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Home My Public Portal About9253 GARIBALDI AVE_Plumbing_8/25/2014_cam" COUNTY OF LOS ANGELES TEMPLE CITY $ 0508 DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 T PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID ON FILE 1FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ASSESSOR INFORMATION NUMBER: 5385-003-015 101 PERMIT ISSUANCE FEE 27.80 1 147 WATER HEATER(S) 1.00 WTH 16.20 1 PENANT: 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 155 GAS METER (PRIVATE) 1.00 MET 16.20 163 WATER PIPING BR/FIX 8.00 FIX 54.40 OWNER: TEL. NO: 1 TOTAL FEES 130.80 1 DANG, WENDY (626) 354-1337- 9253 GARIBALDI AV TEMP 917801626 I I APPLICANT: TEL. N0: CABRERA, CALEB (626) 378-2393- 1167 BROOKPORT ST. COVINA CA 91724 1 CONTRACTOR: TEL. N0: ELITE CONSTRUCTION (626) 378-2393- 1 1167 E BROOKPORT STREET LIC. NO COVINA CA 91724 641247 I I ARCHITECT OR ENGINEER: TEL. NO: � I - LIC. NO: � ML) / r pd�h.i'�d�SY l�tiu� 1 TvI ID: DPR263 ROUTE TO: BS0508 PLUMBING PERMIT PL 0508 1408250034 BUILDING ADDRESS: 9253 GARIBALDI AV TEMP CA 917801626 NEAREST CROSS STREET: THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY ISSUED ON: PROCESSED BY: PLAN BY: 08/25/14 SR FINAL DATE FINCODE: DES�N INSTALL GAS LINE, GAS METER, RE -PIPE 8 FIXTURES COLD AND 1 NATER LINES AND REPLACE WATER HEATER SPECIAL CONDITIOITS, APPROVALS DATE INSPECTOR SIGNATURE =ER SLAB WORK _I NATER SERVICE PLASTIC Y/N METAL Y/N 20UGH PLUMBING n�'�^�.. I i 3A5 PIPING i e tm eY ( , 16� 3AS VENT -�1/�I (��e l -1 iOT WATER HEATER PLUMBING FIXTURES 1 LAWN SPRINKLERS I I 3As TEST -�t�e`f'�r 3TILITY COM ANY N TIFIEDI- - I :WV .RAY WATER SYSTEM I I i OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am exempt from I hereby affirm under penalty of perjury that I am licensed under the Contractors' State License Law for the reason(s) indicated provisions of Chapter 9 (commencing with Section 7000) of below by the checkmark(s) I have placed next to the applicable Division 3 of the Business and Professions Code, and my item(s) (Section 7031.5, Business and Professions Code): Any license is in fullforc� effect. city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also License Class License No requires the applicant for the permit to file a signed statement �._/,,L / that he or she is licensed pursuant to the provisions of the DateContractor Signature Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions WORKERS' COMPENSATION DECLARATION 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 (_) portions of the work, and the structure is not intendedor 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 fon the projects with a licensed Contr9?tor pursuant, to the Contractors' State License Law). (_) I am exempt 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 priorlto completion 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. 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: httD://www.lecinfo.ca.cov/calaw.html. Date: Signature of Property Owner or Authorized Agent 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. Ay No. f 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 insure Dce carter and policy num4er ajg: ��A-7T_ ice,✓ / 70S 49 S/ Carrier Policy Number Expiration Date 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, 1 shall f ith comply with those provisions ature of Applicant ate 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 at 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 ❑ 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 ❑ 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 owners 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. Signature e y O uthorized Agent XDate