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Home My Public Portal About5329 DUPUY CIRCLE_PLUMBING_11/9/2015_COUNTY OF LOS ANGELES TEMPLE CITY M 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORM 9701 LAS TUNAS PL 0508 1511090020 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 5329 DUPUY LN IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917803131 ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: CLOVERLY 8590-005-019 101 PERMIT ISSUANCE FEE 34.40 THOMAS PAGE: 596 GRID: T4 LOCALITY: TEMPLE CITY CA 107 BATHTUBS/SHOWERS 5.00 FIX 101.00 1 TENANT: I11 CIOTHESWASHER(S) 1.00 FIX 20.20 (ISSUED ON: PROCESSED BY: PLAN BY: 113 DISHWASHERS) 1.00 FIX 20.20 111/09/15 SR 121 HOSE BIBB(S) 3.00 FIX 60.60 OWNER: TEL. NO: 125 LAVATORIES / SINKS 8.00 FIX 161.60 IFINAL ATE F t CODE: OLIVE STREET GROUP LLC. (714) 863-9192- 145 WATER CLOSET/URINAL 5.00 FIX 101.00 I 7�9_/// ''7 265 W NAOMI AVE 147 WATER HEATERS) 2.00 WTH 40.40 1 / ARCADIA CA 91007 151 LOW PRS GAS LES OUTS 1.00 SYS 20.20 IDES CR PTI J OF WORK 52 ADDITIONAL OUTLS > 5 3.00 OUT 15.60 IPLUMEING FOR A NEW SINGLE FAMILY DWELLING 155 GAS METER (PRIVATE) 1.00 MET 20.20 I APPLICANT: TEL. NO: 164 WATER PIPNG <. 1 1/2 1.00 LIN 20.20 LAI, PAUL (626) 945-5451- TOTAL FEES 615.60 1444 CHICO AVE pA ISPECIAL CONDITIONS: SO. EL MONTE 91733 CONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE PCL PLUMING INC. (626) 945-5451- 1 PO BOX 1928 LIC. NO (UNDER SLAB WORK INr'- ROSEMEAD CA 91770 518704 R (WATER SE`RyI CE VVV PLASTICb, ,'N METAL/N / ARCHITECT OR ENGINEER: TEL. NO: LEE, PETER (626) 280-9000- IROUGH PLUMBING 1 8748 E VALLEY BLVD SUITE L LIC. NO: ROSEMEAD CA 91770 518704 * • IGAS PIPING IGAS VENT IHOT WATER HEATER IPLUMEING FIXTURES ILAWN SPRINKLERS IGAS TEST PERMIT EXPIRES 180 DAYS IF 1) WORK DOES NOT COMMENCE, OR 2) WORK IS SUSPENDED OR ABANDONED, OR 3) FAILS TO OBTAIN CODE REQUIRED INSPECTION * ADDITIONAL DATA ON FILE REPORT ID: DPR263 ROUTE TO: BS0508 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 perk 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 Contmb or pursuant to the Contractors' State License Law). U: I am exemdt 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 priorl to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an own fl 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: http://www.leginfo.ca.00v/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. License Class,_ License No. Dateontractor 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 insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My works compensation insurance conigr/.,aT;�Od 39�eIi nu e• C 'er P Num�bdr xpi on atNtia me of Agent Phone umbe I certify that, m 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 l/ � Si a ure of Appli to 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 complied and will continue to comply therewith through the application process. licant rint N a) Ap 'antTi net re G r� ompany NMne Dat 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 specked on the hazardous materials information guide? Yes ❑ No ❑ 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 ❑ No ❑ i 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 conceming hazardous material reporting and for obtaining a permit from the SCAQMD. ASBESTOS NOTIFICATION ❑ Notification letter sent to AQMD and/or EPA ❑ 1 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). Lenders 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 Owner or Authorized Agent Date