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Home My Public Portal About9237 BLACKLEY ST_Electrical__ WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) 76A663 APPLICATION FOR ELECTRICAL PERMIT I tiereby•affi;m that I Rave a certificate of consent to Self insure, or a certificate of worker's Compehsation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec. 3800 Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB 5 ADDRESS ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY El1 &2-Family,Sq.Ft. _ $ $ Certified copy is filed with the county building inspection NEAREST department. Multi-family Sq.Ft. CROSS ST. C. Residential Swimming Pools ASSESSOR Date Applicant MAP BOOK PAGE PARCEL OR CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. FFIIRME AME ` �n COMPENSATION INSURANCE First 20 (This section need not be completed if the work involved by the ADDRESS 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 CITY Te.No. is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant l� RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTIC TO APPLI ANT: If, after making this Certificate of 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 �L O p y P Y APPLICANT L provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS 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 CITY Tel.No. /� J�295 Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR v /CVJ !!JJ Over 50 to 100 Incl. REG.NUMBER Class. a / //� Lic.Class — Over 100 DISTRICT NO. ROCe5�6 C) License Number�.��+�vl — GrTj Sery ces, wbd.,M C Parer600rds Contractor to — 9 P./U / FINAL Q DATE ❑ 400-1000 Amp.Un V I am exempt under Sec. VALIDATION W Over 1000 Amp.or Over 600 V FINAL B.&P.C.for this reas ��i a BRANCH CIRCUIT FEES BY „(n 15A,or 20A, 120V,Lighting or Recept.Ile, s=�_ 1 To 10 Branch Circuits -1-;:- Signature 11 To 40 Branch Circuits s L"--"– ❑ . 41 Or More Branch Circuits T_T�f �-_ " Exemption for Re Maint,Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances b6 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit J u 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 Code): ❑ I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors :..'Q 3; —1 it tl i; ! •.'__,` y is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) – 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 (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) PLAN CHECKING FEE 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. 1 agree to comply with all County ordinances an tate laws regulating Electrical wiring,and hereby authorize representa iv f this Co my to enter upon the above-mentioned property I or inspec SEE REVERSE FOR EXPLANATORY LANGUAGE SIGN PERMITT E DATE WOJPKER'S COMPENSATION DECLARATION 20 DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT 76A663 I hereby affi(m teat I have a certificate of consent to self insure 76A663 or a-certificate of Worket's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 3800 Lab C) Policy No Company FOR APPLICANT TO FILL IN JOB NO EACH FEE ADDRESSq23 7 Certified copy is hereby furnished New Residential Bldgs &Pools LOCALITY El 1&2 Family,Sq Ft Certified copy is filed with the county building Inspection NEAREST f' !N' 'I department _ Multi family Sq G Ft CROSS ST &)N Date Applicant Residential Swimming Pools A EBOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec -6—Light-?—Sw OWNER OR FIPM NAME COMPENSATION INSURANCE _ First 20 Z el MAIL (This section need not be completed If the work involved by the Total No � Additionalif U ADDRESS permit is for one hundred dollars($100)or less) I certifytthat in the performance of the work for which this permit CITY r Tel No /t is issued, I shall not employ any person in any er so as t0 PLAN CHECK 7 become subject to the Workers' Compensati La Lighting Fixtures First 20 APPLICANT Total No Additional �_ ADDRESS Date Applicant'' RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT If, after m ing t is Certi icate of 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 APPLICANT Q ERMT provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances r LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA or KVAR ADDRESS KZ 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 CITE �O Tel No Professions Code, and my license is in full force and effect Over 10 to 50 Incl LICENSE OR /� ^,j L Over 50 to 100 Incl REG NUMBER Class d License Number K4Q"/ G(,!�Lic Class� Over 100 DISTRICT NO PROCESSED BY 0 Services,Swbd,MCC&Panelboards cc /�/}�1{�'f 1�}�� - 0 399 Amp Under 600 V FINAL 0 Contractor L/!� (<L ( 7�+ Date DATE ❑ 400 1000 Amp Under 600V f ��i I am exempt under Sec t VALIDATION W Over 1000 Amp or Over 600 V FINAL -B&P C for this reason BRANCH CIRCUIT FEES ByCO Date 15A,or 20A, 120V,Lighting or Recept Z_ 1 To 10 Branch'Circuits _ Signature 11 To 40 Branch Circuits �r^ El _ 41 Or More Branch T.a Circuits _- Exemption for Reg Mamt Elect 15A 20A,208V To 277V Lighting Br Circuits SINGLE FAMILY Temp Power Pole&Appurtenances HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit 1 TErl; 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 TOTAL 4 a 00 Code) 0 I,as owner of the property,will do the work and the structure Misc Conduits&Conductors -ARCH °�!I! is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) k. 1-1. and Professions Code) CONSTRUCTION LENDING AGENCY _ I hereby affirm that there is a construction lending agency for the of jut,--099 l• ' f�i performance of the work for which this permit is issued (Sec, 3097, PERMIT FEE (Sub-Total) f'M lei E i C!- Civ C) PLAN CHECKING FEE 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 Q that the above information is correct I agree to comply with all County ordinances an a laws regulating Electrical wiring,and hereby authorize represent tive s C unty to enter upon the above-mentioned property for insp SEE REVERSE FOR EXPLANATORY LANGUAGE 7- G E MITT DATE WORKER S COMPENSATION DECLARATION DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT 76A663 I heleby affirm that I have a certificate of consent to self Insure, 76A663 or a certlflcate 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) Policy No Company FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy Is hereby furnished New Residential Bldgs &Pools NO EACH FEE El Certified _ $ $ LOCALITY 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 n/� I' MAP BOOK /PAG9/ / PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec P Light---1—Sw C M AME COMPENSATION INSURANCE First 20 (This section need not be completed if the work involved by the MAIL permit is for one hundred'dollars($100)or less) Total No Additional ADDRESS I certify that in the performance of the work for which this permit CITY Tel No is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers' Compensation Laws Lighting Fixtures First 20 L/�1APPLICANT Total No Additional Date � ' Applicant �?iUf��G,tie RESIDENTIAL APPLIANCES NOT OVER 3 HP D O A 53 ADDRESS ' NOTICE TO APPLICANT If, after making this Certificate of CITY Tel No Exemption,you should become subject to the Workers' Compensation OTHER APPLIANCES'NOT OVER 3 HP provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances APPLICANT Ljul�J LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl (commencing with Section 7000) of Division 3 of the Business and CITY Tel No Professions Code,and my license is in full force and effect Over 10 to 50 Incl >_Over 50 to 100 Incl LICENSE OR Class REG NUMBER a- License Number LIC Class Over 100 DISTRICT NO f P SSED BY O Services,Swbd,MCC&Panelboards �� li cc 0-399 Amp Under 600 V FINAL 0 Contractor Date DATE I-_ El - 400 1000 Amp Under 600V C— ,� , U I am exempt under Sec VALIDATION LU Over 1000 Amp or Over 600 V FINAL B&P C for this reason BRANCH CIRCUIT FEES BY y r U) Date 15A,or 20A,120V,Lighting or Recept _,T.'$ Z 1 To 10 Branch Circuits 33-J-3 FS 2. a Signature 11 To 40 Branch Circuits 1- ❑ 41 Or More Branch Circuits 4 1�G -� Exemption for Reg Maint Elect 15A,20A,208V To 277V Lighting Br Circuits TOT.` s SINGLE FAMILY Temp Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 4 � E: 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 Code) ` I,as owner of the property,will do the work and the structure Mlsc Conduits&Conductors _nn_ _ is not Intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) 0L:.3tt�ttttt��-MG 1 5� 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 (Sec 3097, PERMIT FEE (Sub-Total) Civ C) PLAN CHECKING FEE Lender s Name 6 PERMIT ISSUING FEE Lender's Address Q I certify that I have read this application and under penalty of purlury state TOTAL FEE O that the above information is correct I agree to comply with all County ordinances a S to ws regulating Electrical wiring,and hereby authorize represent as s ounty to or upon the above mentioned property for Inspe SEE REVERSE FOR EXPLANATORY LANGUAGE �J N RE ITTE DATE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 9908250005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ID• FEES PAID BUILDING-ADDRESS: TR: 11492 LT: 14 BL: A 9237 BLACKLEY ST FEE DESCRIPTION: QUANTITY. UOM: AMOUNT: TEMP CA 917803137 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ENCINITA 8590-001-017 Al PERMIT ISSUANCE FEE 27 75 _ THOMAS PAGE 596 GRID: J4 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 7.00 OUT 13.65 TmTAwT--- G2 LIGHTING FIXTURES 3.00 LGT 5.85 ISSUED ON PRO P ON: TOTAL FEES 47.25 08/25/99 UT 02/21/00 OWNER: TEL. NO: FINAL DATE FINALBY DE: PASTOR DENIS;VILLALOBOS MARIA CRIST (626) 285-4159- - w 9237 BLACKLEY ST a:::::7 TEMP 9178031375ETC-R-1-PTION OF WORK ELECTRICAL TO RELOCATE BATHR APPLICANTTEL. NO: SAME AS OWNER SPECIAL CONDITIONS: ® CONTRACTOR TEL. N0: G�� E co APPROVALS TE INSPECTOR SIGNATURE �j SAME AS OWNER LIC. NO TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECTOR ENGINEER: - UFER G LIC. N0: 1111111 ROUGH CONDUIT RO GH WIRIN OV4 f1z UBOK C n n 17��n/� 3 MAIN TER [NE \1`J//\\`jJJ ALJ^L{]►L]E(� PLASTIC Y/N METAL Y/N UTILITY COMP IFIED Q o o ® ®5 E 0 c Service lb5L REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0102260006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT: LEG E NADDRESS TR: 11492 LT: 14 BL: A 9237 BLACKLEY ST FEE DESCRIPTION. QUANTITY• UOM: AMOUNT: TEMP CA 917803137 ASSESSOR INFOR NUMBER: NEAREST CROSS STREET. ENCINITA 8590-001-017 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID. J4 LOCALITY: TEMPLE CITY F1 120V, 15/20A BR CKTS 1 00 BR 17.25 TOTAL FEES 45.00 ISSUED ON: PROCESSED Y: PLAN B . 02/26/01 UT 08/25/01 OWNER. TEL. NO FINALATE BY: CODE: PASTOR DENIS;VILLALOBOS MARIA CRIST (626) 285-4159- r' U 9237 BLACKLEY ST TEMP 917803137 DESCRIPTI N OF NEW STORAGE SHE -360 SQ FT 1 ELECTRICAL CIRCUIT APPLICANT: TE 0• SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. NO % �� 9T� APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC NO JI- \ TEMPORARY 0 E UNDERGROUND CONDUIT AR C EER. GROUND VV LIC NO`/ "1111111 ROUGH CONDUIT T _ _ __ w ��i� ROUGH WIRING i7 •� " MAIN WATER LINE - PLASTIC Y/N METAL Y/N - - - -' - UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO BS0508