The URL can be used to link to this page

Home My Public Portal About5006 BALDWIN AVE_Electrical__ WORKERS' COMPENSATION DECLARATION 76A663 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT hereby cffirm that I have a certificate of consent to self CE 8066 insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOBy��ib Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS �7 v - fs(f Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. NEAREST CROSS ST. L(f Residential Swimming Pools OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLight Z Sw. 3-- MA COMPENSATION INSURANCE _ D ADDRESS First 20 (This section need not be completed if the work involved by Total No. Additional CITY Tel. No.3±0— the permit is for one hundred dollars ($100)or less.) PLAN CH CK I certify that in the performance of the work for which this 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 1 ADDRESS Additional Total No. CITY Tel. No. Date Applicant Fixed Appliance's Not Over 1 HP PERMIT ryl'" NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION A440w_i Exemption, you should become 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. ' Hood — Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY >_ and Professions Code,and my license is in full force and effect. 0 12- O Size &Type HP, KW, KVA, or KVAR License Number Lic. Class Up to 1 Incl. FINAL U Contractor Date Over 1 to 10 Incl. DATE / VALIDATION Q Over 10 to 50 Incl. FINAL NAL I am exempt under Sec. Over 50 to 100 Inc. BY U W 100 d 8.8P.C. for this reason Over U)Services, Swbd.,.MCC& Panelboards , Z Date: 0-200 Amp. Under 600 V — Signature 201 - 1000 Amp. Under 600 V Over 1000 Amp, or Over 600 V �;:,;:: . Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole &App urtenances ==;f HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Prof ions Code): ._ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , ;,-;- 13n:='t Business and Professions Code). -- CONSTRUCTION LENDING AGENCY 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) / (� "`j•'' ''` (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE 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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ignoture of Perm ate 1 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT APARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0807020008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285 0488 EXT ILEGAL ID I FEES PAID BUILDING ADDRESS I ON FILE I I 5006 BALDWIN AV I IFEE DESCRIPTION QUANTITY UOM AMOUNT I TEMP CA 917804010 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET 18585 008 013 IA1 PERMIT ISSUANCE FEE 27 75 I THOMAS PAGE 597 GRID B4 LOCALITY TEMPLE CITY Cl IFI 120V 15/20A BR CKTS 1 00 BR 17 25 I I ITENANT IG1 OUTLETS-LGT SW RECP 3 00 OUT 5 85 (ISSUED ON PROCESSED BY PLAN BY EXPIRES ON I IG2 LIGHTING FIXTURES 2 00 LGT 3 90 107/02/08 SR 12/29/08 I 1 TOTAL FEES 54 75 I 1 (OWNER TEL NO I 1FINAL DATE FIN BY CODE 1 ILU VINH P (626) 322 4475 1��ya�� 15006 BALDWIN AV I i ITEMP 917804010 1 IDE CRIPTION OF WORK 1 11 BRANCH CIRCUIT 3 OUTLETS AND 1 LIGHT FIXTURE (APPLICANT TEL NO 1 KHAN (626) 318 9839 1 19101 HERMOSA DR 1SPECIAL CONDITIONS I ITEMPLE CITY CA 91780 I I I I I I I I I I I 1CONTRACTOR TEL NO 1 (APPROVALS DATE INSPECTOR SIGNATURE I IVINH P LU (626) 443 9642 15006 BALDWIN AVENUE LIC NO 1 ITEMPORARY POWER POLE I I I 1TEMPLE CITY CA 91780 NONE I I I I (UNDERGROUND CONDUIT I I I (ARCHITECT OR ENGINEER TEL NO I IUFER GROUND I I I I I I LIC NO IROUGH CONDUIT 1-1 I I I I I 1ROUGH WIRING I I I IMAIN WATER LINE I (PLASTIC Y/N METAL Y/N I (UTILITY COMPANY NOTIFIEDI I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1REPORT ID DPR265 ROUTE TO BS0508 I I I I I I ,1 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0205140012 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285 0488 EXT LEGAL ID FEES PAID U LDING ADDRESS ON FILE 5006 BALDWIN AV FEE DESCRIPTION QUANTITY UDM AMOUNT TEMP CA 917804010 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LA ROSA 8585 008 013 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID 84 LOCALITY TEMPLE CITY _ F1 120V, 15/20A BR CKTS 2 00 BR 34 50 TENANT G1 OUTLETS LGT SW,RECP 26 00 OUT 47 10 ISSUED ON PROCESSEDBY PLAN BY EXPIRES 0 G2 LIGHTING FIXTURES 12 00 LGT 23 40 05/14/02 JK 11/10/02 LB 200 AMP PANELS MCC 1 00 PAN 38 85 OWNER TEL NO TOTAL FEES 171 60 FINAL DAT FINAL BY CODE VINH P LU PHUONG T HUYNH (626) 443 9642 11537 CHERRYLEE DR jj Z EL MONTE 91732 DESCRw TION OF WORK ELECTRICAL FOR ADDITION/REMODEL APPLICANT HIEN NGUYEN (626) 614 8165 5219 ACACIA ST _ SPECIAL CONDITIONS SAN GABRIEL 91776 ' CONTRACTOR TEL NO _ ��: APPROVALS DATE INSPECTOR SIGNATURE EG BUILDER (626) 614 8165 5219 ACACIA ST LIC NO �/' a . TEMPORARY SAN GABRIEL, CA 91776 NONE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER TEL NOER GROUND LIC NO ROUGH CONDUIT ROUGH WIRING MPYN WATER LINE d� PLASTIC Y/N METAL Y/N —_ - _ UTILITY C0 ED Z l� c � REPORT ID DPR265 ROUTE TO BS0508