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Home My Public Portal About9477 Blackley St_Electrical_9/4/2013_COUNTY OF LOS ANGELES TEMPLE CITY N 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1309040044 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: ON FILE ASSESSOR INFORMATION NUMBER: 8590-004-014 TENANT OWNER: TEL. NO: CHE, CRAY C 4320 GROSSVALE AVE EL MONTE CA 91733 APPLICANT: TEL. NO: LAM, CHSUNG S (714) 801-2859- 6980 ARAGON CIR BUENA PARK CA 90620 CONTRACTOR: TEL. NO: CSL BUILDERS (714) 801-2859- 6980 ARAGON CIR SUITE 2 LIC. NO BUENA PARK CA 90620 982802 OR ENGINEER: TEL. NO: LIC. NO: FEES PAID FEE DESCRIPTION: QUANTITY: UOM: Al PERMIT ISSUANCE FEE C2 SPAS, HOT TUBS, OTHR G1 OUTLETS-LGT,SW,RECP G2 LIGHTING FIXTURES HA FAU LESS 3HP H2 RES GRBG DISP IT 3HP H3 RES DISHWASHR IT 3HP H4 RES RANGE HOE LT 3HP H5 RES WASH MACH IT 3HP H7 RES EXHAUST FANS JB AC UNITS t3-10HP REPORT ID: DPR265 1.00 SPA 52.00 OUT 69.00 LGT 1.00 FAU 1.00 DIS 1.00 DIS 1.00 H00 1.00 WAS 4.00 EX 1.00 AC TOTAL FEES ROUTE TO: BS0508 AMOUNT 27.80 54.50 82.00 104.80 11.00 11.00 11.00 11.00 11.00 44.00 19.70 387.80 BUILDING ADDRESS: 9477 BLACKLEY ST TEMP CA 917603158 NEAREST CROSS STREET: THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, C ISSUED ON: PROCESSED BY: PLAN BY: 09/04/13 SR FINAL DATE FI CODE: -�SVD PTION F WORK ELECTRICAL WORK FOR NEW SINGLE FAMILY RESIDENCE SPECIAL CONDITIONS: DATE INSPECTOR SIGNATURE IRARY POWER POLE :GROUND CONDUIT GROUND I CONDUIT I WIRING WATER LINE 'IC Y/N METAL Y/N TY COMPANY NOTIFIED j'7/7„/J� „n 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 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 Classq • ' License No�eO 06r P /, Z Date % Contractor Signature� WORKERS' COMPENSATION DECLARATION WiMING: 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 wpr a s' compeosafo0ynsurance carr�'@r gn�.policy n rub r ire: !, 7 �70r T'rH% l� GI 0 6 / 5 .5r/ O /7 z/ Carder Policy Number Expiration Date Name of Agent Phone Number UI am exempt from licensure under the Contractors' State I certify that, in the performance of the work for which this License Law for the following reason: 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 By my signature below I acknowledge that, except for my workers' compensation provisions of Section 3700 of the Labor personal residence in which one to completioq I must have resided for at least of the improvements by Code, I shall forthwith comply with those provisions year priori this permit, Icgnnot legally sell covered a structure that I have built as an �!, ��/ /meq `� owner -builder if it has not been constructed in its entirety by Applicant Datei / licensed contractors. I understand that a copy of the applicable Igna of law, Section 7044 of the Business and Professions Code, i available upon request when this application is submitted or at LOBBYIST ORDINANCE CERTIFICATION the following Web site: httD://vnvw.lecinfo.ca.cov/calaw.html. Complete this section for permits in Date: Signature of Property Owner or Authorized Agent 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 throw a application process. plicant (Print Name) Applicant Signa re C;SI_ Burl r0_A-t2 17117/ 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 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 ❑ 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 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 Oymer or Authorized Agent