HomeMy Public PortalAbout9659 Garibaldi Ave_Electrical_1/16/2015_ID: DPR265 ROUTE TO: BS0508
ELECTRICAL PERMIT
EL 0508 1501160006
BUILDING ADDRESS:
9659 GARIBALDI AV
TEMP CA 917801738
NEAREST CROSS STREET:
THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY C
ISSUED ON: PROCESSED BY: PLAN BY:
01/16/15 SR
FINAL ATE FIA BY: CODE:
D S�' CRIU�O woax
REPLACE LIGHT NG OUTLETS, RE ECTICLE, AND SWITCHES AND
EXHAUST FAN CHANGE OUT
SPECIAL CONDITIONS:
APPROVALS DATE INSPECTOR SIGNATURE
TEMPORARY POWER POLE
UNDERGROUND CONDUIT
UFER GROUND
ROUGH CONDUIT I
ROUGH WIRING qe/I L`LA I
MAIN WATER LINC/&(d �l. `
PLASTIC Y/N METAL Y/N I
I I
UTILITY COMPANY NOTIFIED( I
TEMPLE CITY
• COUNTY OF LOS ANGELES
DEPARTMENT OF
PUBLIC WORKS
BUILDING AND SAFETY
/ LAND DEVELOPMENT
LEGAL ID:
ITR: 13277 LT: 15
UN: .002
I
ASSESSOR INFORMATION NUMBER:
91780
15385-017-022
1
ITENANT:
I
PHONE: (626) 285-0488
I
(OWNER:
TEL. NO:
IMARAHA PROPERTIES
(714) 541-1002-
11666 MAIN STREET
FEES PAID
ISANTA ANA CA 92705
(APPLICANT:
TEL. NO:
TAULNEY, GEOFF
(562) 522-3190-
112062 VALLEY VIEW 12
17A GARDEN GROVE CA
I
I
]CONTRACTOR:
TEL. N0:
IGMT
(562) 522-3190-
112062 VALLEY VIEW 127A
LIC. NO
IGARDEN GROVE CA 92845
869082
1ARCHITECT OR ENGINEER:
TEL. N0:
LIC. NO:
ID: DPR265 ROUTE TO: BS0508
ELECTRICAL PERMIT
EL 0508 1501160006
BUILDING ADDRESS:
9659 GARIBALDI AV
TEMP CA 917801738
NEAREST CROSS STREET:
THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY C
ISSUED ON: PROCESSED BY: PLAN BY:
01/16/15 SR
FINAL ATE FIA BY: CODE:
D S�' CRIU�O woax
REPLACE LIGHT NG OUTLETS, RE ECTICLE, AND SWITCHES AND
EXHAUST FAN CHANGE OUT
SPECIAL CONDITIONS:
APPROVALS DATE INSPECTOR SIGNATURE
TEMPORARY POWER POLE
UNDERGROUND CONDUIT
UFER GROUND
ROUGH CONDUIT I
ROUGH WIRING qe/I L`LA I
MAIN WATER LINC/&(d �l. `
PLASTIC Y/N METAL Y/N I
I I
UTILITY COMPANY NOTIFIED( I
TEMPLE CITY
#
0508
9701 LAS TUNAS
TEMPLE CITY CA
91780
PHONE: (626) 285-0488
EXT:
FEES PAID
FEE DESCRIPTION:
QUANTITY: DOM:
AMOUNT:
Al
PERMIT ISSUANCE FEE
27.80
GI
OUTLETS-LGT,SW,RECP
59.00 OUT
91.40
H7
RES EXHAUST FANS
2.00 EX
22.00
TOTAL FEES
141.20
ID: DPR265 ROUTE TO: BS0508
ELECTRICAL PERMIT
EL 0508 1501160006
BUILDING ADDRESS:
9659 GARIBALDI AV
TEMP CA 917801738
NEAREST CROSS STREET:
THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY C
ISSUED ON: PROCESSED BY: PLAN BY:
01/16/15 SR
FINAL ATE FIA BY: CODE:
D S�' CRIU�O woax
REPLACE LIGHT NG OUTLETS, RE ECTICLE, AND SWITCHES AND
EXHAUST FAN CHANGE OUT
SPECIAL CONDITIONS:
APPROVALS DATE INSPECTOR SIGNATURE
TEMPORARY POWER POLE
UNDERGROUND CONDUIT
UFER GROUND
ROUGH CONDUIT I
ROUGH WIRING qe/I L`LA I
MAIN WATER LINC/&(d �l. `
PLASTIC Y/N METAL Y/N I
I I
UTILITY COMPANY NOTIFIED( I
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 (,/) 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).
U 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 cq'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: http://www.leainfo.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 Professions Code, and my
license is in full force and effect.
License Class .'7 License No. 2 -
Date �SContractor Signature
WORKERS' COMPENSATION TION
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 ofthework 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
/e'rmit is issued, I shall not employ any person in any manner
so as to be e subject to the workers' compensation laws of
California, agree that, if I should become subject to the
workers' c nsation provisions of Section 3700 of the Labor
Code,Tshlrthwith comply with those provision
Signat licant Datd
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 CPapter 2.160 et seq.,
(relating to the Los Angeles County Lobbyist Prdinance) and that
all persons acting on behalf of myself com ad and will continue
to com y therewith through the applicatSDa
6604r" '7h
r If
ApplicanameL _ App
Company Name C1�
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 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 pequry 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 repr sen tives of this county to enter the
above -identified rp rty for inspection purposes.
Signature of Pf6#kdy)W0Jr fr Authorized Agent
Date
COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
ITR: 13277 LT: 15
ASSESSOR INFORMATION NUMBER:
15385-017-022
(TENANT:
I
OWNER:
IMAKAHA PROPERTIES
11666 MAIN STREET
ISANTA ANA CA 92705
I
I
(APPLICANT:
ITAULNEY, GEOFF
112062 VALLEY VIEW 12
17A GARDEN GROVE CA
1
ICONTRACTOR:
IGMT CONTRUCTION
112062 VALLEY VIEW 127A
IGARDEN GROVE CA 92845
(ARCHITECT OR ENGINEER:
UN: .002
TEL. NO:
(714) 541 -1002 -
TEMPLE CITY
9701 LAS TUNAS
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
FEES PAID
IFEE DESCRIPTION: QUANTITY: UOM
IA1 PERMIT ISSUANCE FEE
IG1 OUTLETS-LGT,SW,RECP 8.00 OUT
JH2 RES GRBG DISP LT 3HP 1.00 DIS
JH4 RES RANGE HDS LT 3HP 1.00 HOO
I TOTAL FEES
TEL. NO:
(562) 522-3190- 1
I
I
I
TEL. NO:
(562) 522-3190- I
LIC. NO 1
869082 I
I
TEL. NO: 1
LIC. NO:
REPORT ID: DPR265
I
# 0508
ROUTE TO: BS0508
ELECTRICAL PERMIT
EL 0508 1502120035
BUILDING ADDRESS:
9659 GARIBALDI AV 1
AMOUNT: TEMP CA 917801738
NEAREST CROSS STREET:
27.80 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY CAI
16.00
11.00 JISSUED ON: PROCESSED BY: PLAN BY:
11.00 102/12/15 SR 1
65.80 1
FINAL/BATF � FIY: CODE:
DIDDISCRI[i6T/MN OF WORK
IKITCHEN REMODEL REPLACE EXI TING 8 GFCI, GARBAGE DISPOSAL 1
(AND RANGE HOOD 1
ISPECIAL CONDITIONS: I
1
(APPROVALS DATE INSPECTOR SIGNATURE I
ITEMPORARY POWER POLE I I
1UNDERGROUND CONDUIT 1 1
IUFER GROUND I I 1
I I I 1
IROUGH CONDUIT I I I
I �
TROUGH WIRING
IMAIN WATER LINE I 1
I i I
PLASTIC YIN METAL YIN
UTILITY COMPANY NOTIFIED1 i 1
I I I I
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 (_) 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 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 priori to completion of the improvements covered by
this permit, I.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://www.leainfo.ca.cov/celaw.htmi.
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 Professions Code, and my
license is in full force and effect. _ A
License*Clas � License No. Date �Contractor Signature
WORKERS' COMPENSATION TION
WARNING: FAILURE TO SECURE WOR E S' MPENSATION
COVERAGE IS UNLAWFUL, AND S ALL SUBJECT AN
EMPLOYER TO CRIMINAL PENALTIES Ar
CI IL 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
Ngme of Agent Phone Number
�X\ I certify that, in the performance of the work for which this
permit is 1 ued, I shall not employ any person in any manner
so as to co subject to the workers compensation laws of
Califomi nd me that, if I should become subject to the
workers' m sation provisions of Section 3700 of the Labor
Code, I s II f wit comply with those provisioons
Signa�kur6 o /Applic9lnt Date// 2/Jr
/LOBQ'1'IST ORDINANCE CERTIFICATION
Coolmplete 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.
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 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 and state laws relating to building
I authorize4e r entatives of this county to enter the
above-ident' I operty, for inspection purposes.
Signature�
Applicant (Print Name) Applicant Signature I Trier or Authorized Agent
Company Name Date