The URL can be used to link to this page

Home My Public Portal About9233 BROADWAY_Plumbing_3/4/2015_COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1503040007 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: FEES PAID JTR: 124110 LT: 6 FEE DESCRIPTION: QUANTITY: UOM: ASSESSOR INFORMATION NUMBER: 1 18588-002-006 101 PERMIT ISSUANCE FEE 147 WATER HEATER(S) 1.00 WTH (TENANT: OWNER: TEL. NO: TONG YAN;HUNG;SEE HUNG YUK (626) 215-8640- 19233 BROADWAY TEMP 917802402 APPLICANT: TEL. NO: IMATA, DANIEL (818) 345-9048- 128372 CONSTELLATION VALENCIA CA 91355 CONTRACTOR: TEL. NO: AFFORDABLE WATER HEATER AND PLUMBIN (855) 345-904£ 28372 CONSTELLATION RD LIC. NO VALENCIA CA 91355 627368 ARCHITECT OR ENGINEER: TEL. NO: I LIC. NO: TOTAL FEES REPORT ID: DPR263 ROUTE TO: BS0508 BUILDING ADDRESS: 9233 BROADWAY AMOUNT: TEMP CA 917802402 NEAREST CROSS STREET: 27.80 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CAI 16.20 44.00 [ISSUED ON: PROCESSED BY: PLAN BY: 103/04/15 SR 1FAL DATEFIN L CODE: 1 ;,00f000"? ID SCRIPTION OF WORK REPLACED 40 GAL WATER HEATER SAME SIZE/LOCATION OUTSIDE SHED SPECIAL CONDITIONS: APPROVALS UNDER SLAB WORK WATER SERVICE PLASTIC YIN METAL YIN ROUGH PLUMBING (GAS PIPING GAS VENT HOT WATER HEATER 1 ]PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED( ICWV IGRAY WATER SYSTEM DATE INSPECTOR SIGNATURE wn 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 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 Contractor pursuant .to the Contractors' State License Law). (_). I am exemft 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 whlci 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.htmi. 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 L License No. 4toc1Dateontractor Signatu 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 ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. i hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self - insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is i ued. P icy No. I have and will maintain workers' compensation i s ance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issue . workerL p n,tion insu1 r My li$�rreTl Carrier Policy Number Expirafion Oate 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 proviSl. o of Section 3700 of the Labor C I shall forthwith comply those provisions S' �fure of Applic Date j 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 et seq., (relating to the Los Angeles County Lobbyist Ordinance) and t t all persons acting on behalf of my complied and will con' ue to comply therewith through the applic ion process ApQiVat9PWinN cant Sn Company Name Dat 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 ❑ 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. 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 this county to enter the ab -identified property far nspection purposes. g a re of Prop r Auth z d Agent ate a �l