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Home My Public Portal About9909 LOWER AZUSA RD_PLUMBING_6/13/2016_COUNTY OF LOS ANGELES- TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1606130034 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 9848 IT: 12 9909 LOWER MUSA RD FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804041 ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 8589-024-024 101 PERMIT ISSUANCE FEE 34.40 THOMAS PAGE: $97 GRID: BS LOCALITY: TEMPLE CITY 107 BATHTUBS/SHOWERS 3.00 FIX 60.60 1 TENANT: 111 CLOTHESWASHER(S) 1.00 FIX 20.20 ISSUED ON: PROCESSED BY: PLAN BY: 113 DISHWASHERS) 1.00 FIX 20.20 06/13/16 SR 121 HOSE BIBB(S) 4.00 FIX 80.80 OWNER: TEL. NO: 125 LAVATORIES / SINKS 6.00 FIX 121.20 IFINAL TE FINAL BY: CODE: WEI SHARON - 145 WATER CLOSET/URINAL 3.00 FIX 60.60 1i��r �d 5593 ANGELUS AVE 147 WATER HEATER(S) 1.00 WITH 20.20 11 �✓/ {� �r `�- • / q TEMP917804041 151 LAW PRS GAS LES OUTS 1.00 SYS 20.20 DES PTI N OF WORK 155 GAS METER (PRIVATE) 1.00 MET 20.20 1PLUMEING FOR NEW DETACHfD CONDO 64 WATER PIPNG <. 1 1/2 1.00 LIN 20.20 APPLICANT: TEL. NO: I TOTAL FEES 478.80 WONG, KAM (626) 570-9969- 809 S ATLANTIC BLVD. ISPECIAL CONDITIONS: MONTEREY PARK 91754 1 I CONTRACTOR: TSL. NO: JAPPROVALS DATE INSPE R SIGNATURE MCWONG HOLDING CO. (626) 570-9969- B09 S ATLANTIC BLVD, STE 201 LIC. NO JUNDER SLAB WORK 1 MONTEREY PARK, CA 91754 685220 )WATER SE!��YICE IPTICV METAi�', N ARCHITECT OR ENGINEER: TEL, NO: SPACE LIGHT STRUCTURE DESIGN (626) 799-8818- IROUGH PLUMBING 1414 FAIR OAKS AVE STE 2 LIC. NO: SOUTH PASADENA, CA 91030 23755 IGAS PIPING �� /l / ERMIT EXPIRES 180 DAYS IF WORK DOES NOT COMMENCE, OR WORK IS SUSPENDED OR ABANDONED, OR FAILS TO OBTAIN CODE REQUIRED INSPECTION ID: DPR263 ROUTE TO: BS0508 TEST ITY COMPANY WATER SYSTEM 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 Contre?tor pursuant to the Contractors' State License Law). (_) I am exem(t 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 priori to completior} 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://Y~.Ieginfo.m.gov/mlaw.html. Date: Signature of Property Owner or Authorized Agent PJ1 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. G License Class ��- License No. Date(e 1 / 12? /l Contractor 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. 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 --.i greater than the amount specked on the hazardous materials o information guide? 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 wwrkersnsu nc �/ Po' mbar 7:7 Ca 'er Policy Number Exilfiration ate 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 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 Signature of Applicant Date of Yes ❑ N o ❑ 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 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 ❑ 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 LOBBYIST ORDINANCE CERTIFICATION provided Is correct. Complete this section for permits In I agree to comply with all applicable city and county Unincorporated Los Angeles County only ordinances and state laws relating to building This is to certify that I, as permit applicant, am familiar with the construction. requirements of Los Angeles County Code Chapter 2.160 at seq., (relating to the Los Angeles County Lobbyist Ordinance) and that I authorize representatives of this county to enter the all persons acting on behalf of myself complied and will continue above -identified property for inspection purposes. to comply therewith through the application process. e:; ig aturecof Property Owner or Authorized Agent .Applicant Pnnt Nate I))!cant Si atu a)��=1 f-F�(�/N�-t Date Company Name / Date