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Home My Public Portal About5137-5139 1/2-5141 SERENO DR_Sewer__ DEPARTDILNT OF OOUNTY ENOINZ= I SEWER-SEWAGE DISPOSAL 1 DMSION OF BUILDING AND SAFETY PERMIT APPLICATION COV7= OF LOS ANarr _ WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS FOR APPLICA TO RLL IN LOCALITY BUILDING NEAREST / ADDRESS WHIRR ST LOCALITY ( DISTRICT NO SqhAL.NO PERMIT NO CROSS ST REPXIVEO BY RnAb'I"Innoo8w DATE ISSUED OWNER �l �iJ tl D UB ZONE O� PANCY B�MAP AOBRE ' \ G CITY AEL NO CONTRAC R CO IMP NO �—. ADDRESSS JOB.No CITY TEL NO 1 ao/ Tp(/NK PERMI O STATE REGIBTRA ON NO E COUNTY ROAD PERMIT MO DESCRIPTION, _LOT NO GAL f'�I -L/ �� PERMIT NOROACRMEI47 BLOCN�-V TR�i(f,,T ,A ` I I WASTE APPROVAL SIZ£OF LO NO OF SLOGS b MOW ON LOT CR ES USE OF BUILDINGS CONNECTION CHARGE FEE NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSEAMERCONM IN 0 PUBLIOSEWER ! E Sw RECEIPT NO DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG OR TI EXCEPON RECORDED WORK TO HOUSE SEWER 100 40 ALTERS OR REPAIR EXISTING /NO DATE BY\ SEWER OR DISPOSAL SYSTEM 100 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA SEPTIC TANK SEEPAGE 11-1–T-6—B PITS AND/OR GRAINFIELD 2.00 STATION DEPTH CESSPOOL- DWYWELL SPECIAL CONDITIONS ONLY 200 1 MANHOLE REFERENCE UPPER LOWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT $ I I DO Y CURB P L ML TOPIL AUTHORIZATION TOTAL FEE I1AG ED CONTRACTOVE RS DATE TO CONNECT ABOVE DESCRIBEDIEX STING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS _ _ _DAY OF ___ _19` NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT _ __ ._ _ _ _ _ __ _ BUILDING OR WORK SEPTIC TAM SEEP PIT(8) ADDRESS ARD/OII GRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELLE] CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY THAT I AM AMD/OR LI ENSED CERTIFY AS REQRED BY PROPERLY EANGE E8 REGISTER COUNTY DISCONNECT PLUG AND AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN. ABANDON HOUSE SEWER ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILLSTAM Ka ��11 BEEPPIT(S)C] CESSPOOLVO BIC NATURE OF PERMITTE 76A642D 003 1/68 DEPARTMENT OF OOUNTY ENOVMM SEWER-SEWAGE DISPOSAL 1 ` DIVISION OF sUMDING AND SAFETY PERMIT APPLICATION OOUNTY OF LOS AN0ELF8 I Bu1LDIMa / WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS /w J AA FOR APPUC T TO IN I LOCALITY q BUILDING NEAR[8T ADDRESS CROSS ST J (1'N LQJ�V✓l.[lt /� LOCALITY I DISTRICT NO J SERIAL NO (( ��PEV//��RMIT NO. �¢- NEAREST Ad191 4=' 5 CROSS 8T RECEIVED BY Reub for lorP2etleS 'DATE ISSUED OWNER JIM �3-I o- S'3 MAIL ADDRESS � USE ONE /OCCUPANCYI ��MAP_ OONTRAC _ CITY TEL NO ,'0 ,� _ CO IMP NO �3 7 ADDRESS / JOB NO cf%7e.. TEL NO TRUNK PERMIT NO O-UNT \ REG ISTRA M NO ` (� �1 � / COUNTY ROAD PERMIT NO LEGAL bV`IL l/ 1i I1 /J7 DESCRIPTION LOT NO L STATE ENCROACHMENT \ J-y PERMIT NO WAST OWE APPROVAL TRIAL BIZ!OF Lfl A X 3 �S.. MS J/ ON LOTCHARD USE OF BUILDINGS �i0 CONNECTION CHARGE FEE NO DESCRIPTIO OF WORK FEE REINSURSEMENTFEE PU8LIOBEWERER CONI IM TO a 200 RECEIPT NO DATE BY HOUSE 6EWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 MNEDT AD01T10-- MAL GLDG OREXCEPTION RECORDED WORK TO HOUSE SEWER 100 ALTER OR REPAIR EXISTING DATE BY HEWER OR DISPOSAL SYSTEM 100 AND/OR ABANDON SEWER RDISPOSAL STEM100 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR GRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 200 ` MANHOLE REFERENCEUPPER LOWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT I: I I ao Y CURB P L. M L TO P L AUTHORIZATION I TOTAL FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS__—_DAY OF— —19_. NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT _ _ _ __ __ ___ _ _ BUILDINGORWORK BEPTIOTAMK BEEP PIT(8) AGGRESS__ _ _ _ _ _ _ __ _ _ _ _� __ AND Op GRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL DRYWELL �� ✓ �� 3 CATION AND STATE THAT THE ABOVE IS C08RECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,RfiPA1R EWEROR REGULATING PLUMBING AND SEWERS 8EWA8E EPAI(R<AL EROR I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED DISCONNECT PLUS AND ANDYSTEM AND/STATE OFOR BCALIFORNIA ED AS UORETHAT 1 AD BY N THEE LEGAL OWN ABANDON HOUSE SEWER ER OF THE ABOVE DESCRIBEgOESiDENTIAL PROPERTY BACKFILL SEPTIC TANKB SIGNATURE BEEP PIT(8)E] CESSP06LYE3 OF PERMITTEE fSA618D 888 1/08 4 DEF•AATICUNT OF COUNW ENS SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILMING AND SAFETY PERMIT APPLICATION OOIINTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENDINEER BUILDING /3 AODRE88 FOR APPLICA TO FILL IN LOCALITY T BUI LOINS NEAREST ADDRESS_ '5 7 f1�� CR08867 //1 n LOCALITY DISTRICT MO SERIAL NO PERMIT MD NEAREST p �__/ n 1 A S CROS88T /1' �/ R OEIVEDB ROAOT for lOtMetleN DAT ISSUED OWNER '3-_/Q -� MAIL ��/�� pw_�) PQ AODRE U8 ZONE OOC NCY YM CITY TEL NO CONTRACT co IMP NO ) 7 ADORE" f'•c�- JOB NO CITY EL NO TRUNK PERMIT NO STATE RET N MO 2 O COUNTY ROAD PERMIT NO LEGAL DESCRIPTION LOT NO STATE ENCROACHMENTPERMIT NO BLOCK TRACT INDUSTRIAL WASTE APPROVAL SIZE OF LOT 6 K_] �� NOW ON LOTS CHARQIX USE OF I BUILDINGS CONNECTION CHARGE FEE MO DESCRIFrrION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECIM TO PUBLIOSEWER 0 8 300 1 RECEIPT NO DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECTADDITIONAL BLDG OR CEPTION RECORDED WORK TO HOUSE SEWER 1 00 M DATE BY ALTER OR AI REPR EXISTING SEWER OR DISPOSAL SYSTEM 100 l ANO OflNDCT I' L8 ABAEll NDON SEWER 100 CONNECTION DATA 8 PTIC TANK SEC fi PAG[PIT OR PITS AND/OR GRAINFIELD fd0 STATION DEPTH OE POOL—DRYWELL SPECIAL CDNDITIOMB ONLY 200 / MANHOLEUERREFERENCE LOWER TYPE OF CONNECTION LENGTH FROM OWNERS !AKF! $ I 1 00 Y CURB P L M L TO P L AUTHORIZATION 1 HAVE THIS DATE CONTRACTED WITHTHE HEREIN NAMED CONTRACTOR TO CONNECT ESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE GATE DWELLING TO THE PUBLIC SEWER SIGNED THIS ___.DAOF __19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL WORKAL OWNERS AGENT _ _ _ _ _ _ _ _-- -- SEPTIC TANK BEEP PITS) ADDRE88 _ _ _ ___ _ _ _ _ AND/OR GRAINFIELD / 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOLP DI[YWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPO AL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/Oq LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUO AND ANO STATE OF CALIFORNIA OR THAT 1 AN THE LEGAL OWN. ABANDON HOUSE SEWER ER OF THE ABOVE DESCRIBED IDENTIAL PROPERTY BACKFILL SEPTIC TAM n SIGNATURE BEEP PIT(S)[] CESSPOOL$ OF PERMITTEE 76A842D 680 1/68 0 DEPABTAffiVT OF COUNTY EN GUfE= I SEWER-SEWAGE DISPOSAL 1 DMSION OF BMLDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES JANDIDLIDING WILLIAM J. FOX, COUNTY ENGINEERESB S I FOR APPLI NT TO F INLITY BUILDING EST ADDRE S ST LOCALI TRICT NO ,� IAI NO /PERtl1TNO NEAREST A f V k3 s CRQ88 8T iEIVHO BY RoSp for lespoafloa DATE IBSU HD OWNER MAIL USE LONE 07M YAP PO ADDRESS CITY Y / TEL N CONTRACTOR r CO IMP NO Z-3 77 ADDRESS d, / JOB.NO CI '.0 TRUNK PERMIT NO REGISTRATION NO COUNTY ROAD PERMIT NO Q 8 DESCRIPTION LOT NO r')1/ STATE ENCROACHMENT ^^��,, PERMIT NO BLOCK V RACT �� ^i1—�3 INDUSTRIAL WASTE APPROVAL BILE OF/LOT NO OF M BLD LOTGS CHARGES i NOW O USE GONNEGTIONCHARGEFEE NO DESCRIPTION OF WORK FEE '^^^---- REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLICSEWER m S S00 C! RECEIPT NO DATE BY MOUREBEWERC NMECT NG TO, PRIVATE DISPOSAL SYSTEM 100 CONNECTADDIT--IWNAL�SLOG OR EXCEPTION RECORDED WORK TO HOUSE SEWER ISo /�U ALTEROR REPAIR EXISTING �N / ^ A/ SEWER OR DISPOSAL SYSTEM 100 ! �{7 / 77 V-ALI— J AMDO RMDISPOSALSYSTEYM EWER 100 CONNECTION DATA SEPTICTANK SETLPAGEPIT R , PITS AND/OR GRAINFIELD LAS STATION 3 7. J DEPTH rzl CESSPOOL--ORYWELL SPECIAL CONDITIONS ONLY 2A0 / ESQ YAM PF[H EFERENCE I (O PE OF COMNE TION LENGTH FROM 1 OWNERS PERMIT $ l 1 00 'r" CURB ai— M L TO P L J AIJTHORRATION TOTAL FEE I 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIED EXISTING APPROVALS IMSPEOTOWSSIBNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS-16!1!� DAYO _ 19 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGEBUILDING OR WORK AGENT / _�_ SEPT IC TANK, F PIT(S) AA / RAINELD CATIONNAND STATE THAT THE ABOVE 18VCORRECTTAND AGREE CESSPOOL DRYWELL TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAlfq,SEWER OR REGULATING PLUNGING AND EWERS SEWAGE DISPOSALSYSTEM AMD/OR LICENSED IAB REQUIRED BY THAT I AN POLOS ANG REGISTERED B OUNTY DISCONNECT PLUG AND AND STATE OF CALIFORNIA OR THAT 1 ANT GAL OWN- ABANDON HOUSE SEWER ER OF THE DESCRI Rfi DENTIA PERTY AC F LL PT CTAM 13SIONATURE SEEP PIT(S)[] CESSPOOLS[] OF PERtlITTE - •x TOAOUD 663 1/58 rORKERI COMPENSATION DECLARATION I)ter4byy�fflrm that I have a certificate41 ,a/Br of con"rit to self . oeXm lwure or a cdrtificate of Workers Compensation Insurance or a lits S'ed ropy thereof (Sec ny Lab C > CE�B APPLICATION FOR PERMIT ,Peollly No Company - as LJ 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 BUIL - COMPENSATION INSURANCE ADDDING RESS �LJO D F L VG sTnTioN (This sectan need not be completed if the work involved by theMPNHgIE REFEENCE R permit is for a" hundred dollars ($100)or less ) Locum i �i . L 1 certify that in the performance of the work for which the ROSSSH FROM T L3 � L L TYPE Of CONNECTION Mt TOPL permit is issued I shall not employ any person in any manner v culls P L M L TOPL L so cis to become susu Lbject to the mWwker Compensation Laws ovrtER L p✓� Pus P- CO W NO ioe NO NkAIL Date _O` /�'-'vApphcant.lK ��"^ �1 / O ss 5 �"N'� fs��1 ��O Umma TRUNK KRMT NO ROAD PERAVT tq NOTICE TO APPLICANT If after making this Certificate CITY TEL rvo -LOG PFfiDAVli WAIVER EASFA1FNt RECORD NSTR ro DATE Exemption, you should become subject to the Workers LEGAL t Compensation provisions of the Labor code, you must forthwith DE CRIMION LOT No HWY MST WIDENING comply with such provisions or this permit shall be deemed revoked BLOCK TRACT STATE ENCR(I LICENSED CONTRACTORS DECLARATIONNO a eLDGs KMT NO I hereby affirm that 1 am licensed under provisions of Chapter SIZE a LOT Now ON TOT. or 9 (commencing with Section 7000) of Division 3 of the Bust USE T G CHARGES nen and Professions Code and my license is in full force and effect CONTRACTOR CONNECTION CHARGE FEE a License Number Lic Class— ADDRESS REIMe NT EEE a O Contractor DoteDISTRICT NO _ MAF SSED BY L.) CITY TEL NO a pG = ❑ I am exempt under Sec of the L A Co STATE NO ALU O f Plumbing Code and/or Sec of the DESCRIPTION OF WORK rHi HNu U HOUSE SEWERCOFRLECTevG TO DATE ALID W Ix B 8 P Code for the following reason Pu&�� R '18 N PTIC TANK SEEPAGE%TOR ALt�J = %TS AND/OR DRAHNHEID C Dale HOUSE SEWER CO CTHNG TO A AN 61 WeAl eY ( � tO Signature - CONNECT ADDITIONAL&DG OR n �'J c O OWNER-BUILDER DECLARATION WRK TO HOLM SEWER ► '� L CNERFLOW SEEFAGE%T DRAINFIE I hereby affirm that I am exempt from the Contractor s License E%TN CESSPOOL DRYWELL MA I Low for the following reason (Section 7031 5, Bwsness and Pro- ALTER REPAIR OR AEANDON HOUSE Q 524-88 fenions Code) SEWER OR ERS u SYSTEM Cm owner of the S ` ` Icy I, 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 70", Business and Professions Code) OWNER'S Permit f -��y �` \Lam. ` -I `�• ElI as owner of the property,am exclusively contracting with AUTHORIZATION TOTAL FEE licensed contractors to construct the project (Section 7040 I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON11tACEOR 10 i a IN Business and Professions Code) CONNECT THE ABOVE DESCRIBED E%ISTING DWELLING TO THE PUBNC SEWER �— CONSTRUCTION LENDING AGENCY PON. - 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 Lenders 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 jaws regulating Plumbing and Sewers, and hereby authorize representatives of this County to enter upon the aaalb000vvee--mmentioonnnee7/,Fd��.fproperty for Inspection purposes p Signature of Peimitfee Date a i`�o SEE REVERSE FOR EXPLANATORY LANGUAGE