Loading...
HomeMy Public PortalAbout9828 Garibaldi Ave_Electrical_2/18/2015_COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 6561 LT: 55 UN: .003 ASSESSOR INFORMATION NUMBER: 5385-027-003 TENANT: OWNER: MR. AN CHAO 9828 GARIBALDI AV TEMP 917801712 APPLICANT: PARTON, BRUCE 1351 TOTTENHAM CT OAK PARK CA 91377 CONTRACTOR: IHP ASSOCIATES, INC. 1351 TOTTENHAM CT OAK PARK CA 91377 ARCHITECT OR ENGINEER: CHARLES BLAUGRUND 114994 MARQUETTE STREET IMOORPARK CA 93021 I TEL. NO: TEL. NO: (818) 879 -5002 - TEL. NO: (818) 879 -5002 - LIC. NO 740238 TEL. NO: (805) 529 -1979 - LIC. NO: C25792 TEMPLE CITY 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: FEES PAID FEE DESCRIPTION: QUANTITY: UOM: IA1 PERMIT ISSUANCE FEE IE1 TEMP SERV POWER POLE 1.00 TMP TOTAL FEES 1* ADDITIONAL DATA ON FILE REPORT ID: DPR265 ROUTE TO: BS0508 ELECTRICAL PERMIT EL 0508 1502180008 BUILDING ADDRESS: 9828 GARIBALDI AV AMOUNT:l TEMP CA 917801712 NEAREST CROSS STREET: GOLDEN WEST 27.80 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY CAI 43.70 71.50 JISSUED ON: PROCESSED BY: PLAN BY: 102/18/15 SR 1 FINAi' ` 1TE � FI AL ZTV CODE: 1 ID�SCRIPTION OF WORK TEMPORARY POWER POLE SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE TEMPORARY POWER POLE I I UNDERGROUND CONDUIT 'Pill 1UFER GROUND/ n ROUGH COND61T j7,�—/ ROUGH WIRING MAIN WATER LINE PLASTIC YIN METAL YIN 1UTILITY COMPANY NOTIFIE 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.). (_) 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 Contrb�tor pursuant .to the Contractors' State License Law). (_) I am exem fit 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: httD://www.leainfo.ca.aov/calaw.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 Profession Code, and my license is in full forme and effect, -License Class License No. ,Date ?Zdl�ntractor Signature / v WORKERS' COMPENSATION/'DEC RATION WARNING: FAILURE TO SECURE WORKERS' C PENSATION COVERAGE IS UNLAWFUL, AND SHALL S BJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL INES 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 word' cgfnposati96 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' c ensation provisions of Section 3700 of the Labor Code, I s all f rthwith comply with those provisions Sign ure of Applicant 1 ' 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 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 ❑ 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 ❑ 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 ❑ 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 r r entatives of this county to enter the above-ide ified operty for inspection purposes. Signatur o rty Owner or Authorized Agent \),a-te ��_4 COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID TR: 6561 IT: 55 UN: .003 ASSESSOR INFORMATION NUMBER: 5385-027-003 TENANT: OWNER: TEL. NO: MR. AN CHAO 9828 GARIBALDI AV TEMP 917801712 NYYL1.X : PARTON, BRUCE 1351 TOTTENHAM CT OAK PARK CA 91377 CONTRACTOR: HP ASSOCIATES, INC. 1351 TOTTENHAM CT OAK PARK CA 91377 ARCHITECT OR ENGINEER: CHARLES BLAUGRUND 14994 MARQUETTE STREET MOORPARK CA 93021 TEL. NO: (818) 879 -5002 - TEL. N0: (818) 879 -5002 - LIC. NO 740238 TEL. NO: (805) 529 -1979 - LIC. NO: C25792 TEMPLE CITY $ 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: FEES PAID FEE DESCRIPTION: QUANTITY: DOM: Al PERMIT ISSUANCE FEE G1 OUTLETS-LGT,SW,RECP G2 LIGHTING FIXTURES HA FAU LESS 3HP H2 RES GREG DISP IT 3HP H3 RES DISHWASHR IT 3HP H4 RES RANGE HOS IT 3HP H5 RES WASH MACH IT 3HP JB AC UNITS +3-10HP LB 200 AMP PANELS. MCC * ADDITIONAL DATA ON FILE IREPORT ID: DPR265 40.00 OUT 12.00 LGT 1.00 FAU 1.00 DIS 1.00 DIS 1.00 HOO 1.00 WAS 1.00 AC 1.00 PAN TOTAL FEES ROUTE TO: BS0508 ELECTRICAL PERMIT EL 0508 1502090003 BUILDING ADDRESS: 9828 GARIBALDI AV AMOUNT: TEMP CA 917801712 NEAREST CROSS STREET: GOLDEN WEST 27.80 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY CAI 65.90 24.00 'ISSUED ON: PROCESSED BY: PLAN BY: 11.00 02/09/15 SR 11.00 11.00 FINAL DATE FI BY: CODE: 11.00 11.00 BE&�. � 19.70 F WORK 38.90 140 OUTLETS, 12 LIGHT FIXTURES, FAU, AC UNITS, DISHWASHER, 231.30 IRANGE HOOD, WASHING MACHINE, GARBAGE DISPOSAL, AND UPGRADE SERVICE PANEL TO 200 AMP (SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE TEMPORARY POWER POLE UNDERGROUND CONDUIT UFER GROUND ROUGH CONDUIT ROUGH WIRING IMAIN WATER LINE �1 PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED,(�.'(- �? � I 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) 1 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 Contractor pursuant .to the Contractors' State License Law). U. I am exem fit 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 priori to completion; of the improvements covered by this permit, I c1'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: httD://www.leainfo.ca.aov/calaw.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. License Class 6 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 w rs' a pe sation insu���rrjer and policy n b r e: ((/ td Y 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' cqfPo nsation provisions of Section 3700 of the Labor Code, I s Ihwithcomply with those provisions Wq((r Signat of Applicant 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 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, 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 rresentatives of this county to enter the above-iden ' ie property for inspection purposes. Signatur f perry Owner or Authorized Agent fA r Date