HomeMy Public PortalAbout5058 SULTANA AVE_PLUMBING_10/16/2017_P17-35058 (2)TEMPLE CITY PERMIT NO. P17-35058
City Of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templecdy.us
Address: 5058 Sultana Ave, Temple City, Callfomia 91780 Parcel: 5388-017-028
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Permit No: P17-35058
Type: Plumbing Subtype:
Subtype: Residential
Description: PLUMBING FOR NEW DETACHED CONDO
AND CONNECT TO Special
PUBLIC SEWER
Conditions.
_
Issue Date: 30-16-2017
Expire Date: 06-14-2018 Extension:
Extension:
Permit expires on date shown it: 1) work does not commence, or 2) work is suspended or abandoned, or 3) applicant
falls to obtain Date required
inspection.
�ia CIS
_
owner Sultana Highland Villa LLC 5922 North Burton Avenue, San Gabriel, California 91775
(626) 922-7373
Applicant Jan Hokgaft en
1227 W Valley Blvd 1109, Alhambra, Caldomla 91803
(626) 523-7070
Contractor Boomerang Engineering
Inc. 1227 W Valley Blvd #109 - 115, Alhambra, California 91803
(626) 780-6694 861501
A hitect ARC Design
1227 West Valley Boulevard, Alhambra, California 91803
(626) 715-7222
Plumbing Details
Backwater 1 Backflow 0
Bathtub/Shower 3 Clothes 1
Dishwasher 1
Valve Device
Washer
Drinking 0 Floor Drain 0
Floor Sink 0 Hose Bibb 2 Interceptor/Clarifier
0
Fountain
Lavatory/Sink 4 Miscellaneouf 0
Pressure 0 Roof Drain 0
Solar Water Heater 0
Regulator
Pool Trap 0 Trap Primer D
Water Close[ 3 Water 1
Water Treatment 0
Heater
Gas: Low 5 Gas: 0
Gas Meter 1 Gas 0
Alteration/Repair 0
Press Med/High
Regulator
Press
Greywater 0 Pipe 0
Future Branches 0 Other: 1.5 1
Other: 2-3 inches 0
System Replacement
inches or
less
Other: over 3 0 Sewer: 1
Sewer: Manhole 0 Sewer: 0
Sewer: Private 0
inches Connection
Addition
Connection
Sewer: G Sewer: Pit 0
Sewer: 0 Sewer:
Pit/Dralnfield Extension
Alteration Tap6Saddte
Combe
Waste/Vent Earthquake Chemical Rainwater
Greywater
Shutoff Wast.
- Fees Total
Plan Chack Few $20044 Permit Fees $501.09
Plumbing Inspections
_
Approval „IWtS 1 s
at,Gas
Approval -Batas In _—_ Approval —�
—
lit
UnderSlabWork /sJ/�ryFF/-•F-'F
Piping '�ft��aj-�(L-2/Oq— Gas Ten109L
�
Water Service
Ranic
Metal Y/N e/JVL
1 m/ is
Gas Vent UDllry Co NotifiLN
CWV
Water Heater Gray
Plumbing
Plumbing s Gray Water Syetem
PluYINmbing
Rough Plumbloe
Sprinklers
Lawn Sprinklers FINAL
- Se_wer Inspections
Approval sp or
Approval Data Inspector Approval
Data Inspect"
New House Sewer
Connect Adt'I
Drywall Backfill Tank/At
Alter/Repmr Gray Water System
Septic Tank/Rt —_
DisconnecUPlug FINAL
91104 $If AW" W
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 ContrS�tor 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 except for my
personal residence in which I must have resided for at least
one year priorl 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 leoinfo ca cov/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. !-^r
Licari
DatelvLLl1 L_�Contrector Signature
WORKERS' COMPENSATION CLARATION
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' 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 beco subject to the workers' compensation laws of
Calwomia, d gree that, if I should become subject to the
workers' m nsation provisions of Section 3700 of the Labor
Code, I ~orthwith comply with those provisions
(d t
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 compiled 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
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, I understand my requirem nts
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 to.each of the following:
I am the property owner or authorized to act on the
property owners 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 repres tatives of this county to enter the
above -identified arty for inspection purposes.
Signature of P rty Owner or Authorized Agent
Date