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Home My Public Portal About9526 BLACKLEY ST_PLUMBING_6/13/2017_TEMPLE CITY PERMIT NO. P17-34379 City of Temple City 1 9701 us Tunas Drive I Temple City, California 91780 1 (626) 285.2171 1 wwwtempleclty. us Address: 9526 Blackley Street, Temple City, California 91780 Parcel: 8590-007-027 Permit No: P17-34379 Type: Plumbing Subtype: Subtype: Residential Description: GAS UNE FOR FURANCE Special Conditions: Issue Data: 06-13-2017 Expire Date: 12-10-2017 Extension: Extension: Permit expires on date shown d: 1) work does not commence, or 2) work is suspended or abandoned, Or 3) applicant falls to obtain code required inspection. Contacts Owner Beverly Hayton e[ Insp o 9526 Blackley Street, Temple City, California 91780 (626) 287-4283 Applicant Cana Contreras Inspector 4931 Encmita Avenue, Temple City, California 91780 (626) 286-3157 Plastic Y/N Contractor Connor Air Conditioning 4931 Encmita Avenue, Temple City, California 91780 (626) 286-3157 403735 - Sewer I s ectlons Plumbing Details Approval Date Inspector New House Sewer Conned Add'I Backwater 0 Backflow 0 Bathtub/Shower 0 Clothes 0 Dishwasher 0 Valve Device Washer Drinking 0 Floor Drain 0 Floor Sink 0 Hose Bibb 0 Interceptor/ Clarifier 0 Fountain Lavatory/Sink 0 Miscellaneous 0 Pressure 0 Roof Drain 0 Solar Water Heater 0 Regulator Pool Trap 0 Trap Primer 0 Water Closet 0 Water 0 Water Treatment 0 Heater Gas: Low I Gas: 0 Gas Meter 0 Gas 0 Alteration/Repair 0 Press Med/High Regulator Press Greywater 0 Pipe 0 Future Branches 0 Other: 1.S 0 Other: 2-3 inches 0 System Replacement 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: 0 Sewer: 0 Pit/Drainfield Extension Alteration Tap&Saddle Cembo Waste/Vent earthquake Chemical Rainwater Greywater Shutoff Waste - Fees Total e[ Insp o Plan Check Fees $113.60 Permit Fees $20.50 - Plumbing Inspections Approval Date Inspector Under Slab Work Water Service Plastic Y/N Metal Y/N Rough Numbing - Sewer I s ectlons Approval Date Inspector New House Sewer Conned Add'I Septic Tank/Nt Approval e[ Insp o Gas Pipinq Gas Vent Hot Water Heater Numbing Fixtures lawn Sprinklers Approval Date Drywall Alter/Repair Disconnect/Plug Approval Date Inspector Gas Test Utility Cc Notified CWV Gray Water System FINAL Inspector Approval Backfill Tank/plt Gray Water System FINAL Data Inspector 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 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 Contr9r(tor pursuant to the Contractors' State License Law). ' (_) I am exemi4t 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 whicf I must have resided for at least one year priori to 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: httpJ/www.leginfb.ca.00v/mlaw.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 We, and my license is in full force and effect. �� (�� ^� License ClasQ�icense No. W�� / �� Dateor tractor 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 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 d 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 0 1 have read the hazardous materials information guide and the SCAOMD 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 insurance, as required by Section 3700 of the Labor Code, for � I declare that notification of asbestos removal is not the performance of the work for which this permit is issued. My applicable to addressed project. workers'co pens tion i c c r`ar p Iicy numbIr r: V' Carrie policy Number xpiration Oafs N me 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, sh II ith comply with those provisions [Qb\n Signature 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 compli d 'll continue to gblryply therewiliththrough the application p App a tApp a t (P 'nt Name Appl Compa 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 pennit 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 auth rize representatives of this county to enter the abov i+gtified property for inspection purposes. Date or Authorized Agent