Flood Permit Application - Los Angeles County Department Of Public Works printable pdf download

LOS ANGELES COUNTY DEPARTMENT OF PUBLIC WORKS

FOR LOS ANGELES COUNTY FLOOD CONTROL DISTRICT

900 S. FREMONT AVE.

TRACKING NO. ______________

ALHAMBRA, CALIFORNIA 91803-1331

FLOOD PERMIT APPLICATION

_______________

DATE RECEIVED

OWNER/ APPLICANT:

TELEPHONE:(_____)

ADDRESS:

Street

City

Zip Code

AGENT/ CONTACT:

TELEPHONE:(_____)

ADDRESS:

Street

City

Zip Code

E-MAIL

SITE ADDRESS

Street

City

Zip Code

NEAREST INTERSECTION:

THOMAS GUIDE:

SCOPE OF WORK:

PERSON/AGENCY RESPONSIBLE FOR THE

MAINTENANCE OF THE PROPOSED FACILITY:

PHONE: (

)

The undersigned certifies that the applicant for this permit is familiar with the requirements of the County Lobbyist Ordinance (Los Angeles County Code

Chapter 2.160), and that all persons acting on behalf of the applicant have complied with and will continue to comply with this ordinance throughout the

application process. It is further agreed that the Owner/Applicant is the financially responsible party for all fees, deposits, charges, collections

and refunds, regardless if payment is made by others

Print Name of Owner/Applicant

Signature of Owner/Applicant

Date

Submittal Requirements:

1. Four sets of final construction plans (seven if the Corps is involved) with structural details and profiles of the existing and proposed facilities.

2. Two sets of letter size structural and/or hydraulic and hydrology calculations. The plans and calculations must be stamped and signed

by a registered civil/structural engineer licensed to practice in the State of California.

3. Four copies of the As-Built drawings of the District’s facility impacted by the proposed work and two of the right-of-way map.

4. Letter from Owner/Applicant authorizing Agent/Contact to request a permit on their behalf.

5. For storm drain connections, complete EXHIBIT “A” when applicable, and submit SUSMP.

6. Fees will be charged according to the current ordinance established by the Board of Supervisors

7. Certificate of Liability Insurance ($1 Million minimum coverage) and additional insured endorsement naming the County of Los Angeles,

the Los Angeles County Flood Control District, and, when applicable, the U.S. Army Corps of Engineers as co-insured.

8. Complete and sign acknowledgement that Applicant has read, understands, and agrees to fully comply with the Best Management Practices (BMP)

Attachment to this permit per Los Angeles County Code Chapter 12.80 Stormwater and Runoff Pollution Control.

The applicant must show that the proposed work will not adversely affect the District's interests; i.e., (1) Hydraulic and Hydrologic Design;

(2) Structural integrity; (3) Maintenance standards; (4) District's property rights, etc.

FOR DISTRICT USE ONLY

RECEIVED BY:_________ ASSIGNED TO:_________

PAYMENT

Issuance Fee: $

Project No. _______________

Suggested Routing:

Plan Check: $

FMD

DES-H

DES-S

Project No. _______________

(Fee or AC)

WMD

WRD

MPM

Inspection: $

Project No. _______________

(Fee or AC)

ACE

PDD

EPD

Other: $

Project No. _______________

(Fee or AC)

AED

GMED

T&L

Total: $

RMD

Road Unit

_________

Other

TYPE

Storm Drain Connection

Landscaping

Overbuild

Access

Catch Basin Relocation

Major Modifications

Bridge

LNO

Catch Basin Modification

Minor Modifications

Utility Crossing

Other

INFO

Stream/Project

File Code

P.O. # ___________

PD/MTD (To be Transferred)

Tract/P.M. No.

P:\ldpub\Permits\Flood Unit\Flood Permit Application APPROVED BY MA 11-2011

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Flood Permit Application - Los Angeles County Department Of Public Works

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