMIT $ I _I 00 - — ------- —. —' - --- --- —'--r -- REIMBURSEMENT FEE' AUTHORIZATION TOTAL FEE APPROVALS I Dn7E - I INSPECTOR-SSIGNATURE [ HAVE A7 THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING.TO THE PUBLIC SEWER. yp NEW HOUSE SEWER SIGNED THIS "_ DAY OF19 _ CONNECT--- ADD17[ONAb OWNER ORBUILDING OR WORK OWNERS AGEN .'' "'�`- -v'a:.Y"'i -SEPTIC TANK,SEEP,PIT(S) -- '-- E kk ADDRESS li ,i� d;..✓e:S'cr to+'�'YG,wV -.., 1-' AND/OR GRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL D DRYWELL L'i AND STATE THAT THE' ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING _ALTER;REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR :DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND��ScTATE OF ABANDONItOUSESEbYER -�_ CALIFORNIA OR THAT � AM THE LEGAL,.GLW I`YER OF I UL AB,�y ----� - - SEWER -._- S R[$ED RE7E PROPT.Y a 4 BACKFILL SEPTIC TANKSr• � ,� Ilk1, „ > e `-.'. eP . SEER.P PIT( Ll CESSPOOLS[1 _-- F PERMITTEI 4 ------- - --- I i [OHN A. LAMBIE.COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PL.BG. INSPECTOR CK. Pi l d�f ,1 WORKERS'COMPENSATION DECLARATION •1 hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, or 7eA8420 a Certified copy the eof„(Sec. 3800, La C 92-0002 DPW s.-88 A , -f� ,,.. :� �� ;; APPLICATION FOR PERMIT Policy-No. ompany ❑ 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 L A', Applicant `.st i r' 'p ' FNEAREST ) FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' / C.. ? t STATION DEPTH COMPENSATION INSURANCE AD ,SS (This section need not be completed if the work involved by thet / MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100)or less.) 1 (-.� LOWER certify that in the f% i'7 TYPE OF CONNECTION LENGTH FROM y performance of the work for which this . C a Y. CURB P.L. V..L TO P.L. permit is issued, I shall not employ any person in any manner Jy -� p so os to become subject to the Workers'Compensation laws. OWNER � �\ ` ids CO.IMP.NO. los No. MAIL . ROAD PERMIT NO. Dote, Applicant ADDRESS NONCE TO APPLICANT: If, after makingthis Certificate of y AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE CITY TEL.NO. Exemption, you should become subject to the Workers' LEGAL Compensation provisions of the Labor code, you must forthwith DESCRIPTION LOT NO. HWY.OR$T.WIDENING comply with such provisions or this permit shall be deemed revoked. BLOCK TRACT STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION NO,OF BIDGS. PERMIT NO. SIZ€.OF LOT NOW ON LOT I hereby affirm that I am licensed under provisions of Chapter USE aF 9 (commencing with Section 7000) of Division 3 of the Busi- BUI(DINGS CHARGES ness and Professions Code, and my license is in full force and effect. CONTRACTORC” ?a tC CONNECTION CHARGE FEE License Number � ,0^> ic.Class ADDRESS - "�. C I �, ,_. � � �� .� REIMBURSEMENT FEE 12 a��8 ` yt�_ rr�` DISTRICT NO. GROUP MAP PROCESSED BY Z Contractor J � ' .. J V Date .M. CITY _ TEL.NO. � x t - BK PG 0 ❑ dam exempt under Sec. of the L.A.Co. LICENSE NO. r ciAss Plumbing Code and/or Sec. of the NO. DESCRIPTION OF WORK FEE FINAL Q„ HOUSE SEWER CONNECTING TO / DATE ,e 6 e VALIDATION 0 B. 8 P. Code for the following reason PUBLIC SEWER ! Lf Z SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD FINAL Dare By HOUSE SEWER CONNECTING TO PRIVATE DISPOSALSYSTEM Signature. a CONNECT ADDITIONAL BLDG.OR OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD I hereby affirm that I am exempt from the Contractor's License EXTN.,CESSPOOL DRYWELL MANHOLE Low for the following reason (Sectors 7031.5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE fessions 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 is not intended or offered for sale (Section 7044, Businessf� and Professions Code). OWNERS Permit $ El 1,as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE 2 -:, licensed contractors to construct the project (Section 7044, I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO .Rte` Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. CONSTRUCTION LENDING AGENCY I herebyaffirm 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 issued (Sec. 3097, Civ. C.). OWNERS AGENTADUREss'w � Lender's Name 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. Signature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, or 78A642D a certified Eopy tf o Sec. 3800, C. ) 92-0002DPW 6/88 APPLICATION FOR PERMIT Policy Noompany_'`Et 'rr tt; is hereby furnished. S ❑ Certified copy EWER - SEWAGE DISPOSAL i- ❑ Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY d7parttm nl.t, Date AppIicont_,. ._JtJq, �.-- "" FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' FDESCRIFTION ING - 3 p STATION DEPTH COMPENSATION INSURANCE ESS L (This section need not be completed if the work involved by the MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100)or less.) LITY f IL • LOWER I certifythat in the performance of the work for which this ST TYPE OF CONNECTION LENGTH FROM P ST. � f-�"�. + � Y. C11R8 P.L. M.l.TO P.L. permit is issued, I shall not employ any person in any manner } r y'so as to become subject to the Workers Compensation Laws. R , \ 4 Er7t,E / �s�-v`'k��rr'"'L��h" CO.IMP.NO. JOB NoDateApplicant ESS MAIL •I % '- TRUNK PERMIT NO. ROAD PERMIT NONOTICE TO APPLICANT: If, after makin this Certificate ofp_ AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE g � f�r rEL.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 deemedrevoked. TRACT STATE ENCROACHMENT NO.OF BLDGS. PERMIT NO. LICENSED CONTRACTORS DECLARATION 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, CONTRACTOR // E CONNECTION CHARGE FEE CL License NumberLIC.Class- ADDRESS F (e1 'A' > REIMBURSEMENT FEE ((( Contractor ) i rG� } �� DISTRICT NO. GROUP MAP PROCESSED BY Z " if Date f` 1 A s,a r^Fc & //�� e "> , r - CITY v. f� i.. v!TEL.NO. `�.-.� '-.. ;�"�+. BK PG - Q ElI am exem t under Sec. of the L.A.Co. STATE LIC. P LICENSE NO. i., (,r .!" CLA55 � e, �� CJ � � `�r NO. DES RIPTIONOFWORK FEEUJ Plumbing Code and/or Sec.T of the FINAL 6 -HOUSE SEWER CONNECTING TO 1 DATE ,�' VALIDATION CP1 PUBLIC SEWER - - B. & P. Code for the following reason SEPTIC TANK,SEEPAGE PIT OR L � PITS AND/OR DRAINFIELD FINAL F Date HOUSE SEWER CONNECTING TO BY ,. PRIVATE DISPOSAL SYSTEM Signature CONNECT ADDITIONAL BLDG.OR OWNER-BUIL ER DECLARATION WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD hereby affirm that I am exempt from the Contractor's License EXTN.,CESSPOOL,DRYWELL,MANHOLE Low for the following reason (Secton 7031.5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE z 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 sole (Section 7044, Business and Professions Code). OWNER'S Permit $ ❑ i,as owner of the property,am exclusively contracting with AUTHORIZATION 1 TOTALFE licensed contractors to construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR 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 y�— �.��"� 19�°„=%= for the performance of the work for which this permit is OWNER OR » R - issued (Sec. 3097, Civ. C.). OWNERS AGENT �' ADDRESS Lender's Name Lender's Address I Certify that 9 have read this application and state that the _ owve information is correct. I agree to comply with all County v`. a• " ordinances and State laws regulating Plumbing and Sewers, and hereby authorize representatives of this County to enter t" upon r. p he above-mentioned property for inspection purposes. Signature of Permittee i Date SEE REVERSE FOR EXPLANATORY LANGUAGE i<; WORKERS'COMPENSATION DECLARATION .I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, or easa2D a certified co th eof Sec. 3800, L b )2-DD02 DPW 6/88 Policy.No. 0Y ��'._ (Sec, y- r �� - Oji, APPLICATION FOR PERMIT ❑ Certified copy is hereby furnished. SEWER - SEWAGE DISPOSAL ❑ Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY depar nt w Dote - L_Applican4 � ,�£� �° �' �� FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING <' COMPENSATION INSURANCE ADDRESS ` STATION DEPTH (This section need not be completed If the work involved by the MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100)or less.) LOCALITY l t LOWER NEAREST TYPE OF CONNECTION LENGTH FROM I certify that in the performance of the work for which this CROSS ST. '; permit is issued, I shall not employ any person in any manner Y culls P.L M L.TO P.l__ P.C.NO. so as to become subject to the Workers'Compensation LOWS. OWNER - r: CO.IMP.NO. JOB NO. MAIL ' ,; !u" TRUNK PERMIT NO. ROAD PERMIT NO, Date Applicant ADDRESShs: yyy�� NOTICE TO APPLICANT: If, after making this Certificate of CITY �. :a AFFIDAVIT WAIVER EASEMENT RECORD INSTR.NO. DATE Exemption, you should become subject to the Workers' ' '" i TEL.NO. l 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. 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 effect. �. CONTRACTOR �; (, ,Cl CONNECTION CHARGE FEE /ti License Number " Lic.Class ADDRESS ,� r^-,. ; f< REIMBURSEMENT FEE Z DISTRICT NO. GROUP MAP PROCESSED BY Contrar_tor ,� fay } —1S L_ Date_ J l•< ? C%, d CITY ,: TEL.NO. ❑ i am exempt under Sec. of the L.A.Co. BK PG p STATE NO.. +., „Y lit. C rill CLASS -� s G" NO. DESCRIPTION OF WORK FEE P �dN to lumbing Code and/or Sec. of the FINAL Ll: HOUSE SEWER CONNECTING TO �' DATE. VALIDATION PUBLIC SEWER B. 8 P. Code for the following reason SEPTIC TANK,SEEPAGE PIT OR z PITS AND/OR DRAINFIELD FINAL Date HOUSE SEWER CONNECTING TO BY Tyrtol PRIVATE DISPOSAL SYSTEM Signature Ike£```` r E 1 CONNECT ADDITIONAL BLDG,OR OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER ► I hereby affirm that I am exempt from the Contractor's License EOXTNFLOC SSPOOL,DRYEEPAGE WELR,4INFIELD MANHOLE Law for the following reason (Secton 7031.5, Buisness and Pro- ALTER,REPAIR OR ABANDON HOUSE fessions Code): SEWER OR DISPOSAL SYSTEM -•- ❑ 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, Businessla and Professions Code). OWNERS Permit S �� ❑ I, as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE licensed contractors to construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO I t+ e Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. CONSTRUCTION LENDING AGENCY SIG r 1410 I hereby affirm that there iso construction lending agency NED THISDAY OF _ for the performance of the work for which this permit is OWNER OR t' t, OWNERS 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 inspection purposes. Signature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'COMPENSATION DECLARATION .1 hereby affirm that 1 have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, or ' "D a certified cop n dor(sec. 3800, .y j 9 �o1DPW 6 88 APPLICATION FOR PERMIT Policy-No. ✓ ompany ❑ Certified copy is hereby furnished. SEWER » SEWAGE DISPOSAL ' ❑ Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY deparn cknj Date' J. �.', C, Applicant_ '�.� t' Lim� FOR APPLICANT TO FILL IN CONNECTION DATA �t r, ' CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING COMPENSATION INSURANCE ADDRESST. '1 U3 " STATION DEPTH (This section need not be completed if the work involved by the MANHOLE REFERENCE UPPER permit is for one hundred dollars($100)or less.) LOCALITY LOWER I c,�rtif that in The NEAREST I TYPE Of CONNECTION LENGTH FROM y performance of the work for which this CROSS ST. Y. CURB P.L M.L.TO P.L. permit is issued, I shall not employ any person in any manner -- so as to become subject to the Workers'Compensation Laws. ry I P.C. NO. p OWNER :"V' CO.IMP.NQ JOB NO. MAIL I j TRUNK PERMIT NO. ROAD PERMIT NO, Date Applicant ADDRESS J ictn NOTICE TO APPLICANT: If, after makin this Certificate Of �, AFFIDAVIT WAIVER EASEMENT RECORD.INSTR NO. DATE g CITY {''' /" L.NCI. Exemption, you should become subject to the WorkersLEGAL 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 PERMIT NO. LOT SIZE OF LOT NOW ON LOT 1 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 effect. `�� . CONTRACTOR CONNECTION CHARGE FEE License Number L' "'Lic.Class Jp� P , ADDRESS 4`iTEL.N, ' ,,.- .,y REIMBURSEMENT FEE ITY a S Contractor < ' \_ raV Date _7 �'' C T-7O ,a ..,`� DISTRICT NO. GROUP MAP PROCESSED BY Z BK PG ❑ I am exempt under Sec. of the L.A.Co. SHOE DESCRIPTION CLASS U p LICENSE NO CLASS _ .�e'"/ r.' ',:✓a";,a'=-a -,G Plumbing Code and/or Sec. of theOF WORK FEE FINAL �' C: HOUSE SEWER CONNECTING TO DATE _ VALIDATION B. z & P. Code for the following reason PUBLIC SEWER / i �, — SEPTIC TANK,SEEPAGE PIT OR FINAL PITS AND/OR DRAINFIELD Date HOUSE SEWER CONNECTING TO BY y PRIVATE DISPOSAL SYSTEM 1 Signature cf j, I �'Y fL::r" . s' ? CONNECT ADDITIONAL BLDG,OR OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD I hereby affirm that I am exempt from the Contractor's License EXTN.,CESSPOOL,DRYWELL,MANHOLE Low 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 sole (Section 7044, Business and Professions Code), OWNER'S Permit $ �� K (_] 1,as owner of the property, am exclusively contracting with AUTHORIZATION TOTAL FEE 'j` ? licensed contractors to construct the project (Section 7044, HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO ¢ Business and Professions Code). CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER . CONSTRUCTION LENDING AGENCY f, hereby affirm that there is a construction lending agency SIGNED THIS f^` DAY OF e 19 ► w for the performance of the work for which this permit is OWNER OR Issued fOWNERS AGENTSec. 3097, Civ. C.). - - - ADDRESS Lender's Nome ^,- 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. Signature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE