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Home My Public Portal About5734 CLOVERLY AVE_Electrical_12/3/2014_ (2)COLINTY OF LOS ANGELES • DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 6561 LT: 698 ASSESSOR INFORMATION NUMBER 8587-011-020 00NX h OWNER: LI WEI, DAI 5734 CLOVERLY AV TEMP 917802551 APPLICANT: LOPEZ, JUAN 22632 GOLDEN SPRINGS DIAMOND BAR CA 91765 CONTRACTOR: ALLIED RESTORATION SERVICES INC 22632 GOLDEN SPRINGS DRIVE DIAMOND BAR, CA 91765 ARCHITECT OR ENGINEER • ON: •002 TEL. NO: TEL. NO: (888) 860 -1003 - TEL. NO: (714) 944 -0004 - LIC. NO 908870 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 E1 TEMP SERV POWER POLE 1.00 TMP TOTAL FEES ADDITIONAL DATA ON FILE REPORT ID: DPR265 ROUTE TO: RS0508 AMOUNT: 27.80 43.70 71.50 ELECTRICAL PERMIT EL 0508 1412030071 BUILDING ADDRESS: 5734 CLOVERLY AV TEMP CA 917802551 NEAREST CROSS STREET: THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY ISSUED ON: PROCESSED BY: PLAN BY: 12/03/14 SR FINAL -15 44 FINAL X CODE: SSRIPR_yI`PPTION OF WORK TEMPORARY POWER PLUG METER SPECIAL CONDITIONS: APPROVALS DATE TEMPORARY POWER POLE UNDERGROUND CONDUIT UFER GROUND ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED INSPECTOR SIGNATURE OWNER -BUILDER DECLARATION 1 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 U 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 Contra?tor pursuant to the Contractors' State License Law). U I am exeml4t 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 whicf I must have resided for at least one year priorl to completion; of the improvements covered by this permit, I cannot 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:/Avww.lecinfo�.aov/�law.html/�law.html. Date: Signature of Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION• I hereby affirm under penalty of perjury that I am licen under provisions of Chapter 9 (commencing with Sectio 7 00) of Division 3 of the Business and P ions Cod nd my license is in full force and effect. '-46censeClass 2) License Datel? 3 t�'Contractor SignaturoL J WORKERS' COMPENSATI/g/TyDEC TION WARNING: FAILURE TO SECURE RKERS' ECF MPENSATION COVERAGE IS UNLAWFUL, AND SHAL UBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FORIN 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: Carrier Policy Number Expiration Date 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 subje o the workers' compensation laws of Calif ia, and agree if I should become subject to the wor ers' c mpensati n o isions of Section 3700 of the Labor C e, -r)Il II forthwi y with those provisions }c f 213IN olicant I Date f 1 LBYIST'ORDINANCE CERTIFICATION !V/ omplete this section for permits in U ncorporated 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 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 Company Name Date JOB ADDRECS LOCALITY + HATARDOUS MATERIAL DECLARA'i iON 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 pennit 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 conceming 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 const tion. I a o ze repr e t ives of this county to enter the a ove-i entifie pr rty for inspection purposes. ignat of p Owner or Authorized Agent A a �y ' COUNTY OF WE ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 6561 LT: 698 UN: .002 ASSESSOR INFORMATION NUMBER: 8587-011-020 TENANT TEL. NO: LI WEI, DAI 5734 CLOVERLY AV TEMP 917802551 APPLICANT: TEL. NO: LOPEZ, JOAN (888) 860-1003- 22632 GOLDEN SPRINGS DIAMOND BAR CA 91765 CONTRACTOR: TEL. NO: ALLIED RESTORATION SERVICES INC. (714) 944-0004- 22632 GOLDEN SPRINGS DRIVE LIC. NO DIAMOND BAR, CA 91765 908870 OR ENGINEER: TEL. NO: LIC. NO: TEMPLE CITY # 0508 9701 LAS TUNAS TEMPLE CITY CA 91760 PHONE: (626) 285-0488 EXT: FEES PAID FEE DESCRIPTION: QUANTITY: DOM: Al PERMIT ISSUANCE FEE G1 OUTLETS-LGT,SW,RECP G2 LIGHTING FIXTURES HA FAU LESS 3HP H2 RES GRBG DISP IT 3HP H3 RES DISHWASHR IT 3HP 144 RES RANGE HUB IT 3HP H5 RES WASH MACH IT 3HP H7 RES EXHAUST FANS JB AC UNITS s3-10HP LB 200 AMP PANELS, MCC ADDITIONAL DATA ON FILE REPORT ID: DPR265 55.00 OUT 45.00 LOT 1.00 FAU 1.00 DIS 1.00 DIS 1.00 H00 1.00 WAS 1.00 EX 1.00 AC 1.00 PAN TOTAL FEES ROUTE TO: BS0508 AMOUNT 27.80 86.00 72.60 11.00 11.00 11.00 11.00 11.00 11.00 19.70 38.90 311.00 ELECTRICAL PERMIT EL 0508 1410200035 BUILDING ADDRESS: 5734 CLOVERLY AV TEMP CA 917802551 NEAREST CROSS STREET: THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY C ED ON: PROCESSED BY: PLAN BY: 0/14 SR FINAL /��DATE ��j�' FI BY/� CODE: D IPTI X WORK L/•VVV/_y1/'/ 55 OUTLETS, 45 LIGHT FIXTURES, A/C a HEATING UNITS, GARDAGE DISPOSAL, RANGE HOOD, WASHING MACHINE, EXHAUST FAN AND UPGRADE SERVICE PANEL TO 200 AMP SPECIAL CONDITIONS APPROVALS DATE INSPECTOR SIGNATURE TEMPORARY POWER POLE UNDERGROUND CONDVIT UFER GROUND ROUGH CONDUIT ROUGH WIRING V MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED] 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.). (_) 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 Contractor pursuant .to the Contractors' State License Law). i `) I am exem�t 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 prion to completioq of the improvements covered by this permit, I cannot 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: httD://www.leainfo.ca.aov/calaw.html. Date: Signature of Property Owner or Authorized Agent 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 ) b License No. Date l O Z 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. X 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' co pens 'on insurance carrier and policy nur are: r f TC/ -/-5- Carrier Vo cy Number Expiration Date 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 Calif ,and agre at, if I should become subject to the w ers ;compen ion provisions of Section 3700 of the Labor C de, I s all fort th " omply with those provisions � Sig tura of pplicnt D�t/2 OBBYIST 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 complied and will continue to comply therewith through the application process. Applicant (Print Name) Applicant Signature Company Name 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 ❑ 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. 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). Lender's Name Lender's 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 represqR�atives of this county to enter the ab a -I entified Ke' rty for inspection purposes. Si natu f P/roe Owner or Authorized Agent 2 I Dat U