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Home My Public Portal About5008 SULTANA AVE_Sewer__ 7'A94 9-59 1° APPLICATION FOR PERMIT "'°° COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPABTbIM OF COUNTY ENGINEES BUILDING AND SAFETY DIVISION BUILDING p S' _ Com E�w ADDRESS O" D 0"Roa 6 5"Vl d pw-1 7 LO ALM . NEAREST FOR APPLICANQT 70 FILL IN CROSS ST L EGAL /O O OWNER IPTION LOT NO TRACT MAIL �• - / ADDRESS )� NO OP BLDGS CITU F LOT 0•Z fIJdNOW OM IDT TTE- No F , DISTRICT NO GROUP YAP PROCESSED BY ING PG RACTO /( CONNECTION DA7 TfTEL NO 6 STATION --gDEPTH STATEMANHOLE REFERENCE ZTRATION NO U T 0 ER NO I DESCRIPTION O R FEE HOUSE SEWER CONNECTING TO 0 D PUBLIC SEWER 0 SS DO TYPE OF CONNECTION LENGTH FRO■ PITS AND/OR DSRAINfGE FIELD OR SS 00 T CURB ML LTO P L OVERFLOW SEEPAGE PIT DRAINFIELD KTN CES P DRTWELL C NO HOIVAES DI EPOCTALSTCTI N�TO S 0 CO IMP NO JPOB XO CONNR KECT H DDIJIl E'Y!A LIG OR TRUNK PERMIT NO ROAD PERMIT NO i A TER REPAIR OR Go ABANDON HOUSE STATE ENCROACHMENT TZN 100 PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES O S PERMIT DD CONNECTION CHARGE FEE ADTHOHIIATION TOTAL FEE a REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TD CONNECT THE ABOVE DESCRIBED FASTING DWELLING APPHOVAM ATE INSPEC S SIGNATURE TO THE PUBLIC SEW 183 D rLiY SIGNED THI A NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNFAS AGENT BUILDING OR WORK SEPTIC TANK SEEP PITIS) ADDRESS AND/OR GRAINFIELD 1 HEREBY ACKNOWLEDGE T AT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYNELI Ll WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBT CERTIFT THAT I A PROPERLY IST 0 TE OR DISCONNECT PLUG AND LICENSED AS REO UI REO L NG CO lY STATE OF ABANDON HOUSE SEWER OR THAT A H L 0 ER TH ABOVE BACKFILL Sfi CTANKS �� '�•(--�f ESCRIBEO R DENT L P - SEEP PITS CESSPODIQ 7" 0 9 OF TURE a, ATION ROBERT A WOOD CL ■ 0. CAKII SUPERVISING MECHANICAL ENGINEER �&9677�S MOR 261 0 A 5.00 x OEPA1r.rhMKNT OF OOUNW ENGINEER SEWER—SEWAGE DISPOSAL r,SnSiON_OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, CGUNTY ENGINEER / BUILDING ADDRESS FOR APPLICANT TO FILL IN LOCALITY JD �'� BUILDING NEAREST ADDRESS SOo CROSS ST LOCALITY 1•T DISTRICT NO SERIAL NO PERMIT MO Vhf� NEAREST n A RIPS CROSS BY BEC 1 ED BY Rmb tw I"An"NI ISSUED OWNER MAIL f ADDRESS USEZONfi OCCUPANCY MAP BK PB CITY TEL ND CONTRACTOR CO IMP NO ADDRESS � JOB NO CITY EL NO -(J�.390 TRUNK PERMIT NO IV REGISTRATION NO , —COUNTY ROAD PERMIT NO LEGAL DESCRIPTION LOT NO I • STATE ENCROACHMENT PERMIT NO BLOCK TRACT INDUSTRIAL • NO BF BLDG$ /JJ WASTE APPROVAL SIZE OF LOT �QO I NO ON LOT CHARGES USE OF BUILDINGS k/• CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE OUSE SEWER CONNECTING TO REIMBURSEMENT FEE PLBLIDSEWER e S SOO RECEIPT NO GATE BY HOUSE SEWER 6UNWIECT-INGPRIVATE DISPOSAL SYSTEM TO 100 mO 0 NNE T ADDITIONAL BLDG OR EXCEPTION RECORDED WORK TO HOUSE SEWER 100 AL Efl-bR REP AIR EXISTING NO DATE SY SEWER OR DISPOSAL SYSTEM IAO DISCONNECT AND ABANDON SEWER AMD/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA / 8 PTICTANK SEEPAGE PITO PITS AND/OR GRAINFIELD ZJM .2 CQ STATION DEPTH 88 W LL SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE UPPER LOWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT 111 1 DO Y CURB P L M L TO P L AUTHORIZATION TOTAL FEE D 1 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 t-7 SIGNED THIS DAY OF_ K 14.0 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT !!!!lI LLLLLL--cddr _ — _ ___ _ BUILDING OR WORK AGGRESS ANDIC TANK BEEP PITS) I HEREBY ACKNOWLEDGE THAT I RAVE READ THIS APPLI- CESSPOOL 0 DRYWELL� OATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR REGULATING PLL NEIN ANDSEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIB D RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS�'1 SIGNATURE BEEP PIT(S)0 CESSPOOL$ OF PERMITTEE f6�J �c?�t�C` - TIIAGUU) 008 1/68 WORKERS COMPENSATION DECLARATION 20 Cost DPW IS/BR I hereby affirm that I have a certificate of consent to self nswe or o certificate of Workers Compensation Insurance or >BABE2D a certified copy thereof (sec Lab C , APPLICATION FOR PERMIT El Cy Na Company Tny ❑ 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 WILDwO 5[� SULT7tL�l STATION DEPTH COMPENSATION INSURANCE ADDRE55 7 This section need not be completed If the work Involved b the UPPER ( P Y LOCALITY MANHOLE RffERENCE LOWER perms a for one hundred dollars ($100) or less ) TYPE OF CONNECTION NEAREST LENGTH FRQN permit i that d the performance of the work for y mo this CFIOSS ST 7✓IJCIN IT Y CURB PL ML TO Pt permit IS issued I shall not employ any person many manner LEGAL PC NO so as to come subject to the Workers Comp e tion Law DESCRIPTION LOT NO CO IMG NO JOB NO �J n AppLc / N7c BLOCK TRACT TRUNK PERMIT NO MJ ROAD PERT NO Date Z. I at �C NOTICE APPLICANT If af4 makingthis ertlficate of A�E°=R o /— /�� AFFIDAVIT WAIVER EASEMENT RECORD INsrR NID DATE MAP BOOK Q PAGE � K� PARCEL �'V CoExemptionCompensation you should become subject o the Workers NO OF BLDG$ Compensation provivons of the labor code you must 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 Ve5l STATE ENCROACHMENT PERMIT NO LICENSED CONTRACTORS DECLARATION OWNER ll-06METc— I hereby affirm that I am licensed under provisions of Chapter /s' �^�F� 9 (commencing with Section 7000) of Division 3 of the Bust MAIL �� CHARGES mess and Professions Code orTd ADDRESS my license Is�n full force and /J effect (/� CITY TEL NO Z — 45'79 CONNECTION CHARGE FEE License Nu mber� E� Llc Class offiREIMBURSEMENT FEE Contra0or��Date J�� 5- [ ADDRESS CONTRACTOR ^ ,,,/1 DisrRlCr No GROuv MAP PROCESSED By ADDRESS5-12-4:::) G Ecy- BK PG ❑ I am exempt under Sec of the L A Co � circ � I TEL No 3'rCY' J O Plumbing Code and/or Sec of the STATE // uc FINAL O LICENSE NO I/!J CLASS D4iE VALIDATION Z t B 8 P Code for the following reason No DESCRIPTION OF WORK FEE O HOUSE SEWER CONNECTING TO �D FI AL `{ Date PUBLIC SEWER Signature NTS AND 09 DRA NSEPTC TANK FIELD'O4 .T y g T a OWNER BUILDER DECLARATION HOUSE SEWER CONNECTING TOPRIVATE DISPOSAL SYSTEM oil 71.If I hereby affirm that I am exempt from the Contractors License CONNECT ADDITIONAL BLDG OR Law for the following reason (Secton 7031 5 Bwsness and Pro WORK TO HOUSE SEWER 1 ITEMS fesslons Code) Ci LOW SEEPAGE oN DRAINFIELD J� EKTN CE$5POO1. DRYWELL MANH«E TI]TAL 71 - 10 ❑ I as owner of the property or my employees with wages as AVER REPAIR OR ABANDON HOUSE FE T/ their sole compensation will do the work and the structure SEWER OR DISPOSAL SYSTEM Cf1Gl_TK '17 ./{` Is not Intended or offered for sole (Section 7044 Business rlr( and Professions Code) CH91GE . ❑ I as owner of the property am exclusively contracting with OWNER'S Permit f Q licensed contractors to construct the Project (Section 7044 Business and Professions Code) AUTHORIZATION TOTAL FEE G 12/16I04 CONSTRUCTION LENDING AGENCY i HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO 4 I hereby affirm that there Is a construction lending agency CONNECT THE ABOVE OEXRIBED ExI57ING DNEUING TO THE PUBLIC SEWER t'B I ]•Lr{ for the performance of the work for which this permit is issued (Sac 3097 CIv C ) SIGNED THIS DAY OF 19_ Owvt.OR Lender s Name OWNERS AGENT Lender s Address ADDRESS I certify that I have read this application and state Thal the above mformabo l s corr t I agree la comply with all County ordinances State I s regulating Plumbing and Sewers and here au oriz epresentatives of this County to enter upon th abov me sed operty for in pRetr6n put es Slgnot Permittee Date �� SEE REVERSE FOR EXPLANATORY LANGUAGE