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Home My Public Portal About9550 LIVE OAK AVE_Electrical_12/23/2014_EL 0508 1407090037COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC'WORKS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: # 0508 ELECTRICAL PERMIT EL 0508 1407090037 LEGAL ID: ON FILE ASSESSOR INFORMATION NUMBER: 8588-007-004 TENANT: OWNER: LI, JASSON 9550 LIVE OAK AV TEMP 917802513 TEL. NO: (213) 308 -7788 - APPLICANT: QIU LIN 9087 LAS TUNAS DRIVE TEMPLE CITY CA 91780 TEL. NO: (626) 589 -8299 - CONTRACTOR: T AND J CONSTRUCTION 5628 N GLADYS AVE SAN GABRIEL CA 92776 TEL. NO: (626) 703-6653- LIC. NO 993453 ARCHITECT OR ENGINEER: TEL. NO: LIC. NO: FEE DESCRIPTION: Al PERMIT ISSUANCE FEE G1 OUTLETS-LGT,SW,RECP G2 LIGHTING FIXTURES H7 RES EXHAUST FANS JA HEAT PUMPS +3-10HP LA 100 AMP PANELS, MCC REPORT ID: DPR265 FEES PAID QUANTITY: UOM: 15.00 OUT 7.00 LGT 1.00 EX 1.00 HT 1.00 PAN TOTAL FEES ROUTE TO: BS0508 AMOUNT: 27.80 30.00 14.00 11.00 19.70 38.90 141.40 BUILDING ADDRESS: 9550 LIVE OAK AV TEMP CA 917802513 NEAREST CROSS STREET: TEMPLE CITY • THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY CA ISSUED ON: PROCESSED BY: PLAN BY: 07/09/14 SR FINAL DATE ;))3.4 D SCRIPTION dF WORK 15 OUTLETS, 7 LIGHT FIXTURES, EXHAUST FAN, HEAT PUMP AND REPLACING EXISTING ELECTRICAL PANEL UPGRADE TO 100 AMP FIJTALBY: CODE: SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE TEMPORARY POWER POLE UNDERGROUND CONDUIT UFER GROUND ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIE OWNER -BUILDER DECLARATION I here by a ffirm under pena lty of perjury that I am exempt from the Contractors' State License Law for the re ason(s) indicated below by the checkma rk(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, improv e, demolish, or repair any structure, prior to its issua nce, a lso 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 Profe ssions Code) or that he or she is exempt from licensure and the basis for the alleged ex emption. Any v iolation of Section 7031. 5 by any applican t for a permit subjects the applicant to a civ il penalty of not more than fiv e hundred dollars ($500). ): U I, as o wner of the property, or my employees with wage s as their sole compensation, will do (V) a ll of or L) portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Co ntractors' State License Law does no t apply to an owne r of property who, through employe es' or pe rsonal effort, builds or improv es 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 O wner - Builder will hav e the burden of proving that it was not built or improved for the purpose of sale.). Q I, as owner of the property, am ex clusive ly contracting with lice nsed Contractors to construct the pro ject (Section 7044, Business and Pro fessions Code: The Contractors' Sta te License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant . to the Contractors' Sta te License Law). U. I am exempt from licensure under the Contractors' State License Law for the following reason: By my signa ture below I acknowledge that, except for my personal residence in which I must have resided for at least one year priori to completions of the improv ements covered by this pe rmit, I c4nnot legally sell a structure tha t I hav e built as an owner -builder if it has not been constructed in its entirety by lice nsed contractors. I understand that a copy of the applica ble law, Section 7044 of the Business and Professions Code, is av ailable upon reque st whe n this applicatio n is submitte d or at the following Web site: http://www.leoinfo. ca.aov/ca law.html. Date: Signature of Pro pe rty Owner or Authorized Agent Signature of Applicant LICENSED CONTRACTOR'S DECLARATION I hereby affirm unde r pe nalty of p erjury that I am licensed under pro visions of Chapter 9 (commencing with Secti on 7000) of Division 3 of the Business and Professions Code, and my license is in full force and e ffe ct. License Class A , g . License No . Date Contractor Signature WORKERS' COMPENSATION DECL ARATION WARNING: FAILUR E TO SECURE WORKERS' COMPENS ATI ON COVERA GE IS UNLA WFUL, AND SHALL SUBJECT AN EM PLOYER TO CRIM INAL PENALTIES AND CI VIL FINES UP TO O NE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COM PENSATION, D AMAGES 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 ha ve a nd 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 wo rk for which this permit is issued. My workers' compensation insurance carri er and policy number are: Carrier Policy Number Expiration D ate Na me of Agent Phone Number I certify that, in the performance of the work for which this permit is issued, I shall not empl oy any person in any manner so as to become subject to the work ers' compens ation laws of California, and agree that, if I should become subject to the wo rkers' co mpensa tio n prov isions of S ection 3700 of the Labor Code , I sha ll fo rth 'th comply with those provisions 7/q/fq Date LOBBYIST ORDINANCE CERTIFIC ATION Co mplete this s ectio n for permit s in Uninco rporated Los A ngel es C ounty only This is to certify that I, as permit applicant, am familiar with the requirements of Los A ngeles County Code Chapter 2 .160 et 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 JOB ADDRESS LOCALITY HAZARDOUS MATERIAL DECLAR ATION Will th e 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 0 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 (SC AQ MD)? See permitting checklist for guidelines. Yes 0 N .o 0 I have read the hazard ous materials information guide and the SC AQ MD permitting checklist, I underst and my requirements under the Los Angeles C ounty Cod e Title 2, Chapter 220' Sections 220.100 through 220.140 concerning hazardous materi al r eporting and for obtaining a permit from the SCAQMD. ASBESTOS NOTIFIC ATI ON ❑ Notification letter sent to AQ MD and/or EPA ❑ I declare that notificati on of asbestos removal is not applicable to addressed project. DECLARATI ON REGARDING CONSTRUCTION LENDIN G AGEN CY I h er eby affirm under penalty of perjury th at there is a C onstruction 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 ha ve read this application and th e informati on I ha ve provided is correct . I agree to comply with all applicable city and county ordinances and state laws relating to building construction. I authorize representati ves of this county to enter the ab ove -identified property for inspection purposes . Signature of Property Owner or Authorized Agent Company Name Date D ate