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Home My Public Portal About10310 LA ROSA DR_Electrical_2/2/2015_r • COUNTY OF LOS ANGELES 1 TEMPLE CITY # 0508 DEPARTMENT OF PUBLIC WORKS I TEL. NO: 1 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT 1 TEMPLE CITY CA 91780 � 1 (CONTRACTOR: I TEL. NO: PHONE: (626) 285-0488 EXT: LEGAL ID: 120285 WESTERN AVE. #200 LIC. NO 1 FEES PAID ITR: 37580 LT: 18 (ARCHITECT OR ENGINEER: I I TEL. NO: 1 1 1 I I TALL GROUNDING AND BONDING OF THE PV IFEE DESCRIPTION: QUANTITY: UOM: ASSESSOR INFORMATION NUMBER: NOTE: WEEB PLATESI 1 ACCEPTED. I I 18585-018-081 I 1 IA1 PERMIT ISSUANCE FEE I IP2 PC RES PV<10KW TENANT: I I (APPROVALS DATE IP3 INVRTR RES PV<10KW TEMPORARY POWER POLE I I TOTAL FEES OWNER: TEL. NO: I ISCANLAN, JOHN (626) 401-2907- I 110310 LA ROSA DR 1 (TEMP 917803401 I 1APPLICANT: I TEL. NO: 1 IDE LA CRUZ, MARIO (310) 357-5820- 1 120285 S WESTERN AVE 1 ITORRANCE CA 90501 I � 1 (CONTRACTOR: I TEL. NO: IVERENGO INC. (714) 744-6911- 120285 WESTERN AVE. #200 LIC. NO 1 ITORRANCE,CA. 90501 935263 1 I (ARCHITECT OR ENGINEER: I I TEL. NO: 1 1 - I LIC. NO: 1 I I I TALL GROUNDING AND BONDING OF THE PV I I SYSTEM SHALL COMPLYI (WITH LOS ANGELES COUNTY REQUIREMENTS. NOTE: WEEB PLATESI I, WASHERS, AND SIMILAR DEVICES ARE NOT I I ACCEPTED. I I I I (REPORT ID: DPR265 ROUTE TO: BS0508 I ELECTRICAL PERMIT EL 0508 1502020034 (UTILITY COMPANY NOTIFIEDI I I I I BUILDING ADDRESS: 1 10310 LA ROSA DR AMOUNT:l TEMP CA 917803401 1 NEAREST CROSS STREET: 1 27.80 I THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY CAI 153.90 27.90 JISSUED ON: PROCESSED BY: PLAN BY: 209.60 02/02/15 SR FINAL DATE,.,,--- FAL BY: CODE: ID91SCRIPTION OF WORK I 1 (ROOF SOLAR, 33 MODULES, R RATE MAIN I BREAKER 1 I I I (SPECIAL CONDITIONS: I I I I I I (APPROVALS DATE I I INSPECTOR SIGNATURE TEMPORARY POWER POLE I I I (UNDERGROUND CONDUIT I I I1 I I IUFER GROUND I I I 1 I I (ROUGH CONDUIT I I I 1 I I I (ROUGH WIRING I I 1 1 I 1 I (MAIN WATER LINE 1 1 I I I 1 (PLASTIC Y/N METAL Y/N 1 I 1 (UTILITY COMPANY NOTIFIEDI 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).): L) 1, as owner of the property, or my employees with wages as their sole compensation, will do (✓) all of or L) 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.). L) 1, 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 Contrhgtor pursuant .to the Contractors' State License Law). U. I am exempt from licensure under the Contractors' Stale 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 priorito completion of the improvements covered by this permit, I cgnnot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. 1 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: hfD://WWW.leainfo.m.cov/calaw.htmi. 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 fo/�rce, and effect. �7 a License Class /7G/d License No. 4 J�0i9 Date 2 ZContractor Signature= _ .._ -1 v 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? WORKERS' COMPENSATION DECLARATION Yes ❑ No ❑ 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 rssu . Poli 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 workg'compe-Osation insurance carrier and policy number are: T-4J[0�(oGO es, 9 Cartier policy Numbumb er Ex iration 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 provi ' s of Section 3700 of the Labor Code, I shall for!hith�om wit ose provisions v Si fQV cant Date 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 c ue to comply therewith through the application proces;/J�/ Appli P'nt Na a Applicant igna i - N�'a �Z�<s 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 requirem@nts 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). 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 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 propert®r insp ction purposes. v� Signature of Pro wa d Agent