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Home My Public Portal About8810 ELM AVE_Electrical_9/3/2015_COUNTY OF LOS ANGELES TEMPLE CITY 8810 ELM AV DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS NEAREST CROSS STREET: MUSCATEL BUILDING AND SAFETY / LAND DEVELOPMENT 34.60 TEMPLE CITY CA 91780 16.00 JISSUED ON: PROCESSED BY: PLAN BY: 2.00 PHONE: (626) 285-0488 EXT: 11.00 ILEGAL ID: I 11.00 IFIN DAAFT FINAL FEES PAID ON FILE 1 A�014-1� I 1 IP33.00 I DESC:2IPTON OF WORK ]FEE DESCRIPTION: QUANTITY: UOM ASSESSOR INFORMATION NUMBER: IBATHROOM FAN, OUTLETS FOR KITCHEN CABINETS, 1 IGE DISPOSAL 1 15387-011-033 I ISPECIAL CONDITIONS: I IA1 PERMIT ISSUANCE FEE I I (APPROVALS DATE I IF1 120V, 15/20A BR CKTS 2.00 BR TENANT: I I I (UNDERGROUND CONDUIT I I IG1 OUTLETS-LGT,SW,RECP 8.00 OUT I I IG2 LIGHTING FIXTURES 1.00 LGT I I I TROUGH WIRING � kI- � IH2 RES GRBG DISP LT 3HP 1.00 DIS (OWNER: TEL. NO: 1H4 RES RANGE HDS LT 3HP 1.00 HOO INGUYEN, ANTHONY (213) 324-9088- 1H7 RES EXHAUST FANS 3.00 EX 1633 N SPRING #1 I TOTAL FEES ILOS ANGELES CA 90012 I 1 1 (APPLICANT: TEL. NO: I 1 (SAME AS OWNER - 1 CONTRACTOR: SAME AS OWNER ARCHITECT OR ENGINEER: TEL. NO: _ I LIC. NO I I I I TEL. NO: _ I LIC. NO: I I I I I I IPERMIT EXPIRES 180 DAYS IF 11) WORK DOES NOT COMMENCE, OR 12) WORK IS SUSPENDED OR ABANDONED, OR 13) FAILS TO OBTAIN CODE REQUIRED INSPECTION I # 0508 REPORT ID: DPR265 ROUTE TO: BS0508 ELECTRICAL PERMIT EL 0508 1509030011 BUILDING ADDRESS: 8810 ELM AV AMOUNT:l TEMP CA 917801806 NEAREST CROSS STREET: MUSCATEL 27.80 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY CAI 34.60 16.00 JISSUED ON: PROCESSED BY: PLAN BY: 2.00 109/03/15 SR 11.00 I I 11.00 IFIN DAAFT FINAL CODE:135.40 1 A�014-1� I 1 IP33.00 I DESC:2IPTON OF WORK 1 (ADDING LIGHT FIXTURE, GFCI RECEPTORS, DOUBLE GANG SWITCH, 8 1 IBATHROOM FAN, OUTLETS FOR KITCHEN CABINETS, SWITCH FOR GARBAI IGE DISPOSAL 1 I ISPECIAL CONDITIONS: I I 1 I � I I (APPROVALS DATE INSPECTOR SIGNATURE I ITEMPORARY POWER POLE I I I I I I (UNDERGROUND CONDUIT I I I 1 I I I IUFER GROUND I I I I IROUGH CONDUIT I I I I I TROUGH WIRING � kI- � e 1 v I I IMAIN WATER LINE I I I IPLASTIC YIN METAL YIN I I I I I (UTILITY COMPANY NOTIFIEDI I I I I I I I I I I I I I I OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) Indicated below by the checkmark(s) I have placed next to the applicable item(s) (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 Contnc�tor pursuant.to the Contractors' State License Law). (_) I am exempt 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 which I must have resided for at least one year priorl to completion of the improvements covered by this permit, Icannot 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: hfto://www.leoinfo.m.aovlcalaw.html. Date:lofPrr/e SignaOwn /or�Authorized Agent V 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 Class License No. Date Contractor Signature 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 workers' compensation insurance carrier and policy number are: 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 ❑ N o ❑ 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 AQMD and/or EPA ❑ I declare that notification of asbestos removal is not applicable to addressed project. Carder Policy Number Expiration Date DECLARATION REGARDING CONSTRUCTION LENDING AGENCY 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 forthwith comply with those provisions Signature of Applicant Date LOBBYIST ORDINANCE CERTIFICATION Complete this section for -permits In Unincorporated Los Angeles County only This is to cert' that I, as permit applicant, am familiar with the requiremen of Los Angeles County Code Chapter 2.160 et seq., (relating �n. a os Angeles County Lobbyist Ordinance) and that all persoing behalf of myself complied and will continua to compl wit ugh the application process. Applir/ Vnt Nalne) Applicant Signal Company Name Datd ' 'l�' '— 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,pfj✓iperty for inspection purposes. Signature of Prol)M/Owner4rfALljllodged Agent Date 71 W I