HomeMy Public PortalAbout10680 KEY WEST ST_PLUMBING_3/9/2017_TEMPLE CITY PERMIT NO. P17-33819
City of Temple qty 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templedty.us y
Address: 10680 Key West Street, Temple City, California 91780 Parcel: 8585-029-033
Permit No: P17-33819 Type: Plumbing Subtype: Subtype: Residential
Description: REPLACE BATHTUSS/SHOWERS Special Conditions:
Issue Date: 03-09-2017 Expire Date: 09-05-2017 Extension: Extension: -
Permit expires on date shown If: 1) work does not commence, or 2) work is suspended or abandoned, or 3) applicant fails to obtain code required -
Inspection.
Contacts
Owner Henry Tsai 19369 Darien Street, Rowland Heights, California (323) 8064408
91748
Applicant Freddy 14439 3oanbridge Street, Baldwin Park, (626) 338-8565 -
Garcia California 91706
Contractor New Sky Line Stone Inc. DBA New Sky Line 14439 3oanbridge Street, Baldwin Park, (626) 338-8565 970096
Development California 91706
Plumbing Details
_
- Plumbing Inspections
Backwater 0
Backflow 0
Bathtub/Shower 2
Clothes 0
Dishwasher 0
Valve
Device
Work
Washer
Drinking 0
Floor Drain 0
Floor Sink 0
Hose Bibb 0
Interceptor/Clarifier 0
Fountain
/-1
Rough �L_F
Plumbing
Fixtures
Plumbing
Lavatory/Sink 0
Miscellaneous 0
Pressure 0
Roof Drain 0
Solar Water Heater 0
Approval Date Inspector
Approval
Regulator
New House _
Orywell
Pool Trap 0
Trap Primer 0
Water Closet 0
Water 0
Water Treatment 0
Disconnect/Plug
Septic Tank/Pit -
Heater
Gas: Low 0
Gas: 0
Gas Meter 0
Gas 0
Alteration/ Repair 0
Press
Med/High
Regulator
Press
Greywater 0
Pipe 0
Future Branches 0
Other: 1.5 0
Other: 2-3 inches 0
System
Replacement
inches or
less
Other: over 3 0
Sewer: 0
Sewer: Manhole 0
Sewer: 0
Sewer: Private ^_
inches
Connection
Addition
Connection
Sewer: 0
Sewer: Pit 0
Sewer: 0
Sewer: 0
Pit/Drainrield
Extension
Alteration
Tap&Saddle
Combo
Waste/Vent
Earthquake
Chemical
Rainwater
Greywater
Shutoff
Waste
Fees Total
Plan Check Fees $0.00 Permit Fans, $41.01
- Plumbing Inspections
Approval Date Inspector
Approval
Date Inspector
Under Slab
Gas Piping
Work
Gas Vent
Water Service
Hot Water
Plastic N
Metal Y/N
Heater
/-1
Rough �L_F
Plumbing
Fixtures
Plumbing
Lawn Sprinklers
- Sewer Inspections
Approval Date Inspector
Approval
Date Inspector
New House _
Orywell
Sewer
Alter/Repair
Connect Atli
Disconnect/Plug
Septic Tank/Pit -
Approval
Gas Test
Utility Cu Notified
CWv
Gray Water
System
FINAL
Date Inspector
Approval Data
Backfill Tank/Pit
Gray Water
System
FINAL
Inspector
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from
the Contractors' State License Law for the reason(s) indicated
below by the checkmark(s) I have placed next to the applicable
item(s) (Section 7031.5, Business and Professions Code): Any
city or county that requires a penult to construct, alter, improve,
demolish, or repair any structure, prior to its issuance, also
requires the applicant for the permit to file a signed statement
that he or she Is licensed pursuant to the provisions of the
Contractors' State License Law (Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professions
Code) or that he or she is exempt from licensure and the basis
for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars ($500).):
U I, as owner of the property, or my employees with wages as
their sole compensation, will do (✓) all of or (_) portions of the
work, and the structure is not Intended or offered for sale
(Section 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of
property who, through employees' or personal effort, builds or
Improves the property, provided that the improvements are not
intended or offered for sale. If, however, the building or
improvement is sold within one year of completion, the Owner -
Builder will have the burden of proving that R was not built or
Improved for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with
licensed Contractors to construct the project (Section 7044,
Business and Professions Code: The Contractors' State License
Law does not apply to an owner of property who builds or
improves thereon, and who contracts for the projects with a
licensed Contractor pursuant.to the Contractors' State License
Law).
J:I am exemdt from licensure under the Contractors' State
License Law for the following reason:
i
By my signature below I acknowledge that, except for my
personal residence in whict1 I must have resided for at least
one year prion to completionk of the Improvements covered by
this permit, i nnot legally sell a structure that I have built as an
owner -builder f it has not been constructed in its entirety by
licensed contractors. I understand that a copy of the applicable
law, Section 7044 of'the Business and Professions Code, is
available upon request when this application is submitted or at
the following Web site: htto•//www Iecinfo.ce.cov/calaw.html.
Date:
Signature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, and my
license is in full force and effect. N
License Class
9 License No. 700 Y
Date �/7_Contractor Signature
WORKERS*COMPENSATI DECLARA
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION
COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN
EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION
TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED
FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following
declarations:
I have and will maintain a certificate of consent to self -
insure for workers' compensation, issued by the Director of
Industrial Relations as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit
is issued.
Po} cy No.
� I have and will maintain workers' compensation
Insurance, as required by Section 3700 of the Labor Code, for
the performance of the work for which this permit is issued. My
ws=r2nwtfcn I sura a ,p i a/id policy number are: 2
Carrier Policy Number policy
ration Date 7
of Agent Phone Number
I certify that, in the performance of the work for which this
permit is issued, I shall not employ any person in any manner
so as to become subject to the workers' compensation laws of
California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor
Cod71sh forthwith comply with those provisions
3 7 (7
Si re o Appli Date
LOBBYIST ORDINANCE CERTIFICATION
Complete this section for permits in
. Unincorporated Los Angeles County only
This is to certify that I, as permit applicant, am familiar with the
requirements of Los Angeles County Code Chapter 2.160 at seq.,
(relating to the Los Angeles County Lobbyist Ordinance) and that
all persons acting on behalf of myself complied and will continue
to comply therewith through the application process.
Applicant (Print Name) Applicant Signature
Company Name Date
JOB ADDRESS
LOCALITY
HAZARDOUS MATERIAL DECLARATION
Will the applicant or future building occupant handle a hazardous
material or a mixture containing a hazardous material equal to or
greater than the amount specified on the hazardous materials
information guide?
Yes ❑ No ❑
Will the intended use of the building by the applicant or future
building occupant require a permit for construction or
modification from the South Coast Air Quality Management
District (SCAQMD)? See permitting checklist for guidelines.
Yes ❑ No ❑
I have read the hazardous materials information guide and the
SCAQMD permitting checklist, I understand my requirements
under the Los Angeles County Code Title 2, Chapter 220'
Sections 220.100 through 220.140 concerning hazardous
material reporting and for obtaining a permit from the SCAOMD.
ASBESTOS NOTIFICATION
❑ Notification letter sent to AQMD and/or EPA
❑ 1 declare that notification of asbestos removal is not
applicable to addressed project.
DECLARATION REGARDING CONSTRUCTION LENDING
AGENCY
I hereby affirm under penalty of perjury that there is a
Construction lending agency for the performance of the work for
which this permit is issued (Section 3097, Civil Code).
Lender's Name
Lender's Address
By my signature below, I certify to. each of the following:
I am the property owner or authorized to act on the
property owners behalf.
I have read this application and the information I have
provided is correct.
I agree to comply with all applicable city and county
ordinances and state laws relating to building
construction.
I authorize representatives of this county to enter the
above -identified property for inspection purposes.
Signatu Prope9wner or Authorized Agent
Da