HomeMy Public PortalAbout6059 Golden West Ave_Electrical_10/20/2014_COUNTY OF LOS 'ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
1LEGAL ID:
ITR: 6561 LT: 90 UN: .003
1
1ASSESSOR INFORMATION NUMBER:
15385-019-001
I TENANT
OWNER: TEL. NO:
UYEN LE (626) 215-2722-
6059 GOLDEN WEST AV
TEMP 917801755
APPLICANT: TEL. NO:
NGUYEN, PETER (562) 843-3186-
13002 GRAYSTONE ST
NORWALK CA 90650
CONTRACTOR: TEL. NO:
PETER TUAN NGUYEN (562) 843-3186-
13002 GRAYSTONE STREET LIC. NO
NORWALK CA 90650 780628
OR ENGINEER: TEL. 140:
LIC. NO:
TEMPLE CITY $ 0508
9701 LAS TUNAS
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
FEES PAID
FEE DESCRIPTION: QUANTITY: DOM
Al
PERMIT ISSUANCE FEE
G1
OUTLETS-LGT,SW,RECP
20.00
OUT
G2
LIGHTING FIXTURES
26.00
WT
H2
RES GREG DISP LT 3HP
1.00
DIS
H3
RES DISHWASHR IT 3HP
1.00
DIS
H5
RES WASH MACH IT 3HP
1.00
WAS
TOTAL FEES
ID: DPR265 ROUTE TO: BS0508
ELECTRICAL PERMIT
EL 0508 1410200023
BUILDING ADDRESS:
6059 GOLDEN WEST AV
AMOUNT:1 TEMP CA 917801755
NEAREST CROSS STREET: GARIBALDI
27.80 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY CA
40.00
47.10 JISSUED ON: PROCESSED BY: PLAN BY:
11.00 110/20/14 SR
11.00 1
1.00 iFI JAL D FINAL BY: CODE:
1477.90 � bI//S( /_[I[�i\
CIS PTIO OF WORK
120 OUTLETS, 26 LIGHT FIXTURES, GARBAGE DISPOSAL, DISHWASHER,
(WASHING MACHINE AND EXHAUST FAN
CONDITIONS:
DATE INSPECTOR SIGNATURE
�RARY POWER POLE
'.GROUND CONDUIT
GROUND
I CONDUIT
WIRING
WATER LINE
'IC YIN METAL YIN
'.TY COMPANY NOTIFIED
I II
I 1i
OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS
I hereby affirm under penalty of perjury that I am exempt from I hereby affirm under penalty of perjury that I am licensed under
the Contractors' State License Law for the reason(s) indicated provisions of Chapter 9 (commencing with Section 7000) of
below by the checkmark(s) I have placed next to the applicable Division 3 of the Business and Professions Code, and my
item(s) (Section 7031.5, Business and Professions Code): Any license is In full force and effect.
city or county that requires a permit to construct alter, Improve, e .� /I / / p
demolish, or repair any structure, prior to its issuance, also �C License Class _ License No. T t_I b A
requires the applicant for the permit to file a signed statement / 1 �TION that he or she is licensed pursuant to the provisions of the 7— Date kontractor Signature r1I•-/Contractors' State License Law (Chapter 9 (commencing withSection 7000) of Division 3 of the Business and Professions W R ERS'C(MPENSATION�DEC
Code) or that he or she is exempt from licensure and the basis
for the alleged exemption. Any violation of Section 7031.5 by WARNING: FAILURE TO SECURE WORKERS' COMPENSATION
any applicant for a permit subjects the applicant to a civil COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN
penalty of not more than five hundred dollars ($500).): 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
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 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 whicl1 I must have resided for at least
one year priorito 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: hfD://www.leainfo.m.aov/calaw.htmi.
Date:
Signature of Property Owner or Authorized Agent
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 carder and policy number are:
Carrier Policy Number Expiration 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, 1 shall forthwith comply with those provisions
lignaat re ot'AApliCato
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 et 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 ❑ 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 SCAOMD.
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 .
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 Property Owner or Authorized Agent
e V-4 /t
" " C O [ , ' N T Y O F ' L O S A N G E L E S
D E P A R T M E N T O F P U B L I C W O R K S
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L I C . N O
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T E M P O R A R Y P O W E R P O L E
U N D E R G R O U N D C O N D U I T
U F E R G R O U N D
R O U G H C O N D U I T
R O U G H W I R I N G
M A I N W A T E R L I N �
P L A S T I C Y / N M E T A L Y / N
U T I L I T Y C O M P A N Y N O T I F I E D
D A T E I N S P E C T O R S I G N A T U R E
T E M P L E C I T Y
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R O U G H C O N D U I T
R O U G H W I R I N G
M A I N W A T E R L I N �
P L A S T I C Y / N M E T A L Y / N
U T I L I T Y C O M P A N Y N O T I F I E D
D A T E I N S P E C T O R S I G N A T U R E
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 Contractor pursuant .to the Contractors' State License
Law). I
(_) 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: htto://www.leainfo.ca.aov/calaw.htmi,
7 -Date: 2 — I % — 1Jli
Signature of Prop 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 Contractor Signature
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 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:
Cartier Policy Number Expiration 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
Signature of Applicant " Daie -
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 requirements
under the Los Angeles County Code Title 2, Chapter x.20'
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
❑ 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
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 gfpropertxOw�r,er or Authorized Aoant
COUNTY OF IAS ANGELES
TEMPLE CITY
p 0506
ELECTRICAL PERMIT
DEPARTMENT OF
PUBLIC WORKS
9701 LAS TUNAS
EL 0508 1411200034
BUILDING AND SAFETY
/ LAND DEVELOPMENT
TEMPLE CITY CA
91760
PHONE: (626) 285-0488
EXT:
(LEGAL ID:
FEES PAID
BUILDING ADDRESS:
ITR: 6561 IT: 90
UN: .003
6059 GOLDEN WEST AV
I
IEEE DESCRIPTION:
QUANTITY: DOM:
AMOUNT:(
TEMP CA 917801755
]ASSESSOR INFORMATION NUMBER:
I
I NEAREST CROSS STREET: GARIBALDI
15385-019-001
IA1 PERMIT ISSUANCE FEE
27.80
THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY
G1 OUTLETS-LGT,SW,RECP
4.00 OUT
8.00
102 LIGHTING FIXTURES
21.00 LGT
40.30
(ISSUED ON: PROCESSED BY: PLAN BY:
[TENANT:
TOTAL FEES
76.10
111/20/14 SR
]OWNER:
TEL.
NO:
]
IFI//[[..��AL DATE FINAL BY: COD6:
16059 LE
16059 GOLDEN WEST AV
(626) 215-2722-
]
I
] //� �
]
]TEMP 917801755
]
] E R T OH' F WORK
I
14 OUTLETS AND 21 RECESS LIGHTS
]
]APPLICANT:
TEL.
NO:
I
]
I
1
]SAME AS OWNER
]
[
ISPECIAL CONDITIONS:
]
]
(CONTRACTOR:
TEL.
NO:
I
]
I
I
(APPROVALS DATE INSPECTOR SIGNATURE
(SAME AS OWNER
-
]
I
1
LIC. NO
1
ITEMPORARY POWER POLE I I
[
I
[UNDERGROUND CONDUIT
(ARCHITECT OR ENGINEER:
TEL.
NO:
]
IUFER GROUND
LIC. NO:
]
]
]ROUGH CONDUIT �
I
(ROUGH WIRZNG
]
1
I
(MAIN WATER LINE
(PLASTIC YIN METAL YIN I
I
I
I
[
1
I
]UTILITY COMPANY NOTIFIED I
I
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REPORT ID: DPR265
I
ROUTE TO: 850508
I I
I I I
I I 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).):
U I, as owner of the property, or my employees with wages as
their sole compensation, will do (J) 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.).
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
L. I am exem)it 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.leainfo.ca.aov/calaw.htmi.
Date: 1 16r-7 O /v,
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.
License Class License No.
Date Contractor Signature
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 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
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 sh dhwih comply with those provisions
11-a0 ala
Sig licant 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 ❑ 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 ❑ 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 conceming 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
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 party -Owner- 'zed Agent
Date