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Home My Public Portal About9336 BROADWAY_Plumbing_5/21/2014_PLUMBING PERMIT FL 0508 1405210024 BUILDING ADDRESS: 9336 BROADWAY AMOUNT: TEMP CA 917802403 NEAREST CROSS STREET: 27.80 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY 64.80 16.20 JISSUED ON: PROCESSED BY: PLAN BY: 81.00 105/21/14 SR 64.80 1 254.60 iF,�AL DATE FINAL BY: CODE: 1DESCRIPTION F WORK PLUMBING FOR BATHROOMS AND KITCHEN REMODEL SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE UNDER SLAB WORK WATER SERVICE PLASTIC Y/N METAL Y/N 1 ` COUNTY OF IAS =ANGELES ^ TEMPLE CITY # 0508 DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS r BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 HOT WATER HEATER PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID ON FILE GAS TEST UTILITY COMPANY NOTIFIED CWV 1FEE DESCRIPTION: QUANTITY: DOM: ASSESSOR INFORMATION NUMBER: 1 8588-030-042 101 PERMIT ISSUANCE FEE 107 BATHTUBS/SHOWERS 4.00 FIX TENANT: DISHWASHERS) 1.00 FIX I13 25 LAVATORIES/SINKS 5.00 FIX 145 WATER CLOSET/URINAL 4.00 FIX OWNER: TEL. NO: I TOTAL FEES MOUNT VERNON HOLDINGS, LLC (909) 702-6858- 2831 ROSE PKWY #290 HENDERSON NV 89052 APPLICANT: TEL. N0: O'LAUGHLIN, BRIAN (909) 702 -6853 - PO BOX 487 LA VERNE CA 91750 CONTRACTOR: TEL. N0: DIVERSIFIED BUILDING CONTRACTORS (909) 261-0148- 2416 FIFTH STREET LIC. NO LA VERNE CA 91750 760941 ARCHITECT OR ENGINEER: TEL. N0: 1 I - LIC. NO: 1 I I I I I I I I REPORT ID: DPR263 ROUTE T0: BS 0508 PLUMBING PERMIT FL 0508 1405210024 BUILDING ADDRESS: 9336 BROADWAY AMOUNT: TEMP CA 917802403 NEAREST CROSS STREET: 27.80 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY 64.80 16.20 JISSUED ON: PROCESSED BY: PLAN BY: 81.00 105/21/14 SR 64.80 1 254.60 iF,�AL DATE FINAL BY: CODE: 1DESCRIPTION F WORK PLUMBING FOR BATHROOMS AND KITCHEN REMODEL SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE UNDER SLAB WORK WATER SERVICE PLASTIC Y/N METAL Y/N 1 ROUGH PLUMBING GAS PIPING r GAS VENT 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 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 full force and effect. city or county that requires a permit to construct, alter, improve, 6 / demolish, or repair any structure, prior to its issuance, also Class License No. requires the applicant for the permit to file a signed statement that he is licensed to the the v^-icense ^ _ Daley 2 / ontractor Signature LCTION or she pursuant provisions of Contractors' State License Law (Chapter 9 (commencing withv` / Section 7000) of Division 3 of the Business and Professions WORKERS' COMPENSATItS� Code) or that he or she is exempt from licensure and the basis WARNING: FAILURE TO SECURE WORKERS' COMPENSATION for the alleged exemption. Any violation of Section 7031.5 by any applicant for permit subjects the applicant to a civil COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN than five hundred dollars t EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO penalty of not more ($500).): N HUNDRED THOUSAND DOLLARS $100 000 IN ADDITION 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 Contra?tor pursuant.to the Contractors' State License Law). ' U: I am exemplt 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 priori to completion, of the improvements covered by this permit, I c4nnot 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: hfD://www.leoinfo.ca:cov/calaw.htmi. Date: Signature of Property Owner or Authorized Agent O E ( I ), 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. Policy No. 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 number are: Carder Policy Number Expiration Date Name of Agent Phone Number e nI certify that, in the performance of the work for which this it 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 pro tsions of Section 3700 of the Labor Code shall forthwit corn y with those provisions ig r oT�p' nt LOBBYIST ORDINANCE CERTIFICATION Complete this section for permits in Unincorporated Los Angeles County only This is to certify that 1, 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 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 requirem@nis under the Los Angeles County Code Title 2, Chapter 220' Sections 220.100 through 220.140 conceming 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 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 o this county to enter the above -identified property for in pection purposes. Signatur rope Owner or uthorized Agent NTRACTOR: TEL. NO: VERSIFIED BUILDING CONTRACTORS (909) 261-0148- 16 FIFTH STREET LIC. NO VERNE CA 91750 760941 CHITECT OR COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: ON FILE NO ASSESSOR INFORMATION NUMBER: 18588-030-042 TENANT: I I OWNER: TEL. NO: MOUNT VERNON HOLDINGS, LLC (909) 702-6858- I2831 ROSE PKWY #290 ]HENDERSON NV 89052 FEE APPLICANT: TEL. NO: JORTIZ, JUAN (909) 261-0148- 12416 FIFTH STREET PERMIT ISSUANCE FEE ILA VERNE CA 91750 27.80 NTRACTOR: TEL. NO: VERSIFIED BUILDING CONTRACTORS (909) 261-0148- 16 FIFTH STREET LIC. NO VERNE CA 91750 760941 CHITECT OR ENGINEER: TEL. NO: 9701 LAS TUNAS LIC. NO ID: DPR263 ROUTE TO: ES0508 PLUMBING PERMIT PL 0508 1408280011 BUILDING ADDRESS: 9336 BROADWAY TEMP CA 917802403 NEAREST CROSS STREET: THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CA ISSUED ON: PROCESSED BY: PLAN BY: 08/28/14 SR FINAL DATE a FjN$7�HY: CODE: -)-I �J DESCRIPTION bF WORK RELOCATE WASHER AND DRYER HOOK UPS SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE UNDER SLAB WORK WATER SERVICE PLASTIC YIN METAL YIN ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST I UTILITY COMPANY NOTI FI EDI CWV GRAY WATER SYSTEM TEMPLE CITY # 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: FEES PAID FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 01 PERMIT ISSUANCE FEE 27.80 11 CLOTHESWASHER(S) 1.00 FIX 16.20 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 TOTAL FEES 60.20 ID: DPR263 ROUTE TO: ES0508 PLUMBING PERMIT PL 0508 1408280011 BUILDING ADDRESS: 9336 BROADWAY TEMP CA 917802403 NEAREST CROSS STREET: THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CA ISSUED ON: PROCESSED BY: PLAN BY: 08/28/14 SR FINAL DATE a FjN$7�HY: CODE: -)-I �J DESCRIPTION bF WORK RELOCATE WASHER AND DRYER HOOK UPS SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE UNDER SLAB WORK WATER SERVICE PLASTIC YIN METAL YIN ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST I UTILITY COMPANY NOTI FI EDI CWV GRAY WATER SYSTEM 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 (/) 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). U:I am exempit 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 whicl1 I must have resided for at least one year priorl to completion; of the improvements covered by this permit, Icannot 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.leainfo.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 �l License No. // '!J/ `76ate Contractor Signatu—re / WORKERS' COMPENSAYi0 N CLARATION 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. Policy No. 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 number are: 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,, a forthwit�ico, ply with those provisions Sign ure gf�Applicant -Date C/ 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 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). 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 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 of this county to enter the above -identified property for inspection purposes. Sig ture o P n o uthorized Agent Sit