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Home My Public Portal About5551-5551 1/2 SANTA ANITA AVE_Sewer__ iHR842;D APPLICATION'E:808 I I_S7 . . FOR PERMIT - 1 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING IOHN A. LAMBIE, County Engineer —ADDRESS '- ------ - --_-_----- --- - -- __.__� _. CASSATT D. GRIFFIN, Supt of Building LOCALITY FOR APPIJCANT TO FILL IN NEAREST ROST.--- LEGAL -- ----- ----- ---- DESCRIPTION LOT NO. OWNER BLOCK — TRACT J ,` ,., ,. MAIL -- ! ADDRESS . NQ.OF BLDGS. - SITE OF LOTNO'W ON LOT CITY. TEL.NO. U5E OF BUILDINGS _ N0. GROUP MAP CONTRACTOR ._� ��'�� ADDRESS CONNECTION DATA CITY EL,N0. STATION - DEPTH ° --- �_--_ STATE MANHOLE REFERENCE - - �'' UP R REGISTRATION N0, _ [] COUNTY •.� LOWER NO. E DES(RIPTION OF WORK _FEE HOUSE SEWER CONNECTING TO ,6 �_ PUBLIC.SEVIER C $$,50 ��: _ - SEPTIC TANK,SEEPAGE PIT OR 1YPE OF CONNECTION LENGTH FROM PITSA_ND;OR DRAINFIELD @ $3,00 ' � CURB P,L. M.L.TO P.L. OVERFLOW SEEPAGE PIT,DRAINF'IELD - EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 HOUSE SEWER.CONNECTING TO P. C.NO. - PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO. 'ON NECT ADDITIONAL.BLDG.OR WORK TO HOUSE SEWER @ $1.00 �-- tf:0. TRUNK.PERMIT NO.41y�,")/S YROAD PERMIT N0.' ALTER,REPAIR OR ABANDON HOUSE i SEWER OR DISPOSAL SYSTEM @ $I.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL H OWNER'S PERMIT _ t OO CONNECTION CHARD �- AUTHORIZATIOIVTOTAL FEE REIMB NT EEE k I HAVE AT THIS DATE ACONTRACT WITH THE HEREIN NAMED CON• ,-II TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING , APPROV � -Ta ":.:' NSPECTQP S SIGNATURE,> TO THE PUBLIC SEWER. SIGNED THIS—----DAY aF �—_ l9.__ NEWS ous OWNER OR - CONN CT A RA.L OWNERS AGENT---- BUILD G OFF'ORK r __ ADDRESS -. SEPTIC ANI(, __- - AND/OR. RAIN] I HEREBY ACKNOWLF,DGE THAT I HAVE READ THIS APPLICATION *•°' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL - DRYWELL[II�� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.,REPAIR,SEWER OR PLUMBING AND SEWERS. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORSEWAGE DISPOSAL SYSTEM --------- LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND. STATE OF DISCONNECT PLUG AND ABANDON HOUSE CALIFORNIA OR THAT I AM THE LEGAL..QWNER OF THF, AB ABA_. _ DESCRIBED RESIDENTI&k-fg'�RTJ, ��,, , t'✓ BACKFILL SEPTIC TANKS ❑ -_ SIGNATURE f _._�— ------- SEEP.PIT(5) ❑CESSPOOLS ❑ OF P6RM'TTEE ' .; t .F '�....,'. - r� rL..... . )a 1 VALIDATION ROBERT A. WOOL? SUPERVISING MECHANICAL ENGINEER -91 i" f' d, APPLICATION FOR PERMIT DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBiE, COUNTY ENGINEER CASSATT D. GRIFFAN, SUPT OF BufLoir4G LOCALITY I EAREST T F R APPLICANT TO F � ILL IN ROSS S . LEGAL _.DESS7_i PT)_GN LOT N0. OWNER BLOCK TRACT MAIL ADDRESS SIZE OF LOT NOW ON LOT NO. OF BLDGS. I CITY TEL NO. USE O -'------ -----— ---- --F BUILDINGS DISTRICT NO, GROUP MAP BKPG CONTRACTOR :_ 5,_/-:: x CONNECTION DATA ADDRESS STATION DEPTH CITY TEL. NO, MANHOLE REFERENCE UPPER 'Dj STATE REGISTRATION NO. L— I COUNTY NO, ; DESCRIPTION OF WORK FEE ------- I r -P -u E SETYPE OF CONNECTION LENGTH FROM ') 5 SEWER CONNECTING NG TO PUBLIC SPA ER @ $3.5_q Y, -CURB P-A- TO P,L SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRA 1NF iELD $3.100 OVERFLOW SEEPAGE PIT, DRAINFIELD F. C_ NO. EXI N..CESSPOOL,DRYWELL.MAN L OLE iEw. 5 2,00 C.J. 1 M P, NO..--- JOB NO, HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM S 1.00 TRUNK PERMIT NO. kUAD FF.R.MIT ND Ni ADI)ADDITIONAL ULDG. OR STATE ENCROACHMENT _C__T- .—TI c-N B- _IAIORK TO HOUSE- S5W-ER PERMIT_NO. ALTER,—T EPA)R OR ABANDON HOUSE: INDUSTRIAL SEWER OR DISPOSAL SYSTEM 1.0c WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT 11 oQ I -_ ____._1 ------ REIMBURSEMENT FEE AUTHORIZATION I TOTAL FEE I HAVE. AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON"- APPROVALSL SATE P6 FG CT } _gS1Gnt '!;RE TRACTOR TO CONNECT ThE ABOVE DESCRIBED EXISTING DWELLT N, TO THE PUBLIC SEWEX NEW HOUSE SEWER SIGNED THIS_-. DAY OF— CONNECT ADDITIONAL OWNER OR OWNERS AGENT--------- SEPTIC TANK,SEEP,FITS) ANWOR DRAINFiELD AP,DRESS__ 1 HEREBY ACKNOWLEDGE THAT J HAVE READ THIS APPLICATiON CESSPOOLO DRYWELLD 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 C,1_RTTFT IHAT 1 AN, PROPERLY PECISTERED AND/OR LICENSED AS REQUIPED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA Oil. T;-.AT I AN!'THE LILGAL OW-NER OF THE ABOVE ABANDON HOUSE SEWER DESCRIIBFD RESIDENTIAL PRGPERTY. BACKFILL SEPT TC TANKS L] SIGNATURE SEEP.PIT(S! LI CESSPOOLS OF PERMITTEP IOHN A. LAMBIE.COUNTY ENGINEER -VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR C K CASH 3 7 1 2'S '-1 A WORKERS'COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self ,insure, Oar a certificate of Workers'Compensation Insurance, Or 76A642D a certified copy thereof (Sec. 3800, Lab C. CE 806(REV.8/81) APPLICATION FOR PERMIT Policy No._ Company �s ❑ 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 TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING - COMPENSATION INSURANCE A110" S R jib STATION DEPTH (This section need not be completed if the work involved by the y r y- MANHOLE REFERENCE UPPER permit is for one hundred dollars ($100)or less.) LOCALITY f �' LOWER I CerTl{ that in the performance of The work for Which this NEAREST TYPE OF CONNECTION LENGTH FROM Y P CROSS ST. Y. CURB P.L. M1.TO P.L. permit is issued, I shall not employ any person in any manner _ so as to become subject to the Workers4 Comvpepsation La P.C.No. S. OWNER x L r �` �:� ` ' CO.IMP.NO. JOB NO. Date/2Y Applicant f.` t'�" ; ADDRESS .7 ylLill t G"r "'f j MAIL TRUNK PERMIT NO. ROAD PERMIT NO. AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR.NO. DATE NOTICE TO APPLICANT: If, after making thisertificate of CITY «, /� [r.f# s; 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 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 CONNECTION CHARGE FEE °t License Number Lic.Class- lie REIMBURSEMENT FEE Contractor DateDISTRICT NO. GROUP MAP PROCESSED BY CITY 6'' TEL.NO. / I ❑ I am exempt under Sec. of the L.A.Co. ceNSE No. LIC, r/ �3 BK PG ' - / 0 Plumbing Code and/or Sec. of the NO` DESCRIPTION OF WORK FEE FINAL HOUSE SEWER CONNECTING TO DATE �, VALID ON N PUBLIC SEWER , GT _ B. & P. Cade for the followingreason SEPTIC TANK,SEEPAGE PIT ORC o $� z PITS AND/OR DRAINFIELD YL, -- _ Date HOUSE SEWER CONNECTING TO y y iT 9 iPRIVATE DISPOSAL SYSTEM %.� t' 9dSignature CONNECT ADDITIONAL BLDG.OR / OWNER-BUILDER DECLARATION WORK TO HOUSE SEWER 'j 0 OVERFLOW SEEPAGE PIT,DRAINFIELD 9 !, r> �✓ I hereby affirm that I am exempt from the Contractor's License EXTN.,CESSPOOL,DRYWELL,MANHOLE Law for the following reason (Secton 7031.5, BUlsness and Pro- ALTER,REPAIR OR ABANDON HOUSE a 9. 0 x 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, Business and Professions Code). OWNERS Permit $ r` r ❑ 1,as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE licensed contractors to construct the project (Section 7044, I 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 19._, for the performance of the work for which this permit is OWNER OR issued (Sec. 3097; Civ. C.). OWNERS AGENT - ADDRESS 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. SI ittee Date f // Y SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'COMPENSATION DECLARATION I hereby, affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance, or 76A842D a certified copy thereof (Seca 3800, Lab C.) ee 808(REV.8.81) APPLICATION FOR PERMIT Policy No, Company CQ;s c 'A/ p►c c El Certified copy is hereby furnished. SEWER . SEWAGE DISPOSAL ❑ Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY deportment. Date Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUDDING »- � COMPENSATION INSURANCE ADDRESS S•) ;! % rebel"'7 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 . r {�' LOWER I certify that in the performance of the work for Which this NEAREST TYPE OF CONNECTION LENGTH FROM . . . permit is issued, I shall not employ any person in any manner CROSS ST. Y. CURB PL. M.LTO PI. P.c.No. so as to become subject to the Workers'Compensation Laws. OWNER . (.. y�. 7 '; CO.IMP.NO. JOB NO. r -Z •tl MAIL 1 r TRUNK PERMIT NO. ROAD PERMIT NO.ADDRESSDate.z2-Z?..- Apphcant lr f AFFIDAVIT I WAIVER EASEME4JT RECORD.INSTR.NO. DATE NOTICE TO APPLICANT: If, after making this ertificate of CITY r STEL,NO. { J 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. 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 CONNECTION CHARGE FEE y. License Number Lic.Classa _ ADDRESS REIMBURSEMENT FEE O Contractor Date DISTRICT NO, GROUP MAP PROCESSED BY U CITY - 114TEL.NO. PG z ATE UC ❑ I am exempt under Sec, of the L.A.Co. LICENSE NO. CLASS �J " PlumbingCode and/or Sec. of the NG. DESCRIPTION OF WORK FEE HNAir� t f HOUSE SEWER CONNECTING TO g III CL B. & P. Code for the following reason Il PUBLIC SEWER �� 10 DATE r"'" °� --^,;-1''" VALIDAT N to SEPTIC TANK,SEEPAGE PIT OR F;NA Z PITS AND/OR DRAINFIELD Date HOUSE SEWER CONNECTING TO BY / 4 - PRIVATE DISPOSAL SYSTEM / f' - Signature CONNECT ADDITIONAL.BLDG OR 'L- OWNER-BUILDER DECLARATION IWORK TO HOUSE SEWER s s I OVERFLOW SEEPAGE PIT,DRAINFIELD I hereby affirm that I am exempt from the Contractor's License EXTN-,CESSPOOL,DRYWELL,MANHOLE Law for the fallowing reason (Secton 7031.5, Bulsness and Pro- ALTER,REPAIR OR ABANDON HOUSE �, ' fessions Code): SEWER OR DISPOSAL SYSTEM _ 1` ❑ 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, Business � ". and Professions Code). OWNER'S Permit $ ❑ I,as owner of the property,am exclusively contracting with AUTHORIZATION I TOTAL FEE 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 19_ for the performance of the work for which this permit is OWNER OR issued (sec. 3097,.Civ. C.). OWNERS AGENT ADDRESS 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 upas e above-mentioned property for inspection purposes. Slgn� *ermlitee Date SEE REVERSE FOR EXPLANATORY LANGUAGE