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Home My Public Portal About9621 BROADWAY_PLUMBING_10/12/2017_P17-35039 (2)TEMPLE CITY PERMIT NO. P17-35039 City of Temple City 1 9701 as Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templedty.us Addreas: 9621 Broadway, Temple City, California 91780 Parcel: 8588-009-016 Permit No: P17-35039 Type: Pumping Subtype: Subtype: Residential Description: PLUMBING FOR NEW DETACHED CONDO AND CONNECT TO Special Approval PUBLIC SEWER Conditions: Issue Date: 10-12-2017 Expire Date: 04-10-2018 Extension: Extension: Water Service oe Permit expires can date shown If: 1) work does not commence, or 2) work Is suspended or abandoned, or 3) applicant fails to obtain code required inspection. Hot Water Illeater F ix Plumbing tures Fixers Contacts Owner Applicant John Hua Contractor Architect Engineer I ,Malls Backwater 0 Valve Drinking 0 Fountain Lavatory/Sink 4 Pont Trap 0 Gas: Low 4 Press Greywater 0 System Other: over 3 0 inches Sewer: o Pit/Dmulfield E -Highland (US) Corp John Hua General Contractor 5003 Golden West Avenue, Temple City, California 91780 3514 Hawkwaod Ad, Diamond Bar, California 91765 3514 Hawkwood Rd, Diamond Bar, California 91765 (626) 226-8864 (626) 731-5406 (626) 731-5406 751479 T 8 W Consulting Engineers 1168 San Gabnel Boulevard, Rosemead, California 91770 (626) 288-0708 Backflow 0 Device Floor Drain 0 Miscellaneous 0 Trap Primer 0 Gas: 0 Med/High Press Pipe o Replacement Sewer: I Connection Sewer: Pit 0 Extension Combo Waste/Vent Earthquake Shutoff Bathtub/Shower 3 Floor Sink 0 Pressure D Repulator Water Closet 3 Gas Meter I Future Branches 0 Sewer: Manhole 0 Sewer: a Alteration Chemical Waste clothes Washer Hose Bibb 3 Roof Drain 0 Water Heater Gas 0 Regulator Other: 1.5 1 inches or less Sewer: 0 Addition Sewer: 0 Tap6Saddle Rainwater Dishwasher 1 Interceptor/Clarifier 0 Solar Water Heater 0 Water Treatment 0 Alteration/Repair 0 Other: 2-3 inches D Sewer: Private 0 Connection Gi eywa er - Fees Total Plan Check Fed $184.44 Permit Fues $461A1 - Plumbing Inspections Approval Di s to Approval D to Ins or pe Approval _ Date Inspector Under SWb Work Gas Piping _ Gas Test Water Service oe Gas Utility Co Notified PaStiC Y/N Metal Y/N /� Rough Pumbinq TTT� Hot Water Illeater F ix Plumbing tures Fixers GWV Gey Water $ystlm SprPlumbing Lawn FINAL ^ Sewer Inspections _ Approval is sp Approval Data Inspector Approval Date Inspector New House Sewer Drywall Backfill Tank/Mt Correct Adil Alter/Repair Gray Water System Septic Ta Rt Diston ect/Plug FINAL j* OWNER -BUILDER DECLARATION 1 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 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). (,: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 whit I must have resided for at least one year priorl to completion 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 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: httb://www.leolnfo.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. JOS ADDRESS LOCALITY HAZARDOUS MATERIAL DECLARATION License Class _ License No. Tr ( cl� % 7 O Will the applicant or future building occupant handle a hazardous material or a mixture containing a hazardous material equal to or f f -Y � eater than the amount specified on the hazardous materials t Date --OL-1 Contractor Signature Information guide? 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 workers' compensation Insurance carrier and policy number are: Carder 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 shall forthwith comply with those provisions 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 appliranL 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 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 requlrem¢nts under the Los Angeles County Code TMe 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 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. Signature of Property Owner or Authorized Agent Date LO/(J-FI 'A