HomeMy Public PortalAbout9828 Garibaldi Ave_Electrical_2/18/2015_ (3)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