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Home My Public Portal About9915 BROADWAY_Electrical_6/17/2014_r COUNTY OF IAS ANGELES TEMPLE CITY # 0508 DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 L ID: 13805 LT: 10 SSOR INFORMATION NUMBER: WEN, QI L 5327 LOMA AVENUE TEMP 917802635 LIN, DAVID 5812 TEMPLE CITY BL TEMPLE CITY CA 91780 CONTRACTOR: EDMOND HANK KWONG 360 E FIRST STREET #500 TUSTIN CA 92780 ARCHITECT OR ENGINEER: CHU, CHENG MING 18276 SENTENO ST ROWLAND HEIGHTS CA 91748 PHONE: (626) 285-0488 EXT: FEES PAID FEE DESCRIPTION: QUANTITY: UOM: I JAI PERMIT ISSUANCE FEE �E1 TEMP SERV POWER POLE 1.00 TMP TOTAL FEES TEL. NO: I (626) 822-1329- j j I TEL. NO: (626) 928 -4876 - TEL. NO: (626) 926-4876- j LIC. NO 756780 TEL. NO: (626) 922-5550- j LIC. NO: NONE REPORT ID: DPR265 ROUTE TO: BS0508 ELECTRICAL PERMIT EL 0508 1406170071 j BUILDING ADDRESS: 9915 BROADWAY AMOUNT: j TEMP CA 917802635 NEAREST CROSS STREET: BALDWIN 27.80 THOMAS PAG£:, 597 GRID: A3 LOCALITY: TEMPLE CITY 43.70 71.50 JISSUED ON: PROCESSED BY: PLAN BY: 06/1':/14 SR jFI *. DATE FING$I�•/yBY: CODE: IDEeTZO�F WORK ITEMDORARY POWER POLE CONDITIONS: ,BABY POWER POLE (GROUND CONDUIT GROUND CONDUIT WIRING DATE INSPECTOR SIGNATURE c'Y 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 ContrA?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 priori 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: httn://www.leoinfo.ca.aov/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 force and effect. / b License �Class � & License No. �l S 6 ❑ n `�- Date (�/h! / Contractor Signature WORKERS' COMPENSATION DEC12RATION WANING: 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 w I�rs'porn sa on insu crl d policy num r. 1 R+C + � ga f S Carder Policy Number Expirati n a e 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 ( Signature of App ,;ff. nt 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 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 ❑ 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 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 representatives of this county to enter the above -identified property for inspection purposes. Signature of Property Owner or Authorized Agent Date (/ COUNTY OF LOS ANGELES TEMPLE CITY 8 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1406170070 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: TR: 13805 IT: 10 ASSESSOR INFORMATION NUMBER: 8588-015-010 WEN, QI L 5327 LOMA AVENUE TEMP 917802635 LIN, DAVID 5812 TEMPLE CITY BL TEMPLE CITY CA 91780 EDMOND BANK KWONG 360 E FIRST STREET «500 TUSTIN CA 92780 ARCHITECT OR ENGINEER: CHU, CHENG MING 18276 SENTENO ST ROWLAND HEIGHTS CA 91748 TEL. NO: (626) 822 -1329 - TEL. NO: (626) 928 -4876 - TEL. NO: (626) 926 -4876 - LIC_ NO 756780 TEL. NO: (626) 922 -5550 - LIC. NO: NONE FEES PAID FEE DESCRIPTION: QUANTITY: DOM: Al PERMIT ISSUANCE FEE B2 1 OR 2 FAMILY DWELL REPORT ID: DPR265 2902.00 SQ TOTAL FEES ROUTE T0: SS0508 BUILDING ADDRESS: 9915 BROADWAY AMOUNT:( TEMP CA 917802635 NEAREST CROSS STREET: BALDWIN 27.80 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY CA 293.40 321.20 ISSUED ON: PROCESSED BY: PLAN BY: 06/17/14 SR FINAL DATE , FGy�N�A/�1\)/^BY: CODE: IDE NTPT� OF WORK 1 (ELECTRICAL FOR A NEW SINGLE FAMILY DWELLING CONDITIONS: DATE INSPECTOR SIGNATURE TEMPORARY POWER POLE (UNDERGROUND CONDUIT LIFER GROUND I TROUGH CONDUIT I � ROUGH WIRING II\ MAIN WATER LINE IPLASTIC YIN METAL YIN I (UTILITY COMPANY NOTIFIED F /) i I i i I I II II I I I I I 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' Slate 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 thereonf and who contracts for the projects with a licensed Contrar(tor pursuant, to the Contractors' State License Law). L), 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 priorlI to completion., of the improvements covered by this permit, I InnoI 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://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. License Class �> License No. Date (di -4 Itontractor SignatureaDETION WORKERS' COMPENSATION 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 w��NNers' pe tion insure e c rier r�d,policy numb r e: ` Ar i—u> �o a �bS L2 2 1� Carder 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 comply with those provision n c- Signature of A ant 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 ❑ 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 ❑ i I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my requiremgnts under the Los Angeles County Code Title 2, Chapter 220' Sections 220.100 through 220.140 oonceming 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 certity 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. Signaturt Property O r or Authorized Agent Date