The URL can be used to link to this page

Home My Public Portal About9669 BROADWAY_Electrical_12/15/2014_1 i � f COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: ON FILE ASSESSOR INFORMATION NUMBER: 18588-010-018 I TENANT: I I OWNER: IMOK, ERIC 19669 BRODADWAY TEMPLE CITY CA 91780 APPLICANT: IBERANCH, JUSTIN 122741 VENTURA BLVD. WOODLAND HILLS 91364 CONTRACTOR: (ADR ELECTRIC 122741 VENTURA BLVD WOODLAND HILLS CA 91367 ARCHITECT OR ENGINEER: TEL. NO: (626) 673 -5072 - TEL. NO: (805) 248 -6028 - TEL. NO: (818) 223 -8344 - LIC. NO 696338 TEL. NO: LIC. NO: IALL GROUNDING AND BONDING OF THE PV SYSTEM SHALL COMPLY WITH LOS ANGELES COUNTY REQUIREMENTS. NOTE: WEEB PLATES 1, WASHERS, AND SIMILAR DEVICES ARE NOT ACCEPTED. I I I I I I* ADDITIONAL DATA ON FILE I IREPORT ID: DPR265 I ROUTE TO: BS0508 ELECTRICAL PERMIT EL 0508 1412150043 BUILDING ADDRESS: 9669 BROADWAY TEMP CA 917803211 NEAREST CROSS STREET: THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPEL CITY CAI ISSUED ON: PROCESSED BY: PLAN BY: 12/15/14 SR FIA=) AT FI Y: CODE DtSCRI'TION OF WORK SOLAR 12 PANELS W/(N) 200 AMP MAIN SERVICE UPGRADE I SPECIAL CONDITIONS: APPROVALS DATE TEMPORARY POWER POLE I I I UNDERGROUND CONDUIT IUFER GROUND I TROUGH CONDUIT ROUGH WIRING / IMAIN WATER LINE IPLASTIC Y/N METAL Y/N I (UTILITY COMPANY NOTIFIEDI I I I INSPECTOR SIGNATURE TEMPLE CITY # 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: FEES PAID IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: I IA1 PERMIT ISSUANCE FEE 27.80 ILE 200 AMP PANELS, MCC 1.00 PAN 38.90 IP2 PC RES PV<10KW 153.90 IP3 INVRTR RES PV<10KW 27.90 I TOTAL FEES 248.50 IALL GROUNDING AND BONDING OF THE PV SYSTEM SHALL COMPLY WITH LOS ANGELES COUNTY REQUIREMENTS. NOTE: WEEB PLATES 1, WASHERS, AND SIMILAR DEVICES ARE NOT ACCEPTED. I I I I I I* ADDITIONAL DATA ON FILE I IREPORT ID: DPR265 I ROUTE TO: BS0508 ELECTRICAL PERMIT EL 0508 1412150043 BUILDING ADDRESS: 9669 BROADWAY TEMP CA 917803211 NEAREST CROSS STREET: THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPEL CITY CAI ISSUED ON: PROCESSED BY: PLAN BY: 12/15/14 SR FIA=) AT FI Y: CODE DtSCRI'TION OF WORK SOLAR 12 PANELS W/(N) 200 AMP MAIN SERVICE UPGRADE I SPECIAL CONDITIONS: APPROVALS DATE TEMPORARY POWER POLE I I I UNDERGROUND CONDUIT IUFER GROUND I TROUGH CONDUIT ROUGH WIRING / IMAIN WATER LINE IPLASTIC Y/N METAL Y/N I (UTILITY COMPANY NOTIFIEDI I I I INSPECTOR SIGNATURE 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 (-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 Contre?tor 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 prion to completion; of the improvements covered by this permit, I c 'nnot legally sell a structure that 1 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.leginfo.ca.gov/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 wit Section 7000) of Division 3 of the Business and Professio s Code, and my license is in full force and effect. License Class _06nLicense No. Date t [�� 1� Contractor Signature l (` �.J L WORKERS' COMPENSATION DEC T N WARNING: FAILURE TO SECURE WORKE 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' insura ,r ler and polic numb are: Currier Policy Number Ex ' tion 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' Zensation provisions of Section 3700 of the Labor Code, I sith comply wi>ikrthose provisions II-. �5,1�- Date LOBBYIST ORDINANCE CERTIFICATION Co plete this section for permits In Unineorporated Los Angeles County only This is to certify that I, as permit applicant, am familiar with the requirements of Los Angeles County Code lihapter 2.160 et seq., (relating to the Los Angeles County Lobbyis r in ce) and that allrsons actin on behalf of myself complie and rll continue to c�nply there +i h through the application proceiks. App ' nt me Applicanigna ur Compariy ame Date JOB ADDRESS , LOCALITY HAZARDOUS MATERIAL DECLARA71 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 ❑ 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 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 1 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 represent 'v f this county to enter the above -identified prope or in pection purposes. Signature of Property Owner o Authon d Agent C Date L �--.,