The URL can be used to link to this page

Home My Public Portal About5031 SANTA ANITA AVE_Sewer__ I hereby affirm that 1 have a certificate of consent to self insure/or a certificate of Workers'Compensation Insurance, or ;3AG42D a certi(ie co thereof Sec. &->,'lab C. ex-WOW DPW 8/88 Policy N6� PY ,Company ) APPLICATION ROM PEItAAI _ SEWER . SEWAGE DISPOSAL ❑ Certified copy is hereby furnished. a + , ertified copy is filed withthe c din inspection �f COUNTY OF LOS ANGELES BUILDING AND SAFETY department Date tb 3-010 Applicant R APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILD&G STATION r-- - DEPTH COMPENSATION INSURANCE AD E55 (This section need not be completed if the work involved by the !i'•- "NHOLE REFERENCE --- LOWER permit is for one hundred dollars($100)or less.) L Lm TYPE OF CONNECTION LENGTH FROM I certify that in the performance of the work for which this il` CR oss sT. - Y. CURB P.L. M.L.TO P.L. permit is issued, 1 shall not employ any person in any manner k;�_ 'P.C.NO. so as to become subject to the Workers'Compensation Laws. OWNER r Co IMP.NO. JOB NO. MAL Date Applicant (I' ADDI RESS O C Ant. L TRUNK PERMIT No. ROAD PERMIT No. 11 AFFIDAVIT WAIVER EASEMENT RECORD:HNSTR:NO. ---DATE -NOTICE TO APPLICANT: If, after making this Certificate of CITY A� TEL NO. - t Exemption, you should become subject to the Workers' Compensation provisions of the Labor code,you must forthwith . DESCGIR LEGAL LOT NO. HWY.OR Sr.WIDENING j 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 off irm that I am licensed under provisions of Chapter y a OF _ 9 (commencing with Section 7000) of Division 3 of the Busi- 1, BUILDINGS CHARGES ness and Professions Code, and my license is in full force and H�r e- CONNECTION CHARGE FEE effect. n CONTRACTOR a + License Number 3 Lic.Class l 3�O ADDRESS eV3REIMBURSEMENT FEE -- IDISTRICT NO. OUP LIMP PROCESSED BY 0 Contra cto Date %Ib�3�� 6 CITY 1N>N CAC TEL. 0. - S PG ' �• STATE . �f/rJ - ❑_I am exempt under Sec. of the L.A.Co. LICENSE IJO. — — CtUCA55 GR40 1W Plumbing Code and/or Sec. of the No. DESCRIPTION OF WORK FEE flNAI Cn HOUSE SEWER CPUBLIC SEWER ONNECTING TO a/' DATE I t ACCT.1LIDATION !/�- B. 8 P. Code for the following reason �' SEPTIC TANK.SEEPAGE PIT OR FINAL I4 PITS AND/OR DRAINFIELD Date qLA HOUSE SEWER CONNECTING TO BY 37 [I[I PRIVATE DISPOSAL SYSTEM •T•�►.t Sianatu r. CONNECT ADDITIONAL BLDG.OR 1 / 1 T I L1 i OWNER-BUILDER DECLARATION ,1 WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT,DRAINFIELD �r�y�rw` �.-y�-•� I hereby affirm that I am exempt from the Contractor's License J.. EXTN.,CESSPOOL,DRYWELL,MANHOLE (/ - TOTAL I F1L. s uV Law for the following reason (Secton 7031.5,Buisness and Pro- ALTER.REPAIR OR ABANDON HOUSE �+y �L (� fessions Code): SEWER OR DISPOSAL SYSTEM _ Mr, 56.00 ❑ I,as owner of the property,or my employees with wages as CkAHLE v[R[I their sole compensation,will do the work and the structure - ' is not intended or offered for sale (Section 7044, Business Permit $ and Professions Code). OWNERS - _ - ( Q-Q�Q1 1�� 3� � El 1.as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE eO _ p A� licensed contractors to construct the project (Section 7044, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO - O -1 FR I $:011 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 1 SIGNED THIS DAYOF 19_ for the performance of the work for which this permit is ,;, OWNERS OWNER OR issued(Sec. 3097,Civ. C.). ADDRESS Lender's Name RON - 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 represent tives of this County to enter - upon the above-ene do ed per for inspection purposes. f: r Signature of Permittee Date SEE REVERSE FOR EXPLANATORY LANGUAGE 6A 6420 -CE808-10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS ri rL LOCALITY27;� 414?/co_ FOR APPLICANT TO FILL IN NEAREST ^'I/e CROSS ST. / �J LEGAL DESCRIPTION LOT NO. _ OWNER MAIL BLOCK TRACT - ADDR �" NO. OF SLOGS. l./ SIZE OF LOT _ /,' - NOW ON LOT CIL Do T NO. USE OF DISTRICT N0, GROU. -_P AP ..2@SiCESSED 8Y BUILDINGS -_ _ PS ` 40NTRACTOR ,�i I i ADDRESS CONNECTION DATA CITY TEL. NO. STATION DEPTH STATE LIC MANHOLE REFERENCE UPPER LICENSE NO CLASS LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER 0 $7.00 -- SEPTIC TANK,SEEPAGE PIT OR P.C.NO. PITS AND/OR ORAINFfELD $10.00 CO.IMP.NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. 6. PRIVATE DISPOSAL SYSTEM $3.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER I EASEMENT RECORD. INSTR.NO. DATE u WORK TO HOUSE SEWER $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD OC EXTN..CESSPOOL.DRYWELL, 0 $5.00 HWY.OR ST.WIDENING ALTER.REPAIR OR ABANDON HOUSE F'- SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT W MANHOLE $7 OO PERMIT NO. IL -- INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ 3 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE- -j 1 j�' 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 DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS-- BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY -- --- WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL Cl DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS UNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNE F. AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE VE SCRIBED RESID NTIA PROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ❑ SEEP.PIT(S) ❑ CESSPOOLS VALIDAfMN CK. M.O. t,-CASH ' J '6A 6420 -CE808 -10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FADDRESS ING LITY -��EST —�FOR APPLICANT TO FILL IN S ST. LEGAL DESCRIPTION LOT NO. � OWNER MAIL BLOCK TRACT �� '��. 'j ADDRESS +:ate+ ✓�� NO. OF BLDG$. SIZE OF LOT X a✓ "G' NOW ON LOT CITY TEL. NO. 7 I c g 4 USE OF UP BK MAP P PROCESSED BY BUILDINGS y � - -�' DIS TRICT NO. GRO CONTRACTOR /� -- 7-k- 13 :T ADDRESS _-,T'�/i, �f"`- % � /�/f]� CONNECTION DATA LTi >✓�� ' "�'—'_ � CITY TEL. STATION" _t._.yDEPTH} 5 CENSE NO: ��',�� j �� " GiLASB i- MANHOLE REFERENCE �^�y' - UPPERLI ' �, NO.. DESCRIPT ON OF W RK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO 1 Y. CURB P.L. M.L.TO P.L. - C.'' PUBLIC SEWER 0 $7.00 I tA, '' 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. J PRIVATE DISPOSAL SYSTEM $3.00y- � O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wAIVEN tAS EXExr RECORD. INSTR.NO. DATE V WORK TO HOUSE SEWER $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD 09 EXTN..CESSPOOL.DRYWELL. $5.00 HWY.OR ST.WIDENING O ALTER,REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM $3.00 _ STATE ENCROACI�ME r ,iV C MANHOLE 0 $7 00 PERMIT NO. W d INDUSTRIAL WASTE APPROV - Z OWNERS PERMIT $ 5p S, C NGES AUTHORIZATION TOTAL FEE 6 CONNECT CHA ff Ff d� i-MENT FEk` I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBU � TRACTOR UB CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APP -VALS c�` ;9. DATE PECTOR'S SIGNATURE TO THE PUBLIC SEWER. S/(IGJy�6THIS/ -- DAY OF 19_ /NER OR """-""-'-`_C C!'el�,.['�,, NEW HOUSE SEWER �y, OWNERS AGEN T ADDITIONAL ADDRESS BUILDING OR WORK , a SEPTIC TANK,SEEP,PIT(S) ✓ ., 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION i ./ AND/OR DRAINFIELD AND STAT, THAT THE ABOVE IS CORRECT AND AGREE 70 COMPLY -_— WITH �((U[ COUNTY ORDINANCES AND STATE LAWS REGULATING �e— PLUMB G AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSEQ AS REQUIRE BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CA LlFORNIA OR THAT AM THE LEGAL OWNER OJ- C ND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE ABO RIBED RE NTIALPERTY, ABANDON HOUSE SEWER _ �` SIGNATURE BACKFI SEPTIC TANKS OF PERMITTEE _ SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION CK. M.O. CASH i, , 0 w I