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Home My Public Portal About5657 McCULLOCH AVE_PLUMBING_4/19/2017_ (3)TEMPLE CITY PERMIT NO. P17-34014 Contacts Owner Applicant Chris Borland Contractor Engineer Plumbing Details Backwater 0 Valve Drinking 0 Fountain Lavatory/Sink 4 Pool Trap 0 Gas: Low 5 Press Greywater 0 System Other: over 3 0 inches Sewer: 0 Pit/Drainfield Combo Waste/Vent The Olson Company Oki Ranch Parkway, Seal Beach, California 90740 (562) 596-4770 3010 Old Ranch Parkway, Seal Beach, California 90740 (562) 412-6450 OLSON URBAN HOUSING LP 3010 Old Ranch Parkway Suite 100, Seal Beach, California 90740 (562) 412-6450 939166 Damelian Associates 60 Corporate Park, Irvine, California 92606 (949) 474-6030 Backflow 0 City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www,templecity.us Address: 5657 McCulloch Avenue Unit 103 , Temple City, California 91780 Parcel: 8573-011-029 Permit No: P17-34014 Type: Plumbing Subtype: Subtype: Residential Description: PLUMBING FOR NEW ATTACHED CONDO AND CONNECT TO Special Interceptor/ Clarifier 0 PUBLIC SEWER Conditions: Issue Date: 04-19-2017 Expire Date: 30-I6-2017 Extension: Extension: Regulator 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 Plumbing inspection, Water Closet 3 Contacts Owner Applicant Chris Borland Contractor Engineer Plumbing Details Backwater 0 Valve Drinking 0 Fountain Lavatory/Sink 4 Pool Trap 0 Gas: Low 5 Press Greywater 0 System Other: over 3 0 inches Sewer: 0 Pit/Drainfield Combo Waste/Vent The Olson Company Oki Ranch Parkway, Seal Beach, California 90740 (562) 596-4770 3010 Old Ranch Parkway, Seal Beach, California 90740 (562) 412-6450 OLSON URBAN HOUSING LP 3010 Old Ranch Parkway Suite 100, Seal Beach, California 90740 (562) 412-6450 939166 Damelian Associates 60 Corporate Park, Irvine, California 92606 (949) 474-6030 Backflow 0 Bathtub/Shower 2 Clothes 1 Dishwasher I Device Approval Washer Under Slab Floor Drain 0 Floor Sink 0 Hose Bibb 2 Interceptor/ Clarifier 0 Miscellaneous 0 Pressure 0 Roof Drain 0 Solar Water Heater 0 A07 Regulator 7 A411 Plumbing Trap Primer 0 Water Closet 3 Water 1 Water Treatment 0 Heater Gas: 0 Gas Meter 1 Gas 0 Alteration/ Repair 0 Med/High Regulator Press Pipe 0 Future Branches 0 Other: 1.5 1 Other: 2-3 inches 0 Replacement inches or less Sewer. I Sewer: Manhole 0 Sewer: 0 Sewer: Private 0 Connection Addition Connection Sewer: Pit 0 Sewer: 0 Sewer: Extension Alteration Tap&Saddle Earthquake Chemical Rainwater Greywater Shutoff Waste Fees Total Daty I In - �— Plan Check Fees $163.19 Permit Fees $40].98 - Plumbing Inspections --- _Approval Approval O�Ins r Under Slab Gray Water Work System Water Service FINAL Plastic Y/N Metal YIN A07 Rough 7 A411 Plumbing Sewerinspe Approval New House Sewer Connect Addll Septic Tank/Pit Data Inspector Approval D t line Gas Piping Vr Gas Vent Hot Water �2 Heater Plumbing Fixtures Lawn Sprinklers Approval Daty I In - �— Gas Test Utility Co Notified CWV Gray Water System FINAL Approval Data Inspector Approval Date Inspector Drywell Backfill Tank/Pit epatr Gray meter Disconnect/Plug lr -sem Disconnect/Plug System FINAL OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason($) 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 Contractor pursuant to the Contractors' State License Law). U: I am exeml t from licensure under the Contractors' State License Law for the following reason: By my signature below 1 acknowledge that, except for my personal residence in whit I must have resided for at least sl year priorlto completlo of the Improvements covered by this permit, I cannot legally s�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/calaw.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. e License Class )� License No. n Date LI-20"IContractorSignature Cb WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMIN4L 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 Insurance, as required by Section 3700 of..the Labor Code, for the performance of the work for which this permit is issued. My wo kers' compensation in sur c9ue carrier and olicy number are: 1-111((11 C)> Co ==X 1 ( I I Carrier Policy Number Expiration Date 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 shall forthwith comply with those provisions ,aC,-i�� 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 actingon 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 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 I have read the hazardous materials information guide and the SCAQMD, pernittIng checklist, I understand my requirem@nts under the Los Angeles County Code T1tie 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 purposes. Signature of Property glyner or Authorized Agent Date