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Home My Public Portal About9552 FLAHERTY ST_Plumbing_2/5/2015_COUNTY'OF LOS ANGELES TEMPLE CITY H 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1502050041 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: IR: 17179 LT: 62 4SSESSOR INFORMATION NUMBER: 5385-012-027 TENANT JWNER: TEL. NO: IHIEU, CAM (626) 400-9095- 9552 FLAHERTY ST TEMP 917801645 'LICANT: TEL. NO: NO, JACK (626) 274-9357- 5 LEE AVENUE p3 EL MONTE CA 91733 CONTRACTOR: TEL. NO: SWM CONSTRUCTION INC. (626) 274-9357- 2645 LEE AVENUE #3 LIC. NO SO EL MONTE CA 91733 836333 OR ENGINEER: TEL. NO: LIC. NO: FEES PAID FEE DESCRIPTION: QUANTITY: UOM: 01 PERMIT ISSUANCE FEE 07 BATHTUBS/SHOWERS 25 LAVATORIES/SINKS 45 WATER CLOSET/URINAL REPORT ID: DPR263 1.00 FIX 1.00 FIX 1.00 FIX TOTAL FEES ROUTE TO: BS0508 AMOUNT: 2'1.80 16.20 16.20 16.20 76.40 BUILDING ADDRESS: 9552 FLAHERTY ST TEMP CA 917801645 NEAREST CROSS STREET: PRIMROSE THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY CA ISSUED ON: PROCESSED BY: PLAN BY: 52/05/15 SR FINDATE FINAL BY: CODE: ] WON OF WORK V 3ATHTUB/SHOWER, LAVATORIE AND WATER CLOSET FOR NEW BATHROOM 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 UTILITY COMPANY NOTIFIED CWV GRAY rTER SYSTEM / I I � OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION I 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, L 2 demolish, or repair any structure, prior to its issuance, alsG'_License Class _� License No. b ,✓ requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Date / Contractor Signature / Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions WORKERS' COMPENSATION ECLARATIO 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 1, 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 1, 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 Contr'a�or pursuant .to the Contractors' State License Law). (_) 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 pdorl to completion, of the improvements covered by this permit, I cpnnot 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: hffD://www.lecinfo.ca.cov/calaw.html. Date: Signature of Property Owner or Authorized Agent 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 cartificate 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. Pg11cy 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' cor pe satin ins ra e R a num r re: am r' 'FLY Policy Number F,cpimtion ba e 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' compensation provisions of Section 3700 of the Labor Code, 3ha I forthwit c mply with those provisions Date I Signatul Appli n 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 ❑ N o ❑ r i I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my requi.mm@nts 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: 1 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 tiprop pro;;for inspection purposes. Signature o P rty er r uthorized Agent I r � COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: ITR: 17179 LT: 62 1 ASSESSOR INFORMATION NUMBER: 5385-012-027 1 TENANT: OWNER: TEL. NO: ITHIEU, CAM (626) 400-9095- 19552 FLAHERTY ST TEMP 917801645 APPLICANT: TEL. NO: PAN, DZEN KUO (626) 284-5721- I1604 S MONTEREY PARK JALHAMBRA CA 91801 CONTRACTOR: TEL. NO: DZEN KUO PAN (626) 922-0279- 11604 S MONTEREY STREET LIC. NO IALF7.AMBRA CA 91801 518456 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: UOM: 101 PERMIT ISSUANCE FEE 151 LOW PRS GAS 5 OUTLET 1.00 SYS TOTAL FEES REPORT ID: DPR263 ROUTE TO: BS0508 AMOUNT: 27.80 16.20 44.00 PLUMBING PERMIT PL 0508 1502190046 BUILDING ADDRESS: 9552 FLAHERTY ST TEMP CA 917801645 NEAREST CROSS STREET: PRIMROSE THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY CAI ISSUED ON: PROCESSED BY: PLAN BY: 02/19/15 SR FINAL DATE FIN Y: CODE: I17ESCRI15TION OF WORK ITO REPLACE THE GAS MAIN LINE FROM THE GAS METER TO THE GAS MAIN VALVE SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE UNDER SLAB WORK WATER SERVICE PLASTIC Y/N METAL Y/N ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST j UTILITY COMPANY NOTIFIED ICWV 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 ($600).): 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 Contr9ctor pursuant.to the Contractors' State License Law). U 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, 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: htto://www.leainfo.ra.00v/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. rcense Class—J � License No. 2—I q -1r S /� JCDate Contractor SignaturP�K LAY V 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 w rkers' co ensation insurance arrier and poli�cy numb a N/V � 0 L 'O�l `-F v �amer Policy Num eb r �/ pPSf TATE //-Vc. 626- -Rq37 Name of gent Phone Num er 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, 1 shall forthwith co pl with those provisions ignature of Applicant F2 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. 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 (SCAQM D)? 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 -identified property for inspection purposes. TZ�N I./ .O �v t'�U Signature of Property Owner or Au onzed Agent Applicant (Print Name) Applicant Slgnature---! tit n_ /'�2•/c/../S' to 02—rd....1s , Company Name -Date