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Home My Public Portal About5076 SERENO DR_Sewer__ + _ PEPARTBIEzNT of OouNTY xNamom SEWER—SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION OOTINW OF LD8 ANGELES WILLIAM J. F'OX. COUNTY ENGINEER BUILDING ADDRESSM 79 Q FOR APPLICANT TO RLL IN p e-oP, ,- BUILDING EASIEST LOCALITY SERIAL NO PERMIT NO NEAREST S f' 7 3�0- S RaaOY fv Iwartlaa D E 1 ED OWNER NAILADDRESS l�� Lt7 OCCUPANCY ONMAP PG CITY 1 TEL NO ��1 _CONTRACTOR ADDRESS JOB NO CITY TEL NO TRUNK PERMIT NO STATE a REGISTRATION NO B LEGAL COUNTY ROAD PERMIT NO r l i / S DESCRIPTION I LOT NO N• STATE ENCROACHMENT PERMITNO BLOCK TRACT /(--5, SG ��2�� INDUSTRIAL r6rTATION VAL SIZE OF LOT 5'X 39J MOW OM LOTS Z. CHARGES oos USE DI BUILDINGS r��nm�e RBE FEE NO DESCRIPTION OF RK FEE HOUSE SEWER CONNECTING TO ENT FE PUBLIC SEWER • i SAO RECEIPTNO DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL B OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1 00 ALTERORHEPAIR EXISTING NO DATE BY SEWEROR DISPOSAL SYSTEM IMI DISCONNECT AND ABANDON SEWER AMD/OROISPOSALSYSTEM IGo CONNECTION DATA SEPTIC TANK,SEEPAGE PIT R PITS AMD OO GRAINFIELD 2A0 H 0 SBPO R ELLSPECIAL CONDITIONS ONLY 200MANHOLE Epof UPPLOWER OMNECTI LEN FROMOWNERS PERMR f I DD ups P L r L rD AUTHORIZATION TOTAL FEE1 ZOO I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIBNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS _DAY OF _ __19_ NEW HOUSE SEWER a OWNER OR CONNECT ADDITIONAL j OWNERS AGENT _ _ _ __ __ ___ _ __ __ _ BUILDINOORWORK ADDRESS __ _ _ _ SEPTICTANK SEEP.PIT(S) AND OR GRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL 0 DRYWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWEROR REGULATING PLUM RING AND SEWERS SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND AND STATE OF CALIFORNIA OR THAT I AN THE LEGAL OWN- ABANDON HOUSE SEWER ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY RACKPILLSEPTICTANKS SIGNATURE BEkp PIT(S)0 CESSPOOL�11 OF PEprITTE 7"O"UD BBD I/SD °EeeuT"mvT OF COUNTY ENGINEER SEWER--.SEWAGE DISPOSAL 1 DIVISION OF BUMDDiG AND SAFETY PERMIT APPLICATION COUNTY OF L08 ANOEI.PR WILLIAM J. FOX. COUNTY ENDIN[[R ADDRESS .SO ler- 7? GCie,: FOR APPLICANT TO RLL IN LOCALITY BUILDINO SO7?-;rV_Z ,t,..� oxr oe9 CRAOSSR�BY ADDRE88 LOCALITY DISTRICT NO. - SERIAL NO PERMIT NO C NEAREST ei i1».F ,./ 0 3 L-,/ SO/ 5 / HECEIY R�'tr INFpMNe %� OWNER p ADDRMAILESS 5�Q 7p �,/JI JET /�- USEZONE OCCUPANCY G N P— BK PS CITY / �A _ �(-- TEL NO .�/ �S71 CONTRACTOg IR C. N �n AT Cc of Tempkeft CO IMP NO ADDRESS 5933 N CLOVERLY AVE JOB NO CITY TEMPLE*91iD CALIF. Dj TRUNK PERMIT NO REGISTRATION No g4/7, o COUNTY ROAD PERMIT NO LEGAL DESCRIPTION LOT NOS— �J STATE ENCROACHMENT PERMIT NO BLOCK TRACT �.5. SG —/1 —/ 4 INDUSTRIAL SIZE OF LOT WASTE APPROVAL NO LOTS�/ i(y.�9,(� NON ,� CHARGES USE OF 'A BUILDINGS CONNECTION CHARGE F [ NO DESCRIPTION OF W K FEE HOUSE SEWER OONNECTINO REIMBURSEMENT FEE PUBLICSEWER ! 8 860 RECEIPT NO DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONALB LDG OR EX PTIO RECORDED WORK TO MOUSE SEWER 100 DO ALTER OR REPAIR EXISTING NO TE BY SEWER OR DISPOSAL SYSTEM IDO _ DISCONNECT AND ABANDON SEWER AND OR DISPOSAL SYSTEM 100 * CONNECTION DATA REPTIO TANK.S EEPA E IT OR . - PITB AND OR DRAINFIELD 200 STATION DEPTH E 0 RYW LL SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE UPPER A LOWER TYP[0 CTION LEN rRbx OWNERS PERMIT $ I I DO c a .w, M L o P L AUTHORIZATION I TOTAL FEE DO L I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED At O 3 2— CONTRACTOR CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOIYS SIGNATURE DATE DWELLING TO THE PUBLIC SEWER 3 SIGNED THIS_-�a—DAYQF . 19_j__ NEW HOUSE SEWER OWNER ORCONNECT ADDITIONAL OWNERS AGENNTTT1�/ _ _ _ Jf __ BUILDINOORWORK ADDRESS OKCL IT(8)AMD/ DDANFID I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL� CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEW[ROR REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED pt8CONNECT PLUG AND AND/OR LICEYS[D AB Rf0(tIRFD er L08 ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT E AN THE LEGAL OWN• ER OF THE ABOVE DESCRIBED RESIDE TIAL PROPERTY BAOKFI TARR*[] 7K G AaZ« �o BEEP PIT(S)o CESSPOOLSp SIGNATURE OF PERMITTEE LOy 'JL �-=— WORKERS'COMPENSATION DECLARATIONW I hereby affirm that 1 hove a certificate of consent to self . . " imurti a'gmfKwe of Workers'Compensation Insurance, or 70As421) - dcertified copy thepaf(See 3B00 Lob C ) �� APPLICATION FOR PERMIT Policy No Co66mp//any��'tie �_ ❑ Cerafi coyy��py" ifly4umnshed SEWER - SEWAGE DISPOSAL ' ❑ Certified copy is filed with the county building nmpectlon COUNTY OF LOS ANGELES BUILDING AND SAFETY •r department �Dais &7/ Applicant � - `='�� FOR APPLICANT TO FILL IN CONNECTION DATA CS -EWFIFICATE OF EXEMPTION FROM WORKERS Butuxl COMPENSATION INSURANCE ADDRESS . 7G SrAroN oErrH ' (This section need not be completed if the work Involved by the MAWICU!RaERMCEUPPER perm" Is for one hundred"Ion ($100)or less ) I certify that In the perforrtance of the work fp which the CRgT 14 91 TVR as aaslaR10N FROM s Issued 1 shall not employ Y Cutin r L ''t" is v E permitP Y an Y person In any manner so as to become subject to the Workers'Compensation LowsNo- CO Ihoe NO MM AM 1 AMM iRUNx IERAvi MI Date I Applicant ADDRESS NO ROAD PERT NO NOTICE TO APPLICANT If, cher making this Certificate of NO ATFDAVIT WAPVER EASEMetT REc4M INSTR Na oAE Exemption, you should become subjecG t to the Workers' �u TEL ,Compensation provisions of the Labor code, you must forthwith DESCRIPTION trnw comply with such provisions or this permit shall be deemed HWr MST WxNn+G revoked CROCK TRACT STATE ePOIOAIXMlM LICENSED CONTRACTORS DECLARATION Ea OF BLDGS PERtWT f1O I hereby affirm that I am licensed under provisions of Chapter SIZE OF LOT NOW ON ran 9 (commencing with Section 70DO) of Division 3 of the Bum- USE OFIGS [NAAC,ES nen and Professions Code, and my license is In full force and effect 7 Z CONLRACt011 E tOEr[crgN CIMRGE rH License Number.�yTSY tic Clop ,rapper Contractor ��'=' •s--yate� Cin TEL NO �j .. 1 �Z DISTRICT NOQ' VC4.t0l.11 AMP PROEWO 51- O PG ❑ 1 am exempt under Sec of the L A Co UOEKISE NO awti5 C— Z h/DQn r Plumbing Code and/or Sec of the NO DESCRIPTION OF WORK IEE y 1 � / � / ttOLaE SEWER axaERRac ro DATE 2 Jr—�� VALIDATION B 6 P Code for the following reason PUNEC SEWER Z SEPTIC NRC SEEPACA m OR .Q Dote O PRS AwioR DRAJAFIEID By IfOPRTVAT S[WER=051 RINO TO Signa iiia QJtEECT ADDITIONN NDC OA �� OWNEQ 1.11LDER DECLARAI WORK TO HOUSE SEWERCAIERRO ► E PIT 555313— 1 hereby affirm that I am exempt from the Dr's Ucense "'M 0 oRrwat At,wNdE Law for the following reason (Secion 7031 5, Bulsness and Pro- ALTER REPAIR at HOUSE 10 fetsiom Code) SEWER OR DISPOSAL SYSTEM ❑ I,as owner of the property,or my employees with wages as I � AC(T.T their sole compensation, will do the work and the structure 3307 3'r.50 is not Intended or offered for sale (Section 7011, Busmen FBEmtt { pp 1 ITEM Professions Code) OWNER'S El 1,of, n ower of the property am exclusively contracting with AUTHORIZATION TOTAL FEE /.E licensed contractors to construct the project (Section 7001 I HAVE AT MIS DATE A CONTRACT WITH THE ME KUM NAD CON OR TO _ TOTAL 34 .50 Business and Professions Code) CONNECT THE ABOVE DESCRIBED ExISTIN6 DWELLING TO THE PUBLIC SEWER WK C 3 4.50 .CONSTRUCTION LENDING AGENCY LEILl fT I s IG hereby offnn, that there a construction lending agency SIGNED THIS Nt DAY OF 19_ CHANE0[1for the performance of the work for which this permit Is OYMER OR Issued (Sac 3097, CivOW ERS AGSMv C ) ' ADDRESS Lender s Name 1 12/1J�G0 Lender's Address 44554 - 1 AM 9e it I certify that 1 have read this cppllmtlon and state that the above information Is correct I agree to comply with all County ordinances and State jaws regulating Plumbing and Sewers, , and hereby authorize representatives of this County to enter upon the above-mentioned property for Inspection purposes Signa a of Permlaee Date SFE EEVERif FOR I MPLANATOEY LANGUAGE ,