HomeMy Public PortalAbout9625 BROADWAY_Plumbing_8/4/2016_TEMPLE CITY PERMIT NO. P16-32639
City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templecity.us
Address: 9625 Broadway, Temple City, California 91780 Parcel: 8588-009-035
Permit No: P16-32639 Type: Plumbing Subtype: Subtype: Residential
Description: 50 gallon water heater change out same location garage Special Conditions:
Issue Date: 08-04-2016 Expire Date: 01-31-2017 Extension: Extension:
Permit expires on date shown if: 1) work does not commence, or 2) work is suspended or abandoned, or 3) applicant falls to obtain code required
inspection.
Contacts
Owner Wenyon9 Chen 9625 Broadway, Temple City, California 91780 (626) 291-5794
Applicant Joanne Cleary 27919 Smyth Drive, Santa Clanta, California 91355 (661) 775-2944
Contractor Payless Water Heaters & Plumbing Inc. 27919 Smyth Drive, Santa Clanta, California 91355 (661)775-2944 83616 R
Plumbing Details
Backwater 0
Backflow 0
Bathtub/Shower 0
Clothes 0
Dishwasher
0
Valve
Device
Washer
Drinking 0
Floor Drain 0
Floor Sink 0
Hose 0
Interceptor/Clarifier
0
Fountain
Bibb
Lavatory/Sink 0
Miscellaneous 0
Pressure 0
Roof 0
Solar Water Heater
0
Regulator
Drain
Pool Trap 0
Trap Primer 0
Water Closet 0
Water 1
Water Treatment
0
Heater
Gas: Low 0
Gas: 0
Gas Meter 0
Gas 0
Alteration/Repair
0
Press
Med/High
Regulator
Press
Greywater 0 Pipe 0 Future Branches 0 Other: 0 Other: 2-3 Inches 0
System Replacement 1.5
Inches or
less
Other: over 3 0 Sewer: 0 Sewer: Manhole 0 Sewer: 0 Sewer: Private 0
inches Connection Addition Connection
Sewer: 0 Sewer: Pit 0 Sewer Alteration 0
Pit/Drainfield Extension
Combo
Waste/Vent Earthquake Chemical Rainwater Greywater
Shutoff Waste
Fees Total
Plan Check Fees $0.00 Permit Fees $20.16
Plumbing Inspections
Approval Date Inspector Approval Date Inspector
Under Slab Work Plumbing Fixtures
Water Service Lawn Sprinklers
Plastic Y/N Gas Test
Metal Y/N
Rough Plumbing Utility Co Notified
CWV
Gas Piping Gray Water System
Gas Vent fll..C..�C.[.L 14 FINAL
Hot Water Heater / l
Sewer Inspections
Approval Date Inspector Approval Date Inspector
New House Sewer Alter/Repair
Connect Add9 Disconnect/Plug
Septic Tank/Pit Backfill Tan WPit
Drywall Gray Water System
FINAL
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 I, 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 Contrb�tor pursuant.to the Contractors' State License
Law).
U I am exemiit 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 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: htto://www.leeinfo.ca.eov/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 ce an effect. > /�
Ligiee/e9lass License No.��C�/`-'')
DM / I�' Contractor Sionature---.-%`�
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
FORIN 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.
P Iicy
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 IN permit is issued. y
work�npensatlon in bCamI /ri0cy r
Namone Number D
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' corn/I tion provisions of Section 3700 of the Labor
Code, I sh�fort h comply with those p/frovvv tons /
gnat a 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 at seq.,
(relating to the Los Angeles County Lobbyist Ordinance) and that
all Pers ns acting on behalf of myself com lied and will continue
to co ly therewith throu I) a applies on proces .
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 ❑ No ❑
I have read the hazardous materials information guide and the
SCAQMD permitting checklist, I understand my requirements
under the Los Angeles County Code Tide 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).
Lenders Name
Lenders 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.
Signatdre of Property Owner ooy`�.yQgoriizzed/Agent
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