HomeMy Public PortalAbout6022 ENCINITA AVE_PLUMBING_7/20/2016_TEMPLE CITY PERMIT NO. P16-184
City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templKfty.us
Address: 6022 Enclnita Avenue, Temple City, California 91780 Parcel: 5385-004-011
Permit No: P16-184 Type: Plumbing Subtype: Subtype: Residential
Description: Replace water heatersame size/loc: 50 gal/garage Special Conditions:
Issue Date: 07-20-2016 Expire Date: 01-16-2017 Extension: Extension:
Permit expires on date shown if: 1) work does not commence, or 2) work is suspended or abandoned, or 3) applicant falls to obtain code required
inspection.
Contacts
Owner Joanne
Wang
Applicant Daniel
Mata
Contractor
EXPIRED
Affordable Water Heater &
Plumbing Inc.
- Plumbing Details
28358 Constellation Road Suite
Backwater 0
Backflow 0
Valve
Device
Drinking 0
Floor Drain 0
Fountain
Clothes 0
Lavatory/Sink 0
Miscellaneous 0
Pool Trap 0
Trap Primer 0
Gas: Low 0
Gas: 0
Press
Mad/High
Regulator
Press
Greywater 0
Pipe 0
System
Replacement
Other: over 3 0 Sewer: 0
inches Connection
Sewer: 0 Sewer: Pit 0
Pit/Drainfield Extension
6022 Encinita Avenue, Temple City, California 91780
28358 Constellation Road Suite
698, Santa Oarita,
California 91355
28358 Constellation Road, Santa Clanta, California 91355
1 °%'-st---R--'-- _
_- ____ -_
Bathtub/Shower 0
Clothes 0
Washer
Floor Sink 0
Hose 0
Bibb
Pressure 0
Roof 0
Regulator
Drain
Water Closet 0
Water 1
Heater
Gas Meter 0
Gas 0
Regulator
Future Branches 0
Other: 0
1.5
inches or
less
Sewer: Manhole 0
Sewer: 0
Addition
Sewer Alteration 0
Combo
Waste/Vent Earthquake Chemical Rainwater
Shutoff Waste
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 Add'I
Septic Tan WPIC
Drywell
(855)345-9048
(855)345-9048 627368
Dishwasher 0
Interceptor/Clarifier 0
Solar Water Heater 0
Water Treatment 0
Alteration/Repair 0
Other: 2-3 inches 0
Sewer: Private 0
Connection
Approval Date Inspector
Plumbing Fixtures
Lawn sprinklers
Gas Test
Utility Co Notified
CWV
Gray Water System
FINAL
Approval Data
Atter/Repair
Disconnect/Plug
Backfill Tank/Ptt
Gray Water System
FINAL
Inspector
Greywater
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 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 Contrh or 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 whicf 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: hftp,//www.leginfo.ca.gov/calaw.htmi.
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. �1
Licens Cl a s � License No. ti 43�
DateO Contractor Signet
WORKERSCOMPENSA ON 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.
ZPo y No.
I have and will maintain workers' compensation
i surance, as required by Section 3700 of the Labor Code, for
the performance of the work for which this permit is issued. My
workers' co pensatio uran carrier and ol'c num r re:
Carrier Policy Number
Expi on ale
�.1I�_ t�bl -qt-IlS'l
Name of Ag 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 sh uld become subject to the
IgnaTu
' compensation provisi of Section 3700 of the Labor
shall forthwith those p visions
1 a of Applic 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) a that
all persons acting on behalf of my mplied and will ti
to comply therewith through the appljra' 'on process.
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
SCAQMD permitting checklist, I understand my requimm@nts
under the Los Angeles County Code Title 2, Chapter 220'
Sections 220.100 through 220.140 cenceming 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 authodz presentatives of this cowto enter the
!above-identifl d property for iry§pectiopr urposes.
Date