HomeMy Public PortalAbout9233 BROADWAY_Electrical_9/25/2014_f' i
COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
TR: 12410 IT: 6
ASSESSOR INFORMATION NUMBER:
8588-002-006
TENANT
OWNER: TEL. NO:
TONG YAN;HUNG;SEE HUNG YUK (626) 215-8640-
9233 BROADWAY
TEMP 917802402
TEMPLE CITY 8 0508
9701 LAS TUNAS
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
FEES PAID
FEE DESCRIPTION: QUANTITY: UOM:
Al PERMIT ISSUANCE FEE
P2 PC RES PV<IOKW
P3 INVRTR RES PV<IOKW
TOTAL FEES
ELECTRICAL PERMIT
EL 0508 1409250040
BUILDING ADDRESS:
9233 BROADWAY
AMOUNT:1 TEMP CA 917802402
NEAREST CROSS STREET:
27.80 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CA
153.90
27.90 ISSUED ON: PROCESSED BY: PLAN BY:
209.60 09/25/14 SR
(FINAL PATE FI Y: CODE:
DESCRIPTION OF WORK
SOLAR SYSTEM, 21 MODULES 5.25 KW
APPLICANT: TEL. NO:
OR LA CRUZ, MARIO (310) 912-4088-
20285 WESTERN AVE SPECIAL CONDITIONS:
TORRANCE CA 90501
CONTRACTOR: TEL. NO:
VERENGO SOLAR (310) 912-4088-
20285 WESTERN AVE. 8200 LIC. NO
TORRANCE,CA. 90501 935263
ARCHITECT OR ENGINEER: TEL. NO:
LIC. NO
ALL GROUNDING AND BONDING OF THE PV SYSTEM SHALL COMPLY
WITH LOS ANGELES COUNTY REQUIREMENTS. NOTE: WEED PLATES
, WASHERS, AND SIMILAR DEVICES ARE NOT ACCEPTED.
REPORT ID: DPR265
ROUTE TO: BS0508
APPROVALS DATE INSPECTOR SIGNATURE
TEMPORARY POWER POLE
UNDERGROUND CONDUIT
UFER GROUND
ROUGH CONDUIT A7
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 I, as owner of the property, or my employees with wages as
their sole compensation, will do (J) 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 Contractor 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: httD://www.leainfo.ca.aov/calaw.html.
Date:
Signature of Property Owner or Authorized Agent
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. 2 �J
---(License Class IY td License No. 61 o ✓t2,63
/Damm 2 f Contractor Signstu�
7 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 Co 06, for the performance of the work for which this permit
Labor
YPoli 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
worl��errs' cpp Jr�Pp sation insurance carrier and pollc nu er are:
GSTf1l� /(100oc/ZS9 a /
Carrier Policy Number Expiration ate
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 mply with those provisions
X, 5112�,Ilq
�Si§nature of A h a 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 continue
to comply therewith through the application press
4pp
Print erne) �AppttEant �igpalure U
Company Name�D�y/tte
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 ❑ �-
I have read the hazardous materials information guide and the
SCAQMD permitting checklist, I understand my requirem@n
under the Los Angeles County Code Title 2, Chapter 22ts0'
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
❑ 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
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 property for inspection purposes.
Signature of Pro wn r Au zed Agent
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