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Home My Public Portal About5713 ENCINITA AVE_Mechanical_6/7/2016_COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1606070009 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: 5713 ENCINITA AV ON FILE IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917802418 ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 15387-019-027 102 PERMIT ISSUANCE FEE 34.40 1 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY 102 REFRIG COMP < 100 KB 1.00 COM 33.70 1 (TENANT: JOB FURNACE/HEATER < 100 1.00 UNI 33.70 JISSUED ON: PROCESSED BY: PLAN BY: 130 AIR INLETS/OUTLETS 7.00 IN/ 37.10 106/07/16 SR TOTAL FEES 138.90 1 10WNER: TEL. NO: (FINAL DATE FINAL CODE: IVONG SOPHORN - 5713 ENCINITA TEMP 9178024191780241 AV 8 lDE4YWkRK ICNANGE OUT 3 TON A/C E 70,000 BTU FAU CHANGE OUT 7 DUCTS 11200 SQ.FT. OF R38 INSULATION 1APPLICANT: TEL. NO: � I IROBINSON, TOM (562) 458-4529- 122911 SAVI RANCH PKW ISPECIAL CONDITIONS: IYORBA LINDA CA 92821 1 CONTRACTOR: TEL. NO: SERVICE CHAMPIONS HEATING AND A, C (714) 777-7777- 22911 SAVI RANCH PARKWAY LIC. NO YORBA LINDA CA 92887 799170 C20 ARCHITECT OR ENGINEER: TEL. NO: LIC. NO: PERMIT EXPIRES 180 DAYS IF 1) WORK DOES NOT C0MMENCE, OR 2) WORK IS SUSPENDED OR ABANDONED, OR 3) FAILS TO OBTAIN CODE REQUIRED INSPECTION ID: DPR264 ROUTE TO: BS0508 FAU/WALL FURNACE COMBUSTION AIR OPENINGS DUCT WORK THERMOSTAT FIRE DAMPERS SMOKE DETECTION DEVICES COMMERCIAL HOOD I OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS 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 1, 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 Contre�tor pursuant,to the Contractors' State License Law). U 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 whicF I must have resided for at least one year prior�to completioq 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. 1 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.leainfo.ca.aov/calaw.html. Date: Signature of Property Owner or Authorized Agent 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 effect. —t G License Class � 9License No. / / CZ]l��f�% Date&% �L Contractor Signature�l� 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 ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self - insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Policy No. I have and will maintain workers' compensation . surance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My wy vers' compensation insurance carrier and policy numb rare: 1 7,FYF wpso60b07C�- C 0 N Policy Number Ex im ion Date 5 CCk$-r/- 5-3ss 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 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 therewithn�through the applicati roces"s. t r� Ire fLO�i i-�e'F% �1,tn..l_ (`-'IrJ----- Ap fi t (Print Name) , Applicant Signature E5Yvir-C C�4AciQ,ow5 Company Name Date 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 ❑ WIII 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 i I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my requiremnts under the Los Angeles County Code Title 2, Chapter 220' Sections 220.100 through 220.140 conceming 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. 'gn tur of Prop ner or/Authorized Agent Date 1/ t