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Home My Public Portal About9523 BLACKLEY ST_PLUMBING_4/16/2013_COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT ., - ✓ DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1304160028 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: �. au: FEES PAID BUILDING ADDRESS: TR: 17190 LT: 9 9523 BLACKLEY ST FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917803143 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8590-005-011 01 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY 41 WATER HEATER(S) 1.00 WTH 16.20 1 TENANT: TOTAL FEES 44.00 ISSUED ON: PROCESSED BY: PLAN BY: 104/16/13 SR OWNER: TEL. NO: HOFELING LAWRENCE L;MARJORIE J (626) 285-7693- 9523 BLACKLEY ST TEMP 917803143 KHACHERYAN, MARINE 13400 SATICOY ST #25 N HOLLYWOOD CA 91605 PLUMBING INSTALLERS 13400 SATICOY STREET #25 NORTH HOLLYWOOD CA 91605 TEL. NO: (818) 982 -6952- (818) 982 -6952 - LIC NO 915215 CEL. NO: LIC. NO: -nal ID: DPR263 ROUTE TO: BS0508 DESCRIPTION OF WORK REPLACE WATER HEATER (UNDER SLAB WORK 1 I WATER SERVICE I I [PLASTIC Y/N METAL Y/N 1 IGAS VEND 1 I 1 I 1HOT WATER HEATER I I I PLUMBING FIXTURES (LAWN SPRINKLERS IGAS TEST 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 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 Contr9Ftor pursuant to the Contractors' State License Law). 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 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: htto://www.leginfo.ca.gov/ralaw.html. Date: Signature of Property Owner or Authorized 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. Lcense Cla 3 6 License No. >,DZl //ate�Contractor Signature WORKERS' COMPENSATION DECLARATION WA MNG: 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. 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 checklist for guidelines. Yes ❑ No ❑ I have read the hazardous materials information guide and the I hereby affirm under penalty of perjury one of the following SCAQMD permitting checklist, I understand my requirements declarations: under the Los Angeles County Code Title 2, Chapter 220 1 have and will maintain a certificate of consent to self- Sections 220.100 through 220.140 concerning hazardous insure for workers' compensation, issued by the Dlrector of material reporting and for obtaining a permit from the SCAQMD. Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit ASBESTOS NOTIFICATION is issued. c2No. ❑ Notification letter sent to AQMD and/or EPA I have and will maintain workers' compensation nce, as required by Section 3700 of the Labor Code, for ❑ 1 declare that notification of asbestos removal is not the performance of the work for which this permit Is Issued. My applicable to addressed project. ars' cern an tion .s�uvrsa�nc��e dcy,pyLnberg:a ,M DECLARATION REGARDING CONSTRUCTION LENDING r o'P Iicy Number ��JEx2Jpimrtion Da/t)e/-zll/(//_# / AGENCY Name of Agent Phone Number 1 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 she fort with comply with those provisions x � Si ture of ApplZgnDate 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 compiled a d will continue to gomply,therewith through the appiicatign prrd 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 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 pr arty for inspection purposes. Signatu Owner or Authorized Agent '�a i