HomeMy Public PortalAbout9845 DAINES DR_ELECTRICAL_1/4/2018_TEMPLE CITY PERMIT NO. E18-35473
Contacts
Owner John Culjak
Applicant Ross Pisano
Contractor Middlendge Concepts DBA Bryant Heating & Air
Inc. Conditioning
Electrical Details
New Multifamily 0 New Single- 0
Carnival Ride: 0
Mechanical
Branch Circuit: 0
Lights
Residential 1
Appliance: 3 HP
or less
Power 0
Apparatus: Over
100 HP
Service: Over 0
1000 Amps
Fees Total
Family/Duplex
Carnival Lighting 0
System
Receptacle, 0
Switch, Lighting
Outlets
Non -Residential 0
Appliance: 3 HP or
less
Busway 0
Miscellaneous 0
Plan Check Fees ;113.60 Permit Fees $42.61
Electrical Inspections
Approval Date Inspector
Temp Pole
Underground
Ufer Ground
9845 Daines or, Temple City,
California 91780
2075 E Villa St, Pasadena,
California 91107
2075 E Villa St, Pasadena,
California 91107
New Swimming 0
Pool
Temporary 0
Power Pole
Light Fixture 1
Power 1
Apparatus: 3-10
HP
Sign 0
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
(626) 286-3091
(626) 286-1141
(626)286-1141 948151
Carnival Ride: 0
Electric
Branch Circuit: 0
Outlets
Light Fixture: 0
Theatrical
Power 0
Apparatus:SO-
300 HP
Service: 400- 0
1000 Amps
Approval Date Inspector
City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171
1 www.templecity.us
Address:
9845 Daines or, Temple City, California 91780 Parcel: 8588-016-035
Permit No:
E18-35473 Type: Electrical Subtype:
Subtype: Residential
Description:
ELECTRIC CONNECTIONS FOR NEW FURNACE Special
(ATTIC) AND A/C (REAR OF HOUSE) LIGHT IN Conditions:
ATTIC IF NEEDED
Issue Date:
01-04-2018 Expire Date: 07-03-2018 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
obtain code required inspection.
Contacts
Owner John Culjak
Applicant Ross Pisano
Contractor Middlendge Concepts DBA Bryant Heating & Air
Inc. Conditioning
Electrical Details
New Multifamily 0 New Single- 0
Carnival Ride: 0
Mechanical
Branch Circuit: 0
Lights
Residential 1
Appliance: 3 HP
or less
Power 0
Apparatus: Over
100 HP
Service: Over 0
1000 Amps
Fees Total
Family/Duplex
Carnival Lighting 0
System
Receptacle, 0
Switch, Lighting
Outlets
Non -Residential 0
Appliance: 3 HP or
less
Busway 0
Miscellaneous 0
Plan Check Fees ;113.60 Permit Fees $42.61
Electrical Inspections
Approval Date Inspector
Temp Pole
Underground
Ufer Ground
9845 Daines or, Temple City,
California 91780
2075 E Villa St, Pasadena,
California 91107
2075 E Villa St, Pasadena,
California 91107
New Swimming 0
Pool
Temporary 0
Power Pole
Light Fixture 1
Power 1
Apparatus: 3-10
HP
Sign 0
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
(626) 286-3091
(626) 286-1141
(626)286-1141 948151
Carnival Ride: 0
Electric
Branch Circuit: 0
Outlets
Light Fixture: 0
Theatrical
Power 0
Apparatus:SO-
300 HP
Service: 400- 0
1000 Amps
Approval Date Inspector
Approval
Date Inspector
Ca
Wiring
Utility
Release
Water —
FINAL
Ground
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
items) (Section 7031.5, Business and Professions Code): Any
city or county that requires a perk 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 L) 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 Contr9';tor pursuant to the Contractors' State License
Law).
L): 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 which I must have resided for at least
one year priorl to completionof the Improvements covered by
this permit, I cgnnot legally sll a structure that 1 have built as an
owner -builder if it has not been constructed in its entirely 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.lecinfo.ca.00v/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.
License Class C20 License No.
Date BContrector Signature
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERSCOMPENSATION
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.
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.
k 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
rkers' mpens tion I ISMy�?�e caller and policy number are:
CI&C` TCooJe —22at E'
C, wjer Policy Numb r Expiration Date
V L0 -fir r� 6zG �L�6-,re�lr
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
CoM-114
rthwith ply with those provisions
0..t,4 /_'�_/ 4'
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 compiled and II continue
to comply tpe�ith through the application proce�
AppRY k N fie) Applicant Sig atu`_ rff/ / e -
Company Name 7 Date /
JOB ADDR€SS '
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
I have read the hazardous materials information guide and the
SCAQMD permitting checklist, I understand my requirem@nis
under the Los Angeles County Code Title 2, Chapter 220'
Sections 220.100 through 220.140 conceming hazardous
material reporting and for obtaining a permit from the SCAQMD.
ASBESTOS NOTIFICATION
❑ Notification letter sent to AQMD and/or EPA
❑ 1 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
Lenders 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 -identified property for inspection purposes.
Signatur(e,g)�-P/�operty O or Authorized Agent
Date % —(/-/8