HomeMy Public PortalAbout10234 RANDWICK DR_MECHANICAL_12/13/2018_M18-37248 (2)TEMPLE CITY PERMIT NO. M18-37248
City of Temple City 19701 Las Tunas Drive I Temple City, California 917801 (626)285-21711 www.templecity.us
Address: 10234 Randwick Drive, Temple City, California 91780
Parcel: 8585-004-038
Permit No: M18-37248
Type: Mechanical Subtype;
Subtype: Residential
Description: REPLACE FURNACE CLOSET, REPLACE DUCTS ATTIC,
Special
REPLACE A/C REG
Conditions:
Issue Date: 12-13-2018
E%Vm Date: 12-13-2019 Extension:
Exbmsksn:
Permit expires on date shown if: l) work does not commence, or 2) work is suspended or abandoned, or 3) applicant fails to obtain code
required inspection.
Contacts
Owner jenny Gibson
10234 Randwick Drive, Temple City,
(626) 350-5145
California 91780
Applicant RossPisano
2075 E Villa St, Pasadena, California 91107
(626) 286-1141
Contractor Middieridge DBA Bryant Heating & Air
2075 E Villa St, Pasadena, California 91107
(626) 286-1141 948141
Concepts Inc. Conditioning
- Mechanical Details
Compressor/Furnace/Etc 2 Compressor/Furnace/Etc 0
Compressor/Furnace/Etc 0 Air
0 OR Floor 0
upto1D0k BTU 100-500k BTU
over 500k BTU Inlet/Outlet
Area
Ory
Appliance Vent 0 Air Hand ler up to 2,000 0
Air Handler 2.10,000 0 Air Handler
0 Evaporative 0
CFM
CFM over10,000
Cooler
CFM
Ventilation Fan 0 Ventilation System 0
Kitchen Hood/Spray 0 Fire
0 Duct I
Bootie Damper
Alteration
Fireplace 0
Fees Total
Plan Check Fees $0.00 Permit Fees 1109.80
- Mechanicallnspections
Approval D�tei Ins ect YJ
FAU/Wall Furnace �LL `
Combustion Air
Openings -_ r - , I
Duct Work 'I")�a-"]_tel/_�`J
Approval p��qt�e�R Approval Date Inspector
AC/Compressor V7-'►"� Smoke
Thermostat Detectors
Fire Dampers !1� Commercial
Hood
FINAL
1
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 Contrkrtor 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 I must have resided for at least
one year priorlto 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 lecinfo ca aov/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 C ZO License No. 9V6 s
Dater 2v` 7b Contractor 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
wggers' compensation insurance carrier and policy nu ar ,y,:
5
(5tip+c6la CST /f2a�_Z �� 7
Carr" _ Policy NurgbeS Expi�� q Date
Name of Agent 6 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
workers' compensation provisions of Section 3700 of the Labor
Code, I s 11 forth comply with those provisions
'ovY, r2'fa —(5/7
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 complied an II continue
to co�r�ply the
\rew,t/t{� through the applica(bogyr_oce 11
(C.oSS `T IS✓Mdv
Appy'gant (Print Name) Applicant Signature
R_ 42W z-
Company Name Date
JOB ADDRESS
s
LOCALIIl"
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 ❑ N o ❑
i
I have read the hazardous materials information guide and the
SCAQMD permitting checklist, 1 understand my requiremgnts
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
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 toeach 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.
Signal ur 7P,ropertyy ner or Authorized Agent
Date 2 3 -/ff-