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Home My Public Portal About5632 Cambury Ave_Electrical_6/2/2015_COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1506020021 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 15159 LT: 15 5632 CAMBURY AV FEE DESCRIPTION: QUANTITY: DOM: AMOUNT:j TEMP CA 917802601 ASSESSOR INFORMATION NUMBER: I INEAREST CROSS STREET: LIVE OAK 8588-013-001 JAI PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY [LB 200 AMP PANELS, MCC 1.00 PAN 38.90 TENANT: TOTAL FEES 66.70 [ISSUED ON: PROCESSED BY: PLAN BY: 06/02/15 SR OWNER: TEL. NO: FWAL DATE FINN. B CODE: HUANG, YONG T (626) 641-3063- r 5632 CAMBURY AV !` y TEMP 917802601 [DTSCkIPTION OF WORK UPGRADE 200 AMP MAIN PANEL APPLICANT: TEL. NO: MIN BRAND KO (626) 926-9616- [ 5453 BALDWIN AVENUE CONDITIONS: TEMPLE CITY CA 91780 iSPECIAL CONTRACTOR: TEL. N0: [APPROVALS DATE INSPECTOR SIGNATURE KV ELECTRIC INC. (626) 926-9816- [ 5453 BALDWIN AVENUE LIC. NO ITEMPORARY POWER POLE TEMPLE CITY CA 91780 591509 [ UNDERGROUND CONDUIT [ ARCHITECT OR ENGINEER: TEL. NO: JUFER GROUND LIC. NO: ROUGH COND ROUGH WIRING [ [ [MAIN WATER LINE [ PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED THIS PERMIT EXPIRES 6 MONTHS FROM DATE OF ISSUANCE OR FROM DATE OF LAST VALID INSPECTION. i [ [ [REPORT ID: DPR265 ROUTE T0: BSO508 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 (✓) 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) 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 pursuanLto the Contractors' State License Law). L. 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 priorlto completion: of the improvements covered by this permit, I cnnot 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.leoinfo.ca.aov/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 with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. < c� License Class Gee License No. 7LDate�Contractor Signature WORKERS' COMPENSATION DECLAWION 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 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 ❑ N o ❑ % i 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. Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit ASBESTOS NOTIFICATION is issued. Policy No. ❑ Notification letter sent to AQMD and/or EPA I have and will maintain workers' compensation surance, as required by Section 3700 of the Labor Code, for ❑ I declare that notification of asbestos removal is not the performance of the work for which this permit is issued. My applicable to addressed project. vltgrk€tsI'Pomdeits tir�Rtn�urancepar{ieo artd,dbl j�prypey af2:� �/�/DECLARATION REGARDING CONSTRUCTION LENDING Carrier (� Polic_yiNcummbbeerrr Exlppiir(attiionn Daatte AGENCY 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 Appfrcant � 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 throug he application process. � lican `t Applicant Siure o an arae a[e 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 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 of Property O per o�orized Agent (` o COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 15159 LT: 15 ASSESSOR INFORMATION NUMBER: 8588-013-001 TENANT OWNER: TEL. NO: NG HUANG, MARIA (626) 715-2890- 5632 CA14BURY AV TEMP 917802601 TEL. NO: AS OWNER ACTOR: TEL. NO: AS OWNER LIC. NO OR ENGINEER: TEL. NO: LIC. NO: PERMIT EXPIRES 180 DAYS IF 1) WORK DOES NOT COMMENCE, OR 2) WORK IS SUSPENDED OR ABANDONED, OR 3) FAILS TO OBTAIN CODE REQUIRED INSPECTION (SPECIAL CONDITIONS !APPROVALS DATE INSPECTOR SIGNATURE TEMPORARY POWER POLE UNDERGROUND CONDUIT UFER GROUND ROUGH CONDUIT ROUGH WIRING IN WATER LINE PLASTIC YIN METAL YIN MA UTILITY COMPANY NOTIFIED1 I TEMPLE CITY H 0508 ELECTRICAL PERMIT DPR265 9701 LAS TUNAS 13S0508 EL 0508 1508260009 TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: FEES PAID BUILDING ADDRESS: 5632 CAMBURY AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802601 1 NEAREST CROSS STREET: LIVE OAK Al PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY CA G1 OUTLETS-LGT,SW,RECP 5.00 OUT 10.00 G2 LIGHTING FIXTURES 10.00 LGT 20.00 JISSUED ON: PROCESSED BY: PLAN BY: HI RES ELEC OVEN LT 3HP 1.00 OVE 11.00 08/26/15 SR H2 RES GREG DISP LT 3HP 1.00 DIS 11.00 H3 RES DISHWASHR LT 3HP 1.00 DIS 11.00 IFINAI, D TE FINAL ,$Y: CODE: H4 RES RANGE HDS LT 3HP RANGE 1.00 H00 11.00 � /,MM}�.{{ TOTAL FEES 101.80 V I t IDESCRI ON F ORR 15 OUTLETS, 10 LIGHT FIXTURES, ELECTRIC OVEN, GARBAGE (DISPOSAL, DISHWASHER, RANGE HOOD FOR KITCHEN AND BATHROOMS (SPECIAL CONDITIONS !APPROVALS DATE INSPECTOR SIGNATURE TEMPORARY POWER POLE UNDERGROUND CONDUIT UFER GROUND ROUGH CONDUIT ROUGH WIRING IN WATER LINE PLASTIC YIN METAL YIN MA UTILITY COMPANY NOTIFIED1 I ZEPORT ID: DPR265 ROUTE TO: 13S0508 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 (,i) 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). (J I am exemfit 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 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.leoinfo.ca.ciov/calaw.html. Date: jta f (V 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 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 shall forthwith comply with those provisions PP ay - Signature of A lira Dat 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 ❑ 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 requirem nts 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 toeach 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. SignatLye of Property Owner or Authorized Agent ib Date