HomeMy Public PortalAbout6208 ROSEMEAD BLVD_PLUMBING_5/16/2016_COUNTY OF IAS ANGELES TEMPLE CITY # 0508
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
PLUMBING PERMIT
PL 0508 1605160038
GAL ID:
TEL. NO:
HUSEN, TROSON
FEES PAID
6208 ROSEMEAD BLVD
BUILDING ADDRESS:
5904 LT: 95
APPLICANT:
1 6208 ROSEMEAD BL
MATA, DANIEL
(555) 345-9048-
FEE DESCRIPTION:
QUANTITY: UOM:
AMOUNT:(
TEMP CA 917801542
SESSOR INFORMATION NUMBER:
I NEAREST CROSS STREET:
84-006-001
01 PERMIT ISSUANCE FEE
34.40
THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY
47 WATER HEATER(S)
1.00 WTH
20.20
RANT:
TOTAL FEES
54.60
ISSUED ON: PROCESSED BY: PLAN BY:
05/16/16 SR
OWNER:
TEL. NO:
HUSEN, TROSON
(626) 215-4918-
6208 ROSEMEAD BLVD
TEMPLE CITY CA 91780
APPLICANT:
TEL. NO:
MATA, DANIEL
(555) 345-9048-
28358 CONSTELLATION
VALENCIA CA 91355
CONTRACTOR: TEL. NO:
AFFORDABLE WATER HEATER AND PLUMB (855) 345-9087-
28358 CONSTELLATION ROAD #698 LIC. NO
VALENCIA, CA 91355 627368-C36
TEL. NO:
LIC. NO:
EXPIRED
PERMIT EXPIRES 180 DAYS IF
1) WORK DOES NOT COMMENCE, OR
2) WORK IS SUSPENDED OR ABANDONED, OR
3) FAILS TO OBTAIN CODE REQUIRED INSPECTION
REPORT ID: DPR263 ROUTE TO: BS0508
BY.
REPLACE WATER HEATER SAME SIZE/LOCATION 50 GAL/GARAGE
PLASTIC YIN METAL YIN
ROUGH PLUMBING
9lobYWN
IGAS TEST
I I
(UTILITY COMPANY NOTIFIEDI
ICWv
I
GRAY WATER SYSTEM
I
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 permit 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 (J) 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 it 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 Contrh or pursuant to the Contractors' State License
Law).
U: I am exempt from licensure under the Contractors' State
License Law for the following reason:
By my signature below I acknowledge that, except for my
personal residence in whicf I must have resided for at least
one year priorlto completion of the improvements covered by
this permit, I cannot legally sell a structure that I have built as an
owner -builder H 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.leciinfo.ca.aov/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
D' " 3 f th B' d Pr_*_ Cod d
JOB ADDRESS
LOCALITY
Ivrslof e usiness an ro essions e, an my
license is in full force and effect. HAZARDOUS MATERIAL DECLARATION
Licens Cla s_(�D� License No. Will the applicant or future building occupant handle a hazardous
Date�t material or a mixture containing a hazardous material equal to or
"t ' Contractor Signat a greater than the amount specked on the hazardous materials
information guide?
WORKERS' COMPENSATION DECLARATION Yes ❑ No ❑
WMNING: 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
si sued.
P i y No.
I have and will maintain workers' compensation
i surance, as required by Section 3700 of the Labor Code, for
the performance of the work for which this permit is issued. My
works
co
.rs' a satin igsur i t
umber e:/
.wic� I
Carder Policy Number Expiration ate
wM'[
Name of Agerif one Ni mber
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
work rs' compensation provi ions of Section 3700 of the Labor
Co 1 shall forthwi r with those provisions
nature of ApplKsht 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 L by Ordinance) and th
all persons acting on behalf of myself mplied and will
to comply therewith through the appl' ti n process.
AppIit 'ptNa
me),�A ^ Appl cant n
Comp nyName Date
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 SCAQMD.
ASBESTOS NOTIFICATION
❑ Notification letter sent to AQMD and/or EPA
❑ I 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 author* a representatives of thiscounty to enter the
above -de_ tified property fq;�nspjigfon purposes.
Date