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HomeMy Public PortalAbout9514 PENTLAND ST_Building_2/16/2016_PL 0508 1602160019 water fixtures, gas meter, water pipingCOUNTY -OF LOS AN(9ELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1602160019 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: TR: 14572 LT: 14 1PLUMBING FIXTURES 9514 PENTLAND ST FEE DESCRIPTION: A95ESS0R INFORMATION NUMBER: TEMP CA 917803844 I 8590-013-011 1 101 PERMIT ISSUANCE FEE UTILITY COMPANY NOTIFIED 34.40 107 BATHTUBS/SHOWERS TENANT: 3.00 FIX 111 CLOTHESWASHER(S) 113 DISHWASHER(S) 20.20 121 HOSE BIBB(S) OWNER: TEL. NO: 125 LAVATORIES / SINKS CHANG, ADAM ( 145 WATER CLOSET/URINAL 9514 PENTLAND ST. 1 147 WATER HEATER(S) TEMPLE CITi CA 91780 151 LOW PRS GAS LE5 OUTS 5 5.00 FIX 1.00 WTH 101.00 20.20 155 GAS METER (PRIVATE) 1 // �� 7 1.00 SYS 164 WATER PIPNG <- 1 1/2 ORTEGA, JOSE 12244 JAMESTOWN PL CHINO CA 91710 CA PLUMBING TECH, INC. 1224 JAMESTOWN PLACE CHINO CA 91770 NADER,LKHOURYcnuinncrt 1160 CATALINA STREET LAGUNA BEACH CA 92651 TEL. NO: (626) 367 -0543 - TEL. NO: (626) 367 -0543 - LIC. NO 961720 1GL. V: (949) 637 -8357 - LIC. NO: 61402 ?ERMIT EXPIRES 180 DAYS IF L) WORK DOES NOT COMMENCE, OR 2) WORK IS SUSPENDED OR ABANDONED, OR 3) FAILS TO OBTAIN CODE REQUIRED INSPECTION FEES PAID BUILDING ADDRESS: 1PLUMBING FIXTURES 9514 PENTLAND ST QUANTITY: VOM: AMOUNT: TEMP CA 917803844 I GAS TEST 1 1 NEAREST CROSS STREET: UTILITY COMPANY NOTIFIED 34.40 I THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY 3.00 FIX 60.60 1.00 FIX 20.20 JISSUED ON: PROCESSED BY: PLAN BY: 1.00 FIX 20.20 102/16/16 SR 2.00 FIX 40.40 1 .00 FIX 121.20 IFINAL TE FI CODE: 5 5.00 FIX 1.00 WTH 101.00 20.20 1 // �� 7 1.00 SYS 20.20 IDESCRrPTIONOF WORK 1.00 MET 20.20 PLUMBING FOR NEW SINGLE FAMILY DWELLING 1.00 LIN 20.20 1 TOTAL FEES 478.80 REPORT ID: DPR263 ROUTE TO: BS0508 WORK PLASTIC YIN METAL YIN 1 7 I GAS VEND 1 HOT WATER HEATER 1PLUMBING FIXTURES 1 1 1 LAWN SPRINKLERS I GAS TEST 1 UTILITY COMPANY NOTIFIED I 1« I I GRAY WATER SYSTEM 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 (J) 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 Contractor 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 priorl to completion( of the improvements covered by this permit, I gnnot legally sell a structure that I have built as an owner -builder l 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.lecinfo.ca.cov/calaw.html. Date: Signature of Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 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. {/� '�{ LicenseeC�License No.VDate r Signature WORKERS' COMPENSATION TION WARNING: FAILURE TO SECURE WORKE ' 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. Pa icy 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 wo a 8' co pensati rflhsu nu er ark: _ J 744vJ Carrier—Policy Number Expire an 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' compensationp visions of Section 3700 of the Labor Code, I shall to thwith co ly with those provisions Signature ofPpficarhtU 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 ' 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 specked 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 -identified property for inspection g(rrposes. Signature of Date