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Home My Public Portal About4943 WILLMONTE AVE_Sewer__ ,DFOF'OF' COUNTY ENGINEER SEWER-SEWAGE DISPOSALS �IVYSION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES : WILLIAM J. FOX. COUNTY ENGBUILDING INEER ADDRESS L�` "'(� fflT'. ��= C is FOR APPLICANT TO FILL IN LOCALITY BUILD/� � j�J c7 NEAREST t f ADDRESS i (�V//,("goery e9 CROSS 8T. t~ (..1;-C. ♦ LOCALITYDISTRICT NO. SERIAL N0./ PERMIT NO. NEAREST �CROSS ST. of g) zu C••b •p' �•---- RE,�EIVED BY, Ready for Inspection DATEISSUED OWNER jj, I MAIL USE ZONE 1 OCCUPANCY MAP ADDRESS �> BK PG 1� I CITY 11IV415: 0. CONTRACTO I 1 $ L O.IMP.N0. ADDRESS E t7" JOB.NO. CITY TEL.NO._ Rftp TRUNK PERMIT NO. RERAT NO. ROAD PERMIT NO. LEGA _ STATE ENCROACHMENT DE8CR1 ION LOT NO. PERMIT N0. BLO TRACT INDUSTRIAL / WASTE APPROVAL SIA OF LOT �ONO.OF� NOW ON LOTS r CHARGES ASOF ILDINGS 77� CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER a $ 3.60 RECEIPLN DATE I BY HOUSE SEWER CONNECTING TO - PRIVATEDISPOSALSYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCFkION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO- I DATE I BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR V I PITS AND/OR GRAINFIELD 2.00 STATION �'( y� DEPTH ely CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 t _ MANHDJ,1=REFERENCE /U Wa LOWER TYPE OF CONNECTION._ LENGTH FROM OWNERS Y. CURB SPI ¢ 1 00 M.L.TO P.L. PERMIT AUTHORIZATION TOTAL FEE 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR• SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS.. DAY 0 At ez 1 NEW HOUSE SEWER 2a OWNER OR CONNECT ADDITIONAL DING OR WORK OWNERS AGENT... _ _ _ _ BUIL SEPTIC TANK,SEEP.PIT(S) ADDRES8..__... ., .. _. _ __w.. ._... AND/OR GRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL 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 1 HEREBY CERTIFY THAT 1 AM PROPERLY R STER AND LICENSED AS REQ D BY LOS ANGEL COU Y� D18CONNECT PLUG AND AND STATE OF CALIFORNI 0 THAT 1 AM THE AL 0 N+ ABANDON HOUSE.SEWER ER OF THE ABOV ESC BE REI E IAL P P RTY BACKFILL SEPTIC TANKS❑ SEEP.PIT(S)[] CESSP00 SIGNATURE OF PERMITTEE._ _ �._......____._.._.. 7GA642A 663 7/53 a ,.W4-O iKFeS"::OMPENSATION DECLARATION t, 200051 DPW 6189 I hg-eby a�flrm that i have ❑"certrficote of consent to sell inswre or a certlfical Worker;`Compensation Insurance, or 5A6420 a fer*fled apy'tereaf (sec lgL Lob ; APPLICATION FOR PERMIT Policy No.____—`_^Csmpany,.+ _ ❑ Certified copy is titil furnished ----- SEWER - SEWAGE DISPOSAL [] CeTi,fled copy is filed with the county building inspection COUNTY OF LOS ANGELES BUILDING AND SAFETY department. Dole Applicant__--- ^--__--- FOR APPLICANT TO FILL IN CONNECTION DATA CERTIFICATE OF EXEMPTION FROM WORKERS' BUILDING COMPENSATION INSURANCE ADORs.ss � � � L- L �-� e�� aTlov r/� - P7` DEPTH ilhls section need not be Completed if the work involved by the j 1MNHOI,P REFERENCE ` PP permit is for one hundred dollars 1$100) or less.) LOCALPY �✓ ; "/�, LOWER NEAREST TYPE 0O CONNEC IC7N I certifythat In the performance of rhe work for which this ±` V,L TO PROM P CROSS sr. M t rn P I. permit is Issued, 'I shall not employ any person in any manner CURB LEGAL - p C Nr;) a5 3a become subject 40 4h'FS Workers' COr<'IpeT7Sgtl0'n Laws. DESCRIPTION LOT NO, �l I{J,P No :C-9 NO BLOCK TRACT ,6°UNK PERM(-T NV_, ROAD PERMIT NO Dr<'e___ Appiica'rt _. NOTICE TO APPLICANT: If, after mokin his CertifiCaig? of AS_'Ej OR eS/ / AMDAVIT WAIVER EASEMENT RECORD iNSTR n;6 DATE MAP EiOUK PAGE L'' r. Exemption, �✓ Exemption, you should become subject to the Workers' r _ NO GFBLDcs COi'tpensa.9ioh praviSiUns Of the Labor Ca;.fe, ,YOU must forthwith SIZE LOT 1( ,� NO"ON LOT rwv OR S7 wIUENI.N s Comply with such pro 5ions or this ne•rnit sholl be deemed USE OF revokeCl. E3UIt.DINUS `w,3 `1 F E<ATE ENCROACHMENT LICENSED CONTRACTORS DECLARATION PFRMIT NO 1 hereby affirm that I am licensed under provisions of Chapter OWNER 9 (commencing with Section 7CT00`) of Division 3 of the Susi- fiats CHARGES ness and Professions Code, and rn/license is in full force and - effect. CITY TELL.NO CONNECTION CHARGE FEE License Number bc. Gloss___ RUMEURSEMENT FEE CONTRACTOR Contractor Date DISTRICT NO vROUP MAP PROCESSED BY ADDRESS BK PG I am exempt under Sec. of the A.Co �)/`}t "I[Y - TLC.NO- F�/ sof -mac=-.4,z a. Plumbing Code and/or Sec. Of the STATE uC NAE U LICENSE NO CLASS AT� 1 - VALIDATION B- & P, Core for the following _ NO. DESCRIPTION OF WORK FEE j,{) �L - .reason HCuSF SEWER CONNFi:ING TO -NA' 'I Date PUBLiC SEWER Q SEPT!-TANK SEEPAGE.PIT OR _ 1 4 LU Signature— P S AND OR DRA t FIE ` HOUSE SEW R CONNECT ING TO OWNER-BUILDER DECLARATION PRIVATI DIt Al,SYSTEMz F M. ! hereby affirm that I am exempt from the Contractor's License 7NNr r ADDITIONAL Brute OPLaw for the following reason (Secton 7031.5, Buisness and Pro- 00R'X TCIt L c SE`WE. alp fessions Code): D7 ERFLOW>E>E[PAGE PIT DRAItvFIEtb EaTh CtSSPOOL DRYvrEi L MANHOLE Ly I, as owner of the property, or my employees with wages as; ALTER RPPA R OR ABANDON HOUSE SFWEP OR DISPOSAL SYSTEM their sole compensation, will do the work and the Structure is not intended o Offered for sale (Section 7044. Business and Professions Code). I, as owner of the property, am exclusively contracting with OWNER'S Permit $ licensed conitacfars 4a construct the project (Section 7044, t h Business and Professions Cade). AUTHORIZATION TOTAL FEE ..• - .... �' ,.. s - CONSTRUCTION LENDING AGENCY HAVE AT 11H,S �)< r A CONTRACT WITH HE HER[N NAMED r,TRAc JR TU � , 1 hereh�y affirm thaf there Is a canStru Chon lending. agency CONNE,-T I i,A80 t DI-SCRIBES EXISTINGDNE'.I.:NG TO TPE PUB & SFWq •,< ,_for the performance of the work for which this permit is issued (Sec. 3097, Civ C.). SIGNED THIS_ GAY OF 14 w ER OR Lender's NameOAiNERSAGE%T_ _ _. ADDRESS Lender's Address---_— I ddress _I certify that I have read this applicat,Csn and state that the above information Is Correct. I agree to comply with all County Ordinances and State laws regulating Plumbing and Sewers, and hereby outhonze representatives of this County to enter upon the above-mentioned property for inspection purposes. SI nature ofPermlitee .Dore SEE REVERSE FOR EXPLANATORY LANGUAGE -