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HomeMy Public PortalAbout9552 FLAHERTY ST_Electrical_2/5/2015_CDYVTY'OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEMkRTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1502050057 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: GAL ID: : 17179 LT: 62 SESSOR INFORMATION NUMBER: 85-012-027 THIEU, CAM 9552 FLAHERTY ST TEMP 917801645 NG, JACK 5 LEE AVENUE #3 EL MONTE CA 91733 SWM CONSTRUCTION INC. 2645 LEE AVENUE #3 50 EL MONTE CA 91733 ARCHITECT OR ENGINEER: TEL. NO: (626) 274 -9357 - TEL. NO: (626) 274 -9357 - LIC. NO 836333 TEL. NO: LIC. NO: REPORT ID: DPR265 ROUTE TO: BS0508 BUILDING ADDRESS: 9552 FLAHERTY ST TEMP CA 917801645 NEAREST CROSS STREET: PRIMROSE THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY CA ISSUED ON: PROCESSED BY: PLAN BY: 02/05/15 SR F 1TE FIN BY: CODE: DGS SON OF WORK 10 OUTLETS, 2 LIGHT FIXTURES, FAU AND A/C UNIT FOR NEW CONDITIONS: APPROVALS DATE TEMPORARY POWER POLE UNDERGROUND CONDUIT UFER GROUND ROUGH CONDUIT V ROUGH WIRING MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED INSPECTOR SIGNATURE FEES PAID FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: JAI PERMIT ISSUANCE FEE 27.80 G1 OUTLETS-LGT,SW,RECP 10.00 OUT 20.00 JG2 LIGHTING FIXTURES 2.00 LGT 4.00 1 H FAU LESS 3HP 1.00 FAU 11.00 [J]3 AC UNITS ♦3-10HP 1.00 AC 19.70 TEL. NO: TOTAL FEES 82.50 (626) 400 -9095 - TEL. NO: (626) 274 -9357 - TEL. NO: (626) 274 -9357 - LIC. NO 836333 TEL. NO: LIC. NO: REPORT ID: DPR265 ROUTE TO: BS0508 BUILDING ADDRESS: 9552 FLAHERTY ST TEMP CA 917801645 NEAREST CROSS STREET: PRIMROSE THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY CA ISSUED ON: PROCESSED BY: PLAN BY: 02/05/15 SR F 1TE FIN BY: CODE: DGS SON OF WORK 10 OUTLETS, 2 LIGHT FIXTURES, FAU AND A/C UNIT FOR NEW CONDITIONS: APPROVALS DATE TEMPORARY POWER POLE UNDERGROUND CONDUIT UFER GROUND ROUGH CONDUIT V ROUGH WIRING MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED INSPECTOR SIGNATURE 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 U 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 Contractor pursuant .to the Contractors' State License Law). U- I am exeml t 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 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: http://www.lecinfo.ca.aov/calaw.htmi. 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. License Class License No� 106 3 �,3 Date Contractor Signature / WORKERS' COMPENSATIO DECi1_ARATION 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. 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 ❑ 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 ❑ Ro ❑ �" I have read the hazardous materials information guide and the I hereby affirm under penalty of perjury one of the following SCAQMD permitting checklist, I understand my requirements declarations: under the Los Angeles County Code Title 2, Chapter 220' 1 have and will maintain a certificate of consent to self- Sections 220.100 through 220.140 concerning hazardous insure for workers' compensation, issued by the Director of 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 AI have and will maintain workers' compensation is ranee, 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. erscorn i n on 'nsura ce carrier and c numb r a e: -- � 6D�� ECLARATION REGARDING CONSTRUCTION LENDING Carver Policy Number Expiration Date AGENCY Name of Agent Phone Number _ 1 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 Cal' mi i. and agree that, if I should become subject to the wotk rs' compensation provisions of Section 3700 of the Labor C , I shaII o hwith comply with those provisions Si �tute 6f Applicant date LOBBYIST ORDINANCE CERTIFICATION Complete this section for permits in Unincorporated Los Angeles County only This is to certify that 1, 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 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: 1 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 authorirepresentatives of this county to enter the above -id ified property, for inspection purposes. Signature r Owne r A ho ' e Agent Date f1� B COIIN'!Y GF IAS ANGELES DOARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 17179 LT: 62 ASSESSOR INFORMATION NUMBER: 5385-012-027 CAM FLAHERTY ST 917801645 NG, JACK 5 LEE AVENUE #3 EL MONTE CA 91733 3WM CONSTRUCTION INC. ?645 LEE AVENUE a3 30 EL MONTE CA 91733 %RCHITECT OR ENGINEER: TEL. NO: (626) 400 -9095 - TEL. NO: (626) 274 -9357 - TEL. NO: (626) 274 -9357 - LIC. NO 836333 TEL. NO: LIC. NO: TEMPLE CITY P. 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: FEES PAID 'EE DESCRIPTION: QUANTITY: COM: AMOUNT: .1 PERMIT ISSUANCE FEE 27.80 9 200 AMP PANELS, MCC 1.00 PAN 38.90 TOTAL FEES 66.70 ID: DPR265 ROUTE TO: BS0508 ELECTRICAL PERMIT EL 0508 1503170038 DUPLICATE BUILDING ADDRESS: 9552 FLAHERT'Y ST TEMP CA 917801645 NEAREST CROSS STREET: PRIMROSE THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY Ci ISSUED ON: PROCESSED BY: PLAN BY: 03/17/15 SR FINAL DATE F(Ji�OA(,i�\�/9Y: CODE: D�N OF WORK l UPGRADE METER TO 200 AMP SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE TEMPORARY POWER POLE UNDERGROUND CONDU/IT UFER GROUND /(/1 [ ROUGH CONDUIT I�UC`� ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIES 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 Contractor pursuant .to the Contractors' State License Law). U: 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 whicij I must have resided for at least one year prior) to completion of the improvements covered by this permit, I cannot 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.lecinfo.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 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 Signature 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 ❑ 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 ❑ 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 representatives of this county to enter the above -identified property for inspection purposes. Signature of Property Owner or Authorized Agent Date