HomeMy Public PortalAbout9167 FORTSON DR_PLUMBING_5/21/2018_TEMPLE CITY PERMIT NO. P18-36184
City of Temple Gy 19701 Las Tunas Drive I Temple City, California 917801 (626)285-2171 1 www.templecity.us
Address: 9167 Fortson Drive, Temple City, California 91780
Parcel: 5382-016-013
Permit No: P18-36184
Type: Plumbing Subtype:
Subtype: Residential
Description: INSTALL. (2)4"INCH CLEANOUTS & REPLACE 4 FT. OF
Special
Valve
SEWER PIPE BY THE FRONT DOOR AREA
Conditions:
Washer
Issue Date: 05-21-2018
Expire Date: 05-21-2019 Extension:
Extension:
Permit expires on date shown iE p work does not commence, or 2) work is suspended or abandoned, or 3) applicant
fails to obtain code required
inspection.
Fountain
Rough
Contacts
System
Plumbing
Owner John
9167 Fortson Drive, Temple City,
(626) 348-7170
Erickson
California 91780
- Sewer Inspections
Applicant Bruce
3801 Lenawee Avenue, Los
(310)838-0408
Smythe
Angeles, California 90016
Trap Primer 0
Contractor Mike Diamond Plumbing DBA Mike Diamond
3801 Lenawee Aveml Culver
(310)838-0408 399170
Plumbing Heating and Air Conditioning
City, California 90232
Plumbing Details
- Plumbing Inspections
Backwater 0
Backflow 0
Bathtub/Shower 0
Clothes 0
Dishwasher 0
Valve
Device
Work
Washer
IHRity Co Notified
Drinking 0
Floor Drain 0
Floor Sink 0
Hose Bibb 0
Interceptor/Clarifier 0
Fountain
Rough
Plumbing
System
Plumbing
Lavatory/Sink 0
Miscellaneous 0
Pressure 0
Roof Drain 0
Solar Water Heater 0
- Sewer Inspections
Regulator
Pool Trap 0
Trap Primer 0
Water Closet 0
Water 0
Water Treatment 0
Heater
Gas: Low 0
Gas: 0
Gas Meter 0
Gas 0
Alteration/Repair 0
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
less
Other: over 3 0
Sewer: 0
Sewer: Manhole 0
Sewer:
Sewer: Private 0
Inches
Connection
Addition
Connection
Sewer: 0
Sewer: Pit 0
Sewer: 1
Sewer: 0
Pit/Drainfield
Extension
Alteration
Tap&Saddle
Combo
_
Waste/Vent
Earthquake
Chemical
Rainwater
Greywater
Shull
Waste
- Fees Total
Plan Check Faes 5148.65 Permit Feas $39.36
- Plumbing Inspections
Approval Date Inspector
Approval Date Inspector
Approval
Unci Slab
Gas Piping
Gas Test
Work
Gas Vent
IHRity Co Notified
Water Service
Hot Water
CWV
Plastic Y/N
Metal Y/N
Heater
Gray Water
Rough
Plumbing
System
Plumbing
Fixtures
FINAL
Lawn Sprinklers
- Sewer Inspections
Date Inspector
Approval Date Inspector Approval Date Inspector Approval Dab Inspector
New House Drywall
_. / BackfillaterTank/Pit
Sewer Alter/Repair �!t(li (7Id Gray Water �es
Connect Add'I Disconnect/Plug System
SePti<Tank/Pit FINAL
6
A
7
r
7
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 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"ytor pursuant to the Contractors' State License
Law).
(_):I am exemdt from licensure under the Contractors State
License Law for the following reason:
By my signature below I acknowledge that excep or my
personal residence in whit I must have resided fo at least
one year prior to completlo of the Improvements c ered by
this permit, I nnot legally all a structure that I have bu
owner -builder f 1t has not been constructed In Its entirety by
licensed contractors. 1 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: hfto://www.lealnfo.Ga.goy/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
'DI I I 3f th B i d P fes t C d d
JOB ADDRESS
LOCALITY
v s on o e us ness an ro sons o e, an my
a' (license Is in fu rce a d effect. I HAZARDOUS MATERIAL DECLARATION
/�rce License 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 h ous materials
Contractor Signature information guide?
WORKERS' COMPENSATION DECLARATION Yes ❑ N o
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
declarafior s:
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
�rf ante of the work for which is ertnit is issued. My
r en tt4 poll nu t)ar
Cartier l' Policy Number F�rpirac tion Dat
Agent
Phone Number
I certify that, in the performance of the work for which this
permit is issued, I s II not employ any person in any manner
86-14 to become lett to the workers' compensation laws of
Cel'do is, and a r that, if I , ould become subject to the
wor rs' compe s ion provis s of Section 3700 of the La r
C e, I shall fo Rh I rose p
Signal e o Date
Complete this s on for permits in �
This is to certify that I,
requirements of Los Aqqqq
(relating to the Los An�
At persons Mngon
os Angeles County only
permit applicant, am familiar
s County Code Chapter 2.161
County Lobbyist Ordinanc
I of myself complied an ill
the aoolicatio
the
Will the Intended use of the building by the applicant or future
building occupant require a permit for co on or
modification from the South Coast Air Qu Management
District (SCAQMD)? See permitting ch Ist for guidelines.
Yes ❑ N.o
i
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
materiel 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 3087, Civil Code).
Lender's Name
Lender's Address \ "l' \
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.
1 agree to comply with all applicable city and county
ordinances and state laws relating to building
I authorize repr enta6)fes of this county to enter the
above-identif grope f lnspect* purposes.