HomeMy Public PortalAbout9814 GARIBALDI AVE_Plumbing_12/11/2015_COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
JTR: 6561 LT: 88 BL: .001
ASSESSOR INFORMATION NUMBER:
15385-027-029
1
TENANT:
OWNER: TEL. NO:
JIMRIE JOSEPH H CO TR IMRIE FAMILY T (323) 574-6400-
19814 GARIBALDI AV
TEMP 917801712
APPLICANT: TEL. NO:
IGUTTERREZ, GREG (626) 379-1860-
11204 S THIRD
JALHAMBRA CA 91801
CONTRACTOR: TEL. NO:
SIERRA PACIFIC PLUMBING (626) 457-8845-
11204 S THIRD AVE LIC. NO
1ALHAMBRA CA 91801 810101
ARCHITECT OR ENGINEER: TEL. NO:
LIC. NO:
PERMIT EXPIRES 180 DAYS IF
11) WORK DOES NOT COMMENCE, OR
12) WORK IS SUSPENDED OR ABANDONED, OR
13) FAILS TO OBTAIN CODE REQUIRED INSPECTION
TEMPLE CITY
9701 LAS TUNAS
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
FEES PAID
IFEE DESCRIPTION: QUANTITY: UOM:
101 PERMIT ISSUANCE FEE
151 LOW PRS GAS LE5 OUTS 1.00 SYS
193 INVT NO PERMIT OTHER 344.00 DOL
I TOTAL FEES
# 0508
REPORT ID: DPR263 ROUTE TO: BS0508
PLUMBING PERMIT
PL 0508 1512110010
BUILDING ADDRESS:
9814 GARIBALDI AV
AMOUNT:1 TEMP CA 917801712
NEAREST CROSS STREET:
34.40 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY
20.20
418.90 JISSUED ON: PROCESSED BY: PLAN BY:
473.50 12/11/15 SR
FINAL AT FINAL BY CODE:
al �
IDESCAIPTION OF WORK
REPAIR GAS LEAK
(SPECIAL CONDITIONS:
APPROVALS DATE INSPECTOR SIGNATURE
UNDER SLAB WORK
WATER SERVICE
PLASTIC Y/N METAL Y/N
(ROUGH PLUMBING
IGAS PIPING �
ao
GAS VENT I I _ g
HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS
GAS TEST
UTILITY COMPANY NOTIFIED
CWV
GRAY WATER SYSTEM
OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION 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 (v) all of or (_) 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 or pursuant .to the Contractors' State License
Law). i
(_): I am exem fit 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 completion' of the improvements covered by
this permit, I c 'nnot 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: http://www.leoinfo.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 and effect.
License Class 10 10) License No. C�juv
Date Contractor Signature
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:
l 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.
X 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 carrier and policy numbe�r are:
LJPLP�- Z L c z // /1(C1=1
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
on as to becom s b' t t th k' f 1 f
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 ❑ N o ❑
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 ElN.o El
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
El 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 pedury that there is a
Construction lending agency for the performance of the work for
which this permit is issued (Section 3097, Civil Code).
e u lec o e wor ers compensa ion aws o Lender's Name
California, and agree that, if I should become subject to the
workers' compensationprov' ions of Section 3700 of the Labor Lender's Address
Code, I hall forthwith corn ith those provisions
By my signature below, I certify to,each of the following:
S ire p Date
I am the property owner or authorized to act on the
�c t
property owner's behalf.
I have read this application and the information I have
BBYIST ORDI C CERTIFICATION provided is correct.
Complete this sec on 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 co plied and will {continue
to comply therewith through the applic i process.
Go
Applicant (Pd Name) Applicant Si
��r�1 � a Date
I agree to comply with all applicable city and co
ordinances and state laws relating to buil
construction.
I authorize representatives of this county to enter
above -identified property for inspection purposes.
Signature of Prot y Owner or Aued Agent
Date
unty
ding
the