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Home My Public Portal About5709 OAK AVE_Plumbing_5/3/2000_COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT i LEGAL ID: TR: 6561 LT: 729 BL: .001 ASSESSOR INFORMATION NUMBER: 8587-005-003 TENANT: OWNER: PETRIKAS, JUSTIN 5709 OAK AV TEMP 917802431 APPLICANT: GARY M SEWELL JR 2331 E. FOOTHILL BLV PASADENA, CA 91107 CONTRACTOR: GARY M SEWELL DBA GMS DEVELOPMENT 2331 E. FOOTHILL BLVD. PASADENA, CA 91107 ARCHITECT OR ENGINEER: TEL. NO: (626) 287 -5533 - TEL. NO: (626) 449 -7898 - TEMPLE CITY # 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: FEES PAID FEE DESCRIPTION: QUANTITY: UOM: O1 PERMIT ISSUANCE FEE 07 BATHTUBS/SHOWERS 1.00 FIX 25 LAVATORIES/SINKS 1.00 FIX 45 WATER CLOSET/URINAL 1.00 FIX TOTAL FEES TEL. NO: (626) 449-7898- LIC. NO / 537975 / TEL. NO: LIC. -N F I UBLIC WORKS REPORT ID: DPR263 ROUTE TO: BS0508 PLUMBING PERMIT PL 0508 0005030006 BUILDING ADDRESS: 5709 OAK AV AMOUNT: TEMP CA 917802431 NEAREST CROSS STREET: LIVE OAK 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY 16.20 16.20 ISSUED ON: PROCESSED BY: PLAN HY: EXPIRES ON: 16.20 05/03/00 UT 10/30 00 76.35 ) FINAL DATE JI//�.. vFINAL 1 CODE: DESCRIPTION oF��ORK PLUMBING FOR ROOM CONVERSION SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE UNDER SLAB WORK WATER SERVICE PLASTIC Y/N METAL Y/N IN ROUGH PLUMBING GAS PIPING HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM• / IMI, (I> 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. ense Cla Lic. No. 771 IF rac o s ignature Date OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom 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).): ❑ 1 am exempt under Sec. , B.& P.C. for this reason: [ Electrical, Plumbing & Sewer Permits Only ] ❑ I, as owner of the property, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself, provided that such 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 he or she did not build or improve for the purpose of sale.). [ All Other Permits ] ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such 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 he or she did not build or improve for the purpose of sale ). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law.). WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for worker's compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. O 1 have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: Carrier N N 0 Policy Number l 44& a S Z( 5 l ❑ 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 worker's compensation laws of California, and agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Applicant Signature Date WARNING: FAILURE To SECURE WORKER'S 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. 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 et 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 Owner Signature Date Company Name (if employed by an entity/agency) Date JOB ADDRESS LOCALITY N 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 SCAQMD permitting checklist, I understand my requirements 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 SCAOMD or EPA D 1 declare that notification of asbestos removal is not applicable to addressed project. 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 (Sec. 3097, Civ.C.). Lender's Name Lender's Address Taq? / certify that / have read this application and state under the penalty of perjury that the above information is correct. l agree to comply with all City and County ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter upon the above- ention property fo inspection purposes. Applic t or gent Signatur( / Date