HomeMy Public PortalAbout5328 DUPUY CIRCLE_PLUMBING_11/9/2015_ (2)COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
ON FILE
8590-005-019
TENANT:
OWNER:
OLIVE STREET GROUP LLC.
265 W NAOMI AVE
ARCADIA CA 91007
LAI, PAUL
1444 CHICO AVE #A
SO. EL MONTE 91733
TEL. NO:
(714) 863 -9192 -
TeL. Nu:
(626) 945 -5451 -
CONTRACTOR:
TEL.
NO:
PCL PLUMBING INC.
(626)
945-5451-
P0 BOX 1928
91780
LIC. NO
ROSEMEAD CA 91770
EXT:
518704
FEES
PAID
ARCHITECT OR ENGINEER:
TEL.
NO:
LEE, PETER
(626)
280-9000-
8748 E VALLEY BLVD SUITE L
5.00
LIC. NO:
ROSEMEAD CA 91770
1.00
518704
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
TEMPLE CITY
A 0508
9701 LAS TUNAS
TEMPLE CITY CA
91780
PHONE: (626) 285-0488
EXT:
FEES
PAID
FEE DESCRIPTION:
QUANTITY:
DOM:
O1 PERMIT ISSUANCE FEE
07 BATHTUBS/SHOWERS
5.00
FIX
11 CDOTHESWASHER(S)
1.00
FIX
13 DISHWASHERS(
1.00
FIX
21 HOSE BIBB(S)
3.00
FIX
25 LAVATORIES / SINKS
8.00
FIX
45 WATER CLOSET/URINAL
5.00
FIX
47 WATER HEATER(S)
2.00
WTH
51 LOW PRS GAS LES OUTS
1.00
SYS
52 ADDITIONAL OUTLS > 5
3.00
OUT
55 GAS METER (PRIVATE)
1.00
MET
64 WATER PIPNG <- 1 1/2
1.00
LIN
TOTAL FEES
- ADDITIONAL DATA ON FILE
REPORT ID: DPR263 ROUTE TO: BS0508
PLUMBING PERMIT
PL 0509 1511090019
BUILDING ADDRESS:
5328 DUPUY IN
AMOUNT:j TEMP CA 917803131
NEAREST CROSS STREET: CLOVERLY
34.40 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY
101.00
20.20 ISSUED ON: PROCESSED BY: PLAN BY:
20.20 11/09/15 SR
60.60 (
161.60 FINAL DATw FINA Y. CODE:
141.00 % /
40.40 /u/ o
20.20 IDESCRIPTION bF O
15.60 PLUMEING FOR A NEW SINGLE FAMILY DWELLING
20.20
20.20
615.60
UNDER SLAB WORK
WATER SERVICE
PLASTIC N METAP/N
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS
DATE INSPECTOR SIGNATURE
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.).
( J 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 ContrS�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://www.leainfo.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 r-5 License No.
Date t ontractor Signature
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' mpensation insurance c' r np icy n r.
Canw e5illcy NuIntier Exp' doto
Name of Agent Phone Number
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 ❑ 1
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
I certify that, in the performance of the work for which this
Construction lending agency for the performance of the work for
which this permit is issued (Section 3097, Civil Code).
permit is issued, I shall not employ any person in any manner
so as to become subject to the workers' compensation laws of
Lender's Name
California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor
Lender's Address
Code, I shall forthwith comply with those provisions
��
By my signature below, I certify to each of the following:
Sig eofAppli nt ate
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
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 et 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 rough the application process,
licant rint Na ) I lkAplidant Signatu
/!
ompany N Ve Dat
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 Owner or Authorized Agent
Date