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Home My Public Portal About9459 WOODRUFF AVE_PLUMBING_3/26/2019_P19-37673 (2)TEMPLE CITY PERMIT NO. P19-37673 0 r 0 Bathtub/Shower 0 Clothes 0 City of Temple City 19701 Las Tunas Drive I Temple City, California 917801 (626)285-2171 1 www.templecity.us \ Address: 9459 Woodruff Avenue, Temple City, California 91780 Parcel: 5385-006-017 System Permit No: P19-37673 Type: Plumbing Subtype: Subtype: Residential , Description: INSTALLING A NEW COPPER WATER SERVICE 1" INCH Special Conditions: r Issue Date: 03-26-2019 Expire Date: 03-25-2020 Extension: Extension: Hose Bibb Permit expires on date shown if: l) work does not commence, or 2) work is suspended or abandoned, or 3) applicant faits to obtain code 0 required inspection. Contacts Owner Gordon 9459 Woodruff Avenue, Temple City, (626)283-8530 Lavatory/Sink Wong California 91780 0 Applicant Robert 510 Agostino Road, San Gabriel, California (626)799-0077 Solar Water Heater Garza 91776 Contractor Robert Garza Inc. dba San Gabriel Valley 510 Agostino Road, San Gabriel, California (626) 799-0077 623253 Plumbing 91776 Plumbing Details Backwater 0 Bacldlow, 0 Bathtub/Shower 0 Clothes 0 Dishwasher 0 Valve Gray Water Device System lawn Sprinklers FINAL Washer Drinking 0 Floor Drain 0 Floor Sink 0 Hose Bibb 0 Interceptor/Clarifier 0 Fountain Lavatory/Sink 0 Miscellaneous 0 Pressure 0 Roof Drain 0 Solar Water Heater 0 Regulator Pool Trap 0 Trap Printer 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 1 Other: 2-3 inches 0 System Replacement inchesor 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: 0 Pit/Drainfield Extension Alteration Tap&Saddle Combo Waste/Vent Earthquake Chemical Rainwater Greywater Shutoff Waste Fees Total Plan Check Fees S0.00 Permit Fees $21.96 Plumbing Inspections Approval Date Inspector Under Slab Work Water Service Plastic Y/N Metal Y/N Rough Plumbing Sewer Inspections Approval Date Inspector New House Sewer ConnectAcki Septic Tank/Pit Approval Date Inspector Approval Gas Piping Gas Test Gas Vent Utility Co Hot Water Notified Heater CWV Plumbing Gray Water Fixtures System lawn Sprinklers FINAL Approval Drywell Alter/Repair Disconnect/Plug Date Inspector Date Inspector Approval Date Backfill Tank/Pit _ Gray Water System FINAL Inspector 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 U portions of the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State Ucense 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 e licensed Contrddor pursuant to the Contractors' State License Law). U. I am exeQt 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 whicl I must have resided for at least one year priorlto completioryry of the improvements covered by this permit, I c§nnot legally sdll a structure that I have built as an owner -builder If it has not been constructed In Its entlrety by licensed contractors. I understand that a ccpy of the applicable law, Section 7044 of 4he Business and Professions Code, Is available upon request when this application is submitted or at the following Web site: h2pllwww.leginfo-ce.noy/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, License No. �ta3 7a. 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 ;Q ' Qm�y anter /}/ h' sayprlt nce cArr(ar rjn��plwy nu mbyr re: 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, If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 'I shhaaaIll forthwith comply with those provisions l /1-0V , Signature of Applicant Date LOBBYIST'DRDINANCE 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 ttierewith through the application process. Applicant (Print Name) Applicant Signature Company Name Date .JOBADDRESS 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 checklistforguldelines. Yes ❑ Ro ❑ I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my requiremiints under the Los Angeles County Code Title 2, Chapter 2,?o, Sections 220.100 through 220.140 concerning hazardous material reporting and for obtaining a perk from the SCAQMD. ASBESTOS NOTIFICATION ❑ Notification letter sent to AQMD and/or EPA ❑ I declare that nofiflcation 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 toleach 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. Signet a ropgtyiOwrier or Authorized Agent _�D_ete