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Home My Public Portal About5446 BALDWIN AVE_Electrical__ (2) -Tc (5 .- > 33y7 �rrNfirm that COMPENSATION DECLARATION CE 863 10/81 APPLICATION FOR ELECTRICAL PERMIT ~��r.^r�jy�,�{firm,that I have a certificate of consent to self CE 806G in6ure or t certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy 6✓`eof_,Sec 3800 Lob C ) bie 8 9 Poli o Company �r'�`�� FOR APPLICANT TO FILL IN JOB f,ed copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS jQJij,A ❑ Certified copy is filed with the cou b Idmg mspec 1 & 2 Family Sq Ft Z y0 $ b — $ LOCALITY Te I,,�� eA` . tion department Multi family Sq Ft NEAREST y Residential Swimming Pools CROSS ST 5 Date App ica OWNER OR FIRM NAME t'Go CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec Li Sw MAIL d �- COMPENSATION INSURANCE ghtFirst 20 / ADDRESS 0 p,5 !✓AIN-S (This section need not be completed if the work involved by Total No Additional CITY C Tel No 2�G3 C 3(p the permit is for one hundred dollars ($100)or less ) that in the performance of the work for which this PLAN CHECK I certify P APPLICANT permit is issued I shall not employ any person in any manner so as to become subject to the Work rs Compensation Laws Lighting Fixtures First 20 ADDRESS + Additional Total No CITY Tel No Date O Applicant Fixed Appliances Not Over 1 HP i PERMIT NOTICE TO APPLICANT If after make this Certificate of APPLICANT tiaQGpt cnt C£ C Q� C Exemption you should become su t to the Workers Range_ Heater_D W — A Compensation provisions of the Labor Code you must forth Oven _ Dryer — W M — ADDRESS A ,-y.L,Sr ��J r,C._ with comply with such provisions or this permit shall be To _ FAU, —W H — deemed revoked p CITY to Tel No Hood Fan _ Other_ LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Canal REG NNUMBER 1 L Class (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO P OCE ED BY and Professions Code and my license is in full force and effect — Q 0 U Size &Type HP KW KVA or KVAR FINAL License Number 3ZSO K Lic Class 4r to Up to 1 Incl G��4 �T 8�t q—eG —� Over 1 to 10 Incl DATE �` 7 .9 VALIDATION Contractor W`� Date Over 10 to 50 Incl BY t% !� !ll��i W ❑ I am exempt under Sec Over 50 to 100 Inc BY / B&P C for this reason Over 100� Z_ Date Services Swbd MCC& Ponelboards , 0 200 Amp Under 600 V Signature 201 1000 Amp Under 600V ❑ Over 1000 Amp or Over 600 V Exemption for Reg Maint Elect SINGLE FAMILY Temp Power Pole & Appurtenances HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor s License Additional Sign Branch Circuits Law for the following reason (Section 7031 5 Business and Professions Code) 3 ❑ I as owner of the property will do the work and the Misc Conduits& Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY 5 2 7 1 A I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub Total) (Sec 3097 Civ C ) # • • • e o 2 Lender s Name PLAN CHECKING FEE 1 0 1 0650 1 0 5 0 v �� • • x Lender s Address PERMIT ISSUING FEE �^+'' } I certify that I have read this application and state that the TOTAL FEE V 0 8 1 8-86 above information is correct I agree to comply with all County ordinances and State lows regulating Electrical wiring and hereby authorize representatives of this County to enter upon the above mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur f Permittee Date -WORKERS COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT rl Vt.i�ffinm that I have a ceftrficate of consent to self CE 806G insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 3800 Lab C ) Policy No Company FOR APPLICANT TO FILL IN JOB � Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS r-'¢�/v S Certified copy is filed with the county building inspec 1 & 2 Family Sq Ft $ — $ LOCALITY tion department Multi family Sol Ft — NEAREST CROSS ST Residential Swimming Pools Dare Applicant OWNER ' FIRM NAMM E i/t CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec Li ht Sw _ MAIL COMPENSATION INSURANCE g ADDRE �z� is section neenot completed if the work involved b First 20 (Thtd t b p Y Total No Additional CITY �jy«z�,�.�, Tel No2��3��/� the permit is for one hundred dollars ($100)or less ) performance of the work for which this PLAN CHECK I certify that in the P APPLICANT permit is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS ` Total No Additional CITY Tel No Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT' If after making this Certificate of APPLICAN Exemption you should becomes subject to the Workers Range_ Heater_D W — Compensation provisions of the Labor Code you must forth Oven _ Dryer _ W M — ADDRESS with comply with such provisions or this permit shall be Top _ FAU —W H — deemed revoked s Hood _ Fan _Other_ CITY Tel No LICENSED CONTRACTORS DECLARATION LICENSE OR Disp _ Room Air Cond �p�� Class I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER �� v } (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO P SED BY IL and Professions Code and my license is in fulliforce and effect /--'02yV Size & Type HP KW KVA or KVAR ..7 License Number Lic Class 5 Up to 1 Incl FINAL CL' Over 1 to 10 Incl DATE _ VALIDAT N OF_ Contractor Date Over 10 to 50 Incl U ❑ FIt� W I am exempt under Sec Over 50 To 100 Inc BY d Over 100 B 8P C for this reason Amp Under 600 V Z Services S MCC & Panelboards Date 0 200 A 1 � 50Q3A Signature 201 1000 Amp Under 600V > Over 1000 Amp or Over 600 V Mo o 0 0 0 2 Exemption for Reg Maint Eject 0 0 2550 SINGLE FAMILY Temp Power Pole& Appurtenances o 0 - 2S50'0 HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor s License Additional Sign Branch Circuits 7 '''8 6 Law for the following reason (Section 7031 5 Business and Professions Code) I as owner of the property will do the work and the Misc Conduits &Conductors sr, structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ► 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the worklfor which this permit is issued PERMIT FEE - (Sub Total) (Sec 3097 Civ C ) PLAN CHECKING FEE Lender s Name r PERMIT ISSUING FEE 0 Lender s Address I certify that 1 have read this application and state that the TOTAL FEE a above information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring and hereby authorize representatives of this County to enter upon the above mentioned pr erty for inspectio7Do es SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Per itt COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0306030012 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285 0488 EXT LEGAL ID FEES ID BUILDING ADDRESS BK 187 PG 50 PC 1 5446 BALDWIN AV FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917802624 ASSESSOR INFORMATIONER NEAREST CROSS STREET DAINES 8586 023 028 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID 84 LOCALITY TEMPLE CITY G1 OUTLETS LGT,SW,RECP 15 00 OUT 29 25 TENANTG2 LIGHTING FIXTURES 1 00 LGT 1 95 PROM BY PLAN BY EXPIRES 0 G3 POLE MOUNTED LIGHTS 2 00 POL 4 50 06/03/03 JK 11/30/03 TOTAL FEES 63 45 OWNER TEL NO FINAL DATE FINAL BY CODE PETZHOLT, RAYMOND P & ANNIE A (626) 575 4950 5446 BALDWIN AVy TEMP 917802624 DESCRPfIUN OF WUfM ELECTRICAL FOR FRONT AND BACK YARDS APPLICANTN SAME AS OWNER SPECIAL CONDITIONS CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNA UR SAME AS OWNER LIC NO TEMPORARY POWER POLE 1 UNDERGROUND CONDUIT / ARCHITECT E 0 UFER GROUND i LIC NO _ ROUGH CONDUIT ROUGH I MAIN WATER LINE PLASTIC Y/N METAL Y/N NOTIFIEDUTILITY COMPANY PoR.t� Gii kr .v TcK 7063 REPORT ID DPR265 ROUTE TO BS0508