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Home My Public Portal About6256 AVON AVE_PLUMBING__12/12/2016_TEMPLE CITY PERMIT NO. P16-33324 City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templeclty.us Address: 6256 Avon Avenue, San Gabriel, California 91775 Parcel: 5386-009-007 Permit No: P16-33324 Type: Plumbing Subtype: Subtype: Residential Description: GAS LINE FOR NEW FURNANCE Special Conditions: Issue Date: 12-12-2016 Expire Date: 06-1U-2017 Extension: Extension: Permit expires on date shown if: 1) work does not commence, or 2) work is suspended or abandoned, or 3) applicant falls to obtain code required Inspection, Contacts Owner Robin 6256 Avon Avenue, San Gabriel, (626) 737-0237 Lopez California 91775 Applicant Judy (909)754-0126 Hallock Contractor Peach Home Services Inc, DBA Walton's Heat and Air 532 Malloy Court, Corona, California (714) 462-8174 1018348 Conditioning 92880 Plumbing Details Backwater 0 Backflow 0 Bathtub/Shower 0 Clothes 0 Dishwasher 0 Valve Device Washer Drinking 0 Floor Drain 0 Floor Sink 0 Mose Bibb 0 Interceptor/Clarifier 0 Fountain Lavatory/Sink 0 Miscellaneous 0 Pressure 0 Roof Drain 0 Solar Water Neater 0 Regulator Pool Trap 0 Trap Primer 0 water Closet 0 Water 0 Water Treatment 0 Heater Gas: Low 1 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 inches or 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 Fci'S Tr1181 Plan Check Fees $0.00 Permit Fees $20.50 /rte Plumbing Inspections Approval Date Inspector Approval Date Inspector Approval Date Inspector Under Slab Gas Piping Gas Test Work Gas Vent Utility Cc Notified Water Service Hot Water CWV Plastic Y/N Heater Gray Water Metal Y/N Plumbing System Rough Fixtures FINAL Plumbing Lawn Sprinklers Sewer Inspections Approval Date Inspector Approval Dote Inspector Approval Date Inspector New house _.-- Drywall Backfill Tank/Pit Sewer Alter/Repair Gray Water Connect Aci Disconnect/Plug System Septic Tank/Pit FINAL F 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 (J) 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 ' (_) 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 priorl to completion of the improvements covered by this permit, I cannot 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://www.leginfo.ce.gov/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 ClL4 9 a s icense N O ` "-J i Date Contractor Signat WORKERS' COMPENSATIO 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 FFFS_ 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 permit 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 I hereby affirm under penalty of perjury one of the following SCAQMD permitting checklist, I understand my requirements declarations: under the Los Angeles County Code Title 2, Chapter 2'20' _I have and will maintain a certificate of consent to self- Sections 220.100 through 220.140 concerning hazardous insure for workers' compensation, issued by the Director of material reporting and for obtaining a permit from the SCAQMD. Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit ASBESTOS NOTIFICATION is issued. Policy No. ❑ Notification letter sent to AQMD and/or EPA I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for ❑ I declare that notification of asbestos removal is not the performance of the work for which this permit is issued. My applicable to addressed project. N ensation ip�,@n�g G;�ge,�t o f num r e N n-iM I G1S(l') I2'-1-4-7DECLARATION REGARDING CONSTRUCTION LENDING Carrier Policy Number Expiration Date AGENCY 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 Califomia, and agree that, if I should become subject to the w kers' compensation provisions of Section 3700 of the Labor CMU rthwith comply with those provisions Sign t re of Applicant late 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 ccm ly�th�e-r-e1�w-'Rh�th--ro�'uggghh the application process. Applicant (Print Name) Applican' ^t 2— Company Name Date 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 owners 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 ofropey er or c thorized gent Date I I2- ( G