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Home My Public Portal About6051 GOLDEN WEST AVE_PLUMBING_12/26/2018_P18-37286 (2)TEMPLE CITY PERMIT NO. P18-37286 Plumbing Details Backwater 0 Backflow 0 Valve Device Drinking 0 FloorDrain 0 Fountain Lavatory/Sink 0 Miscellaneous 0 Pool Trap 0 Gas: Low 0 Press Greywater 0 System Other: over 3 0 inches Sewer: 0 Pit/Drainfield Combo Waste/Vent Trap Primer 0 Gas: 0 Med/High Press Pipe 0 Replacement Sewer: 0 Connection Sewer: Pk 0 Extension Earthquake Shutoff Fees Total Plan Check Fees $0.00 Permit Fees $21.96 Plumbing Inspections Approval Date Inspector Under Slab Work Water Service Plastic VN Metal Y/N Rough Plumbing Sewer Inspections Approval Date Inspector New House Sewer Connect Add'] Septic Tank/Pit Bathtub/Shower City of Temple City 19701 Las Tunas Drive I Temple City, California 91780 1 (626)285-2171 1 www.templecity.us Address: 6051 Golden West Avenue, Temple City, California Parcel: 5385-019-003 91780 0 Hose Bibb Permit No: P18-37286 Type: Plumbing Subtype: Subtype: Residential Description: 1 WATER TREATING EQUIPMENT Special Water Closet Conditions: Issue Date: 12-26-2018 Expire Date: 12-26-2019 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 0 Alteration/Repair 0 required inspection. Regulator - Contacts Future Branches Owner TOM AND CYNTHIA 6051 Golden West Avenue, Temple City, (626) 287-2839 inches or WILSON Califomia 91780 Applicant Sewer: Manhole Contractor Lifetime Solutions 15400 Village Dr, Victorville, California 92394 (760) 951-7605 588619 Addition Inc. Sewer: Plumbing Details Backwater 0 Backflow 0 Valve Device Drinking 0 FloorDrain 0 Fountain Lavatory/Sink 0 Miscellaneous 0 Pool Trap 0 Gas: Low 0 Press Greywater 0 System Other: over 3 0 inches Sewer: 0 Pit/Drainfield Combo Waste/Vent Trap Primer 0 Gas: 0 Med/High Press Pipe 0 Replacement Sewer: 0 Connection Sewer: Pk 0 Extension Earthquake Shutoff Fees Total Plan Check Fees $0.00 Permit Fees $21.96 Plumbing Inspections Approval Date Inspector Under Slab Work Water Service Plastic VN Metal Y/N Rough Plumbing Sewer Inspections Approval Date Inspector New House Sewer Connect Add'] Septic Tank/Pit Bathtub/Shower 0 Clothes 0 Dishwasher 0 Gas Piping Washer Floor Sink 0 Hose Bibb 0 Interceptor/Clarifier 0 Pressure 0 Roof Drain 0 Solar Water Heater 0 Regulator Water Closet 0 Water 0 Water Treatment 1 Lawn Heater Gas Meter 0 Gas 0 Alteration/Repair 0 Regulator Future Branches 0 Other: 1.5 0 Other: 2-3 inches 0 inches or less Sewer: Manhole 0 Sewer: 0 Sewer: Private 0 Addition Connection Sewer: 0 Sewer: 0 Alteration Tap&Saddle Chemical Rainwater Greywater Waste Approval Date Inspector Gas Piping Gas Vent Hot Water Heater Plumbing Fixtures Lawn Sprinklers Approval Date Inspector Drywell Alter/Repair Disconnect/Plug Approval Date Inspector Gas Test Utility Co Notified Cra .ater System System FINAL 0 Approval Date Inspector Backfill Tank/Pit Gray Water System a 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 Contrftctor pursuant to the Contractors' State License Law). U: 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 whicl1 I must have resided for at least one year priorlto completioq 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: htto•/lwww leainfo 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 '�' 3f0 License No5 7 V 6 101 Date'2.26'Ig Contractor Signature WORKERS' COMPENSATION DI&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 3708 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 Coda, 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 Cade, for the performance of the work for which this permit Is issued. My workers' compensation insurance carrier and policgbeer re: Ht1z 6La aaL Tv%tc 000y7l `� Carder Policy Number Expiration Date Name of Agent Phone Number A 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, shall forthwith comply with those provisions I-I1r Signature IAPpllcant 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., th (relating to e Los Angeles County Lobbyist Ordinance) and that allpersonsacting on behalf of myself complied and will continue to comply therewith through the applicatl process. 7,4 'Sg19 2Q'� Ap ca t Pdnt Name) Applicant Lenature Ac, '2V—Id 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 ❑ N o Will the intended use of the buildin?bythe 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 requirements under the Los Angeles County Code Tifie 2, Chapter 220' Sections 220.100 through 220.140 conceming 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 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. 1 authorize representatives of this county to enter the above4dentified property for inspection purposes. Signethre�roperty Owner or Authorized Agent or Authorized Agent Date r��'e