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Home My Public Portal About9941 GARIBALDI AVE_Plumbing_6/15/2015_AMOUNT 27.80 16.20 64.80 16.20 16.20 32.40 97.20 16.20 48.60 32.40 16.20 4.20 16.20 16.20 420.80 PLUMBING PERMIT PL 0508 1506150029 BUILDING ADDRESS: 9941 GARIBALDI AV TEMP CA 917801716 NEAREST CROSS STREET: THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY ISSUED ON: PROCESSED BY: PLAN BY: 06/15/15 SR FINALIDAT,t FINAL CODE: MAI DLsc1IP7FON Or 1 ORK U PLOFID INI FOR A NEW SINGLE FAMILY DWELLING SPECIAL CONDITIONS: DATE INSPECTOR SIGNATURE UNDER SLAB WORK WATER SVylCE PLASTI Y N METAL Y/N ROUGH PLUMBING GAS PIPING GAS VENT ' COUNTY OF LOS ANGELES HOT WATER HEATER TEMPLE CITY PLUMBING FIXTURES # 0508 - DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID TR: 32644 IT: 8 1FEE DESCRIPTION: QUANTITY: UOM: ASSESSOR INFORMATION NUMBER: 1 5385-024-049 101 PERMIT ISSUANCE FEE 105 BACKFLOW DEVICES) 1.00 DEV TENANT: 107 BATHTUBS/SHOWERS 4.00 FIX 111 CLOTHESWASHER(S) 1.00 FIX 113 DISHWASHERS) 1.00 FIX OWNER: TEL. NO: 121 HOSE BIBB(S) 2.00 FIX KOO, MIAO LING (626) 294-9396- 125 LAVATORIES/SINKS 6.00 FIX 818 W NAOMI AVE #9 127 PRESS REG DEVICES) 1.00 DEV ARCADIA CA 91007 145 WATER CLOSET/URINAL 3.00 FIX 147 WATER HEATER(S) 2.00 WIN 151 LOW PRS GAS 5 OUTLET 1.00 SYS APPLICANT: TEL. NO: 152 ADDN OUTLETS 1 5 1.00 OUT TRAN, QUYNH (626) 442-6792- 155 GAS METER (PRIVATE) 1.00 MET 8143 CELITO DRIVE 164 WATER PIPNG <= 1 1/2 1.00 LIN ROSEMEAD CA 91770 1 I TOTAL FEES CONTRACTOR: TEL. NO: AIR CARE MECHANICAL CO. (626) 442-6792- 8143 CELITO DRIVE LIC. NO ROSEMEAD CA 91770 516562 ARCHITECT OR ENGINEER: TEL. NO: LUK, SAM (626) 872-8381- 527 N AZUSA AVENUE #309 LIC. NO: COVINA CA 91722 C19131 I I I I I I 1REPORT ID: DPR263 ROUTE TO: SS0508 AMOUNT 27.80 16.20 64.80 16.20 16.20 32.40 97.20 16.20 48.60 32.40 16.20 4.20 16.20 16.20 420.80 PLUMBING PERMIT PL 0508 1506150029 BUILDING ADDRESS: 9941 GARIBALDI AV TEMP CA 917801716 NEAREST CROSS STREET: THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY ISSUED ON: PROCESSED BY: PLAN BY: 06/15/15 SR FINALIDAT,t FINAL CODE: MAI DLsc1IP7FON Or 1 ORK U PLOFID INI FOR A NEW SINGLE FAMILY DWELLING SPECIAL CONDITIONS: DATE INSPECTOR SIGNATURE UNDER SLAB WORK WATER SVylCE PLASTI Y N METAL Y/N ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS :TY COMPANY NOTIFIED WATER SYSTEM Xr IU 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 (,/) all of or L) 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.). L) 1, 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). U I am exemlJt 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 prior) to completion of the improvements covered by this permit, I c 'nnot legally sell a structure that 1 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.leainfo.ca.aov/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 Class IPJ License No. 5;A Date &(/15/ Contractor Signature �� /I . 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 ATTORNEY'S 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 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 arner and policy numb r are: --4 TM W 171 k,7115 115 Carrier Policy Number Expirationtate 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 o�Alicant Da t/A LOBBYIST ORDINANCE CERTIFICATION Complete this section far {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 Company Name Date 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 ❑ N o ❑ r 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 AQMD and/or EPA ❑ 1 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. 1 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 of Property.O�r Authorized Agent Date t �r�