The URL can be used to link to this page

Home My Public Portal About9850 BROADWAY_Electrical__ WORKER S'COMPENSATION DECLARATION CE-806G 12601 APPLICATION! FOR ELECTRICAL PERMIT E-BOfiLJ 1 hereby affirm. that I have a certificate of consent to self COUNTY OF LOS ANGELES - BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800;Lab.C.) FOR APPLICANT TO FILL IN Policy No. AD Company EACH NO. FEE ADDRESS - New Residential Bldgs.&Pools Certified copy is hereby furnished. 1-& 2-Family,Sq. Ft. $ — $ LOCALITY Car C r. OMulti-family Sq. Ft. NEAREST , p , Certified copy is filed with the county building inspection CROSS ST cl 1 � department. Residential Swimming Pools - OWNER OR ' 1 FIRM NAME 1 Date - Applicant Outlets: Rec&Light_Sw. o ADDRESS rC- First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' _ Total No. Additional COMPENSATION INSURANCE CITY t C , Tel No.C� } PLAN CHECK 1 (This section need not be completed if the work involved APPLICANT O Lighting Fixtures First 20 by the permit is for one hundred dollars ($100) or less.) g g ADDRESS Total No. Additional S I certify that in the performance of the work for which thisFixed Appliances Not Over 1 HP CITY Tel No. C) permit is issued; I shall not employ any person in any manner PERMIT U so as to become subject to the Workers' Compen . n aws. Range_.Heater_.D.W. APPLICANT Oven _ Dryer W.M. ADDRESS_S-/4r� z�,/'1r(�IN ¢JC- - Z Dates�AP Aican-. Tap — FAU W.H. 'CITY !' [.� � .(r Tel No. IF2 SZO Hood _ Fan Other— NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond.— LICENSE OR ec Exemption,'-you-should become-subject to the Workers'- - - - -- • - REG,NUMBER- -7 Class C-LD- - Compensation provisions of the Labor Code, you must forth- power Apparatus& Large Appliances DISTRICT NO. PROC S BY with comply with such provisions or this permit shall be Size&Type HP, KW, K% A;or KVAR deemed revoked. O Up to 1 Incl. ` FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 101nc1. DATE VALIDATION Over 10 to 50 Incl. b t'J I hereby affirm that I am licensed under.provisions of Chapter' Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 - BY aC-1J`J ness-and Professions.Code, and my license is in full force and f effect. Services - / License Number ' Lic. Class 0-200 Amp. Under 600 V t 6u S C—I ` (p > (p / 201-1000 Amp.Under 600 V Contractor Date 2 /-1 Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION. Temp. Power Pole&Appurtenances , I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit r License Law for the following reason (Section 70 31.5, Busi- Additional Sign Branch Circuits ! ness and Professions Code): - ;9 4 2 Q,8 A Misc.Conduits&Conductors ❑ I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— # o o e e s 2 structure is not intended or offered for sale (Section 7044, Business and Professions Code). Z.e'a 22.5 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency o is e 2 Z 5 for the performance of the work for which this permit is PERMIT FEE (Sub-Total) S } issued (Sec. 3097,Civ.C.). - 0 227-8 27-8 1 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE - Z� I certify that I have read this application and state that the TOTAL FEE Z 4 above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and �bo horize r resentatives of this County to enter upon enti one prop rty r tion purposes.�f SEE REVERSE FOR EXPLANATORY LANGUAGE Z - Signature of Permi tee ate COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0003170004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 13805 LT: 34 9850 BROADWAY FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802633 ASSESSOR INFORMATION NUMBER: - NEAREST CROSS STREET: BALDWIN 8588-016-009 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, C G1 OUTLETS-LGT,SW,RECP 21.00 OUT 40.35 TENANT: G2 LIGHTING FIXTURES 7.00 LGT 13.65 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 81.75 03/17/00 VG 09/13/0 OWNER: TEL. NO: FINAL DATE FINAL BY: ODE: TAM WILLIE T;KONG WAI LING (626) 285-4988- 9850 BROADWAY TEMP 917802633 DESCRIPTION OF WORK ELECTRICAL FOR ADDITION APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: PNCE LES C� CONTRACTOR: TEL. N0: / �� APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER _ / i0 T� LIC. NO / TEMPORARY POWER POLE / UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: /// UFER GROUND LIC. NO:L / 1111111 ROUGH CONDUIT IU / ROUGH WIRING 444--------------- GF (1 C T1 /l 01-0–1 7 MAIN WATER LINE U'LIDO�Lh \\V(/\\U�/ ILIA 11^Lll<� 11�LJ�((�1 N\�J PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED d C g yrm. G 0 0 sL1i 46//Q ct Service That� REPORT ID: DPR265 ROUTE TO: BSO5O8 COUNTY OF LOS ANGELES TEMPLE CITY k D508 ELECTRICAL PERMIT DEPARTMENT BE PUBLIC WORKS 9901 LAS TUNAS EL 0508 0809020005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 13805 LT: 34 9850 BROADWAY I IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: I TEMP CA 917802633 (ASSESSOR INFORMATION NUMBER: I 1 NEAREST CROSS STREET: EALDWIN 18588- 016-009 IA1 PERMIT ISSUANCE FEE 29.95 THOMAS PAGE: 599 GRID: A3 LOCALITY: TEMPLE CITY, C G1 OUTLETS-LGT,SW,RECP 10.00 OUT 19.50 (TENANT: IG2 LIGHTING FIXTURES 15.00 LOT 29.25 (ISSUED ON: PROCESSED BY. PLAN BY: EXPIRES ON: I IH2 RES GREG DISP LT 3HP 1.00 DIS 10.95 109/02/08 SR 03/01/09 H3 RES DISHWASHR LT 3HP 1.00 DIS 10.95 I I IOWNER: TEL. NO: IH4 RES RANGE HDS LT 3HP 1.00 BOO 10.95 IFINAL DATE FINAL BY: CODE: ITAM WILLIE T;KONG WAI LING TOTAL FEES 109.35 9850 BROADWAY ITEMP 917802633 D SCRIP ON OF OF WOR (ELECTRICAL FOR KITCHEN REMODEL I 1 APPLICANT: TEL, NO: 1 1 CHOI (626) 202-6615- 18837 LONGDEN AVE. 1 ISPECIAL CONDITIONS: ITEMPLE CITY CA 91780 (CONTRACTOR: TEL. NO: 1 APPROVALS DATE INSPECTOR SIGNATURE IS C HOME IMPROVEMENT CONTRACTOR (626) 202-6615- I I 1 18837 LONGDEN AVENUE LIC. NO I (TEMPORARY POWER POLE I I 1 1TEMPLE CITY CA 91780 766250 C10 1 1 1 1UNDEAGROUN) CONDUIT 1I ARCHITECT OR ENGINEER: TEL. N0: IUFER GROUND I LIC. NO: ROUGH CONDUIT IROUGH WIRING I I I MAIN WATER LINE 1 PLASTIC YIN METAL YIN 1I I I (UTILITY COMPANY NOTI FI EDI I I I I 1 II II I I I I I I I I I 1 1 11 I I I I I I I I I I � I I 11 I1 III I I I I I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 III I I I I I I