HomeMy Public PortalAbout6357 TEMPLE CITY BLVD_PLUMBING_6/14/2018_P18-36376TEMPLE CITY PERMIT NO. P18-36376
City of Temple City 1 9701 Las Tunas Dnve I Temple City, Califomia 917801 (626)285-2171 1 www.templecity.us
Address: 6357 Temple City Boulevard, Temple City, California Parcel: 5382-022-071
91780
Permit No: PIB-36376
Type: Plumbing Subtype:
Subtype: Residential
Description: REPAIR BROKEN P.V.C. WATER LINE IN
THE Special
DRIVEWAY.
Conditions:
Issue Date: 06-14-2018
Expire Date: 06-14,2019 Extension:
Extension:
Permit expires on data shown if: l) work
does not commence, or 2) work is suspended orabandoned, or 3) applicant fails to obtain code required
inspection.
- Contacts
_
—
Owner Charton
T.C. HOA
6357 Temple City Boulevard, Temple City,
Chen
California 91780
Applicant Oscar
1703 South Conlon Avenue, West Covina,
(626)917-9650
Rosales
Califomia 91790
Contractor
R R P & Associates DBA Rosales 1703 South Conlon Avenue, West Covina,
(626)917-9650 802004
Plumbing & Rooter
California 91790
Plumbing Details
Backwater 0
Backflow, 0
Bathtub/Shower 0 Clothes 0
Dishwasher 0
Valve
Device
Washer
Drinking 0
Floor Drain 0
Floor Sink 0 Hose Bibb 0
Interceptor/Clarifier 0
Fountain
Lavatory/Sink 0
Miscellaneous I
Pressure 0 Roof Drain 0
Solar Water Heater 0
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
inchesor
less
Other: over 0
Sewer: 0
Sewer: Manhole 0 Sewer: 0
Sewer: Private 0
inches
Connection
Addition
Connection
Sewer: 0
Sewer: Pit 0
Sewer: 0 Sewer: 0
Pit/Drainfield
Extension
Alteration Tap&Saddle
Combo
Waste/Vent
Earthquake Chemical Rainwater
Greywater
Shutoff Waste
- Fees Total
Plan Check Fees 5148.65
Permit Fees 521.06
- Plumbing Inspections
Approval Date
Inspector
Approval Date Inspector Approval
Dab Impactor
Under Slab
Gas Piping Gas Test
Wolk
Gas Vent Utility Co Notified
asbc N
Hot Water CWV
Heater
M
Gray Water
Rough
Plumbing System
Fixtures FINAL
Plumbing
Lawn Sprinklers
- Sewer Inspections
Approval Date
Inspector
Approval Date Inspector Approval
Date Inspector
New House
Drywell Backfill Tank/Pit
Sewer
Alter/Repair Gray Water
Connect Add'I
Disconnect/Plug System
Septic Tank/Pit
FINAL
I
1i
OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am exempt from I hereby affirm under penalty of perjury that I am licensed under
the Contractors' State License Law for the reason(s) indicated provisions of Chapter 9 (commencing with Section 7000) of
below by the checkmark(s) I have placed next to the applicable Division 3 of the Business and Professions Code, and my
hem(s) (Section 7031.5, Business and Professions Code): Any license Is in full force and effect.
city or county that requires a permit to construct, alter, Improve,
demolish, or repair any structure, prior to its issuance, also License Class C-361 License No.
requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Date /�18 Contractor Signature
Contractors' State License Law (Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professions WORKERS' COMPENSATION DECLARA ON
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 I,✓) 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 Contractor pursuant to the Contractors' State License
Law).
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 3760 of the
Labor Code, for the performance of the work for which this permit
Is Issued.
Policy No.
A 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
worke tcom ensatl nInsu�ecarrilrr and policy number are:
Z�
Caller Policy Number Expiration Data
Name of Agent Phone Number
U: I am exemdt from licensure under the Contractors' State I certify that, in the performance of the work for which this
License Law for the following reason: 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 sho Id become subject to the
By my signature below I acknowledge that, except for my workers' compensation provis f Section 3700 of the Labor
personal residence in whicf I must have resided for at least Code._LO" forthwith com those provisions
one year priorlto completio of the improvements covered by
this permit, I gnnot legally s�ll a structure that I have built as a /B
owner -builder If it has not been constructed in its entirety gnature ofA Iica Date
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: hftp:l/www.leginfo.ca,gov/calaw.htmi.
Date:
Signature of Property Owner or Authorized Agent
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 ❑ 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 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
❑ 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 forthe 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 an. 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 cc o enter the
above identifie perry for inspa rposes.
Signatur party Ow Auth e
Date G / i"/%�