HomeMy Public PortalAbout6128 RENO AVE__7/11/2017_ (2)TEMPLE CITY PERMIT NO. E17-34526
Electrical Details
New Multifamily 0
City of Temple City 1 9701 Las Tunas Drive I
Temple City, California 91780 1 (626) 285-2171
1 www.templecity.us
Address:
6128 Reno Avenue, Temple City,
Parcel: 5384-004-011
Pool
Alteration
California 91780
Carnival Ride: 0
Carnival Lighting 0
Permit No:
E17-34526
Type: Electrical Subtype:
Subtype: Residential
Description:
OUTLET FOR TANKLESS WATER
Special
Outlets
Branch Circuit: 0
HEATER
Conditions:
Light Fixture: 0
Issue Date:
07-11-2017
Expire Date: 01-07-2018 Extension:
Extension:
Pole Mount
Permit expires on date shown if: 1) work does
not commence, or 2) work is suspended or abandoned, or 3) applicant fails to
Outlets
obtain code required inspection.
C UI`I�iC(5
Non -Residential 0
Power 0
Power 0
Owner
Michael & Janis
6128 Reno Avenue, Temple City, California
(626) 285-8878
Apparatus: 10-
Long
91780
less
Applicant
Raymond Barron
907 South Magnolia Avenue, Monrovia,
(626) 600-8066
Busway 0
Sign 0
California 91016
Service: 400- 0
Contractor
Nuquest Industries
907 South Magnolia Avenue, Monrovia,
(626) 600-8066 985713
1000 Amps
Inc.
California 91016
Electrical Details
New Multifamily 0
New Single- 0
New Swimming 0
Spa, Hot Tub, 0
Carnival Ride: 0
Family/Duplex
Pool
Alteration
Electric
Carnival Ride: 0
Carnival Lighting 0
Temporary 0
Temporary 0
Branch Circuit: 0
Mechanical
System
Power Pole
Power System
Outlets
Branch Circuit: 0
Receptacle, 1
Light Fixture 0
Light Fixture: 0
Light Fixture: 0
Lights
Switch, Lighting
Pole Mount
Theatrical
Outlets
Residential 0
Non -Residential 0
Power 0
Power 0
Power 0
Appliance: 3 HP
Appliance: 3 HP or
Apparatus: 3-10
Apparatus: 10-
Apparatus: 50 -
or less
less
HP
50 HP
100 HP
Power 0
Busway 0
Sign 0
Service: Under 0
Service: 400- 0
Apparatus: Over
400 Amps
1000 Amps
100 HP
Service: Over 0
Miscellaneous 0
1000 Amps
Fees Total
Plan Check Fees $113.60
Permit Fees $2.76
- Electrical -inspections
Approval Date
Temp Pole
Underground
Ufer Ground -
Inspector
Approval Date Inspector
Conduit A—q
Wiring
Water__
Ground
Approval Date Inspector
Utility
Release
FINAL
9
M
m
Z
d
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 U portions of the
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 `C36
� License No. �1
,Date %]till? Contractor Signature l
WORKERS' COMPENSATIO DE 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
ATTORNEYS FEES.
work, and the structure is not intended or offered for sale
(Section 7044, Business and Professions Code: The I hereby affirm under penalty of perjury one of the following
Contractors' State License Law does not apply to an owner of declarations:
property who, through employees' or personal effort, builds or I have and will maintain a certificate of consent to self -
improves the property, provided that the Improvements are not insure for workers' compensation, issued by the Director of
Intended or offered for sale. If, however, the building or Industrial Relations as provided for by Section 3700 of the
Improvement is sold within one year of completion, the Owner- Labor Code, for the performance of the work for which this permit
Builder will have the burden of proving that it was not built or is issued.
improved for the purpose of sale.).Po icy No.
I have and will maintain workers' compensation
U I, as owner of the property, am exclusively contracting with insurance, as required by Section 3700 of the Labor Code, for
licensed Contractors to construct the project (Section 7044, the performance of the work for which this permit is issued. My
Business and Professions Code: The Contractors' State License c� workers' compensation insurance carder and policy n be are:
Law does not apply to an owner of property who builds or 544 can le lnh,rvr:.aGh O 85-5b ��
improves thereon, and who contracts for the projects with a Ca er �n,,,,�,� Policy Numberj Expi tion Date
licensed Contractor pursuant.to the Contractors' State License 01" !Xnrw --, b tf -bGC! ' EOL.:
Law). I Name cf Agent Phone Number -
U: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 whicF I must have resided for at least
one year priorl to completio 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.ciov/gglaw.html.
Date:
Signature of Property Owner or Authorized Agent
_ 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
�C
Sig V ofA cant Date I '
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 ❑
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.o ❑
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 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 tol,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 rop Owner or Authorized Agent
DateT� �' pl_