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Home My Public Portal About9420-9422-9424 WOODRUFF AVE_Sewer__ 7 E.663 11,55a E.66A tIOATI O ISI FOR PERMIT 3& �. DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDINGq. 1 JOHN A. LAMBIE, COUNTY ENGINEER ADOR EGS a� CASSATT SJ, GRIFFIN, SUPT OF BUILDING ,F x-' LOCALITY FAPPLICANT TO FILL IN NEAREST OR - _ _ cxoss ST. � LEGAL ESRIPOT NO. S t' ' �'a _OWNER DCTIO L - - - --- .r _ MAIL BLOCK TRACT ADDRESS _ ,>" -------------------- NO.OF BLDGS. -`--- CITY `------ TEL. NO. SIZE OF LOT NOW ON LOT _ USE OF DiSTRLCT N0. GROUP +i MAP k3UILDING4-= .z� ,��- - - -- BK PG CONTRACTOR "� y Cfl14IhVEGTIOTi _ ADDRESS DATA a e d � ( -- -- - — - -- - - r' �, 5TA'1IUN -:ai } T nEPTH CITY '.. � T � 3 ➢� ,� ° ..>' -- --- - #- E ----� .--Via`-- - - - .,--_r- -;. - MANHOLE REFERENCE _ � UPPER - TATE REGISTRATION NO. z _f: COUNTY _ NO, DESCRIPTION OF WORK' _ FEE -----------------------------:.__ ._-----. I.-j' --.- . --- - --- TYPE OF C ;..k'ECT Pt LENGTH FROM r„P3 HOUSE SEWER CONNECTING TO I j PUBLIC SEWER (p, _c, xg !r;` - Y. URT;,__. P L..._.M.L.TO P.L. SEPTIC TANK,SEEPAGE PIT OR ?ITS.AND/OR DR:AIINFIELD (rz] _$S.00 j ___-._--- ------ ---__.-- --T -- ---- i -----... _--- R OVERFLOW SEEPAGE PIT,DRANF;ELD P C. NO. 5XTN.,CFSSPOOL,DRYliELL,MANHOLE r c.2.rU t;U. IMP. t�'O. ' JOB N0. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM r $1.00 J "BUNK PERMIT NO ROAD PERMIT NO. j CONNECT ADDITIONAL BLDG.OR - STATE ENCROACHMENT WORK TO HOUSE S-E 41E:R- i.A;0 PERMIT ALTER,REPAIR OR ABANDON HOUSE --- ---------------------------`-- - I INDUSTRIAL _j. SEWER Or DISPOSAL SYSTEM (t $1.00 WASTE APPROVAL i CHARGES CONNECTION CHARGE FE .. OWNER'S PERMIT 5 � 00 --- - -- -- �- AUTHORIZATION TC3TAL FEE � 1 j ( �, R .Ir16uRSE�sENT FEE C HAVE,AT TiflS PATE A CONTRACT WITH THF, HEREIN NAMED CON- _...._-.- APPROVALS _`. DATE.----II:NS.PECTOR'SSIGNATUR TRACT R TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I - TO THE PUBLIC SEWEc ,,, NEW HOUSE.SEWER SIGNER THIS------ ✓ 4Ai GFS CONNECT ADJ1r10NAi.. OWNER OR — '� BUILDING OR WORK .�: OWNERSA ENT .. _ .-^" ro '�-' '— - -- SEPTIC TANK,SEEP PIT(S) ADDRESS AND/OR DRAINNLD I I HEREBY ACKNOWLEDGE THAT I HAVE READ TY,IS APPLICATION CESSPOOL{� DRYW ELL❑ AND STATE. THAT THE ABOVE: IS CORRECT AND AGREE TO COMPLY _-..--_- __--. ---- --_�- -- ___----__.----_-__. 'v^T1'i'H ALL COUNTY ORDINANCES ;AND STATE: LAWS REGULATING ALTER,REPAIR,SEWER OR ! PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM -------- ----- -r------ ' HERt,CY CREQUi 7H AT 1 a OFFALY REGISTERED AND/OR DISCONNECT'PLUG AND LICENSED AS PE.� iRED BY LOS �A rtL S COUNTY AFib STATE OF CALIFORNIA 03 tHA?' i D•1 i'!;E t:C�AL C1NI9ER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RES UE sTd"ht PR:NEP"Y. " \.. a. BACKFILL SEPTIC TANKS D - (--------- --- 91 GNAT U RE z 1A SEEP.PIT(S) LI CESSPOOL'S 71 OF PERMITTEE IOI-IN A. L.:AMBIE, CGUI^TY- GINEER ;' VALIDATION ROBERT A.WOOD, CHIEF F'LBG. INSPECTOR 0.. CASH - :RS'CO`7PEN5.ATFON DECLARATION 76CE 8082(2 00) APPLICATION FOR PERMIT I 1, , ;m that I have a certificate of consent to self SEW ER-S EW A DISPOSAL lr,s r C,rtificate of Workers'Compensation Insurance,or a cerriried L<,r,y thereof(Sec.3800,Lab.C.) COUNTY COUNTY OF LOS ANGELES ,l BUILDING AND SAFETY Policy No. Company El Certified copy is hereby furnished. FOR APPLICANT TO,FiILL IN CONNECTION DATA BUILDING STATION DEPTH Certified copy IS filed with the county buildinginspection AD DRES5 ',.., � J -. ". 'UPPER department. MANHOLE REFERENCE LOC AL[TY ! / - LOWER Dlte Applicant NEAREST TYPE OF CONNECTION LENGTH FROM CERTIFICATE 01; EXEMPTION FROM WORKERS' aRDss ST.T � ✓ Y. CURB P.L. M.L. TO W.L. COMPENSATION INSURANCE P.C. No. .. r OWNER _ J J ��`� 'l CO. IMP. NO. JOB NO. ( his section need not be completed If the work involved ADDRES� � `/a ��) _ TRUNK PERMIT NO. ROAD PERMIT NO. 0. by the permit is for one hundred dollars (S100) or less.) 0/Fi' E� +" AP FIOAVIT WAIVER EASEMENT RECORD.iN STR.NO. DATE CITY 1 _,i� 1" TEL. NOr / t .:F. ` ! J G,.-is, I certify that in the performance of the work for which this LEGAL ' t� ixermrt is issued I shall not employ any person in any mDESCRIPTION LOT Ne.anner Q HWY. OR ST. WIDENING so air to twcomt pbjeet to the Workers C,<,tYnpgii�sation La'o's. 1 BLOCK TRACT STATE ENCROACHMENT Applicant` �� '•_- --� LU NO. OF BLDGS. o-.% P IT NO, f 3, CL "TICS TO APPLICANT: If,' after ilaaking'this Certifkate,of s1aE of LOT Now ON Lor �'L�., fs` ,.��" W sE 9S of U Zf emption, you should become subjeet to the Workers' BSE: O NGS �.' ' C' S mpensation provisions of the Labor Code, you must forth- '7 Ith comply with such provisions or this permit shall be ,' / CONNECTION CHARGE FEE � CONTRACTOR J f' .+" 6` J;r Emed revoked. `�_-�- J f REIMBURSEMENT FEE LICENSED CONTRACTORS DECLARATION ADDRESS 1herebc affirm that I am licensed under provisions of Chapter c DISTRICT NO. CROUP MAF ccs D®Y "r 41'.. WJE ` PG ; ,., ( .. BK �. corn CITYL. NO, ' mencing with Section 7000)of Division 3 of the Busi- r� AA ',_,ess and Professions Code, and my license is in fuIi force gild sTATE'' ✓ i uC. 6 6 O /C-3 s t. LICENSE N,O..t t i( (� CLASS S54 \ - - NO. DESC-RIPTION OF WORK FEE t ,e.� 1' HOUSE SEWER CONNECTING TO FINAL VALIDATION License:Nurnber i � .: '� - 6 LIC.Class( PUBLIC SEWER DATE: S \y 1 SEPTIC TANK,SEEPAGE PITOR / ✓ ,l -.�._. "`-' PITS ANOJOR DRAIHF'IELO contracto '"F�-.4 ' Dote / �, _ FINAL v \, .. - 9i OUSE SEWER CONNECTING TO PRIMATE DISPOSAL SYSTEM BY 1 [ am exempt from the licensing requirements as I am a CONNECY ADDITIONAL 91-01,OR licensed architect or a registered professional engineer WORK TO HOUSE SEWER (/ acting in my professional capacity (Section 7051, Dns- OVERFLOW SE EPA6E PIT,ORAINFIELD mess and Professions Code). CXTN.,CESSPOOL,DRYWELL,MANHOLE - ALTER,REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM l ic,or Reg.No. Date HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's OWN ER`S Permit S License I.aw for the following reason (Section 7031.5, Busi AUTHORIZATIONTOTAL FEE � riess and PI OfeSS1UIiS Code): 1 HAVE AT THIS DATE, A CONTRACT WITH THE HEREIN NAMED CON- I RACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ILEI' 1, as owner of the property, will do the work and the TO THE FlUBLIC SEWER ,r structure is not intended or offered for sale Section 1 ( SIGNED THIS -� , DRY OF_.� - 19 7044, Business and Professions Code). owr,ER OWNERS AC'+ENT CONSTRUCTION I-FsNDiN AGENCY ADDRE I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3047,Civ.C.). Lender's 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 law's regulating Plumbing and Sewers, and hereby authorize representatives of this County to enter Upon the above-mentioned property for inspection purpose, ' SEF. REVERSE FOR EXPLANATORY LANGUAGE Sigttatu"ie o Prtnttee T Date