HomeMy Public PortalAbout5334 Encinita Ave_Plumbing_6/17/2014_COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
TR: 11492 LT: 22 BL: A
ASSESSOR INFORMATION NUMBER:
8590-001-026
TENANT
OWNER: TEL. NO:
SALDIVAR, DANIEL (626) 234-1608-
5334 ENCINITA AV
TEMP 917803114
APPLICANT: TEL. NO:
BUD VILLALOBOS (323) 781-6983-
11606 E WASHINGTON
WHITTIER CA 90606
CONTRACTOR: TEL. NO -
13 M VILLALOBOS INC. (323) 447-1836-
11606 E WASHINGTON BLVD LIC. NO
WHITTIER CA 90601 872939
ARCHITECT OR ENGINEER: TEL. NO:
LIC. NO:
TEMPLE CITY # 0508
9701 LAS TUNAS
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
FEES PAID
FEE DESCRIPTION: QUANTITY: DOM:
01 PERMIT ISSUANCE FEE
11 CLOTHESWASHER(S) 1.00 FIX
13 DISHWASHER(S) 1.00 FIX
25 LAVATORIES/SINKS 3.00 FIX
45 WATER CLOSET/URINAL 1.00 FIX
TOTAL FEES
REPORT ID: DPR263 ROUTE TO: BS0508
PLUMBING PERMIT
PL 0508 1406170042
CONDITIONS:
;R SLAB WORK
R SERVICE
(TIC Y/N METAL Y/
IH PLUMBING
PIPING
VENT
WATER HEATER
SING FIXTURES
I SPRINKLERS
TEST
CITY COMPANY NOTIF
CWV
GRAY WATER SYSTEM
DATE INSPECTOR SIGNATURE
1 \F
BUILDING ADDRESS:
5334 ENCINITA AV
AMOUNT:
TEMP CA 917803114
NEAREST CROSS STREET:
27.80
THOMAS PAGE: 596 GRID: S4
LOCALITY: TEMPLE CITY, C
16.20
16.20
(ISSUED ON: PROCESSED BY: PLAN BY:
48.60
106/17/14 SR
16.20
1
125.00
1 FI T FI AL BY:
CODE:
SRI
IDE CRI ION OF WORK
PLUMBING FOR 1/2 BATHROOM, TCHEN
REMODEL AND LAUNDRY AREA
CONDITIONS:
;R SLAB WORK
R SERVICE
(TIC Y/N METAL Y/
IH PLUMBING
PIPING
VENT
WATER HEATER
SING FIXTURES
I SPRINKLERS
TEST
CITY COMPANY NOTIF
CWV
GRAY WATER SYSTEM
DATE INSPECTOR SIGNATURE
1 \F
OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION 1, 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) 1 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 Contrhor pursuant.to the Contractors' State License
Law). II '
U 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 priorl to completiory 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: htto://www.leoinfo.ca.cov/calaw.html.
Date:
Signature of Property Owner or Authorized Agent
1 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._ +
DateLContractor Signature
WORKERS' C0MPENSA ION 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.
Pelicy No.
77�� 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
Titers 'gOminsurance carer nd policy n ber are:
Carrier tp fio Polio Number Expiration
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' cora�ensation provisions of Section 3700 of the Labor
Code,Jsh�II fort Wits" of h t ose provisions
ffiig�t e of Applican Dat
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 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.
Is69-7*1116 -] I[all II;JWIN 1Eel II
❑ Notification letter sent to AOMD 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 of this county to enter the
above-identifi d• pro erty for inspect' n purposes.
Signa !o rot Owgpf� Aaent
!Date ('a/i I
COUNTY •OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
TR: 11492 IT: 22 BL: A
ASSESSOR INFORMATION NUMBER:
8590-001-026
TENANT
OWNER:
SALDIVAR, DANIEL
5334 ENCINITA AV
TEMP 917803114
APPLICANT:
SAME AS OWNER
CONTRACTOR:
SAME AS OWNER
OR ENGINEER:
TEL. NO:
(626) 234 -1608 -
TEL. NO:
TEL. NO:
LIC. NO
TEL. NO:
LIC. NO:
TEMPLE CITY
#
0508
PLUMBING PERMIT
9701 LAS TUNAS
PL 0506 1408060002
TEMPLE CITY CA
91780
PHONE: (626) 285-0488
EXT:
FEES
PAID
BUILDING ADDRESS:
5334 ENCINITA AV
FEE DESCRIPTION:
QUANTITY:
DOM:
AMOUNT:1
TEMP CA 917803114
NEAREST CROSS STREET:
01 PERMIT ISSUANCE FEE
27.80
THOMAS PAGE: 596 GRID: 74 LOCALITY: TEMPLE CITY, C
25 LAVATORIES/SINKS
2.00
FIX
32.40
45 WATER CLOSET/URINAL
1.00
FIX
16.20
JISSUED ON: PROCESSED BY: PLAN BY:
TOTAL FEES
76.40
08/06/14 SR
IFZ AT FINAL Y: CODE:
IOF WORK
(REPLACE WATER CLOSET AND 2 LAVATORIES ON BATHROOM #2
REPORT ID: DPR263 ROUTE T0: BS0508
SPECIAL CONDITIONS:
APPROVALS DATE
UNDER SLAB WORK
WATER SERVICE
PLASTIC YIN METAL YIN
ROUGH PLUMBING
GAS PIPING
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS
GAS TEST
UTILITY COMPANY NOTIFIED
CWV
GRAY WATER SYSTEM 1 I
INSPECTOR SIGNATURE
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 L) 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
properly 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 ContrbTtor 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 priorlto 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. 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.
-7�bate: v 6 _ l / (
Signa nrmo rly Owns or thorized 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.
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:
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
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
worker ' pensation provisions of Section 3700 of the Labor
Co , I shall ivn�pomn�ith those provisions
8� y
' Si§fiature o 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
JOB ADDRESS
.93Y (O/A 47X
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 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).
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 of this county to enter the
above -id Rti r e e inspection purposes.
Sign re of Pr ty w r orized�Agent
Q )
ate