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Home My Public Portal About5062 SULTANA AVE_ELECTRICAL_10/16/2017_E17-35065TEMPLE CITY PERMIT NO. E17-35065 Contacts Owner Applicant )an Holopainen Contractor Architect Electrical Details New Multifamily 0 Carnival Ride: 0 Mechanical Branch Circuit: 0 Lights Sultana Highland Villa LLC Boomerang Engineering Inc. New Single- 0 Family/Duplex Carnival Lighting 0 System Receptacle, 0 Switch, Lighting Outlets 5922 North Burton Avenue, San Gabriel, California 91775 1227 W Valley Blvd #109, Alhambra, California 91803 1227 W Valley Blvd #109 - 115, Alhambra, California 91803 (626) 922-7373 (626) 523-7070 (626) 780-6694 861501 New Swimming 0 City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templecity.us Address: 5062 Sultana Ave, Temple City, Parcel: 5388-017-028 Temporary 1 Temporary 0 California 91780 Power Pole Power System Permit No: E17-35065 Type: Electrical Subtype: Subtype: Residential Description: TEMPORARY POWER POLE Special Conditions: Issue Date: 10-16-2017 Expire Date: 04-14-2018 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 Applicant )an Holopainen Contractor Architect Electrical Details New Multifamily 0 Carnival Ride: 0 Mechanical Branch Circuit: 0 Lights Sultana Highland Villa LLC Boomerang Engineering Inc. New Single- 0 Family/Duplex Carnival Lighting 0 System Receptacle, 0 Switch, Lighting Outlets 5922 North Burton Avenue, San Gabriel, California 91775 1227 W Valley Blvd #109, Alhambra, California 91803 1227 W Valley Blvd #109 - 115, Alhambra, California 91803 (626) 922-7373 (626) 523-7070 (626) 780-6694 861501 New Swimming 0 Spa, Hot Tub, 0 Carnival Ride: 0 Pool Alteration Electric Temporary 1 Temporary 0 Branch Circuit: 0 Power Pole Power System Outlets Light Fixture 0 Light Fixture: 0 Light Fixture: 0 Pole Mount Theatrical Residential 0 Non -Residential 0 Power 0 Appliance: 3 HP Appliance: 3 HP or Apparatus: 3-10 or less less HP Power 0 Busway 0 Sign 0 Apparatus: Over 100 HP Service: Over 0 Miscellaneous 0 1000 Amps Fees Total Plan Check Fees $113.60 Permit Fees $56.65 Electrical Inspection s ApprovalIna Da ctor Approval Temp Pole �� Conduit Underground Wiring Ufer Ground Water Ground Power 0 Apparatus: 10- 50 HP Service: Under 0 400 Amps Power 0 Apparatus: 50- 100 HP Service: 400- 0 1000 Amps Date Inspector Approval �.DInspeQ0 Utility [U 7 V/ rr7�y�r-` Release`, 7 4 �� FINAL ////�yyC(19�//(__- 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 items) (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 Mil have the burden of proving that it was not built or improved for the purpose of sale.). (_) 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 Contrb or pursuant.to the Contractors' State License Law). U: I am exemiJt 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 whicl I must have resided for at least one year prior) to completion of the improvements covered by this permit, Icannot 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://wnnv.leainfo.ca.dov/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 for and effect. License Class � License No. Date 6Nontractor Signature WORKERS' COMPENSATION DiGIMTION 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 workers' compensation insurance carrier and policy number are: Carder Policy Number Expiration Date Name of Agent Phone Number I certify that, in the performance of the work for which this permit is issued, hall not employ any person in any manner so as to beco a subject to the workers' compensation laws of California, gree that, if I should become subject to the W orkers' o sation provisions of Section 3700 of the Labor Code sha with comply with those provisions lionatureofiApplicant Da ��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. 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 ❑ 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 ❑ N o ❑ i 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 ❑ Nofification 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: f 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 represent 'v s of this county to enter the above -identified proa for inspection purposes. Signature of Properjd Qhher or Authorized Agent Date