HomeMy Public PortalAbout5709 OAK AVE_Electrical_5/3/2000_COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
TR: 6561 LT: 729 BL: .001
ASSESSOR INFORMATION NUMBER:
8587-005-003
TENANT
OWNER: TEL. NO:
PETRIKAS, JUSTIN (626) 287-5533-
5709 OAK AV
TEMP 917802431
APPLICANT: TEL. NO:
GARY M SEWELL JR (626) 449-7898-
2331 E. FOOTHILL BLV
PASADENA, CA 91107
CONTRACTOR: TEL. NO:
GARY M SEWELL (626) 449 -7898 -
DBA GMS DEVELOPMENT LIC. NO
2331 E. FOOTHILL BLVD. 537975
PASADENA, CA 91107 .
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: UOM:
Al PERMIT ISSUANCE FEE
F1 120V, 15/20A BR CKTS 1.00 BR
TOTAL FEES
ELECTRICAL PERMIT
EL 0508 0005030005
BUILDING ADDRESS:
5709 OAK AV
AMOUNT: TEMP CA 917802431
NEAREST CROSS STREET: LIVE OAK
27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY
17.25 /
45.00 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
05/03/00 UT 10/30/00
FINAL DATE
_ FI L 8 CODE:
DESCRIF`TION'1 O; ORK
ELECTRICAL FOR ROOM CONVERSI N
UBLIC WORKS
REPORT ID: DPR265
ROUTE TO: BS0508
SPECIAL CONDITIONS:
APPROVALS
TEMPORARY POWER POLE
UNDERGROUND CONDUIT
UFER GROUND
ROUGH CONDUIT
ROUGH WIRING
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
DATE INSPECTOR SIGNATURE
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 effect.
License Clas Lic. No.
-7066
tractor Signature Date
C
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the
Contractors License Law for the folloWing'reason (Sec. 703 1.5, Business
and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed
statement that he or she is licensed pursuant to the provisions of the
Contractors License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of 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 more than five hundred dollars ($500).):
❑ 1 am exempt under Sec. , B.& P.C. for this reason
[ Electrical, Plumbing & Sewer Permits Only ]
❑ I, 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 not 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 or improvement is sold within one year o7 completion,
the owner -builder will have the burden of proving that he or she did not
build or improve for the purpose of sale.).
[ All Other Permits ]
O I, 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 Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her
own employees, provided that such 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 he or she did not build or improve for the purpose of sale.).
❑ I, as owner 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 builds or improves thereon, and who contracts for such projects with
a contractor(s) licensed pursuant to the Contractors License Law.).
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
O 1 have and will maintain a certificate of consent to self -insure for
worker's compensation, as provided for by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued.
O 1 have and will 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 worker's compensation insurance carrier
and policy number are:
Carrier
Policy Number
❑ 1 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 worker's compensation laws of California, and agree that if
I should become subject to the worker's compensation provisions of
Section 3700 of the Labor Code, I shall forthwith comply with those
provisions.
Applicant Signature Date
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION
COVERAGE 1S 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.
LOBBYIST ORDINANCE CERTIFICATION
Complete this section for permits in
L unincorporated Los Angeles County only J
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 complied and will continue to comply therewith through the
application process.
Applicant (Print Name) Applicant Signature
Owner Signature Date Company Name (if employed by an entity/agency) 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 ❑ No ❑
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 ❑ No ❑
I have read the hazardous materials information guide and the SCAQMD
permitting checklist, I 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 SCAQMD or EPA
❑ 1 declare that notification of asbestos removal is not applicable to
addressed project
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
(Sec. 3097, Civ.C.).
Lender's Name
Lenders Address
"Qq?
1 certify that 1 have read this application and state
under the penalty of perjury that the above
information is correct. l agree to comply with all City
and County ordinances and State laws relating to
building construction, and hereby authorize
Mne-ntZ
at'es Of this County to enter upon the
oel propeoyjtpr inspection purposes.
Date