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Home My Public Portal About9550 LIVE OAK AVE_Electrical_12/23/2014_EL 0508 1408270051COUNTY 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 1408270051 LEGAL ID: ON FILE FEE DESCRIPTION: 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) 269-2668- CONTRACTOR: T AND J CONSTRUCTION 5628 N GLADYS AVE SAN GABRIEL CA 91776 TEL. NO: (626) 703-6653- LIC. NO 993453 ARCHITECT OR ENGINEER: TEL. NO: LIC. NO: Al PERMIT ISSUANCE FEE LB 200 AMP PANELS, MCC FEES PAID QUANTITY: UOM: AMOUNT: 1.00 PAN TOTAL FEES REPORT ID: DPR265 ROUTE TO: BS0508 27.80 38.90 66.70 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: 08/27/14 SR FINAL DATE 1ESCRIPTION OFWORK UPGRADE 100 AMP TO 200 AMP ELECTRICAL PANEL FINAL BY 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 NOTIFIED O WNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indica ted below by the checkmark(s) I ha ve place d ne xt to the applicable item(s) (Section 7031.5, Business and Professions Code): Any city or county that re qu ires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requ ires the applica nt for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Con trac tors' 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 S ection 7031.5 by any applicant for a permit subje cts the applicant to a civil penalty of not more tha n five hundred dollars ($500).): L I, as owner of the property, or my e mplo yee s with wages as their sole compen sa tio n, will do (V ) all of or L) po rtio ns of the work, and the structu re is no t inte nde d, or offered fo r sale (Section 7044, Business and Professions Code : The Contracto rs' State Lic ense Law does not apply to an own er of property who, thro ugh e mplo yees' or personal effort, builds or improve s the property, provided that the improv ements are not inte nde d or off ered 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 prope rty, am exclusiv ely contra cting with lice nsed Contra cto rs to construct the project (Section 7044, Business and Pro fessions Co de : The Contractors' State License Law do es no t apply to an owner of property who builds or improve s there on, and who contracts for the projects with a licensed Contractor pursuant. to the Contractors' State License Law). L ): I am exempt from licensure under the Contractors' State Lic ense Law for the following reason: By my signature below I ac knowledge that, except for my personal residence in which I must have resided for at least o ne year prior to completions of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner -builder f it has not been constructed in its e ntirety by licensed co ntractors. I unders ta nd that a co py of the a pplica ble law, Section 7044 of the Business and Professio ns Co de, is available upon request when this application is submitted or at the follo wing Web site: http://www.le ginfo.ca.gov/calaw.html. Date: Signature of Property Owner or Au thorize d Agen t LICENSED CONTRACTOR'S DECL ARATI ON I he re by affirm under penalty of perjury that I am licensed under provis ions 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 5 License No. Date D (21( i'Co ntracto r Signatur e ` - 41-S 3 WORKERS' COMPENSATION DECLARATI ON WA RNING : FA ILURE TO SECURE W ORKERS' CO MPENSATION COV ERAGE IS UNLA WFUL, AND SHALL SUBJECT AN EM PLOY ER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THO USA ND DOLL ARS ($100,000), IN ADDITION TO THE COST OF COM PENSATION, DA MAGES AS PROVIDED FOR IN SECTION 3706 OF THE LAB OR CODE, INTEREST, AND ATTO RNEY'S FEES. I hereby affirm under penalty of perjury one of the following de clarations: I hav e and will maintain a certificate of consent to s elf - insure for workers' compensation, issued by th e Direct or of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work f or which this permit is issue d. Policy No. I ha ve a nd will maintain workers' compensation insura nce, as required by Section 3700 of the Labor Code, for the pe rformance of the work for which this permit is issued . My workers ' c ompensation insurance carrier and policy number are: Ca rrie r Policy Number Expir ation D ate Name of A gent Ph on e Numb er I certify that, in the performance of the work for which this permit is issued, I shall no t employ any pers on in any manner so as to become subject to the workers' compensation laws of Ca lifornia , a nd agree tha t, if I should bec om e subject to the wo rkers' compe nsa tio n prov isions of Section 3700 of the Labor Co de , I sha ll fo rjhwith comply with those provisions ce(st77(� Signature of Applicant Date LOBBYIST ORDINANCE CE RTIFI CA TION Complete this secti on f or permits in Unincorpo rated Los A ngeles County only This is to ce rtify that I, as permit applicant, am familiar with the requirements of Los Angeles County Code Chapter 2 .160 et s eq., (relating to the Los An geles County Lobbyist Ordinance) and that all pe rsons acting on behalf of myself complied and will c ontinue to comply therewith through the application pr ocess. Applicant (Print Name) Applicant Signatur e J OB ADDRESS LOCALITY HAZARDOUS MATE RIAL DECLAR ATION Will the applicant or future building occup ant h andle a hazardous material or a mixture containing a ha zard ous material equal to or greater than the amount sp ecified on th e hazardous materials information guide? Yes ❑ N o ❑ Will the intended use of the building by th e applicant or future building occupant require a permit for construction or modification from the South Coast Air Quality Man agement District (SCAQMD)? See permitting checklist for guidelines. Yes ❑ No ❑ I ha ve r ead th e haz ardous materials information guide and the SCAQMD permitting checklist, I understand my requirements und er th e Los Angeles County Code Title 2, Chapter 220 ' Sections 220.100 through 220.140 concerning hazardous materi al reporting and for obtaining a permit from the SC AQMD . ASBEST OS NOTIFIC ATION ❑ Notification l ett er sent to AQMD and/or EP A ❑ I declare that notificati on of asbestos remov al is n ot applicable to addressed project . DECL ARATI ON REG ARDING CONSTRUCTION LENDING A GENCY I hereby affirm under penalty of p erjury that there is a Construction lending agency for the perf orma nce of the work for which this permit is issued (S ecti on 3097, Civil Code). Lender's Name Lender's Address By my signatur e bel ow, I certify to,each of the following: I am the property owner or authorized to act on the property owner's behalf . I have r ead this application and the information I ha ve provided is correct. I agree to c omply with all applicable city and county ordin ances and state laws rel ating to building construction. I authorize representati ves of this county to enter the above -identifi ed prop erty for inspection purpos es. Signature Pr Owner or Authori zed Ag ent Co mpany Name Date Date e (-27((ct-