HomeMy Public PortalAbout6355 GOLDEN WEST AVE_PLUMBING__ (2)TEMPLE CITY PERMIT NO. P16-189
City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templecity.us
Address: 6355 Golden West Avenue, Temple City, California 91780
Parcel: 5383-018-029
Permit No: P16-189
Type: Plumbing Subtype:
Subtype: Residential
Description: Gas extension for
FAU
Special Conditions:
Issue Date: 07-20-2016
Expire Date: 01-16-2017 Extension:
Extension:
Permit expires on
date shown if: 1) work does not commenw, or 2) work is suspended or abandoned, or 3) applicant fails to obtain code required
Inspection.
_ Contacts
XPIRFR
Q- t —1'7
Owner Celenia Emanuelli
=in WIIIIIII
6355 Golden West Avenue, Temple City, California 91780
(626) 287-3227
Applicant Tom Robinson
3150 East Birch Street, Brea, California 92821
(714) 777-7777
Contractor
Around the Clock Heating A/C
7216 Varna Avenue, Los Angeles, California 91605
(800) 434-9277 650364
Plumbing Details
Backwater 0
Backflow 0
Bathtub/Shower 0 Clothes 0
Dishwasher 0
Valve
Device
Washer
Drinking 0
Floor Drain 0
Floor Sink 0 Hose 0
Interceptor/Clarifier 0
Fountain
Bibb
Lavatory/Sink 0
Miscellaneous 0
Pressure 0 Roof 0
Solar Water Heater 0
Regulator Drain
Pool Trap 0
Trap Primer 0
Water Closet 0 Water 0
Water Treatment 0
Heater
Gas: Law 1
Gas: 0
Gas Meter 0 Gas 0
Alteration/ Repair 0
Press
Med/High
Regulator
Press
Greywater 0
Pipe 0
Future Branches 0 Other: 0
Other: 2-3 inches 0
System
Replacement
1.5
inches or
less
Other: over 3 0
Sewer: 0
Sewer: Manhole 0 Sewer: 0
Sewer: Private 0
inches
Connection
Addition
Connection
Sewer: 0
Sewer: Pit 0
Sewer Alteration 0
Pit/Drainfield
Extension
Combo
Waste/Vent Earthquake
Shutoff
Fees Total
Plan Check Fees $0.00 Permit Fees $20.16
Plumbing Inspections
Approval Date Inspector
Under Slab Work
Water Service
Plastic Y/N
Metal Y/N
Rough Plumbing
Gas Piping
Gas Vent
Hot Water Heater
Sewer Inspections
Approval Date Inspector
New House Sewer
Connect Addrl
Septic Tank/Pit
Drywall
Chemical Rainwater Greywater
Waste
Approval Date
Plumbing Fixtures
Lawn Sprinklers
Gas Test
Utility Co Notified
CWV _
Gray Water System _
FINAL
Approval
Alter/Repair
Disconnect/Plug
Backfill Tank/PR
Gray Water System
FINAL
Inspector
Date Inspector
M
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 (_) portions of the
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 fAfce and effect.
ac
License Class Cr `,� °6 License No. lP SO 3 4O
CDC
Date e� Contractor Signatur0 _y
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
ATTORNEYS FEES.
work, and the structure is not intended or offered for sale
(Section 7044, Business and Professions Code: The I hereby affirm under penalty of perjury one of the following
Contractors' State License Law does not apply to an owner of declarations:
property who, through employees' or personal effort, builds or I have and will maintain a certificate of consent to self -
improves the property, provided that the improvements are not insure for workers' compensation, issued by the Director of
intended or offered for sale. If, however, the building or Industrial Relations as provided for by Section 3700 of the
improvement is sold within one year of completion, the Owner- Labor Code, for the performance of the work for which this permit
Builder will have the burden of proving that it was not built or is issued.
improved for the purpose of sale.).P, oJicy No.
P I have and will maintain workers' compensation
U I, as owner of the property, am exclusively contracting with Insurance, as required by Section 3700 of the Labor Code, for
licensed Contractors to construct the project (Section 7044, the performance of the work for which this permit is issued. My I
Business and Professions Code: The Contractors' State License workers' compensation insutanoe cerci r and policy umber are
Law does not apply to an owner of property who builds or iZ�PUrTLf C(iAJl1�lZ._ 1 --fix-- �rw-B c&75Y ti. (%
improves thereon, and who contracts for the projects with a Carder Policy Number Ex IrltionDate
licensed Contra or pursuant.to the Contractors' State License I_u KA Aft.- _i Ii5—%�/2 `f37_i
Law). I Name of Agent Phone Number
(_) 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 priorlto 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.leeinfo.ce.eov/calaw.html.
Date:
Signature of Property Owner or Authorized Agent
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, I f forthwith comply with those provisions
/ C
Sign lure 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 theapli Iqn p
T9wt;J,S� QSti
A�plic�ant (Print Name) nt Signatu
ltftoaasn*uf C��K
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 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 checklistfor 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 �20'
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.
Signature oparty O Ter? orized Agent
Date