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Home My Public Portal About5721 OAK AVE_Electrical_1/30/2007_COUNTY OF LOS ANGELES TEMPLE CITY $ 0508 DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS 5721 OAK AV BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: 27.75 FEES PAID TR: 6561 IT: 730 ON: .002 27.30 FEE DESCRIPTION: QUANTITY: UOM: ASSESSOR INFORMATION NUMBER: 10.95 01/30/07 JK 8587-005-005 19.65 Al PERMIT ISSUANCE FEE 38.85 G1 OUTLETS-LGT,SW,RECP 40.00 OUT TENANT: 190.50 G2 LIGHTING FIXTURES 14.00 IGT HA FAU LESS 3HP 1.00 FAU JJB AC UNITS .3-10HP 1.00 AC OWNER: TEL. NO: LB 200 AMP PANELS, MCC 1.00 PAN CHAN, MR&MRS. WING - TOTAL FEES 5721 OAK AV TEMP 917802431 APPLICANT: TEL. NO: � TOM O'LEARY (626) 287-0937- 5823 AGNES AVENUE TEMPLE CITY CA 91780 CONTRACTOR: TEL. NO: TOM D'LEARY CONSTRUCTION (626) 287-0927- 5823 AGNES AVENUE LIC. NO TEMPLE CITY, CA 91780 489354 B-1 ARCHITECT OR ENGINEER: TEL. NO: SAWAYA, RAMZY - 1960 SANTA ANITA AVE. LIC. NO: SIERRA MADRE, CA NONE REPORT ID: DPR265 ROUTE TO: BS0508 ELECTRICAL PERMIT EL 0508 0701250006 SPECIAL CONDITIONS: DATE INSPECTOR SIGNATURE TEMPORARY POWER POLE UNDERGROUND CONDUIT UFER GROUND I ROUGH COND T !r ROUGH WIRING r/Tu1 l MAIN WATER LIN PLASTIC YIN TAL N y UTILITY COMPANY NOTIFIEDi�� /J1J BUILDING ADDRESS: 5721 OAK AV AMOUNT:j TEMP CA 917802431 NEAREST CROSS STREET: 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, C 66.00 27.30 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 10.95 01/30/07 JK 07/29/07 19.65 38.85 F AL ➢AT FIryF�/�Y: CODE: 190.50 i (/� r/ i 4 D IPTIO OF WORK ELECTRICAL FOR ADDITION AND UPGRADE SERVICE PANEL TO 200 AMP SPECIAL CONDITIONS: DATE INSPECTOR SIGNATURE TEMPORARY POWER POLE UNDERGROUND CONDUIT UFER GROUND I ROUGH COND T !r ROUGH WIRING r/Tu1 l MAIN WATER LIN PLASTIC YIN TAL N y UTILITY COMPANY NOTIFIEDi�� /J1J LICENSED CONTRACTOR'S DECLARATION I hereby affirnunder 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 inn full force and effect. License Class Btj_ LLicNo. A9 % L Cohtractors i�ialMi ✓" Dale G–G G OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason (Seo. 7031.5, Business add 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 fora permit subjects the applicant to a civil penally of not more than live hundred dollars ($500).). ❑ 1 am exempt under Sec. , BA P.C. for this reason [ Electrical, Plumbing & Sewer Permits Only ] ❑ I, as owner of the property, wilt 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. It, however, the building or improvement is sold within one year of completion, the owner -Wilder will have the burden of proving that he or she did not build or improve for the purpose of sale.). [ All Other Permits ] ❑ 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 suchwork himself or herself or through his or her own employees, provided that such improvements are not intended or Offered for sale. II, however, the building or improvement is sold within one yearof 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 Conliaclors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractors License Law.). WORKER'S COMPENSATION DECLARATION 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, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 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 workers compensation insurance carrier and policy number are: Carrier � 1AQ1 �G—/�.(.HJ� Policy Number / 3fi !�.°� ❑ 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 became 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 forthwith comply with those provisions /&12, n/ App6cignature / Date WARNING: FAILURE TO SlB E WORKER'S 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 W SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LOBBYIST ORDINANCE CERTIFICATION Complete this section for permits in unincorporated Los Angeles County only, This is to certify that 1, 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 - Data. Company Name (if employed by an entity/agency) Dale 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 Wilding occupant require a permit for construction or modification from the South Coast Air Quality Management District (SCARMD)? See permitting checklist for guidelines. Yes ❑ No ❑ 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 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, Civc ). Lenders Name Lenders Address ".1i I certify that I 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. M �J 1/ Ap lic�ignature