The URL can be used to link to this page

Home My Public Portal About5521 ENCINITA AVE_Electrical_2/12/2014_COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: JTR: 9751 IT: 182 1 ASSESSOR INFORMATION NUMBER: 15387-020-011 DOWNER: TEL. NO: IGARCIA, RICK (720) 236-3836- 15521 ENCINITA AVE TEMPLE CITY CA 91780 APPLICANT: TEL. NO: ]CONTRERAS, CAIRA (626) 286-8157- 14931 N ENCINITA AVE TEMPLE CITY CA 91780 CONTRACTOR: TEL. NO: CONNOR AIR CONDITIONING AND (626) 286 -3157 - REFRIGERATION INC LIC. NO 14931 N ENCINITA AVENUE 403735 ' 1TEMPLE CITY CA 91780 (ARCHITECT OR ENGINEER: TEL. NO: LIC. NO: TEMPLE CITY # 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: FEES PAID FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: Al PERMIT ISSUANCE FEE 27.80 HA PAU LESS 3HP 1.00 FAU 11.00 TOTAL FEES 38.80 ' ADDITIONAL DATA ON FILE REPORT ID: DPR265 ROUTE TO: SS0508 ELECTRICAL PERMIT EL 0508 1402120038 BUILDING ADDRESS: 5521 ENCINITA AV TEMP CA 917802308 NEAREST CROSS STREET: THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY C ISSUED ON: PROCESSED BY: PLAN BY: 02/12/14 SR FINAL DATE FINAL BY: CODE: DESCRIPTION OF WORK ELECTRICAL FO�iALi� _- SPECIAL CONDITIONS: APPRO�IS�\�� DATE/EPECTOR SIGNATURE TEMPORARY POWER POLE UNDERGROUND CONDUIT UFER GROUND 1 ROUGH CONDUIT ROUGH WIRING I MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED I OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons) 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 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 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 Contr9dor pursuant to the Contractors' State License Law). U. I am exel 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 whlcl I must have resided for at least one year priori to completioq of the improvements covered by this permit, 1 nnot legally sell a structure that I have built as an owner -builder if 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: htto://www.lecinfo.ca.aov/mlaw.htmi. Date: Signature of Property Owner or Authorized Agent I hereby affirm under penalty of perjury that I am licensed under I LOCALITY 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 -�7effect. HAZARDOUS MATERIAL DECLARATION License ClassONLicense Nl3�3S Will the applicant or future building occupant handle a hazardous 2� material or a mixture containing a hazardous material equal to or Date 2 ` A ontractor Signature1 )I f I \ \��greater than the amount specified on the hazardous materials information guide? WORKERS' COMPENSATION DECLARATION 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 worke compensation iFPsu c ra a oli n�umber1ll�r14e: �er "' "A' I P lI u Y�pit�tion Dbtb� 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 Code, I shall with comply with those provisions �\l^xI SignYur§bf pican—" 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 et seq., (relating to the Los Angeles County Lobbyist Ordinance) and that all persons acting on behalf of myself cc is will continue _ to coJ�f�lI therewith ro 1ug�h,thhee iappp`lliicatio p Applidan �nt'Name)` _ r Applicari Sign u - — �i t I� Compan � � t t '' t Date � � I 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 ch cklistfor guidelines. Yes ❑ N i- I have read the hazardous materials information guide and the SCAQMD permitting checklist, 1 understand my requirements 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). Lenders 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. Signature of Proprly, tor Agent Date