HomeMy Public PortalAbout5714 OAK AVE_Sewer_11/28/2000_COUNTY OF
LOS ANGELES
TEMPLE CITY
# 0508
SEWER PERMIT
• DEPARTMENT OF
PUBLIC WORKS
9701 LAS TUNAS
SE 0508 0011280005
-BUILDING' AND SAFETY
/ LAND DEVELOPMENT
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID:
SEWER / SEPTIC: S
BUILDING ADDRESS:
TR: 6561 LT: 727
EXIST OCC GRP:
5714 OAK AV
BLDGS. NOW ON LOT:
TEMP CA 917802430
ASSESSOR INFORMATION NUMBER:
CONNECTION TYPE:
NEAREST CROSS STREET: LIVE OAK
8587-010-025
ORIGINATION:
THOMAS PAGE: 596 GRID: J3 LOCALITY:
TEMPLE CITY
LENGTH ML TO PL: STATION:
DEPTH:
TENANT:
MANHOLE REFERENCE: UPPER/LOWER:
ISSUED ON: PROCESSED BY:
EXPIRES ON:
11/28/00 UT
05/28/01
COUNTY IMPROVEMENT NUMBER:
^
OWNER:
TEL. N0:
PLAN CHECK NUMBER:
FINAL DATE IB)
CODE:
WU CHING Y;NING S
(818) 285-9036-
JOB NUMBER:
3
5714 OAK AV
TEMP 917802430
TRUNK PERMIT NUMBER:
ROAD PERMIT NUMBER:
2
DESC 7PTION OF (1u
AFFADAVIT: NO
CONNECT NEW RESIDENI TO PUBLIC SEWER
SYSTEM
WAIVER: NO
APPLICANT:
TEL. NO:
EASEMENT: NO
HUNG YIN CONSTRUCTION INC
(626) 675-8877-
1300 E. MAIN ST.
RECORD INSTRUMENT NBR: RECORD
DATE:
SPECIAL CONDITIONS:
ALHAMBRA, CA
HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CONTRACTOR:
TEL. NO:
.. FEES PAID
APPROVALS DATE
INSPECTOR SIGNATURE
HUNG YIN CONSTRUCTION
(626) 675-8877-
1300 E. MAIN STREET #205
LIC. NO
FEE DESCRIPTION: QUANTITY: UOM:
AMOUNT:
NEW HOUSE SEWER
ALHAMBRA, CA 91803
747902 B
(o �9�/-y-
07 PERMIT ISSUANCE FEE
27.75
CONNECT ADDITIONAL
�
03 CONN TO PUBLIC SEWER 1.00 CON
46.95
BUILDING OR WORK
ARCHITECT OR ENGINEER:
TEL. NO:
TOTAL FEES
74.70
DO, BINH
(626) 572-2895-
SEPTIC TANK, SEEPAGE PIT
8221 GARVEY BLVD. #31
LIC. NO:
AND/OR DRAIN FIELD
ROSEMEAD, CA
NONE
DRYWELL _
SEWER MAP BOOK: PAGE:
ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS
_
SEEP. PIT CESSPOOL
GRAYWATER SYSTEM
REPORT ID: DPR266 ROUTE TO : BS0508
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 `' be. No
Contractor's Signature Date
OWNER -BUILDER DECLARATION
I hereby affirm under penally of perjury that I am exempt from the
Contractors License Law forthe 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 & PC. for this reason:
[ Electrical, Plumbing & Sewer Permits Only I
❑ 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]
❑ I, 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 budding 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.).
❑ 1, 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 ownerof property
who builds or improves thereon, and who contracts for such projects with
a contractors) 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
werkers compensation, as provided for by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued.
❑ 1 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:
Carrier 570FE F --'P
Policy Number i1+ -7771S-7 �U
❑ 1 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 11
I should became subject to the worker's compensation provisions of
Section 3700 of the Labor Code, I shall forthwith comply with those
provisions. r � ,t
Applicant Signature Datef
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
r omplete this section for permits in I
L uninCcorporated 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 (it employed by an entity/agency) Date
JOB ADDRESS
'I
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 (SCAOMD)? 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 SCAQMD or EPA
❑ 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, CivC.)
Lenders Name
Lenders Address
"Qq?
I certify that I have read this application and state
under the penalty of perjury that the above
information is correct. I 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-mentioned property for inspection purposes.
Applicant or Agent Signature [Y pate