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HomeMy Public PortalAbout10504 KEY WEST ST_Plumbing_6/8/2015_COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 11290 LT: 1 ASSESSOR INFORMATION NUMBER: 8585-024-001 TENANT OWNER: SCHULZE, ANN 10504 KEY WEST ST TEMP 917803462 APPLICANT: CORREA, MANUEL 2509 EUCLID CRESCENT UPLAND CA 91784 CONTRACTOR: B X D CONSTRUCTION 2509 EUCLID CRESCENT E UPLAND CA 91784 ARCHITECT OR ENGINEER: TEL. NO: (626) 444 -0976 - TEL. NO: (626) 786 -2347 - TEMPLE CITY NO: # 0508 (626) PLUMBING PERMIT 9701 LAS TUNAS LIC. NO UNDER SLAB WORK PL 0508 1506080005 TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: TEL. NO: " \� FEES PAID BUILDING ADDRESS: •; GAS PIPING 10504 KEY WEST ST FEE DESCRIPTION:' • - QUANTITY: DOM: .. AMOUNT: TEMP CA 917803462 GAS VENT HOT WATER HEATER NEAREST CROSS STREET: FAIRFAX O1 PERMIT ISSUANCE FEE PLUMBING FI%TURES , 27"80 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY CA 07 BATHTUBS/SHOWERS 2.00 FIX 32.40 GAS TEST j 21 HOSE BIBB(S) 2.00 FIX 32.40 ISSUED ON: PROCESSED BY: PLAN BY: 25 LAVATORIES/SINKS 3.00 FIX 48.60 CWV 06/08/15 SR 45 WATER CLOSET/URINAL 2.00 FIX 32.40 - REPORT I0: DPR263 ROUTE TO: B50508 97 WATER HEATER(S) 1.00 WTH16.20 FI IEFZNI . CODE: 69 WATER PI PNG <= 1 1/2 1.00 LIN LIN 16.20 TOTAL FEES 206.00 D I 40N OFF WORK RE -PIPE EXISTING DWELLING & BUILDING MAIN SPECIAL CONDITIONS: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE (626) 786 -2347 - LIC. NO UNDER SLAB WORK 627142 WATER SERV PLASTIC Y/ METAL Y/ TEL. NO: " \� - ROUGH PLUMBING LIC. NO: •; GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FI%TURES , LAWN SPRINKLERS GAS TEST j \ 1 UTILITY COMPANY NOTI FIED1 CWV GRAY WATER SYSTEM - REPORT I0: DPR263 ROUTE TO: B50508 I 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 (_) 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 licensed Con"or pursuant.to the Contractors' State License Law). ' (_) I am exemdt 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, Innot legally sell a structure that I have built as an If 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 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 _ License No. (/iL '�b�Contractor Signature WORKERS' COMPENSATION FTINWARNING: FAILURE TO SECURE WORKN 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 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 ❑ 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 ❑ No ❑ j I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my requirem@nis 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. Labor Code, for the performance of the work for which this permit ASBESTOS NOTIFICATION is issued. Policy No. ❑ Notification letter sent to AQMD and/or EPA I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for ❑ I declare that notification of asbestos removal is not the performance of the work for which this permit is issued. My applicable to addressed project. work rs' comDpen a 'on insurance carrier and p IIi�{�umb r arm �JtSi d© A,2, Ci'��^ ��� (DECLARATION REGARDING CONSTRUCTION LENDING Cartier Policy Number' Expiration Date AGENCY Name of Agent Phone Number I certify that, in the performance of the work for which this permit is issued, I all not employ any person in any manner so as to become bject to the workers' compensation laws of California, and a r e the if I should become subject to the workers' compe s tion ovisions of Section 3700 of the Labor Code, I shall ith c with those provisions Signatu nt Date OBBYIST 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 (Nngeles 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 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 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 tocomply 'th all applicable city and county ordinances and ate laws relating to building construction. I authorize repr t ' ,tig of this county to enter the above-idantifie erl) foy�inspection purposes. Signature of Pr orized Agent ate