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HomeMy Public PortalAbout5431 BALDWIN AVE_Electrical__ e, 57a7i3 - 7-3/�/ WORKERS' COMPENSATION DECLARATION 76-663 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, CE-Bose L1 or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY cogyCthereof(Sec. 3800,Lab.C.) n �i'OIiCy NO. 1,00511 Company �� rum FOR APPLICANT TO FILL IN JOB �] � ❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS 5 3 D4VIA) New Residential Bldgs.& Pools WC+�1 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY Certified copy is tiled with the county building inspection Apartment. Multi-family Sq.Ft. NEAREST 6 CROSS ST. ev L71 �/99 Residential Swimming Pools OWNER OR �QNf Date �"Applicant / FIRM NAME /240j + CE TIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec LightSw. MAIL COMPENSATION INSURANCE First 20 ADDRESS 8. ( zl� ✓Q (This section need not be completed if the work involved by the CITY l Tel. No. -3 2,03 permit is for one hundred dollars($100)or less.) Total No. Additional I certify that in the performance of the work for which this permit PLAN CHECK APPLICANT 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 y� //��// Additional Date , Applicant ©/WJ &Of Total No. CITY Tel.No. Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLIC NT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven — Dryer _ W.M. _ ADDRESS provisions or this permit shall be deemed revoked. Top — FAU _ W.H. CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER Class. Professions Code,and my license is in full force and effect. DISTRICT NO P SED BY Power Apparatus& Large Appliances 0 License Number Z 7' Lic.Class Size & Type HP,KW,KVA,or KVAR U Up to 1 Incl. FINAL f'/11�OJ Y��v, Date al Over 1 to 10 Incl. DATE ��� IX Contractor � VALIDATION 0 E] Over 10 to 50 Incl. F U 1 am exempt under Sec. Over 50 to 100 Inc. Y Wf1 BAP.C. for this reason Over 100 Z Services,Swbd.,MCC&Panelboards 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& Appurtenances p2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACCT. ,g I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits 3307 Code): Iq❑ 25.50 YT Misc.Conduits& Conductors 1 I i M I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) TOTAL 25- 50 5u1, 50 and Professions Code). CHECK S[I CONSTRUCTION LENDING AGENCY t/��.�aqq����f��'- I hereby affirm that there is a construction lending agency for the �+1'FrCp� E (� performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) — Civ. C.). Lender's Name J p�0/71 ATP/— PLAN CHECKING FEE 8/21/809 �f ► f( /� ,AL1 /, f PERMIT ISSUING FEE 518 y �, ��o�� Lender's Address ►�' kl-w &JAI r iee a1,71�/®•14F 1 certify that I have read this application and state that the above TOTAL FEE 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 pro rt for i specfion purp s. SEE REVERSE FOR EXPLANATORY LANGUAGE W-AZ1 /9 l Sign ture of Per tee Date WORKERS' COMPENSATION DECLARATION 76-663 10/e1 {� I•hereby affirm that I have a certificate of consent to self insure, CE-806G APPLICATION FOR ELECTRICAL PERMIT L J or a'certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.�C.C.) Ger Policy No - /Company 1`_�.\� 1 FOR APPLICANT TO FILL IN JOB ElCertified NO. FEE ADDRESS + w Certified copy is hereby furnished. New Residential Bldgs. & Pools 1 & 2-Family,Sq.Ft. � $ — $ LOCALITY Certified copy is filed with the county building inspection r ( department. Multi-family Sq.Ft. NEAREST CROSS ST. Date h� 62� �YApplicant Residential Swimming Poo FORWNER OR M NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Z MAIL O ` 1 COMPENSATION INSURANCE Outlets:Rech Light w. ADDRESS �l0 Ci� (This section need not be completed if the work involved by the First 20 CITY n ^ Tel.No. permit is for one hundred dollars ($100) or less.) Total No. A� Additional h� L(�-f f '3 I certify that in the performance of the work for which this permit PLAN CHECK APPLICANT 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 / Additional Total No. ' CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT F provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer W.M.'_ ADDRESS provisions or this permit shall be deemed revoked. Top — FAU W.H. LICENSED CONTRACTORS DECLARATION Hood Fan Other_ y, / CITY OylCn J 1 a Tel.No. I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room.Air Cond. / O LICENSE OR (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER 5117 Class.*/0 Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PR E ED BY Size& Type HP,KW,KVA,or KVAR V Q License Number S � Lic.Class �—� Up to 1 Incl. FINAL � �j ' Over 1 to 10 Incl. DATE ✓// VALIDATION Q Contractorc� ;— x�%�yILA ��� v Date Over 10 to 50 Incl. FINAL P/ V ❑ I am exempt under Sec. Over 50 to 100 Inc. gy W Over 100 n' B.&P.C.for this reason ` Z Services, Swbd.,MCC& Panelboards j� 0- 200 Amp.Under 600 V Date: �/ , Signature — 201 - 1000 Amp.Under 600 V ❑ Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V i( �q�t SINGLE FAMILY Temp.Power Pole& Appurtenances 3307 1'P4.50L,ti ` HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 IT�f`i I hereby affirm that)am exempt from the Contractor's License Law for the following reason(Section 7031.5,Business and Professions Additional Sign Branch,Circuits Code): TOTAL 144 .50 ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors CHECK 144.Y1 is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) 00 pop. CHPt4lANGE . and Professions Code). 1199 V CONSTRUCTION LENDING AGENCY 0000 t�-,fy I hereby affirm that there is a construction lending agency for the VVV0—owl 10I 9/89 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) Civ.C.). 5121 1 AN11:39 /� PLAN CHECKING FEE ,-/ Lender's Name L)—/K— PERMIT PERMIT ISSUING FEE Lender's Address d I certify that I have read this application and state that the above TOTAL FEE i 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 0 Signature of Permittee ate COUNTY OF LOS ANGELES TEMPLE -,-!Tr y rlj'vir ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0409020023 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE C'i1'Y CA 91780 PHONE: (626) 285-0488 EXT: !LEGAL ID: FEES PAID V�— BUILDING ADDRESS: IEK: 219 PG: 72 PC: 2 5431 BALDYIN AV FEE DESCRIPTION: QUANTITY: UOM: rl.niDT TEMP CA 917802625 (ASSESSOR INFORMATION `DUMBER: NEAREST CROSS STREET: 8588-019-032 Al PERMIT ISSUANCE FEE 27,75 THOMAS PACE: 597 GRID: B4 LOCALITY: TEMPLE CITY, C HA FAU LESS 3HP 1.00 FAU 10.95 TENANT: TOTAL FEES 38.70 ISSUED ON: PROCESSED SY: PLAN BY: EXPIkE ON- 09/02/04 j 03/01/05 (OWNER: — TEL. NO: — FIN L DATE rINAL BY: CUH JIMENEEZ, MANUEL (818) 309-9006- � 531 ALDWIN AV TEMP 917802625 DESCP,iP I .D OF i:ORn-- -- -- ELECTRICAL FOR HA?4GE OUT EXISTING FAU 1APPLICANT: TEL. NO: _ iG OVER (626) 357-5311- 5030 VICEP.ORY AVESP_F -'— ---- CIAL CONDITiO:dS: ,MONROVIA COMTRACTOR: �- —TEL. NO: APPROVALS �_—� DATE INSTOR Sl' 'R%E Nni ; PEC AIR TRO (626) 357-5311- '1630 MYRTLE AVE LIC. NO TEMPORARY POWER POLE-�— MONROVIA CA 91016 25822BC10 UNDERGROUND C :3Cv?T ---'- ARCHiTECT OR ENGII!FIP_—i—_ TEL. RIO:��- UFER GROUND' iLir_.. Ivo: ROUGH 41I NI Nu I I �rIA1II WATER PLASTIC YIN' METAL YIN f UTILITY COMPANY 40—ffr i)�__-- I i� t * ADDITIONAL DATA ON FIL'e: —-- - - REPORT ID: DPR265 ROUTE T0: BS0508 COUNTY OF i_L6 ANGELEC TEMPLE CITY 9 0508 ELEC R--�-'. PERtiIT DEPARTMENT OF PL,;;.";",C WORKS 9701 LAS TUNAS EL 050i� f)409240011 BUiILDING AND SAFETY / LAND DEVELOPMENT 'TEMPLE CITY CA 91780 SHO?2E: (626) 285•x. r'• EXT: LEGAL TG: — --FEES PAID -T- BUILDING ADDRESS: - -� D BK: 219 PG: 72 PC: 2 I 5431 BALDWIN AV FEE DESCRIPTION: QUANTITY_ LIOM: AMOUNT:; TEMP CA 917802625 � tXPIRE ASSESSOR IIF ':MATION NUMBER: NEAREST CROSS STREET: C.L.IVE 8588-O'19-l't32 A' FIERMIT ISSUANCE FEE 27.75 OMAS PAGE: 597 GRln: P4 LOCALITY: TEMPLc --TTY, C JX MOTORS, LT 3 HP 1.00 MOT 15.30 TENANT —�_— v— ��--�- -� TOTAL FEES 43.05 �TaS`D'ON: PROCESSED BY: PLAN BY: EXPIRES ON: 09/21** 04 JK 03/23/05 OWNS:"-- iE!.. 110 !FIN ,i.. l!:TE FIPJF—'L �,,. CODE: --- GIME':EZ, NARIAIMANUEL ;526) 614-9199- 5431 L'ALDUIN AV TEMP 91786-1625 j i;ES N OF WORK — i GATE. I41TH MOTOR FRONT OF HOVE i APPLICANT' -_ — TEL. NO: SAME AS OWNt; !I ,-SFp-ECTS17 CONDITIONS: I j r I —..,—p .3_ a_ CONTr:i;C Oii= "L.'�y!: �-j {A�P�nCV _S DATE — ._;NSrECTOR SI G�A"t:.eft _ SAME AS OWiEN I { LIC. NO i i 1 EP4f+U`r ARY POWER POLE I � � :u i_.�R'f711 IF17 CONDUIT L. LiC. NO: CONDUIT i P (;:?AiN !PLASTIC 'i/N METAL i/N i i REPORT ID: DPR265ROUT�E T0: BS0508