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Home My Public Portal About5112 KAUFFMAN AVE_ELECTRICAL_10/25/2017_E17-35106 (2)TEMPLE CITY PERMIT NO. E17-35106 Contacts Owner Bower Nguyen Applicant Asaf Bloch Contractor Architect sncal Details New Multifamily 0 Carnival Ride: 0 Mechanical Branch Circuit: 0 Lights Residential 0 Appliance: 3 HP or less Power 0 Apparatus: Over 100 MP Service: Over 0 1000 Amps SLR Electric Corporation New Single- 0 Family/Duplex Carnival Lighting 0 System Receptacle, 30 Switch, Lighting Outlets Non -Residential 0 Appliance: 3 HP or less Busway 0 Miscellaneous 0 Fees Total Plan Check Fees $274.00 Permit Fees $391.42 Electrical Inspections Approval Date Temp Pole Underground Ufer Ground 5112 Kauffman Avenue, Temple City, California 91780 19528 Ventura Blvd #176, Tarzana, California 91356 19528 Ventura Blvd # 176, Tarzana, California 91356 (626) 379-9991 (818)454-5747 (818)454-5747 1032067 New Swimming 0 City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templecity.us Address: 5112 Kauffman Ave, Temple City, Parcel: 8589-010-017 Temporary 0 Temporary 0 Califomia 91780 Power Pole Power System Permit No: E17-35106 Type: Electrical Subtype: Subtype: Residential Description: PANEL UPGRADE TO 200 AMP SERVICE Special Power 0 Power 0 AND REWIRE HOUSE Conditions: Apparatus: 10- Issue, Date: 10-25-2017 Expire Date: (M-23-2018 Extension: Extension: Sign 0 Permit expires on date shown if: 1) work does not commence, or 2) work Is suspended or abandoned, or 3) applicant fails to Service: 400- 0 obtain code required inspection. 400 Amps 1000 Amps Contacts Owner Bower Nguyen Applicant Asaf Bloch Contractor Architect sncal Details New Multifamily 0 Carnival Ride: 0 Mechanical Branch Circuit: 0 Lights Residential 0 Appliance: 3 HP or less Power 0 Apparatus: Over 100 MP Service: Over 0 1000 Amps SLR Electric Corporation New Single- 0 Family/Duplex Carnival Lighting 0 System Receptacle, 30 Switch, Lighting Outlets Non -Residential 0 Appliance: 3 HP or less Busway 0 Miscellaneous 0 Fees Total Plan Check Fees $274.00 Permit Fees $391.42 Electrical Inspections Approval Date Temp Pole Underground Ufer Ground 5112 Kauffman Avenue, Temple City, California 91780 19528 Ventura Blvd #176, Tarzana, California 91356 19528 Ventura Blvd # 176, Tarzana, California 91356 (626) 379-9991 (818)454-5747 (818)454-5747 1032067 New Swimming 0 Spa, Mot Tub, 0 Carnival Ride: 0 Pool Alteration Electric Temporary 0 Temporary 0 Branch Circuit: 10 Power Pole Power System Outlets Light Fixture 15 Light Fixture: 0 Light Fixture: 0 Pole Mount Theatrical Power 0 Power 0 Power 0 Apparatus: 3-10 Apparatus: 10- Apparatus: SO - HP SO HP 100 HP Sign 0 Service: Under 1 Service: 400- 0 400 Amps 1000 Amps Inspector Approval Date—////,I�ny�a/p/t/a_e�tor Approval tei pect _ Conduit Utility Wiring Release Water11 I Wer MOEFINAL Ground 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 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 1, 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 Con" or pursuant to the Contractors' State License Law). 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 effac _ License ClassC 1Q License No. 0 ate %B Contractor Signature WORKERS' COMPENSATION DEC 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. 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 wo ce corn nsation Ins WAn c mer_ and policy number are: Cane n� Policy Numtii�' Expiration a e, r.J �R Biu 3W c 24 3 q Name gen Phone Number —o U: I am exempt from licensure under the Contractors' State — I certify that, in the performance of the work for which this License Law for the following reason: 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 By my signature below I acknowledge that, except for `Workers' compensation provisions of Section 3700 of the Labor personal residence in whicf1 I must have resided for at least ode, I shall forthwith comply with those provisions one year priorl to completion} of the improvements covered by _ / this permit, I cannot legally sell a structure that I have built as an 7- D S owner -builder If h has not been constructed in its entirety by Signa a of Applr n Date 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: http,//www.lecinfo.ca.aov/calaw.htmi, Date: Signature of Property Owner or Authorized Agent 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 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 120' 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 to; each of the following: I am the properly 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. 3Qauthorize representatives of this county to enter the gve-identified property for inspection purposes. Owner or Authorized Agent