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Home My Public Portal About4923 SERENO DR_Sewer__ CEeoe 3-e4 APPLICATION FOR PER IT �y,C TaweAZD IJ COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPAATMEN7 OF COUNTY ENGII7EEH BUILDING AND SAFETY DIVISIONJ-TAL�..T, aURDINO A WMALAIIMM Ce IT EoDlp[uADORES. -C WII.LI14►f A NXIM1 S,p'I o! EO141.0 _ p-� LOCALITY �V�- NlAREeT � FOR APPLICANT TO FILL. INDRo.e By L ' DESCRIPTION LOT NO D OOWNER MAIL [LOCK TRACT ADDRNOOF SLOG.SIZE OF LOT XOW ON LOTCITY C TCL NO USC OFDISTRICT NO GROUP MAP PROC D BY BUILDING •K PDCONTRwCTORl0OT' VADDRESS ) CONNECTION D TCI TEL NoDEPTH. V� /3RLOLTRATIOMXOMANHOLE REFERENCENO CESCRI PTI N F WORK FEQTYPE OFCO ION L.ND FROHOUSE SEWER CONN CCTING TOY SBYL ILPUBLIC SEWER C [S00 13 77 PC NO SEPTICTANK BEEPAG[PIT OR JOB NOIITS ANO/OR GRAINFIELD [IOwCO IMP MO HOUSE SEWER CONNECTING TOTRUNK PERMIT NO ROADP[RYR N�PRIVATE DISPOSAL SYSTEM 0 [J00 ) CONNECT ADDITIONAL 6LDO OR AFFIDAVIT W.V.K.I ZU9090T RECORD INSTR NO WORK TO HOUSE 89WER 0 [p 00 9 OVERFLOW SEEPAGE PIT GRAINFIELD 1 1UFL tXTN CESSPOOL DRYW[LL MA NHOL[O 5500 ALTER REPAIR OR ABANDON OU• HWY OR ST WIDENING d SEWER OR DISPOSAL SYSTEM Y [S OO STATE ENCROACHMENT PERMIT NO INDUSTRIAL WAST!APPROVAL CHARGES �OL}WNEIRS S PERMIT s z 00 ATTV LLZORMTION TOTAL FEE 0 CONNECTION CHARGE FEE 1 HAVE AT THIS OAT[ A CONTRACT WITH THE HEREIN NAMED CON RLIMSURS[MIEW FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED [LISTINO DWELLING TO THE PUBLIC S[WCAMOV R DAT[ INSPECTOR S SIGNATURE SIGNED THIS DAY OF IS_ OWNER OR NEW HOUSE SEWER OwNCRS AO..Y �� / •LrsltL-LSA_ ICY CY ADDITIONAL' / BUILDNG OR WORK LAII "4TE S HER ACKNOWLEDGE L[OOC THAT I HAVE READ THIS APPLICATION SEPTIC TANK SCEP PIT(SI AT[ THT TH[ ApOV[ IS COIIRCCT AHO AGRt[ TO COMPLYAND/ORMAIHFlCLD LL COUNTY ORDINANCES AND 'TATE LAWS REGULATING NO AND SEWERS CESSPOOL ❑ DRYWILL ❑ ..Y CERTIFY TX AM MOPCRLY R[OIpTLR[p ANO/OR ALTER REPAIR .EWER OR ED AS RCGW SY ' wNOLSSCOUND STATE OI SWAGE DISPOSAL SYSTEM RNIA OR TH 1 AM L[OAL OWNER NO IHT[ND TO DISCONNECT PLUG AMD IN THEERCBIDCNTI OPEMY ABANDON HOUSE SEWER URERMITTEE SACKIILL SEPTIC TANKS EE // J SP PIT(S) CESSPOOLS A VALIDATION ROBERTA WOOD <K M O GASH SUPERVISING MECHANICAL ENGINEER LA[;p606eZ8 MY2910 D 7.00- 9 WORKERS COMPENSATION DECLARATION 20-Ml DPW BM hereby /ffirm shot I hgve p certificate of consent to self mTOre ar Vte711hcbte Df Workq rs Compensation Insurance or 7SA6@D Policy EalythereQ,f (Sec ny LabC , ,�.� � APPLICATION FOR PERMIT Polley Na Company � ❑ CeH11Ted copy IB hereby furnished SEWER - SEWAGE DISPOSAL ❑ Certified copy is filed with the county building Inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department Date Applicant pl� R APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE L r STATION a�/--ate O DEPiN (This season need not be completed If the work Involved by the MANHOLE REFERENCE J'L / �Vc LOWER permit Is for one hundred dollars ($100)or less ) 'TYPE OF C iqN iN iRCVA � I certify that d the performance of he work for which this ' r CuRe PL ML TO PLpermit a nsued 1 shall not employany person In any manner so as to become sub ect to The Workers Com ensation Laws °C rvo P OT NO CO vSV NO IOe NO Date Appficont BLOCK TRACT TRUNK PERMIT NO ROAD PERMIT NO NOTICE TO APPLICANT If offer makingthis Cerllficate of ASSESSOR AFFIDAwT WUVER EASEMENT RECORD INSTR NO DATE Exemption MAP BOOK PAGE PARCEL p you should become sublets o the Workers NO OF SLOGS Compensation Provisions of the Labor code you muss forthwith SIZE OF LOT NOW ON LOT HWY OR ST WIDENING comply with such provisions or this permit shall be deemed USE OF revoked BUILDINGS STATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION PERMIT NO I hereby affirm that I am licensed under provisions of Chapter OWNER VI 9 (commencing with Section 7100) of Division 3 of the Bust MAIL // /� ADDRESS y S`rG 1 CHARGES nes.and Professions Code and I license is In full force and �t Sit- effect CITY lL til' TEL NO 3 CONNECTION CHARGE FEE License Number LK Class REWBURSEMENT FEE CONTRACTOR Contractor Date DISTRICT NO GROUP MAP PROCESSED BY ADORES. PO ❑ 1 am exempt under Sec of the L A Co -,r 11P 5L �y a CJTEL NO p Plumbing Code and/or Sec of the STATE LIC FINALCAVIL lYJ LICENSE NO CLASS DATE LIDATION = B 9 P Code for the following reason NO DEBCIePIION OF WORK FEE I 0 HOUSE SEWER CONNECTING TOO BNAL Ar .a Dale PUBLIC SEWER Fit yy SEPTIC TANK SEEPAGE PIT OR {. yE, $IgnOture PITS 4N0 OR DRUNFIEI1 .]tJJ 1 .!V/Y OWNER BUILDER DECLARATION HOUSE SEWER CONNECTING TO ► L ITEMS PRlwt DISPOSA vSTFM hereby affirm that am exempt from the Contractor s license CONNECT ADOnIONAL BLDG OR TOTAL - Low for the following reason (Sectors 7031 5 Bulsness and Pro WORK TO HOUSE SEWER 1 u fe5slons Cade) OVERFLOW SEEPAGE RT DRAINNELD ��.lU Eq AIN CES.F'OOK DRYWELL MANHOLE - TL/ ILII as owner of the property or my employees with wages as ALTER REPAIR OR ABANDON`OUSE CHEaY y0 p EWER OR DISPOSAL SYSTEM r x0 their sole compensation will do the work and the structure S Is not Intended or offered for sale (Section 7044 Business and Professions Code) _ ❑ I as owner of he property am exclusively contracting with OWNER'S Permit S [I[�1[I—(fI][I], ],[IJIY4 licensed contractors to construct the project (Section 7044 Business and Professions Code) AUTHORIZATION TOTAL FEE / 7390 1 ;A 3:IN CONSTRUCTION LENDING AGENCY I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO , I hereby affirm that there is a construction lending agency CONNECT THE ABOVE DESCRIBED EXISTING DMUING t0 THE PUBLIC SEWER - for the performance of the work for which this permit Is issued (Sec 3097 Civ C ) SIGNED THIS DAY OF 19_ Lender s Nome OWNER OWNERS R AI NT Lender s Address ADDRESS I certify that I have read this application and state That the above Information Is Correct I agree to comply with oil County ordinances and State laws regulating Plumbing and Sewers and her authorize representatives of this County to enter uPo Cove me roperty for Inspection purposes p a,s- 9y Slgnalure of Permitfee Date SEE REVERSE FOR EXPLANATORY LANGUAGE