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Home My Public Portal About9428 WOODRUFF AVE_ELECTRICAL_5/4/2017_TEMPLE CITY PERMIT NO. E17-34141 City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templecity.us Address: 9428 Woodmff Avenue, Temple City, California Parcel: 8587-007-002 91780 Permit No: E17-34141 Type: Electrical Subtype: Subtype: Residential Description: ELECTRICAL FOR FAU AND AC UNITS Special Conditions: Issue Date: 05-04-2017 Expire Date: 10-31-2017 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. rnntartc W Owner -Builder Owner Patricia Dmytrow Applicant - Electrical Details New Multifamily 0 Carnival Ride: 0 Mechanical Branch Circuit: 0 Lights Residential 1 Appliance: 3 HP or less Power Apparatus: 0 Over 100 HP Service: Over 0 1000 Amps - Fees Total 2043 Canyon Road, Arcadia, Califomia 91006 (626) 589-6519 New Single- 0 Family/Duplex Carnival Lighting 0 System Receptacle, 0 Switch, Lighting Outlets Non -Residential 1 Appliance: 3 HP or less Busway 0 Miscellaneous 0 Plan Check Fear $113.60 Pennit Fees $33.19 Electrical Inspections 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 0 Spa, Hot Tub, 0 Alteration Temporary 0 Power System Light Fixture: Pole Mount Power 0 Apparatus: 10-50 HP Service: Under 0 400 Amps Approval Date Inspector Conduit 1 14 11 Wiring Water Ground 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--//I/a/� 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).): (_,) I, as owner of the property, or my employees with wages as their sole compensation, will do (✓) 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 bulk 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 ConOTtor pursuant to the Contractors' State License Law). U: I am exempt 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 whicl1 I must have resided for at least one year prior to completic, of the Improvements covered by this permit, I �¢j�nnot legally all a structure that I have built as an owner -builder 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: hftpl//Www.leoiifo.ca.govlcalaw.html. Date:5--�L( /% Signaty'9 ci Properly Owner or thorized Agent LICENSED CONTRACTOR'S DECLARATION 1 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 Date Contractor WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINhJ_ 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: Cartier Policy Number Expiration Date Name of Agent Phone Number I certify that, in the performance of the work for which this permit is issued, 1 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 to. Code, all 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 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 ❑ Ro ❑ i i I have read the hazardous materials Information guide and the SCAQMD, permitting checklist, I understand my requiremitnts 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 sentto 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 this county to enter the above-identiffed property for inspection purposes. Signatur,4f party Owner puthood Agent Date