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Home My Public Portal About5728 ROSEMEAD BLVD_Electrical_11/17/2016_TEMPLE CITY PERMIT NO. E16-33237 City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templecity.us Address: 5728 Rosemead Blvd. Unit 106, Temple City, Parcel: 5387-013-031 Califomia 91780 Permit No: E16-33237 Type: Electrical Subtype: Subtype: Non - Residential Description: 2 SETS OF LED ILLUMINATED CHANNEL Special LETTERS Conditions: Issue Date: 11-17-2016 Expire Date: 05-16-2017 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 Terry To Contractor Electrical Details New Multifamily 0 Carnival Ride: 0 Mechanical Branch Circuit: 0 Lights Residential 0 Appliance: 3 HP or less Power Apparatus: 0 Over 100 HP Service: Over 0 1000 Amps Fees Total _ Plan Check Fees $0.00 The Gateway LP 1005 East Las Tunas Drive, San Gabriel, California 91776 1438 Santa Anita Avenue, South EI Monte, Califomia 91733 (626) 443-3333 Signs Express Mfg. Co. 1438 Santa Anita Avenue, South EI Monte, California 91733 (626) 443-3333 552097 Electrical Inspections New Single- 0 Family/Duplex Carnival Lighting 0 System Receptacle, 0 Switch, Lighting Outlets Non -Residential 0 Appliance: 3 HP or less Busway 0 Miscellaneous 0 Permit Fees $65.54 Approval Date Inspector Temp Pole Underground Ufer Ground New Swimming 0 Pool Temporary Power 0 Pole Light Fixture 0 Power Apparatus: 0 3-10 HP Sign 2 Approval Date Inspector Conduit 7 f� Wiring Water Ground Spa, Hot Tub, 0 Alteration Temporary 0 Power System Light Fixture: 0 Pole Mount Power 0 Apparatus: 10-50 HP Service: Under 0 400 Amps Carnival Ride: 0 Electric Branch Circuit: 0 Outlets Light Fixture: 0 Theatrical Power 0 Apparatus: SO - 100 HP Service: 400- 0 1000 Amps Approval Date Inspector Utility Release FINAL Z v 3 b 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, imp ve, demolish, or repair any structure, prior -to its issuanc , also requires the applicant for the permit to file a signed s tement that he or she is licensed pursuant to the provisi sof the Contractors' State License Law (Chapter 9 (com ncing with Section 7000) of Division 3 of the Business an Professions Code) or that he or she is exempt from Iicensur and the basis for the alleged exemption. Any violation of Sq&ion 7031.5 by any applicant for a permit subjects the aliplicant to a civil penalty of not more than five hundred dolls $500).): U I, as owner of the property, or my a loyees with wages as their sole compensation, will do (✓) all f Io ee portions of the work, and the structure is not int ded or offered for sale (Section 7144, Business and rofessions Code: The Contractors' State License Law do s not apply to an owner of property who, through employee or personal effort, builds or improves the property, provided at the Improvements are not intended or offered for sale If, however, the building or improvement is sold within on year of completion, the Owner - Builder will have the burden Af proving that it was not built or improved for the purpose of le.). U I, as owner of the pro rty, am exclusively contracting with licensed Contractorsto flonstruct the project (Section 7044, Business and Profession Code: The Contractors' State License Law does not apply to an owner of property who builds or improves there( cVwho contracts for the projects with a licensed Contractor 701110ivAng uant to the Contractors' State License Law). I U.- I am exemdt frocensure under the Contractors' State License Law for te reason: By my signature Pelow I acknowledge that, except for my personal residen9bin wh(c� I must have resided for at least one year priori to mpletki of the Improvements covered by this permit, I conn t legally sell a structure that I have built as an owner -builder If K 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�/lwww.leoinfo.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. ,1 License C ss ��4 a License No. Ss e Date ��7% >Oon1tT`actor Signature W RKERS' COMPENSATION DECLARATION WAONING: 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. 1 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 rkers' com ens n insurance ca rand oli numb r a Came�� Poll umber Expi o 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 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 ame) Ap cant SlIghature 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 ❑ No Cl 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 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 tis county to enter the above -identified property far insp coon purposes. Signature of Property 9w wr o.,V*Ori7.ed Agent