HomeMy Public PortalAbout6246 ROSEMEAD BLVD_ELECTRICAL_6/5/2017_TEMPLE CITY PERMIT NO. E17-34311
Contacts
Owner Lou Smaldino
Applicant Richard
Mother
Contractor P & P Electric Co
Inc.
New Multifamily 0
City of Temple City 1 9701 Las Tunas Drive I Temple City, Ca ldornia 91780 1 (626) 285-2171
1 www.templecity.us
Address:
6246 Rosemead Boulevard, Temple City,
Parcel: 5384-005-004
Mechanical
System
California 91780
Receptacle, 0
Lights
Permit No:
E17-34311
Type: Electrical Subtype:
Subtype: Non -
Carnival Ride:
Fees T -tel
Pool
Residential
Description:
FIREWORKS STAND LIGHTING - 2017
Special
Temporary 1
Branch Circuit:
0
Conditions:
Power System
Issue Date:
D6 -OS -2017
Expire Date: 12-02-2017 Extension:
Extension:
Light Fixture:
Permit expires on date shown if: 1) work does not commence, or 2) work Is suspended or abandoned,
or 3) applicant fails to
Pole Mount
obtain code required inspection.
Power 0
Contacts
Owner Lou Smaldino
Applicant Richard
Mother
Contractor P & P Electric Co
Inc.
New Multifamily 0
New Single- 0
Appliance: 3 HP
Family/Duplex
Carnival Ride: 0
Carnival Lighting 0
Mechanical
System
Branch Circuit: 0
Receptacle, 0
Lights
Switch, Lighting
Service: Over 0
Outlets
Residential 0
Non -Residential 0
Appliance: 3 HP
Appliance: 3 HP or
or less
less
Power 0
Busway 0
Apparatus: Over
100 HP
California 91780
Service: Over 0
Miscellaneous 0
1000 Amps
Carnival Ride:
Fees T -tel
Pool
Plan Check Fees $113.60
Permit Fees $26.97
Temporary 0
Approval Date Inspector
Temp Pole
Underground__
Ufer Ground
13604 Whittier Boulevard, Whittier, California 90605
(562) 693-8293
Utility
3521 East Miriam Drive, West Covina, California
(626) 309-0734
91791
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P.O. Box 1020, Temple City,
California 91780
(626) 309-0734 569956
New Swimming 0
Spa, Hot Tub, 0
Carnival Ride:
0
Pool
Alteration
Electric
Temporary 0
Temporary 1
Branch Circuit:
0
Power Pole
Power System
Outlets
Light Fixture 0
Light Fixture: 0
Light Fixture:
0
Pole Mount
Theatrical
Power 0
Power 0
Powe'-
0
Apparatus: 3-10
Apparatus: 10-
Apparatus: SO -
HP
50 HP
100 HP
sign 0
Service: Under
Service: 400-
0
400 Amps
1000 Amps
Approval Date Inspector
Conduit
Wiring
Water
Ground
Approval
Inspector
Dat�e{/%
Utility
Release
FINAL
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3
6
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
tem(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 1, as owner of the property, or my employees with wages as
their sole compensation, will do (J) all of or L) 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 1, 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 ConOytor pursuant to the Contractors' State License
Law).
L): 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 whic_� I must have resided for at least
one year prior) to completion 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://www.leainfo.ca.aov/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. 6 V
Date 6 -^/Contractor Signat-
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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:
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:
Cartier Policy Number Expiration Date
Nam9of Agent Phone Number
X 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' pensation provisions of Section 3700 of the Labor
Co sh I forthwith comply with those r 'liens
Si net a 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 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 ❑ 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 ❑ N ❑ �-
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
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 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-ideDtilied)property for inspection purposes.
Situ Owne horifed Agent
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