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Home My Public Portal About5220 Daleview Ave_Electrical_6/11/1952_A 7-81APPLICATION FOIL P ARTOF BUMPING AND SAFETY A�MWT I COUNTY'OF LOS ANGELES ELECTRIC I WILLIAM J. FOX, CHIEF ENGINEER DISTRICT NO. GROUP ZONE PERMIT NO. FOR APPLICANT TO FILL IN I ELECTRICIAN ' RECEIVED )3Y READY FOR DATE ISSUED ADDRESS FIRST INSPECTION CITY TEL. NO. COUNTY LICENSE NO. EXPIRES BUILDING �%,� s�), � PERMIT FEES FEE N ER EACH ADDRESS /KJ. fs�a ,LOCALITY Irk -- 1HEARE13T LIGHT OUTLETS CROSS ST. RECEPTACLES j WALL SWITCHES OWNER � TOTAL OUTLETS SO !¢ � �% MAIL _/ ELEC. RANGES a5 ADDRESS ' ELEC. HEATERS .s► 28 CITY TEL. NO. � FIXTURES 5 4401 HEREBY IACKNOWL&GE THAT I HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IBCORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. ` MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS NuMaER HORSEPOWER ANGELES COUNTY LI NSE, OR I AM THE LEGAL OWNER NEw MVD. HP OVER INC. EACH or THE RESIDENTI OPERTY DESCRIBED ABOVE. A LEes !$ .25 SIGNATURE OF f `Q PERMITTFV a s 1.00 INSPECTION RECORD 8 13 1.50 _ 15 80 2.50 80 200 5.00+ 200 aoo 10.00 J aoo 1000 18.00 Z OVER 1000 20.00 p M.G. SET/FREQ. CHANGER -HP WELDERS: AC-KVA GENERATORS - KW , TRANSFORMERS- KVA TEMP. MOTORS (78% OF CRia.) MOVED MOTORS (75% of ORIG.) MISC. SIGNS NO. NO. TRANS. I APPROVALS NO. NO. LAMP19 I I FOR EACH PERMIT: GATE INSPECTOR'S NAME $1.00 CONDUIT NagWIRING / WIRING ' �'L - -�'•� . FIXTURES $1.00 J ..� ��1 l SUPPLEMENTARY .50 FIXTURES $ •gyp' ✓ POWER TOTAL FEE B '�',+ UTILITY CO. NOTIFIED FINAL -t� TORR' � * j✓ 1 te jr� \� f Y• •il �*� t v1 'fir 'K �• � �� •� XS �1 �4f. 'JTIt �'7'� 4. • c i., r. •3 i e , COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL -0508 1407100052 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: TR: 14020 LT: 5 ASSESSOR INFORMATION NUMBER: 8574-007-005 OWNER: TEL. NO: ALMANZAN RUBEN R;GLORIA F (626) 443-7978- 5220 DALEVIEW AV TEMP 917803523 APPLICANT: TEL. N0: SAME AS OWNER CONTRACTOR: TEL. NO: SAME AS OWNER - LIC. NO ARCHITECT OR ENGINEER: TEL. NO: LI, DAVID (626) 288-1216- 1000 SAN GABRIEL BLVD LIC. NO: #101 ROSEMEAD CA 91770 FEES PAID EE DESCRIPTION: QUANTITY: DOM 1 PERMIT ISSUANCE FEE BUILDING ADDRESS: 1 OUTLETS-LGT,SW,RECP 17.00 OUT 2 LIGHTING FIXTURES 7.00 LGT A FAU LESS 3HP 1.00 PAU B AC UNITS +3-10HP 1.00 AC S 200 AMP PANELS, MCC 1.00 PAN LOCALITY: TEMPLE CITY C, TOTAL FEES ADDITIONAL DATA ON FILE EPORT ID: DPR265 ROUTE TO: BS0508 SPECIAL CONDITIONS: �RARY POWER POLE GROUND CONDUIT GROUND CONDUIT WIRING WATER LINE 'IC YIN METAL YIN TY COMPANY NOTIFI DATE INSPECTOR SIGNATURE BUILDING ADDRESS: 5220 DALEVIEW AV AMOUNT:j TEMP CA 917803523 NEAREST CROSS STREET: 27.80 THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY C, 34.00 14.00 JISSUED ON: PROCESSED BY: PLAN BY: 11.00 107/10/14 SR 19.70 1 38.90 IFI DATE FINAL Y: CODE: 145.40//��{{''//''((,,TT////// �DUP7'ION`OF WORK 117 OUTLETS, 7 LIGHT FIXTURE , A/C + HEATING SYSTEM AND [UPGRADE SERVICE PANEL TO 200 AMP SPECIAL CONDITIONS: �RARY POWER POLE GROUND CONDUIT GROUND CONDUIT WIRING WATER LINE 'IC YIN METAL YIN TY COMPANY NOTIFI DATE INSPECTOR SIGNATURE OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION 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 (,r) 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). L): I am exemat from licensure under the Contractors' State License Law for the following reason: By my signature below 1 acknowledge that, except for my personal residence in which I must have resided for at least one year prior) to completion; of the improvements covered by this permit, I c 'nnot 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:Ilwww.leainfo.ca.aovlcalaw.html. Date: 7 / l D f r ture of Pr a 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 V11ARNING: 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 shall forthwith comply with those provisions 71014 Signature of Applicant Ddte 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 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 ❑ 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.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 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, l 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. Sigrurte of op caner or Authorized Agent Date7//& I