The URL can be used to link to this page

Home My Public Portal About10035 LA ROSA DR_ELECTRICAL_5/26/2016_ (2)` COUNTY OF LOS AAELES TEMPLE CITY A 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1605260033 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: ITR: 10821 IT: 5 BL: A ON: .003 I FEES PAIDBUILDING IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: I 1A1 PERMIT ISSUANCE FEE 34.40 ILB 200 AMP PANELS, MCC 1.00 PAN 48.40 TOTAL FEES 82.80 ; ;UNDERGROUND REPORT ID: DPR265 ROUTE TO: SS0508 ADDRESS: 10035 LA ROSA DR TEMP CA 917803302 NEAREST CROSS STREET: THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY CA (ASSESSOR INFORMATION NUMBER: 18585-007-047 I (TENANT. ISSUED ON: PROCESSED BY: PLAN BY: 05/26/16 SR OWNER: TEL. NO: 2HANG, EHOD LAN (323) 893-6893- 13312 MANITOU ILOS ANGELES CA 90031 (FINAL DATE FINAL BY: CODE: DESCRIPTION OF WORK PANEL SERVICE EXP!RFn SPECIAL CONDITIONS:-� 1 APPLICANT: TEL. NO: SAME AS OWNER - CONTRACTOR: TEL. NO: SAME AS OWNER - LIC. NO APPROVALS DATE INSPECTOR SIGNATURE 1 TEMPORARY POWER POLE CONDUIT ARCHITECT OR ENGINEER: TEL. NO: LIC. NO: LIFER GROUND ;ROUGH CONDUIT ;ROUGH WIRING WATERLINE MAINPLASTICCN YIN UTILITY COMPANY NOTIFIED; I EXPIRED (PERMIT EXPIRES 180 DAYS IF 1) WORK DOES NOT COMMENCE, OR 2)WORK IS SUSPENDED OR ABANDONED, OR 3) FAILS TO OBTAIN CODE REQUIRED INSPECTION I I ; 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 orcounty 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).): lail, 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 built or Improved for the purpose of sale.). V1VI, as owner of the property, am exclusively contracting with , 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 Cont*for pursuant.to the Contractors' State License Law). Wam 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 priorlto completionrt of the Improvements covered by this permit, I nnot legally sAll a structure that I have built as an ownerbuilder 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.goftelaw.html. Date: �-Z 6// 7 SI�� Props rt Owner or Au r ed agent G£ B TI LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed undo, 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. Date- Contractor Signature -. WORKERS' COMPENSATION DECLARATION WAFtMNG: 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. 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 carder and policy number are: Camsr Peltcy Number Fxniraenn Data Name of 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 forthwit}Stgmply with those provisions Signature cant D to 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 compIV4hereWff'lpt rRugktthe application process. Aoo r Namat . Applicant Sipnatum i Company Name Det .JOBADDRESS LOCALITY HAZARDOOS 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 ❑ r 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 forthe 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 toleach 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•.infornation 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 Property Owner or Authorized Agent Date