HomeMy Public PortalAbout5341 SANTA ANITA AVE_PLUMBING__9/25/2017_TEMPLE CITY PERMIT NO.
P17-34934
Under Slab Work
Gas Piping "�,�rI, J/f/
t''
Water Service
city of Temple City 1 9701 Las Tunas Drive I Temple
City, California 91780 1 (626) 285-2171 1 www.templetlty.us
Address: 5341 Santa Anita Ave, Temple City, California 91780
Parcel:
8573-018-045
Rough Plumbing
Permit No: P17-34934
Sewer inspections
Type:
Plumbing Subtype:
Subtype: Residential
Description: GAS LINE FOR SPLIT SYSTEM
Special Conditions:
Connect Atli
Alter/Repair
Issue Date: 09-25-2017
On connect/Plug
Expire Date:
03-24-2018 Extension:
Extension:
Permit expires on date shown If: I) work does not commence, or 2) work Is suspended
or abandoned, or 3) applicant
fails to obtain code repulred
inspection.
Contacts
Owner Donna Owens
5341 Santa Anna Avenue, Temple
City, California 91780
(626) 443-9630
Applicant Maor Atenket
18130 Calvert St, Reseda, California 91335
(818) 292-0172
Contractor
Al Air Conditioning & Heating
6921 Shoshone Ave, Van Nuys, California 91406
(323) 608-7711 991136
- Plumbing Details
_
Backwater 0
Backflow 0
Bathtub/Shower 0
Clothes 0
Dishwasher 0
valve
Device
Washer
Drinking 0
Floor Drain 0
Floor Sink 0
Hose Bibb 0
Interceptor/Clarifier 0
Fountain
Lavatory/Sink 0
Miscellaneous 0
Pressure 0
Roof Drain 0
Solar Water Heater 0
Regulator
Pool Trap 0
Trap Primer 0
Water Closet 0
Water L
Water Treatment 0
Heater
Gas: Low 1
Gas: 0
Gas Meter 0
Gas 0
Alteration/ Repair o
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
lees
Other: over 3 0
Sewer: 0
Sewer: Manhole 0
Sewer: 0
Sewer: Private 0
inches
Connection
Addition
Connection
Sewer: 0
Sewer: Pit 0
Sewer: 0
Sewer: 0
Pit/Drainfield
Extension
AlieraHon
Tap&Saddle
Combo
Waste/Vent Earthquake Chemical
Shutoff waste
Fees Total
Plan Check Fw $113.60 Permit Fees $21,06
Plumbina Inspections
Approval paw Inspector
Approval DP i srsp r
Under Slab Work
Gas Piping "�,�rI, J/f/
t''
Water Service
Gas Vent
Plastic Y/N
Hot Water Heater
Metal Y/N
Plumbing Fixtures
Rough Plumbing
Lawn Sprinklers
Sewer inspections
Approval Data Inspector
Approval Date Inspector
New House Sewer
Drywall
Connect Atli
Alter/Repair
Septic Tank/Pit
On connect/Plug
Rainwater
Graywater
Approval
Date Inspector
Gas Test
Utility Co Notified
CWV
Gray Water System
FINAL
Approval
Date Inspector
Backfill T4nWPlt
Gray Water System
FINAL
t
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 (,/)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.).
L 1 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 Contraor pursuant to the Contractors' State License
Law).
(,: I am exempt from licensure under the Contractors' State
License Law for the following reason:
By my signature below 1 acknowledge that, except for my
personal residence in which I must have resided for at least
one year priorl to completions of the improvements covered by
this permit, I cannot legally sell a structure that 1 have built as an
owner -builder ff 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.leginfo.ca.gov/calaw.htmi.
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. /+
License Class C — 2 O License No.
Date'y/� Contractor Signature I y
WORKERS' COMPENSATION DECLARATION
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.
Policy 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
workers' compensation Insurance carder and policy number are:
Carrier Policy Number Expiration Date
Name of Agent Phone Number
k 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
Code, I shall forthwftVwmply with those provisions
A ��
Signature otApplicanI 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 po will continue
to comply therewith through the application pr
A lipnt fp�nt Narpe) V� Applicant Signa{rr� l
CCompany Name MnNS Date
JOB ADDRESS 1
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 ❑ N.o ❑
I have read the hazardous materials information guide and the
SCAQMD permitting checklist, I understand my requimm nts
under the Los Angeles County Code Title 2, Chapter g{20'
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 owner's 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.
Signature of Property rr uthorized Agent
Date Zf