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Home My Public Portal About5009 BALDWIN AVE_Electrical__ WORKERS'COMPENSATION DECLARATION 70/81 APPLICATION FOR ELECTRICAL PERMIT AI hereby CE-806 affirm that I have a certificate 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 [ �) Jt/� t �j Certified co is hereby furnished. EACH NO. FEE ADDRESS Wq (i(f IU Com-• PY Y New Residential Bldgs. & Pools � S — tC �' Certified copy is filed with the county building inspec- 1 & 2-Family, q• Ft. $ $ LOCALITY T CROSS tion department. Multi-family Sq. Ft. NEARESST. Residential Swimming Pools OWNER OR ' Date Applicant —.OWNER NAME CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Outlets: RLigh-tSw. MAIL I'/ v ADDRESS c�74 (This section need not be completed if the work involved byFirst 20 0 the permit is for one hundred dollars ($100)or less.) Total No. _2� Additional CITY Tel. NO. !, -J PLAN CHECK 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 �y so as to become sbj ct to the Workers' ompensation La Lighting Fixtures First 20 v ADDRESS Z1"�u� Total No. Additional CITY ��_ o. Date ApplicantNiAl'AFixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificat APPLICANT 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. CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ LICENSE OR Room Air Cond. I hereby affirm that I am licensed under provisions of Chapter 9 Disp. REG. NUMBER Class. (commencing with Section 7000) of Division 3 of the Business power Apparatus& Large Appliances DISTRICT NO. PROCE E BY and Professions Code, and my license is in full force and effect. Size &Type HP, KW, KVA, or KVAR' License Number Lic. Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE VAL TION . Contractor Date Over 10 to 50 Incl. aFINAL W I am exempt under Sec. Over 50 to 100 Inc. BY N B.&P.C. for this reason Over 100 ae, Z_ Date: Services, Swbd., MCC& Panelboards ► 0 -200 Amp. Under 600 V 7 Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V 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 Pr fessions Code): I, as owner of the property, will do the work and the Misc. Conduits &Conductors structure is not intended or offered for sale (Section Oth (See Complete Fee Schedule)_ , 3 231 0 A 7044, Business and Professions Code). 0 0 0 0 0 2o CONSTRUCTION LENDING AGENCY 0 o59,50 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) a 0 ° 5 9 5 0 5 (Sec. 3097, Civ. C.). PLAN CHECKING FEE 'A Q 2'1 i 8 5 Lender's Name Lender's Address PERMIT ISSUING FEE U I certify that I have read this application and state that the TOTAL FEE �S0 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 tV ov enti ed per for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Vw. Lo--l- f Signature of Permitte \ Date �—WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) I hereby affirm that I have a certificate of consent to self insure, 76A663 APPLICATION FOR ELECTRICAL PERMIT or a`dertificate•of Worker's Compensation Insurance. or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab. C.) �r�My1 ,'I) /� Policy N0. Company FOR APPLICANT TO FILL IN JOB ADDRESS (. �Y// ` ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE � ❑ _ $ $ LOCALITY—'— Certified Ie. �f l t Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. _ NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK % PAGE q 4 PARCEL �!"d CERTIFICATE OF EXEMPTION FROM WORKERS' A OWNER OR COMPENSATION INSURANCE Outlets:Rec._Light Sw. /D First 20 00 FIRM NAME 1 G A d'\, (Ci'`I (This section need not be completed if the work involved by the Total No. Additional ADDRESS r00 A 1 U)JA V permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY—re m /e Tel.No. is issued, I shall not employ any person in any manner so as to PLAN CHECK U become subject to the Workers' Compensation Laws, Lighting Fixtures First 20 APPLICANT Total No. Additional �U /t ADDRESS Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP. CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITYTel.No. LICENSE OR Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. } Over 50 to 100 Incl. NUMBER Class. REG. d Over 100 DISTRICT NO. P O SSED BY O License Number Lic.Class �. V Services,Swbd.,MCC&Panelboards cc Contractor Date 0-399 Amp.Under 600 V FINAL DATE O ❑ 1 am exempt under Sec. 400-1000 Amp.Under 600 V I_Over 1000 Amp.or Over 600 V FINAL v VALIDATION W B.&P.C.for this reasonBRANCH CIRCUIT FEES BY d Date: 15A,or 20A, 120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits F-141 Or More Branch Circuits '} Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 2 Y SINGLE FAMILY Temp.Power Pole&Appurtenances ACC o4 ii HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit =j� I hereby affirm that I am exempt from the Contractor's License Law .3303 1 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 1 ITEMS Code): q 4 1 F-1t I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors t t.�TNL o 30 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) !'.HECK �j 1.30 and Professions Code). CHANGE C 1�'} CONSTRUCTION LENDING AGENCY t•HANGE o 0V I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, PERMIT FEESub-Total Civ.C.) ( ) DO COOQ-OOQ1 21/ 6/96 PLAN CHECKING FEE 4714 1 AM 9:20 Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the above information is correct. I agree to comply with all County finances and State laws regulating Electrical wiring,and hereby authorize e re entative f this Coun y enter u n the above-mentioned property fo i coon rpose . SEE REVERSE FOR EXPLANATORY LANGUAGE GNATURE OF PERMITTEE DATE COUNTY OF LIDS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0701300007 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: FEES PAID J BUILDING ADDRESS: I ITR: 9848 IT: 24 1 J 5009 BALDWIN AV 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917804011 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LA ROSA 1. 18589-026-048 JA1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, Cl I IG1 OUTLETS-LGT,SW,RECP 32.00 OUT 55.20 1 I (TENANT: JG2 LIGHTING FIXTURES 13.00 LGT 25.35 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1 I JHA FAU LESS 3HP 1.00 FAU 10.95 101/30/07 JK 07/29/07 1 I JH2 RES GRBG DISP IT 3HP 1.00 DIS 10.95 1 I DOWNER: TEL. NO: JH5 RES WASH MACH IT 3HP 1.00 WAS 10.95 1F A'L DAT FIN Y: CODE: J JHUANG, HUEI-MING (626) 279-1382- JJB AC UNITS +3-10HP 1.00 AC 19.65 I 15009 BALDWIN AV 1 - TOTAL FEES 160.80 1 /j�10 J . 1TEMP 917804011 1 IMSCRIPTIC5N OF WORK I I I JELECTRICAL FOR ADDITION AND REMODEL J JAPPLICANT: TEL. NO: J I I JHUANG (626) 279-1382- D I I 15009 BALDWIN AVE 1 (SPECIAL CONDITIONS: J (TEMPLE CITY CA 91780 1 I I (CONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE J JHUEIMING HUANG (626) 279-1382- 1 1 I 15009 BALDWIN LIC. NO 1 ITEMPORARY POWER POLE D 1 I (TEMPLE CITY, CA 91780 NONE 1 1 1 1 I D 1UNDERGROUND CONDUIT I I 1ARCHITECT OR ENGINEER: TEL. NO: D 1UFER GROUND I 1WU, JOHN (626) 293-1001- D 1 I I I 1412 S. STONEMAN AVE. LIC. NO: D (ROUGH CONDUIT I I D ALHAMBRA, CA 91601 NONE TROUGH WIRINGon I I (MAIN WATER LINE 1 I 1 I 1 (PLASTIC Y/N METAL Y/N I I D I I JUTILITY COMPANY NOTIFIED( I 1 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 J J I I I I I (REPORT ID: DPR265 ROUTE TO: BS0508 I I I 1 I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 <-ELECTRI'CAC PERMIT DEPARTMENT OF'PUBLIC WORKS 9071 LAS TUNAS EL 0508 9610020057 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 9848 LT: 24 5009 BALDWIN AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804011 ASSESSOR INFORMATION NU BER: NEAREST CROSS STREET: LA ROSA 8589-026-048 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 15.00 OUT 29.25 TENANT: G2 LIGHTING FIXTURES 5.00 LGT 9.75 -ISSUED OW.-PROCESSED BY: PLAN BY: EXPIRES ON: LA 100 AMP PANELS, MCC 1.00 PAN 38.85 10/02/96 TC 10/02/97 TOTAL FEES 105.60 OWNER: TEL. NO: FINAL DATE FINAL CODE: YOUNG, CATHERINE (818) 582-8267- 5009 BALDWIN AV TEMP 917804011 DESCRI TION OF WORK ELECTRICAL FOR ADDITION APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING '_ V /1/ MAIN WATER LINE PLASTIC PLASTIC Y/N METAL Y/N TIll LLi Y CO PANY NOTI IED REPORT ID: DPR265 ROUTE TO: BS0508