HomeMy Public PortalAbout10144 LA ROSA DR_ELECTRICAL_9/6/2018_E18-36765 (2)TEMPLE CITY PERMIT NO. E18-36765
City of Temple City 19701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templecity.us
Address:
10144 La Rosa Drive, Temple City, California Parcel:
8585-013-048
91780
Permit No:
E18-36765 Type:
Electrical Subtype:
Subtype: Residential
Description:
REPLACE 11 LIGHT FIXTURES, REPLACE 19 Special
OUTLETS AND 8 SWITCHES Conditions:
Issue Date:
09-06-2018 Expire Date:
09-06-2019 Extension:
Extension:
Permit expires on date shown if: 1) work does not commence, or 2) work is suspended or abandoned, or 3) applicantfails to
obtain code required inspection.
,
Contacts
Osmer
Gihan
10144 La Rosa Drive,
(626) 524-8584
Soliman
Temple City, California
91780
Applicant
Estuardo -
9575 Meridian Ave,
(626)284-9000 '
Vasquez
Alhambra, California
91803
Contractor
Aleksa Simich Construction Inc. DBA
957 S Meridian Ave,
(626) 284-9000 910946
Rainbow International of Los Angeles
Alhambra, California
County
91803
Engineer
Hansen- Hokama Structural Engineers
180 E. Main Street, Tustin,
(714)573-0073
California 92780
Electrical Details
New Multilamily 0
Carnival Ride: 0
Mechanical
Branch Circuit: 0
Lights
Residential 0
Appliance: 3 HP
or less
Power Apparatus: 0
Over 100 HP
Service: Over 0
1000 Amps
Fees Total
Plan Check Fees 80.00
New Single- 0
Family/Duplex
Carnival Lighting 0
System
Receptacle, 27
Switch, Lighting
Outlets
Non -Residential 0
Appliance: 3 HP or
less
Busway 0
Miscellaneous 0
Permit Fees 4103.56
Electrical Inspections
Approval Date Inspector
Temp Pole
Underground
Ufer Ground
New Swimming 0
Pool
Temporary 0
Power Pole
Light Fixture 11
Power 0
Apparatus: 3-
IOHP
Sign 0
Approval Date Inspector
Conduit
Wiring
Water
Ground
Spa,HotTub, 0
Alteration
Temporary 0
Power System
Ught Fixture: 0
Pole Mount
Power 0
Apparatus: 10-
50 HP
Service: Under 0
400Amps
Carnival Ride: 0
Electric
Branch 0
Circuit:
Outlets
Light Fixture: 0
Theatrical
Power 0
Apparatus:
50-100 HP
Service: 400- 0
1000 Amps
Approval Date Inspector
Utility
Release
FINAL 3 l
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 (_) 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 T---, License No.'tl tq
Date 9 - 61 � Contractor Signature
WORKERS' COMPENSATION DECLARATI
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.
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.). Polic o.
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 workers' cornenation Insurance carrier and policy number are:
Law does not apply to an owner of property who builds or6�(ca- "�iyt N WC 1 12 Zt—jf�
improves thereon, and who contracts for the projects with a Carder Policy Number Expiration Date
licensed Con" �tor pursuartt.to the Contractors' State License
Law). I Name of Agent Phone Number
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 whicf] I must have resided for at least
one year pdoritp completiol of the Improvements covered by
this permit, Innot legally sell 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: hftp://www.leainfo.ca.aovlcalaw.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 tabor
Code, I shall forthwith comply with those provisions
-Vlk� Ct .I
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 ❑ 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 ❑ i"
i
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 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 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 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 ProO/yy�vner or Authorized Agent
7
Date Ck - G • l y