HomeMy Public PortalAbout5333 Camellia Ave___COUNTY OF LOS ANGELES
^•f ~ DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
TR: 17780 LT: 6
ASSESSOR INFORMATION NUMBER:
8589-001-022
TENANT
CHEVALIER JAMES J;PATRICIA A
5333 CAMELLIA AV
TEMP 917803245
H, JUSTIN
VENTURA BLVD.
,ND HILLS 91364
ADR ELECTRIC
22741 VENTURA BLVD
WOODLAND HILLS CA 91367
ARCHITECT OR ENGINEER:
TEL. NO:
(626) 286-8548-
TEL. NO:
(877) 237 -6477 -
TEL. NO:
(818) 223 -8344 -
LIC. NO
696338
TEL. NO:
LIC. NO:
ALL GROUNDING AND BONDING OF THE PV SYSTEM SHALL
WITH IAS ANGELES COUNTY REQUIREMENTS. NOTE: WEEB
WASHERS, AND SIMILAR DEVICES ARE NOT ACCEPTED.
TEMPLE CITY N 0508
9701 LAS TUNAS
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
FEES PAID
FEE DESCRIPTION: QUANTITY: DOM:
Al PERMIT ISSUANCE FEE
P2 PC RES PV<IDKW
P3 INVRTR RES PV<10KW
TOTAL FEES
• ADDITIONAL DATA ON FILE
REPORT ID: DPR265 ROUTE TO: BS0508
AMOUNT
27 80
153.90
27.90
209.60
ELECTRICAL PERMIT
EL 0508 1412150045
BUILDING ADDRESS:
5333 CAMELLIA AV
TEMP CA 917803245
NEAREST CROSS STREET:
THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY CA
ISSUED ON: PROCESSED BY: PLAN BY:
12/15/14 SR
FINAL DATE FINAL BY: CODE:
Ldc' �
DESCRIPTION OF�WORK
SOLAR 14 PANELS
SPECIAL CONDITIONS:
APPROVALS DATE
TEMPORARY POWER POLE
UNDERGROUND CONDUIT
UFER GROUND
ROUGH CONDUIT
ROUGH WIRING
MAIN WATER LINE
PLASTIC YIN METAL YIN I
UTILITY COMPANY NOTIFIED
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).):
L) 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).
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 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: hfD://www.leginfo.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 Profes)on'Code, and my
license is in full force and effect. � �-1„•�
License ClassLicense No.
Date 12 ��' Contractor Signature
\1 )
WORKERS' COMPENSATION
WARNING: FAILURE TO SECURE WORKERS' OMPtNSATION
COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN
EMPLOYER TO CRIMINAL PENALTIES AN15 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.
Po 'cy No.
I have and will maintain workers' compensation
nsurance, as required by Section 3700 of the Labor Code, for
the performance of the work for which this permit is issued. My
work rs' ompensat'on insu r r po numb r
SK SVT gll,5
i
artier 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 b come subject to the workers' compensation laws of
California, aXforth
ee that, if I should become subject to the
workers' coprovisions of Section 3700 of the Labor
Code, I shallth mplywith those provisions
Signaturecff. pplican Date
LOBB)PST ORDINANCE CERTIFICATION
mplete this section for permits In
Unincorporated Los Angeles County only
This is to certify that I, as permit applicant, familiar with the
requirements of Los Angeles County Code Cha 2.160 et seq.,
(relat' g to the Los Angeles County Lobbyist Or a e) and that
all pe sons acti on behalf of myself complied d ill continue
to co ply tt erew h ough rthhe� application process.
Appli n 'nt ` / /Applicant Si atu '
tt `
Company Name Da
LOCALITY
HAZARDOUS MATERIAL DECLARATION
Will the applic@nt 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 ❑
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 an state laws relating to building
construction.
I authorize represves of this county to enter the
above -identified prop rtY r inspection purposes.
Signature of Property_Own�r or Au odzed gent
Date 112.%t � �U —�