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Home My Public Portal About6207 AVON AVE_PLUMBING__4/30/2018_TEMPLE CITY PERMIT NO. P18-36032 City of Temple City 1 9701 Las Tunas Ddve I Temple City, California 91780 1 (626)285-2171 1 www.templecity.us Backflow 0 Address: 6207 Avon Avenue, San Gabriel, California 91775 Parcel: 5386-007-073 Drinking 0 Permit No: PIB-36032 Type: Plumbing Subtype: Subtype: Residential Description: REPLACE 40 GALLON WATER HEATER SAME LOCATION Special Pool Trap 0 GARAGE Conditions: Gas: 0 Issue Date: 04-30-2018 Expire Date: 04-302019 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 required inspection. System Replacement - Contacts Sewer: 0 inches Owner Paul Chang 6207 Avon Avenue, San Gabriel, California (626)818-0633 Pit/Drainfield 91775 -*W4Lawn Applicant Gregory Constellation Road, Valencia, California (855) 345-9048 Guerry 98355 Sewer: Manhole Contractor Affordable Water Heater& 28358 Constellation Road, Santa Clams, (855)345-9048 627368 Plumbing Inc. California 91355 Sewer: Plumbing Details Backwater 0 Backflow 0 Valve Device Drinking 0 Floor Drain 0 Fountain 0 Hose Bibb 0 Lavatory/Sink 0 Miscellaneous 0 Pool Trap 0 Trap Primer 0 Gas: Low 0 Gas: 0 Press Med/High 0 Water 1 Press Greywater 0 Pipe 0 System Replacement Other: over 0 Sewer: 0 inches Connection Sewer: 0 Sewer: Pit 0 Pit/Drainfield Extension Combo Waste/Vent Earthquake Shutoff - Fees Total Bathtub/Shower 0 Clothes 0 Dishwasher 0 Washer Approval Date Inspector Floor Sink 0 Hose Bibb 0 Interceptor/Clarifier 0 Pressure 0 Roof Drain 0 Solar Water Heater 0 Regulator Gas Vent yI— A .1f U61ityCo Notified Water Closet 0 Water 1 Water Treatment 0 Heater Heater (�'orpl`r Gas Meter 0 Gas 0 Alteration/Repair 0 Plumbing Fixtures Regulator t / _ Future Branches 0 Other: 1.5 0 Other: 2-3 inches 0 -*W4Lawn inches or less Approval Data Inspector Sewer: Manhole 0 Sewer: 0 Sewer: Private 0 New House Addition Connection Sewer: 0 Sewer: 0 Alter/Repair Alteration Tap&Saddle Connect Add'I Chemical Rainwater Greywater Waste Plan Check Fees $148.65 Permit Fees $21.06 - Plumbing Inspections Approval Date Inspector Approval Date Inspector Approval _ Date Inspector Under Slab Gas Piping Gas Test Work Gas Vent yI— A .1f U61ityCo Notified Water Service Plastic Y/N Hot Water-,C,�„� CWV Metal Y/N Heater (�'orpl`r Gray Water Rough Plumbing Fixtures System FINAL t / _ Plumbing Sprinklers -*W4Lawn Sewer Inspections Approval Data Inspector Approval Date Inspector Approval Date Inspector New House Drywel I Backfill Tank/Pit Sewer Alter/Repair Gray Water Connect Add'I Disconnect/Plug System Septic Tank/Pit FINAL 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 Contractor pursuant to the Contractors' State License Law). III U I am exempt 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 prior to completion of the improvements covered by this permit, Innot legally sell a structure that I have built as an owner -builder 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.loginfo.m.govlcalaw.htmi. 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. _4 License Class i_5G License No.Z �` _ _Date ontrector Signature _/ WORKERS' COMPENSATI TION WANING: 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. Poli 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 insuran carrier and policy number are: Tw5 �® o� oCSiLqq Z of til t� Carrie Poy'cy Number xpiration Date C� C'X N Name of AgenU I 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 (•?j0- UF5 igna r Date LOBBYIST'ORDINANCE CERTIFICATION Complete this section for permits in Unincorporated Los Angeles County only This Is to certify that 1, 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 ❑ No ❑ Will the intended use of the building by the applicant or future building occupant require a pertnft for construction or modification from the South Coast Air Quality Management District (SCAQMD)? See permitting checklist for guidelines. Yes ❑ No ❑ I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my requirements under the Los Angeles County Code Me 2, Chapter 220' Sections 220.100 through 220.140 concerning hazardous material reporting and for obtaining a permit from the SCAQMD. `_69.1*t1149:10511 J[NeA i[ 121 ❑ 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 tol,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 county to enter the above -identified property for inspection purposes. Signature of Property O or Authorized A-� �Date��/e