HomeMy Public PortalAbout9526 BLACKLEY ST_PLUMBING_6/13/2017_ (2)TEMPLE CITY PERMIT NO. P17-34379
City of Temple City 1 9701 us Tunas Drive I Temple City, California 91780 1 (626) 285.2171 1 wwwtempleclty. us
Address: 9526 Blackley Street, Temple City, California 91780 Parcel: 8590-007-027
Permit No: P17-34379 Type: Plumbing Subtype: Subtype: Residential
Description: GAS UNE FOR FURANCE Special Conditions:
Issue Data: 06-13-2017 Expire Date: 12-10-2017 Extension: Extension:
Permit expires on date shown d: 1) work does not commence, or 2) work is suspended or abandoned, Or 3) applicant falls to obtain code required
inspection.
Contacts
Owner Beverly Hayton
e[ Insp o
9526 Blackley Street, Temple City, California 91780
(626)
287-4283
Applicant Cana Contreras
Inspector
4931 Encmita Avenue, Temple City,
California 91780
(626)
286-3157
Plastic Y/N
Contractor
Connor Air Conditioning
4931 Encmita Avenue, Temple City,
California 91780
(626)
286-3157 403735
- Sewer I s ectlons
Plumbing Details
Approval Date
Inspector
New House Sewer
Conned Add'I
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 0
Water Treatment
0
Heater
Gas: Low I
Gas: 0
Gas Meter 0
Gas 0
Alteration/Repair
0
Press
Med/High
Regulator
Press
Greywater 0
Pipe 0
Future Branches 0
Other: 1.S 0
Other: 2-3 inches
0
System
Replacement
inches or
less
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
Alteration
Tap&Saddle
Cembo
Waste/Vent
earthquake Chemical
Rainwater
Greywater
Shutoff
Waste
- Fees Total
e[ Insp o
Plan Check Fees $113.60
Permit Fees $20.50
- Plumbing Inspections
Approval Date
Inspector
Under Slab Work
Water Service
Plastic Y/N
Metal Y/N
Rough Numbing
- Sewer I s ectlons
Approval Date
Inspector
New House Sewer
Conned Add'I
Septic Tank/Nt
Approval
e[ Insp o
Gas Pipinq
Gas Vent
Hot Water Heater
Numbing Fixtures
lawn Sprinklers
Approval Date
Drywall
Alter/Repair
Disconnect/Plug
Approval Date Inspector
Gas Test
Utility Cc Notified
CWV
Gray Water System
FINAL
Inspector Approval
Backfill Tank/plt
Gray Water System
FINAL
Data 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 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.).
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 Contr9r(tor pursuant to the Contractors' State License
Law). '
(_) I am exemi4t 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 priori to completion of the improvements covered by
this permit, Icannot 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: httpJ/www.leginfb.ca.00v/mlaw.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 We, and my
license is in full force and effect. �� (�� ^�
License ClasQ�icense No. W�� / ��
Dateor tractor 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
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 d
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 0
1 have read the hazardous materials information guide and the
SCAOMD 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
insurance, as required by Section 3700 of the Labor Code, for � I declare that notification of asbestos removal is not
the performance of the work for which this permit is issued. My applicable to addressed project.
workers'co pens tion i c c r`ar p Iicy numbIr r: V'
Carrie policy Number xpiration Oafs
N me 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
worker ' compensation provisions of Section 3700 of the Labor
Code, sh II ith comply with those provisions
[Qb\n
Signature of Applicant 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 compli d 'll continue
to gblryply therewiliththrough the application p
App a tApp a t (P 'nt Name Appl
Compa
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 pennit 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 auth rize representatives of this county to enter the
abov i+gtified property for inspection purposes.
Date
or Authorized Agent