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Home My Public Portal About9250 LOWER AZUSA RD_ELECTRICAL_6/19/2014_ (2)COUNTY OF LOS ANGELES TEMPLE CITY # 0508 DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID ON FILE FEE DESCRIPTION: QUANTITY: UOM: ASSESSOR INFORMATION NUMBER: 8592-016-010 JAI PERMIT ISSUANCE FEE IE1 IMP SERV POWER POLE 1.00 TMP TENANT: IE2 TEMP DIST SYSTEM 22.00 TMP TOTAL FEES THE OLSON COMPANY 3010 OLD RANCH PRWY SEAL BEACH CA 90740 ERIC SACOBY 5858 DOVETAIL DRIVE AGOURA HILLS 91301 TEMP POWER SYSTEMS 625 FEE ANA STREET PLACENTIA CA 92870 ARCHITECT OR ENGINEER: TEL. NO: (562) 682 -7422 - TEL. NO: (818) 735 -7876 - TEL. NO: (714) 223 -5698 - LIC. NO 696713 TEL. NO: LIC. NO: I . REPORT ID: DPR265 ROUTE TO: BS0508 ELECTRICAL PERMIT £L 0508 1406190044 NUILVINU A VU SS: 9250 LOWER MUSA RD AMOUNT: TEMP CA 91780 NEAREST CROSS STREET: TEMPLE CITY 27.80 THOMAS PAGE: 596 GRID: HS LOCALITY: TEMPLE CITY CA :'43.70 475.20 ISSUED ON: PROCESSED BY: PLAN BY: 546.70 06/19/14 SR FINALDA IDESCR]�FIN Y: CODE: �OFT TEMP POWER POLE 200 AMP, 6 (22) SUB -POLES FOR 74 HOMES POWER 'JUFER GROUND (ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC YIN METAL YIN FUTILITY COMPANY NOTIFIED 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 ContrhFtor 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 which 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 H 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: httD://www.le0info.ca.0ov/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 ClassLicense Nos 16 Dat 1! Liontractor Signatu� WORKERS' COMPENSATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATIOil 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 greater than the amount specified on the hazards 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 L� I have read the hazardous materials information guide and the I hereby affirm under penalty of perjury one of the following SCAQMD permitting checklist, I understand my requirements declarations: under the Los Angeles County Code Title 2, Chapter $20' I have and will maintain a certificate of consent to self- Sections 220.100 through 220.140 concerning hazardous insure for workers' compensation, issued by the Director of material reporting and for obtaining a permit from the SCAQMD. Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit ASBESTOS NOTIFICATION is issued. Policy ❑ Notifica' n letter sent to AQMD and/or EPA I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for declare that notification of asbestos removal is not the performance of the work for which this permit is issued. My applicable to addressed project. w verscro nsation insurance ol_ number are: d4 fil artier Policy umber Expiration Date AGENCY REGARDING CONSTRUCTION LENDING AGENCY 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 Calffomia, 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 ate 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. cc --- iPp Ip Lam�g _.N��t App icon i ure 'f yCompany Name Date 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 er Authorize gent Dater-' / 61