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Home My Public Portal About4903 CAMELLIA AVE_Electrical_1/9/2014_COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT ILEGAL ID: JTR: 14467 LT: 42 ASSESSOR INFORMATION NUMBER: 18589-015-019 TENANT: OWNER: WANG, MELISSA 4903 CAMELLIA AV TEMP 917804243 APPLICANT: IHUANG, CHRIS 223 ALICE STREET #B JARCADIA CA 91006 CONTRACTOR: JASSEN HOMES INC 223 ALICE STREET #B JARCADIA CA 91006 ARCHITECT OR ENGINEER: LEE, PETER 8748 E VALLEY BLVD SUITE L IROSEMEAD CA 91770 TEL. NO: (626) 255 -9336 - TEMPLE CITY 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: FEES PAID FEE DESCRIPTION: QUANTITY: UOM IA1 PERMIT ISSUANCE FEE IE1 TEMP SERV POWER POLE 1.00 TMP TOTAL FEES TEL. NO: I (626) 255 -7445 - TEL. NO: (626) 255 -7445 - LIC. NO 789611 TEL. NO: (626) 280 -9000 - LIC. NO: 789611 * I # 0508 * ADDITIONAL DATA ON FILE REPORT ID: DPR265 ROUTE TO: BS0508 ELECTRICAL PERMIT EL 0508 1401090037 BUILDING ADDRESS: 4903 CAMELLIA AV AMOUNT: TEMP CA 917804243 NEAREST CROSS STREET: 27.80 ( THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY CAI 43.70 71.50 JISSUED ON: PROCESSED BY: PLAN BY: 101/09/14 SR 1FINAL DATA CODE: 1 SCRIPTION OF WORK TEMPORARY POWER POLE SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE TEMPORARY POWER POLE UNDERGROUND CONDUIT IUFER GROUND ROUGH CONDU ZI�L' ROUGH WIRING MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED 1 OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS 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 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 Contrb�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 priorlto 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: httD://www.leoinfo.ca.aovlmlaw.htmi- Date: Signature of Property Owner or Authorized Agent 1 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. ^'7 /' •'License Class . _ License No. /�A Bate Contractor Signatur WORKERS' COM CLARATION 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: Carrier Policy Number Expiration Date Name of Agent Phone 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 workers' compensation laws of California, and agree that, if I should become subject to the workers' comp,61rtsation provisions of Section 3700 of the Labor Code, I shallwit icomply with those provisions ignatu cant Date LOBBYIST 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 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 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 ❑ N o ❑ 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 requiremernts 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 ❑ 1 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 owners 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-identifi pro C for inspection purposes. Signature rope O mer or erized Agent � — jData /-T-I x' COUNTY OF LOS ANGELES TEMPLE CITY R 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1404010073 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: TR: 14467 IT: 42 ASSESSOR INFORMATION NUMBER: 8589-015-019 TENANT OWNER: TEL. NO: WANG, MELISSA (626) 255-9336- 4903 CAMELLIA AV TEMP 917804243 APPLICANT: TEL. NO: BI, HONGWEI (626) 261-2202- 3100 BIG DALTON AVE BALDWIN PARK 91706 CONTRACTOR: TEL. NO: CROWN ELECTRICAL CORP (626) 261-2202- 3100 BIG DALTON AVE STE 170800 LIC. NO BALDWIN PARK, CA 91706 984601 * ARCHITECT OR ENGINEER: TEL. N0: LEE, PETER (626) 280-9000- 8748 E VALLEY BLVD SUITE L LIC. NO: ROSEMEAD CA 91770 984601 * * FEES PAID FEE DESCRIPTION: QUANTITY: DOM: Al PERMIT ISSUANCE FEE B2 1 OR 2 FAMILY DWELL * ADDITIONAL DATA ON FILE REPORT ID: DPR265 BUILDING ADDRESS: 4903 CAMELLIA AV AMOUNT: TEMP CA 917804243 NEAREST CROSS STREET: 27.80 THOMAS PAGE: 597 GRID: AS LOCALITY: TEMPLE CITY CA 3324.00 SQ 336.10 TOTAL FEES 363.90 ISSUED ON: PROCESSED BY: PLAN BY: 04�/0011//11144SR FI{ �FI CODE: LS`SR'E CRIPTION OF WORK ELECTRICAL FOR NEW SINGLE FAMILY DWELLING ROUTE TO: BS0508 SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE TEMPORARY POWER POLE UNDERGROUND CONDUIT UFER GROUND ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE \ PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS 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 1, 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 ContraF or 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 whicl1 I must have resided for at least one year prion 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: httD://www.lecinfo.ca.cov/calaw.html. Date: Signature of Property Owner or Authorized Agent 1 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. ,Zbcense Class L/-/ 0 License No. Date & _/- rfContractor Signature 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? WORKERS' COMPENSATION DECLARATION Yes ❑ N o ❑ 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 FORIN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS 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. ty No. 1 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 r ers' compens�aation insurance carrier nd� Jp otic number a : Came Policy Number Kpiration 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 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 Signadire oWlican "Date LOBBYIST 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 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 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 requi.mmgnts 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 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 owners 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 property for inspection purposes. Signature of P pe Owner or Authorized Agent COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT L ID: 14467 LT: 42 SSOR INFORMATION NUMBER: NNER: TEL. NO: U, ZIYING (626) 863-4250- 903 CAMELLIA AV EMP 917804243 ICANT: TEL. NO: GARY (626) 321 -6969 - CAMELLIA AVENUE 'LE CITY CA 91780 CONTRACTOR: TEL. NO: INCOGNITO CONSTRUCTION INC. (626) 863-4250- 4950 CAMELLIA AVENUE LIC. NO TEMPLE CITY CA 91780 908748 ARCHITECT OR ENGINEER: TEL. NO: LIC. NO: THIS PERMIT EXPIRES 6 MONTHS FROM DATE OF ISSUANCE OR FROM DATE OF LAST VALID INSPECTION. TEMPLE CITY q 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: FEES PAID IEE DESCRIPTION: QUANTITY: DOM: \1 PERMIT ISSUANCE FEE a MOTORS, LT 3 HP 1.00 MOT TOTAL FEES ID: DPR265 ROUTE TO: BS0508 AMOUNT: 27.80 15.30 43.10 ELECTRICAL PERMIT EL 0508 1504220010 BUILDING ADDRESS: 4903 CAMELLIA AV TEMP CA 917804243 NEAREST CROSS STREET: LOWER MUSA THOMAS PAGE: 597 GRID: AS LOCALITY: TEMPLE CITY CA ISSUED ON: PROCESSED BY: PLAN BY: 04/22/15 SR FINAL DATE FBY: CODE: DP� N OF WORK INSTALL ONE ELECTRIC OUTLET FOR GATE OPENER SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE TEMPORARY POWER POLE �I UNDERGROUND CONDUIT I UFER GROUND ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N I UTILITY COMPANY NOTIFIED 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 Contrba or pursuant .to the Contractors' State License Law). (_) I am exemdt 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 priorlto 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:/Aw .leoinfo.ca.aov/calaw.html. Date: Signature of Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS I hereby affirm under penalty of perjury that I am licensed under I LOCALITY i provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my 7 license is in full force and effect. / HAZARDOUS MATERIAL DECLARATION License Class _ License No. �i �Ad Will the applicant or future building occupant handle a hazardous ,,// material or a mixture containing a hazardous material equal to or Date i2 ISContractor Signature—� greater than the amount specified on the hazardous materials —�,-ation guide? 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 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 ❑ j 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. Labor Code, for the performance of the work for which this permit ASBESTOS NOTIFICATION is issued. rNo.El Notification letter sent to AQMD and/or EPA I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for ❑ I declare that notification of asbestos removal is not the performance of the work for which this permit is issued. My I applicable to addressed project. arrier co eI��uhcy umlbg�pxpirationrDate +SAGENCYATION REGARDING CONSTRUCTION LENDING 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 � _ � .1 -Ly- �_JL•�y2 -Sn ,'Signature of Applicant Date -r 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 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. 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 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 owners 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 property for inspection purposes. Signature of Pro orized Agent Applicant (Print Name) Applicant Signature I- _1� C I/ Z 7S Company Name Date