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Home My Public Portal About5330 Encinita Ave_Plumbing_7/15/2014_COUNTY OF LOS ANGELES TEMPLE CITY # 0508 DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 ILEGAL ID: ITR: 11492 LT: 21 BL: A I (ASSESSOR INFORMATION NUMBER: 18590-001-025 1 ITENANT: I I (OWNER: IBOCK ROBERT F;DOROTHY J TRS 15328 ENCINITA AV TEMP 917803114 I I (APPLICANT: IJUAREZ, ALBERT 11617 CENTINELA AVE 11NGLWOOD CA 90302 I ICONTRACTOR: ISUPERIOR 1 PLUMBING 11617 CENTINELA AVENUE 11NGLEWOOD CA 9030243 ARCHITECT OR ENGINEER: I I PHONE: (626) 285-0488 EXT: FEES PAID I 1FEE DESCRIPTION: QUANTITY: UOM: I 101 PERMIT ISSUANCE FEE 121 HOSE BIBB(S) 2.00 FIX 127 PRESS REG DEVICES) 1.00 DEV 147 WATER HEATER(S) 1.00 WTH 163 WATER PIPING BR/FIX 7.00 FIX TEL. NO: I TOTAL FEES (626) 221-4265— I TEL. NO: (323) 932-2020— TEL. NO: (323) 932-7070— LIC. NO 875015 TEL. NO: LIC. NO: I* ADDITIONAL DATA ON FILE I I IREPORT ID: DPR263 ROUTE TO: BS0508 PLUMBING PERMIT PL 0508 1407140023 BUILDING ADDRESS: 1 1 5330 ENCINITA AV 1 AMOUNT:( TEMP CA 917803114 1 NEAREST CROSS STREET: LOWER AZUSA 1 27.80 I THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CAI 32.40 1 I 16.20 (ISSUED ON: PROCESSED BY: PLAN BY: 1 16.20 107/15/14 SR 1 47.60 1 I 140.20 IFINAL DATE FIN movk CODE: 1 1 DISC PTIO OF WORK 1 I COPPER REPIPE 7 FIXTURES, 2 HOSE BIBBS, 1 PRESSURE REGULATOR( (AND WATER HEATER 1 I I I ISPECIAL CONDITIONS: 1 I I I I (APPROVALS DATE INSPECTOR SIGNATURE 1 (UNDER SLAB WORK 1 I IWATER SERVICE 1 I IPLASTIC Y/N METAL Y/N 1 I IROUGH PLUMBING I I I I 1 1GAS PIPING I I GAS VENT I I HOT WATER HEATER I I I IPLUMBING FIXTURES I I I ILAWN SPRINKLERS I I I I I I I IGAS TEST I (UTILITY COMPANY NOTIFIEDI I I I I f IcWV I I I IGRAY WATER SYSTEM I I I I I I I I I I I I I I 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 (_) 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 Contr9ctor pursuant .to the Contractors' State License Law). I (_) I am exempt 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. 1 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://w .lecinfo.ca.cov/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 l and effect . Q [— License Class lam/ License NoC�r�"��c� I Date ontractor 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: 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: 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 Califo ia, and agree that, if I should become subject to the wor r 'compensation provisions of Section 3700 of the Labor CoFI shall forthwith comply with those provisions Signature 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 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 requiremgnts 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). 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 authoriz@� representatives of this county to enter the above-idAtified property for inspection purposes. Sign �f perry vGner or Authorized Agent / Date (-,5--7