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Home My Public Portal About9818 WENDON ST_Sewer__ 5 E-E53 12.34 ' IAD APPLICATION FOR PERMIT S t E= DIVISION OF BUILDING AND SAFETY SEWER-SEWAGt DISPOSAL Department of County Engineer County of Los Angeles BUILDING WM. J. FOX, COUNTY ENGINEF-R _ADDRESS CASSATT D. GRIFFIN, SUPT OFE3.Utl.DlhiG LOCALITY FOP{.APPLICXNT TO FILL iN �NE.AREST cR6S ST. LEGAL ....�_....__.�._- DE_SCR[P7ION LOT NO. OWNER ,,r+ n BLOCK TRACTd�.-"x I r,i MAIL �+',Y0' f a� r �, ADDRF'—....3 SIZE OF_LOT N0. OF BLDGS, i y _ NOW_ON LOT CITY ¢y_,� �a. TEL. M0. _ „'��V '. USE OF < 4 BUILDINGS . �, K j - �,,, _ DISTRICT N..� ,I GROUP JMAP. SK—' _ G CONTRACTOR r rjA°' ADDRESS , CONNECTION DATA CITY I r=.. `' - TEL. NO +j°4 r v 'r` STATION Y - 'a op DEPTH ;, — - ':da 1�' d' _ +� _ TATE rp MANHOLE REFERENCE REGISTRATI NO.. 'UNTY - I�r✓ +` FJ�'� UPPER -FE OF CONNECTION _ LENGTH FROM No. ; DESCRIPTION OF WORK FEE _ CURB - ice. N.L.TO,P.LL. HOUSE SEWER CONNECTING TO ;_PUBLIC SEWER _ _ � $ 3.50 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 I _.,-_ ---------•---- -- CONNECT AC ^NAL BLDG, C3 I� I WORK To H _ SE_S FV4 CO, If.1.P.NO. JOB, NO,ER 1 OG ' =� ___..__�,.. ALTER OR REPAIR EXTSTING I SEWERNO. �TI (IRSPCEAL SYSTEM 1.00 I TRUNK PERMIT NO. ROAD PERMIT NO DiSCONNIECt AND ABANDON SESVER - SPATTE. ENCROACHMENT — E ENCR A---� A 'D/OR DISPOSAL SYSTEM 1 00 ! I OACH hiENT -_ PERMIT NO, I SEPTIC P T5 AND,'OR DRAINFIELD 2.00 ` INDUSTRIAL _---�". !--- WASTE APPROVAL ! CESS?OOL DRYWELL - -- SPECIAL CONDITIONS.ONLY 2.00 I CHARGES e PERMIT -- CONNECTION CHARGE FEE OWNERS AUTHORIZATION TOTAL FEE L �n�:' REIMBURSEMENT FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- �a TRACTOR TC CONNECT THE ABOVE DESCRIBED EXISTING DWELLING �� APPROVALS DATE CNSPECTCR'S SIGNATURE TO THE PUBLIC SEWER `�"" '"--- --'---- '----`. SIGNED THIS DAY OF —I9----- � NEW HOUSE SEWEROWNER 0R CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTIC TANK, SEE.^-, PITS) AND/OR_DRA!_N,`_':ELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑`DRYWELLC]___._ AND STATE THAT THE A30VE IS CORRECT AND AGREE TO COMPLYWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/CR DISCONNECT PLUG AND LICENSED AS REOUIREED BY LOS ANGELES COUNTY AND STATE OF _DISCONN HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OYINER OF THE ABOVE. DESCRIBED RESIDENTIAL PFvOPERTY• BACKFILL SEPTIC TANKS❑ SIGNATURE - SEEP.PITS) Cl CESSPOOLS , r s'' y; _ ._......._..._.. . ®-...�___.u,..._...r. OF PERMITTFE ��+L', _ WILLIAM J. FOX, COUNTY ENGINPER. VALIDATION BY i_0 a 5 3'621 FEB 11 4 4-,5 DEPUTY DEPUTY BY BY - DEPUTYq-�, J"v QEPUTY wORk1'.RS'C0VIPENSATI0NDEC.LARAfION 76A6420 APPLICATION FOR PERMIT CE 808 (2-80) I hl eby affirm that I have ;I certificate of consent to self SEWER-SEWAGE DISPOSAL insure, or 4 eerdficate of Workers'Compensation.Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY a'certified copy thereof(Sec.. 3800— ,,�ab. C. ' Poll vNci::"r 3 Companyr__. - °• CONNECTION DATA `G , 4 FOR APPLICANT TO FILL IN Certified copy is hereby furnished. , ry STA?ION DEPTH BUILDING ,+ J Jy/g ',J ry ADDRESS o f'bd`�e.`G �T � UI.PF:'.}d J� 'rtlfivd copy 15 Tiled with th'C CFf11Rt}'b1IlI(a`gRg 1pe CtlOn .--,Z MANHOLE REFERENCE depar nt �n)J)� /h y{ LOCALITY f � /� y LOWF.;R D$T }i Applicant T yr , ; -- NEAREST V ! TYPE OF CONNECTION LENGTH FROM LC. T Y. CURB P.L.. M.L. TO P.L. CROSS ST ry/'jam�. f.�,ss"� .J C. TfI IC'ATi;OF F;XFNTPTION FROM WORKERS' r P.C. NO. CODIPENSA"ItON INSURANCE rADDRES! /f1 d � 1 ✓eTJY/.� V GO. IMP. NO. JOB NO. f f �P ROAD PERMIT NO. (This section need not be completed if the work involves TRUNK AE RMIT NO. by the permit is for one hundred dollars ($100) or less.) AF F'IDAVIT WAIVER EA--EMENT RECORD. INSTR. NO. 1ATI � l Lt it dollars 1. 11J / I i�� "TENO. ly1 certify that in the performance of 'the work for which this ALbJpermit 1s issued, I shall not employ any person m any manner PTION LOT NO. HWY. OR ST. WIDENING _— so as to become subject to the Workers' Compensation Laws. STATE ENCROACHMENT U1 BLOCK TRACTPERMIT NO. —.._ rL NO. of raL Date_ Applicant 592E OF LOT NOW ON LOY .�— NOTICE TO APPLICANT: If, aftt,.r making this Certificate of USE OF ARGES — Exemption, you should become subject to the Workers' — CH B US L;DINGS _ Compensation provisions of till'. Labor Code, You must forth- FEE�,f ,f�, �+ CONNECTION CHARGE FEE with comply with such provisions or this permit shall be CONTRACTOR ,i''i. LJ"- "' f,..•^'" '.".7'^''+ deemed revoked. REIM8URSEMENT FEE LICENSED CONTRACTORS DECLARATION ADDRESS ___ st. DJ sICT No. GROUP MAP , �cEssED BY 9 PG I hereby affirm that l am licensed under provisions of Chapter CITY �i P TEL. NO. ' ��„ H 9 (commencing with Section 7000) of Division 3 of the Busi- STATE LIC c} , ness and Professions Code, and my license I,, in full force and LICENSE NO � �� CLASS �� effect. NO DESCRIPTION OF WORK FEE FINAL VALIDATION �j.,s .USE SEWER CONNECTING TO DATE ? 1 Lie.Class PUBLIC S".11 License Number )— -- SEPTIC YANK,---PA — ----- G F_ PIT OR "S PITS AND IOR DRAINFIELD FINAL 4-1411&6Contractor ate HOUSE SEWER CONNECTING TO By PRIV AT£ DISPOSAL SYSTEM I am exempt from the licensing requirements as I am a CONNECT AOOITIONAL•a.......+. licensed architect or a registered professional engineer WORK TO HOUSE SEWER _ _.— ._ OVER,' SEEPAGE PIT,OR AINFIE LD +• � ,. - acting In ill}' professional y \capacity (Section ?051, BUS EXTN.,CESSPOOL,ORYWELL�MANHOLE mess and Professions Cade)• ALTER, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM Lie.or Reg.No._—� Date HOME OWNER-BUILDER DECLARATION OWNER'S Permit s w 1 hereby affirm that I am exempt from the Contractor's AUTHORIZATION �o License Law for file following reason (Section 7031.5. Busi- TOTAL FEE ness and Professions Code): HAVP: AT' 'THIS DATE A CONTRACT WITH THE HEREIN NAMED C.ON- +� Q TRACTOR TO CONNECT THE ABOVE DESCRIBED CXISTING DWELLING If I, as owner of the property, will do ttie work and the TO TME P�BLIc SEWER. structure is not intended or offered for sale (Section SIGNED THIS, DAY OF--19- 44, F is44, Business and Professions Code). OWNER OR OWNERS AGENT_ - - CONSTRUCTION LENDING AGENCY ADDRESS ___—_ t I hereby affirm that there is a construction lending agency for tile performance of the work for which this permit is n issued(Sec 3097,Civ.C'.). " Lender's Name Lender's Address— (sl4j v I certify that I have read this application and state that the above information is,current. I agree to comply with all County ordinances and Stnte laws regulating Plumbing and Sewers, and hereby Ali thoriz.e,�prazrsentatives of this COLIrItY to enter upOr"'he buveyrtenijoned p operty for inspect on purpeses. �� SEE REVERSE I OR EXPLANATORY LANGUAGE ignature of Permittee k5ate