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Home My Public Portal About6204 OAK AVE_Electrical_10/10/2017_TEMPLE CITY PERMIT NO. E17-35016 Contacts Owner Applicant Meirav Eisenberg Contractor Electrical Details New Multifamily 0 Carnival Ride: 0 Mechanical Branch Circuit 0 Lights SGS International 112 N Earle St, San Gabriel, California City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templecity.us Address: 6204 Oak Ave, Temple City, California Parcel: 5385-010-034 California 91362 Electric 91780 (626) 698-3090 873553 California 91731 Permit No: E37-35016 Type: Electrical Subtype: Subtype: Residential Description: 100 AMP TEMPORARY POWER POLE Special Light Fixture: 0 Light Fixture: 0 120/240 V (SINGLE PHASE) Conditions: Pole Mount Issue Date: 30-10-2017 Expire Date: 04-08-2018 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 Power 0 obtain code required inspection. Appliance: 3 HP or Apparatus: 3-10 Contacts Owner Applicant Meirav Eisenberg Contractor Electrical Details New Multifamily 0 Carnival Ride: 0 Mechanical Branch Circuit 0 Lights SGS International 112 N Earle St, San Gabriel, California (626) 285-3408 91775 Carnival Ride: 0 31225 La Baya Drive, Westlake Village, (818) 732-7876 California 91362 Electric United Site Services of 4511 Rowland Avenue, EI Monte, California (626) 698-3090 873553 California 91731 Branch Circuit: 0 Residential 0 Appliance: 3 HP or less Power 0 Apparatus: Over 100 HP Service: Over 0 1000 Amps Fees Tutal Plan Check Fees $113.60 New Single- 0 New Swimming 0 Spa, Hot Tub, 0 Carnival Ride: 0 Family/Duplex Pool Alteration Electric Carnival Lighting 0 Temporary 1 Temporary 0 Branch Circuit: 0 System Power Pole Power System Outlets Receptacle, 0 Light Fixture 0 Light Fixture: 0 Light Fixture: 0 Switch, Lighting Ground Pole Mount Theatrical Outlets Non -Residential 0 Power 0 Power 0 Power 0 Appliance: 3 HP or Apparatus: 3-10 Apparatus: 10- Apparatus: SO - less HP SO HP 100 HP Busway 0 Sign 0 Service: Under 0 Service: 400- 0 400 Amps 1000 Amps Miscellaneous 0 Permit Fees $56.65 Electrical Inspections Approval I ssp/e// r Approval Date Inspector Approval p/ayt I p r �D/rite _ Temp Pole JJ3LL2f---tM^'� Conduit Utility (J�a Underground r r / , Wiring Release Ufer Ground Water FINAL Ground T4 r 0 s O 3 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 (J) 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 Contrbr pursuant to the Contractors' State License Law). ?to U: I am exempIt from licensure under the Contractors' State License Law for the following reason: I By my signature below I acknowledge that, except for my personal residence In whlc I must have resided for at least one year priorl to completio of the Improvements covered by this permit, I c§nnot legally s II 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.leoinfo.ca.ciov/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. LicenseClass( '9>0 License No. SSS Date r'// 4%ntractor Signature WORKERS' COMPENS N DEC TION 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 JOBADDRESS 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 ❑ No ❑ i 1 have read the hazardous materials information guide and the SCAQMD, permitting checklist, 1 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. Labor Code, for the performance of the work for which this permit ASBESTOS NOTIFICATION is issued. Polio o. ❑ Notification 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 ❑ 1 declare that notification of asbestos removal is not the performs of the work for which this permit is issued. My applicable to addressed project. twoers' ensatlonJt�su cari and p number are: a'I�'T./l/ (A-V � C'1 !JF/ 4 37—C-3 DECLARATION REGARDING CONSTRUCTION LENDING CZCa ler Policy Number Expiration Date AGENCY ,rocr� r'0 C - �a 3 a go Name of Agent Phone Number I hereby affirm under penalty of perjury that there is a I certify that, in the performance of the work for which this Construction lending agency for the performance of the work for 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 wfth 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 person ailing on behalf of myself compiled and will continue to co, ( herewith through the application process. F7lff�,j�_ Applicaot,(Print,Name) 1 _ Applicant Sigp y Company Name S Date which this permit is Issued (Section 3087, Civil Code). Lender's Name Lenders Address By my signature below, I certify to;each of the following: .1 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 P1. ri/ Owner or Authorized Agent a lel/ e