HomeMy Public PortalAbout10651 FREER ST_PLUMBING_10/11/2017_TEMPLE CITY PERMIT NO. P17-35030
City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templecity.
us
Approval Date
Address: 10653 Freer St,
Temple City, California
91780
Parcel: 8585-031-032
Utility Co Notified
Water Service
Permit No: P17-35030
Plastic Y/N
Type: Plumbing Subtype:
Subtype:
Residential
Description: RE -PIPE OF MAIN
GAS SERVICE FROM METER VAULT
TO Special
Approval Date
Inspector
DWELLING.
Connect Add'I
Conditions:
Septic Tank/Pit
Issue Date: 30-11-2017
Expire Date: 04-09-2018 Extension:
Extension:
Permit expires on date shown if: 1)
work does not Commence,
or 2) work is suspended or abandoned, or 3) applicant
fails to obtain code required
inspection.
Contacts
Owner Benny Lopez
10651 Freer St, Temple City, California 91780 (626) 807-6455
Applicant
Rudy's Plumbing
P. O. Box 407,
Monrovia, California 91017 (626) 758-1490
Contractor
Rudy's Plumbing
P. 0. Box 407,
Monrovia, California 91017 (626) 758-1490
Plumbing Details
Backwater 0
Backflow
0
Bathtub/Shower 0 Clothes 0
Dishwasher
0
Valve
Device
Washer
Drinking 0
Floor Drain
0
Floor Sink 0 Nose 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 1
Gas:
0
Gas Meter 0 Gas 0
Alteration/Repair
0
Press
Med/High
Regulator
Press
Greywater 0
Pipe
0
Future Branches 0 Other: 1.5 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
Combo
Waste/Vent
Earthquake
Chemical Rainwater
Greywater
Shutoff
Waste
- Fees Total
Plan Check Fe" $113.60
Plumbing Inspections
Permit Fees $21.06
Approval Date
Inspector
Under Slab
Work
Utility Co Notified
Water Service
Hot Water Heater
Plastic Y/N
Metal Y/N
Gray Water System
Rough Plumbing
Lawn Sprinklers
Sewer Inspections
Approval Date
Inspector
New House Sewer
Connect Add'I
Septic Tank/Pit
Approval Dafp , I pe
Approval
Data Inspector
Gas Piping l7tzDf,[/fivr/L-2
Gas Test
Gas Vent
Utility Co Notified
Hot Water Heater
CWV
Plumbing Fixtures
Gray Water System
Lawn Sprinklers
FINAL
Approval Date Inspector Approval Date Inspector
Drywall Backfill Tank/Pit
Alter/Repair Gray Water System—
Disconnect/Plug FINAL
I
N
�l
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from
the Contractors' State License Law for the mason(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 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 Contm or pursuant to the Contractors' State License
Law).
(,:I am exempt from licensure under the Contractors' State
License Law for the following reason:
i
By my signature below I acknowledge that, except for my
personal residence In which I must have resided for at least
one year prior to complefioryry of the Improvements covered by
this permit, I nnot legally sdll a structure that I have built as an
owner -builder f 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.leoinfc.ca.cov/calaw.html.
Date:
Signature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATION
1 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. �y
Licens�e� Class C-3� License No.
V \Date 44--k-contra Signature _:v
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 3760 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
workers' compensation Insurance carrier and policy nurpbpr are:
I'm LL ^Y -r.. I, lr
Carrier— Policy Number �piration Date
It -'R2 310-7521-c, iGJ
Name 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 taws 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
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 compiled and will, continue
to comply therewith through the application process.
Applicant (Print Na e) Applic t Signqturp
—21 d Jf( J v
Company Naomi me J Date
JOB ADDRESS
7
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 ❑ N o ❑
WIII 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 ❑ N.o ❑
i
I have read the hazardous materials information guide and the
SCAQMD_ permitting checklist, I understand my requirem nts
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
❑ 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
Lenders Address
By my signature below, I certify to!each of the following:
I am the property owner or authorized to act on the
property owners 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.
Sign re of Prop Owner or A4odzed Agent
Date