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Home My Public Portal About5721 OAK AVE_Plumbing_1/30/2007_COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0701250005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: I FEES PAID I BUILDING ADDRESS: TR: 6561 IT: 730 UN: .002 I 5721 OAK AV IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:( TEMP CA 917802431 ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 8587-005-005 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, C 107 BATHTUBS/SHOWERS 2.00 FIX 32.40 TENANT: 121 HOSE BIBS(S) 2.00 FIX 32.40 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 125 LAVATORIES/SINKS 4.00 FIX 64.80 101/30/07 JK, 07/29/07 145 WATER CLOSET/URINAL 2.00 FIX 32.40 1 OWNER: TEL. NO: 47 WATER HEATER(S) 1.00 WTH 16.20 IF AL DA FIN Y: CODE: CHAN, MR&MRS. WING - 151 IOW PRS GAS 5 OUTLET 1.00 SYS 16.20 (/�yj�7/ i 5721 OAK AV TOTAL FEES 222.15 ]_ TEMP 917802431 I IDEECR� ION OF WORK I ]PLUMBING FOR NEW 2 BATHROOMS APPLICANT: TEL. NO: ] TOM O'LEARY (626) 287-0937- 5823 AGNES AVENUE (SPECIAL CONDITIONS: TEMPLE CITY CA 91780 CONTRACTOR: TEL. NO: 1APPAOVALS DATE INSPECTOR SIGNATURE TOM O'LEARY CONSTRUCTION (626) 287-0927- 5823 AGNES AVENUE LIC. NO (UNDER SLAB WORK I I TEMPLE CITY, CA 91780 489354 B-1 (WATER SERVICE (PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: SAWAYA, RAMZY - IROUGH PLUMBING 1 Q / err �-I/ 1960 SANTA ANITA AVE. LIC. NO: SIERRA MADRE, CA NONE (GAS PIPING (GAS VENT I I (HOT WATER HEATER I 1 I I (PLUMBING FIXTURES I ] I (LAWN SPRINKLERS I I I I I I I IGAS TEST I I ]UTILITY COMPANY NOTIFIEED Cw I I I I I I I I I GRAY WATER SYSTEM I I I I I I I I Ii I I I I I I I I (REPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I I I I LICENSED CONTRACTOR'S DECLARATION I hereby afffrmunderpenally 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 forcee and effect. License Clas �— Lic. No. ` / nl—lo s Sg' nature 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. , BA PC 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. 11, 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 of 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 properly, 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 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 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. ❑ 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 insurance carder and policy number are: Garner Policy Number ❑ 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 if I should become subject to the worker's compensation provisions of Section 3700 of the Labor Code shall forlhwtlh comply with those Pr,isionss ApplEant 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 Coplete 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 entitylagency) Dale 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 peril for construction or modification Imm 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 SCAOMD permitting checklist, I understand my requirements under the Los Angeles County Code Title 2, Chapter 220 Sections 220.100 through 220.140 concerning hazardous melenal reporting and for obtaining a peri! from the SCAOMD. ASBESTOS NOTIFICATION ❑ Notification letter sent to SCAOMD or EPA Cl I declare that notification of asbestos removal is not applicable to addressed project. CONSTRUCTION LENDING AGENCY I hereby aHvm 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.). Lenders Name Lenders Address "Q11:?? l certify that l 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 -me ' nedpro ertyforinspectionpurposes. 3 7 �A,icant or Agent tgnature / Date