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Home My Public Portal About5716 RIO HONDO AVE_Plumbing_2/18/2015_COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 6561 LT: 757 UN: .004 ASSESSOR INFORMATION NUMBER 8587-004-006 OWNER: TEL. NO: OLMOS CARLOS M;SILVIA A;OLMOS CESAR (323) 363-1541- 5716 RIO HONDO AV TEMP 917802432 (APPLICANT: TEL. NO: BATIOFF, EMILY (714) 381-7974- 111715 N. CREEK PKWY IBOTHELL WA 98011 i �crvrvixacavx: TSL. NU: FAST WATER HEATER (425) 636-7054- 11715 CREEK PKWY SO. #C106 LIC. NO BOTHELL, WA 98011 III 987398 ARCHITECT OR ENGINEER: TEL. NO: LIC. NO: TEMPLE CITY # 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: I CEJ YN1U EE DESCRIPTION: QUANTITY: GUM: 1 PERMIT ISSUANCE FEE 7 WATER HEATER (S) 1.00 WIN TOTAL FEES REPORT ID: DPR263 ROUTE TO: BS0508 PLUMBING PERMIT PL 0508 1502180022 BUILDING ADDRESS: 5716 RIO HONDO AV AMOUNT:( TEMP CA 917802432 NEAREST CROSS STREET: 27.80 THOMAS PAGE: 596 GRID: 73 LOCALITY: TEMPLE CITY 16.20 44.00 ISSUED ON: PROCESSED BY: PLAN BY: 02/18/15 SR DESCRIPTION OF WORK REPLACE WATER HEATER EXISTING LOCATION (GARAGE) 40 GALLONS SPECIAL CON . ...onw (APPROVALS DATE INSPECTOR SIGNATURE (UNDER SLAB WORK I I (WATER SERVICE IPLASTIC YIN METAL YIN IHOT WATER NEATER I I PLUMBING FIXTURES LAWN SPRINKLERS (GAS TEST (UTILITY COMPANY NOTIFIED( I Com' I I (GRAY WATER SYSTEM 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).): (_) I, as owner of the property, or my employees with wages as their sole compensation, will do (,/)all of or U 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 Con" �tor 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 which I must have resided for at least one year priori to completion of the improvements covered by this permit. I cannot legally sell a structure that I have built as an owner -builder If 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:/Avww.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 License No. late ILI It'IY7Contractor Signature WORKERS' COMPENSATIO DEC WARNING: FAILURE TO SECURE WOR RS' MPENSATION COVERAGE IS UNLAWFUL. AND 3 L SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND C L 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: Carder Policy Number Expiration Date Name 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 shouul me subject to the workers' compensation provisions o ti 3700 of the Labor Code, I shall for(�with comply v�th th ro sions Im LOBBYIST ORDINANCE CERTIFICATION \�Complete this section for permits in rporated 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) Company Name Applicant Signature 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 ❑ N o ❑ 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 Secdons 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 ❑ 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 inspegtiop-purposes. Of