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Home My Public Portal About6438 TRELAWNEY AVE_Sewer__ e fl b CBOBi °` SASLEO APPLICATION/FOR PERMIT T COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING )/ JOHN A LAMBIE COUNTY ENGINEER ADDR[S. V COLEMAN W JENKINS SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN C. `T LEGA D[{cRlmoN LOT.. )MOO-q3.. AIH S 2a ownER I MAIL BLOCK TRACT ADDRESS NO OF BLDG SIZE OF LOT ryOW ON LOT CITY TEL NO U8[ OR DISTRICT NO OROUP NAP OCESS[D BY BUILDINGS ( CONTRACTOR �3t 1(Le, consyyt V v. �I -T- ADDRESS SK ADDRESS 1"II�A1`\L M11 E.I p� C/O—NNECiION DATA CITY NO BrATIOX s1 6 DEPTH Y UPPER LICENSE NO OLABB MANHO FER[NC6L`TN. VPS/ OW[ NO DESCRIPTION O WORK F[E TYPE OF S 10 LEGTH FOY HOUBf 6EWER CONNECTING TO Y CU M LNTO P Lfla PUBLIC 6EWER 0 [6 GO O SEPTIC TANK SEEPAGE PIT OR JOB NO PITS AND/OR DRAINFIELD Y {Ip OO CO IMP NO p NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO d' PRIVATE DISPOSAL SYSTEM SSW 0 CONNECT ADDITIONAL SLOG OR AFFIDAVIT I RMTER TAAIINKT RECORD INSTR NO DAT[ r WORKTO HOUSCSEWER O $306 WV OVERFLOW SEEPAGE PIT GRAINFIELD D. EATN CESSPOOL ORYW[LL MANHOLE Q ALTER REPAIR OR ABANDON HOUSE `S°O HWY ON By WIDENING Z BOWER OR DISPOSAL SYSTEM C {300 STATE ENCROACHMENT PCRYIT NO INDUSTRIAL WAST[APPROVAL Ovvr&ws CHARGES J PEAMI7 f 2 00 CONNECTION CHARGE FEE AUTHORIZATION 7o7AL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT PCC TRACTOR TO CONNECT T E ABOVE DE{CR EO 16T N W!L 1�}�E� *p TO THE To • f APPROVALS DAT[ INSPECTOR{{IONATUR[ SIGNED THIS DA F I ` OW NER OR NEW HOUSE SEWER ? OWNEFS Aa! CONNECT ADDITIONAL BUILDING OR WORK AGGRESS SEPTIC TANK BEEP PIT(B) HEREBY ACKNOWLEDGE THAT 1 HAVE R D THIS APPLICATION AND/OR GRAINFIELD AN STATE THAT THE ABOVE IS CORRECT AND Aa REE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMB [NO AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT I AM PROFERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS R[ RC Y LOS ANGLES COUNTY AND STATE OF SEWAGE O1600BAL SYSTEM GLIFORH IA O M THE L OWNER OF AND INTEND TO DISCONNECT PLUG AN REBID! IN 6 DESCRIBE RE I. pROP[RT ABANDON HOUSE SEWER OFPERE BACKFILL SEFTIC TANKS ❑ OF PQRMRTE IS ef¢P FTrlm ❑ c[B{PooLB ATION JACK R ALL N cK M o CASH SUPERVISING MECHANICAL ENGINEER bq45 1 8 2�2 J024 1 0 D 7.00- A WORKERS COMPENSATION DECLARATION 20 ro5T DPsv ere9 I hereby affirm that I have a certificate of consent to self N005176A642D Insure or a certificate of Workers Compensation Insurance or o certified copy thereof (Sec 3000 Lab C , - APPLICATION FOR PERMIT Policy No company SEWER - SEWAGE DISPOSAL ElCertifiedcopy n hereby furnished ❑ Certified copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department Dale Applicant FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS BUILfXNG COMPENSATION INSURANCE ADDRESS �4"I STATION DEPTH (This section need not be completed If the work Involved by the MWFRJIE REFERENCE UPPER permit Is for one hundred dollars ($100)or less ) LaCALrrr L R NEAREST 11 TYPE O<CO CURB ON M L TH FROM I certify that In the performance of the work for which this CR095ISTt—E r CURB Pt ML TOPE permit is Issued I shall nor employ any person In any manner LEGAL I PC NO so as to become subject to the Workers Compensation Laws DESCRIPTION LOT NO CO IMP NO rOe NO Date Applicant BLOCK TRACT TRUNK PERMIT NO ROAD PERMIT NO NOTICE TO APPLICANT If after makinth Fs Certificate o ftf ASSESSOR AFFIDAVn W Q EASEMENT RECORD INSTR NO DATE g MAP BOON PAGE PARCEL Exemption you should become subject to the Workers I NO OF BLDGS Compensaiion provisions of the Labor code you must forthwith SIZE OF LOT NOW ON LOT HWY OP Si 1VIDENING comply with such provisions or this permit shall be deemed USE OF B revoked BUILDINGS STATE ENCPOACHMFNi LICENSED CONTRACTORS DECLARATION PERMIT NO I hereby affirm that I am licensed under provrsions of Chapter OWNER 9 (commencing with Section 7000) of Division 3 of the Busl MAIL ADDRESs w�/�"� CHARGES ness and Professions Cade and my'license Is in full force and ' F� �/ RCE TEE effect a" E.� \TEL NO 7 CONNECTKDN CHARGE License Number be Class REIMBURSEMENT FEE CONTRACTOR Contractor Date 1 DISTRICT NO GROUP ALP PROCESSED By ADDRESS q SK PG Y ❑ am exempt under Sec of the L A Co � ,/3 e�S jy Cin TEL No Oddi Plumbing Code and/or Sec o1 rhe STATE LR: FA _ LICENSEEcLICENSEE NO cuss DATE rE q VALIDATION Z B & P Code for the following reason NO DMRIFmON OF WORK FEE L 0 HOUSE Date PUBLIC SEWER WER CONNECTING r0 SY AL H SEPTIC TANK SEEPAGE FIT OR It_f W Signature PITS AND OR DRAINFtELD — a HOUSE SEwE4 CONNECIiNG 10 00 OWNER BUILDER DECLARATION PRIvwrF DISPGSAI YsrEM ► ArCT•T I hereby affirm that I am exempt from the Contractor s License OCI ADDngNAL BLDG OR Law for the following reason (Secton 7031 5 Buisness and Pro wCRK 10 HOUSE SEWER _ _ •-•-- fesslons Code) OVERFLOW SEEPAGE NT DRAINRELD ExTN CESSPC I DPYWELI MANHOLE 1 ITEM. ❑ I as owner of the property or my employees with wages as Af TER REPAIR OR ABANDON HOUSE their sole compensation will do the work and the structure SEWER OR DISPOSAL SYSTEM TOTAL CC _ 35 Is not Intended or offered for sale (Section 7014 Business CHECK Sr].C' and Professions Code) I as owner of the property am exclusively contracting with CHAP IE .I�) rcensed contractors to construct he project (Section 7044 OWNERS Permit $ a Business and Professions Code) AUTHORIZATION I TOTAL FEE (}�� rr((''FFrr,, CONSTRUCTION LENDING AGENCY I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONTRACTOR TO WIJL,I—LPfV [F/ r"4 I hereby affirm that there Is a constructton lending agency Ca NECT THE ABOVE O -MED E.ISTING DMLLING TO THE PUBLIC SEWER for the performance of the work for which this permit Is \ f T'�I� 1 41 fE-� issued (s5ec 3097 Civ C ) SIGNED THIS DAY OF J Iv_ ONNFq Oq Lendtt s Nome OWNERS AGENT Lender s Address '�DgE55 I certify that 1 have read this application and slate rhot the ' above Information Is correct I agree to comply with all County Ord n sand $tore laws regulating Plumbing and Sewers o her by author ze representatives of this County to enter U n P;;?Zboned property for/ti's cgtio purposes(o O SI nature of Perm iliac Date SEE REVERSE FOR EXPLANATORY LANGUAGE