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Home My Public Portal About5703 OAK AVE_Electrical_12/1/2005_. COUNTY'OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0512010011 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: IN: 6561 LT: 729 5703 OAK AV FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917802431 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LIVE OAK B587-005-002 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, C B2 1 OR 2 FAMILY DWELL 1880.00 SQ 197.40 TENANT: LB 200 AMP PANELS, MCC 1.00 PAN 38.85 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 264.00 12/01/05 JK 05/30/06 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: FULCO NORMAN J;DOROTHY J- /j 10- 5703 OAK AV / TEMP 917802431 DESCRIPTION OF WORK REWIRE ENTIRE HOUSE AND SERVICE CHANGE TO 200 AMP APPLICANT: TEL. NO: TERRY FOLEY ELECTRIC INC. (909) 590-3391- 3233 ENGLISH ROAD SPECIAL CONDITIONS: CHINO HILLS CA 91709 CONTRACTOR: TEL. NO: APPROVALS .DATE INSPECTOR SIGNATURE TERRY FOLEY ELECTRIC INC. (909) 590-3391- 3233 ENGLISH ROAD LIC. NO TEMPORARY POWER POLE CHINO HILLS, CA 91709 533448CIO UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UPER GROUND JIM H. KUHN (818) 446-7000- 125 WHEELER AVE, SUITE F LIC. NO: ROUGH CONDUIT ARCADIA, CA 91006 NONE ROUGH WIRING ags MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 LICENSED CONTRACTOR'S DECLARATION I hembyaKrn under penalty of perjury that 1 am licensed underprovisions of Chapter9 (commencing with Seclfon 7000) of DMsion 3 of the Business and Professions Code, and my license is in full force and effect. f Ucens Class U �Uc. No. eontacto s no Lire �3syv s ,J.201--S- Date J1,0/-rajDale OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to constmcL alter. Improve, demolish. or repair arty slruryLure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he or she is licensedpursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 o the Business and Professions Code) or that he or she is exempt therefrom 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 mom than five hundred dollars ($500).): ❑ 1 am exempt under Sec. , BA P.C. for this reason: C Electrical, Plumbing & Sewer Permits Only ] ❑ ],as owner of the property, will do the work, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does act apply to an owner of property who builds or Improves thereon, and who does such work himself or herself, provided that such improvements are not intended or offered for sale. If, however, the building orimprovement is sold within one year of completion, the owner -builder will have the burden of proving final he or she did not build or Improve for the purpose of sale.). ( All Other Permits ] If [,as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Conlreclom License Law does rat apply to an ownerof property who builds orimproves thereon, and who does such vroh(himself or herself or through his other own employees, provided that such Improvements are not intended or offered for sale. 11, however, the Wilding or Improvement is sold within one year of completion, the owner -builder will haw the burden of proving that he or she did not build or improve for the purpose of sale.). ❑ I, as ovmer of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:The Contractors License Law does not apply to an owner of property who Wilds or improves thereon, and who contracts for such projects with a conlmctor(s) licensed pursuant to the Contractors License Law.). WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for mrkBe$ compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. ❑ IhaveandwN maintain worker's compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is Issued. My workers compensation Insurance carder . and policy number are: Cartier SIr!-Tar-r✓J Policy Number ❑ 1 certify gal 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 SecOon 3700 f the labor Code, 1 shell forthwith comply with those Provs0 G� /�2--d1-yr Applicant 519na -bate WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS UNLAWFUL, AND SHAH SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($/00,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LOBBYIST ORDINANCE CERTIFICATION Commit triplets this section for parrots in unincorporated Los Angeles County only ] This is to cereythat I, as permit applicant, am hamiliarwilh 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 Owner Signature Data Company Name (it employed by an entity/agency) Date JOB ADDRESS LOCALITY HAZARDOUS MATERIAL DECLARATION Will the applicant orfulum 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 Wiiding.ty the applicant or future building occupant require a permit lorconstntction or modification from the South Coast Air Quality Management District (SCAQMD)? See perrtdtdng rJaddist for guidelines. - Yes ❑ No ❑ I have read the hazardous materials information guide and the SCAOMD permitting checklist, l 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 SCAOMD. ASBESTOS NOTIFICATION' ❑ Notification letter sent to SCAOMD or EPA - ❑ 1 declare that notification of asbestos removal is not applicable to addressed project. CONSTRUCTION LENDING AGENCY I hereby alfirm underpenalty of perjury dot there is a construction lending agency for the performance on the work for which this permit is issued (Sec. 3097, CivC.). Lenders Nam - Lenders Address wa°q? / certify that l have read this application and state under the penalty of perjury that the above information is correct. I agree to comply with all City and County ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter upon the above-mentioned property forinspection purposes. Applicant or P6e Slgmu.. Date