HomeMy Public PortalAbout10123 LA ROSA DR_PLUMBING_4/27/2017_P17-34094 (2)TEMPLE CITY PERMIT NO. P17-34094
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City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templeaty.us
Address: 10123 La Rosa Drive, Temple City, California 91780 Parcel: 8585-007-016
Permit No: P17-34094 Type: Plumbing Subtype:
Subtype: Residential
Description: BATHTUB/SHOWER, CLOTHESWASHER, HOSE BIBBS, LAVATORIES, Special
-
WATER CLOSET, WATER HEATER AND WATER PIPING REPLACEMENT Conditions:
Issue Date: 04-27-2017 Expire Date: 10-24-2017 Extension:
Extension:
Permit expires on date shown If: 1) work does not commence, or 2) work is suspended or abandoned, or 3) applicant fails to obtain code required '
inspection.
Contacts
Owner Henri Butthuls 10123 La Rosa Drive, Temple City, California 91780
(626) 279-1682 "
Applicant Rod Perryman 2740 East Cameron Avenue, West Covina, California 91791
(626) 695-8175
Contractor J & R Perryman Construction Inc. 2740 East Cameron Avenue, West Covina, California 91791
(626) 332-5306 562559 1
- Plumbing Details
Backwater 0 Backflow 0 Bathtub/Shower 1 Clothes I
Dishwasher 0 '
Valve Device Washer
Drinking 0 Floor Drain 0 Floor Sink 0 Hose Bibb 2
Interceptor/Clarifier 0
Fountain
Lavatory/Sink I Miscellaneous 0 Pressure 0 Roof Drain 0
Solar Water Heater 0
Regulator
Pool Trap 0 Trap Primer 0 Water Closet 1 Water 1
Water Treatment 0
Heater
Gas: Low 0 Gas: 0 Gas Meter 0 Gas 0
ANeration/Repair 0
Press Med/Nigh Regulator
Press
Greywater 0 Pipe 1 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: 0
Sewer: Private 0
inches Connection Addition
Connection
Sewer: 0 Sewer: Pit 0 Sewer: 0 Sewer:
Pit/Drainfield Extension Alteration Tap&Saddle
Combo
Waste/Vent Earthquake Chemical Rainwater
Greywater
Shutoff Waste
Fees Total_
Plan Check Fees $113.60 Permit Fees $152.06
Plumbing Inspections
- --- -
Approval Dpt� r Ins Approval Da - In pector Approval
Under Slab /�G/jr(tt�yvt/-F,.F Gas Gas Test
Date Inspector
—... �nf�1Iy's�p�,{�•1—
Wow Gas Vent Utility Co Notified
Water 5erwce Het Water CWV
• f"
Plastic Y/N Heater Gray Water
Metal Y/N Plumbing System
Rough Fi%tures FINAL
_
Plumbing T(/"� `�
Lawn Sprinklers
Sewer Inspections 9��p (y t� l� IL it
Approval Date Inspector Approval Date Inspector Approval
Date Inspector
New House Drywell Backfill Tank/Pit
Sewer Alter/Repair Gray Water
Connect Add'I Disconnect/Pklg System
Septic Tank/Pit FINAL
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 Tile 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 Con"ftor 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 I acknowledge that except for my
personal residence in which 1 must have resided for at least
one year prior to completiol of the improvements covered by
this permit, I nnot legally sdil a structure that I have built as an
owner -builder f it has not been constructed in its entirety, by
licensed contractors. I understand that a copy of the applicable -
law, Section 7044 01"the Business and Professions Code, is
available upon request when this application is submitted or at
the following Web site: htti),//www.leginLo.Ga,gov/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
Division 3 of the Business and Professions Code, and my
license is in
full force and effect. "
License Class �Z License No. 56Z
Date`f %.1% Contractor Signature
WORKERS' COMPENSATION DECLARATI N
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
ATTORNEYS 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 carrier and policy number are:
Carrier 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, 1f I should become subject to the
workers' compensation provisions of Section 3700 of the Labor
I shall torJJ1*"_
th comply with those provisions
4=27-1`7
Signature of Applicanty
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 and will continue
to comply therewith through the application process.
Applicant (Print Name) Applicant Signature
Company Name 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 ❑ No ❑
Will the intended use of the building by the applicant or future
building occupant require a permit for construction or
mod cation from the South Coast Air Quality Management
District (SCAQMD)? See permitting checklist for guidelines.
Yes ❑ No ❑ %
i
I have read the hazardous materials information guide and the
SCAQMD permitting checklist, I understand my requirem nts
under the Los Angeles County Code 1711a,2, Chapter �40'
Sections 220.100 through 220.140 concerning hazardous
material reporting and for obtaining a permit from the SCARMD.
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 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.
Sig�gp o4roperty Owner or Authorized Agent
Date 4-L