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Home My Public Portal About9951 BROADWAY_Electrical__ WORKERS'COMPENSATION DECLARATION 76A663 10/81 I J� I liw�by afhMa that,k have a certificate of consent to self insure, CE-806G APPLICATION FOR ELECTRICAL PERMIT ylull or a certifli of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800:Lab.C.) -y Policy NO. - Company FOR APPLICANT TO FILL IN J' JOB �p,�,� .ter ❑ EACH NO. 'FEE ADDRESS �, *X rw / �% C,I' Certified copy is hereby furnished. New Residential Bldgs.& Pools _ / ❑ Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ $ LOCALITY department. Multi-family Sq.Ft. — NEAREST GROSS ST. Date Applicant Residential Swimming Pools 0 NER OR NAME LAI 'r CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Ree— Light _ Sw. — MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved�by the First 20 Total No. Additional CITY Tel.No. permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit PLAN CHECK APPLICANT is issued, I.shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel.No. Date Applicant - Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT Exemption,you should become subject to the Workers'Compensation Range_ Heater W. _ APPLICANTl� provisions of the Labor Code, you must forthwith comply with such Oven Dryer W.M. _ �O. O ADDRESS provisions or this permit shall be deemed revoked. Top FAU W.H. _ CITY - Tel.No. LICENSED CONTRACTORS DECLARATION Hood Fan Other_ I hereby affirm that I am licensed under provisions of Chapter 9 - UCENSE OR (commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Class. Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances DISTRICT NO. �j PRO C ED BY dr Size& Type HP,KW,KVA,or KVAR U License Number Lic.Class Up to 1 Incl. FINAL Over 1 to 10 Ind. DATE VALIDATION O Contractor Date Over 10 to 50 Incl. E] I am exempt under Sec. Over 50 to 100 Inc. FINAL \ V BY W n 8.8 P.C.for this reason Over 100 � Z Date: Services,Swbd.,MCC & Panelboards u- Signature - 200 Amp.Under 600 V /u- Signature 201 - 1000 Amp. Under 600 V I ❑ - Over. 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. 2 SINGLE FAMILY Temp. Power Pole& Appurtenances ACCT.VA HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits 3303 4$•00 for the following reason(Section 7031.5, Business and Professions c° ) 1 ITEMS I,as owner of the property,will do the work and the structure Misc.Conduits& Conductors TOTAL -48 .00 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) p and Professions Cade). , CHECK 40.00 CONSTRUCTION LENDING AGENCY - CHANGE .00 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) Q (� I�t��I Civ. C.). PLAN CHECKING FEE 0000-0001 11/17/95 Lender's Name `.r DV 5b 1 PM 12:02 PERMIT ISSUING FEE j Lender's Address x I certify that I have read this application and state that the above TOTAL FEE t%n 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 , .I : � t t 5- ]�Signature of Permittee Date WORKERS' COMPENSATION DECLARATION zaomcDPW aiez APPLICATION FOR ELECTRICAL PERMIT O I hereby affirm that I have a certificate of consent to self ce-eoaG 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 JOB F1Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS ❑Certified copy is filed with the county building inspec- 18 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST Residential Swimming Pools CROSS ST. Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec4—Light3Sw.A_ q MAIL COMPENSATION INSURANCE ,2 First 20 / '3 ADDRESS (This section need not be completed if the work involved by Total No. Additional CITY �� Tel. No. the permit is For one hundred dollars ($100) or less.) CK CHE I certify that in the performance of the work for which this PLAN PLANC HE permit is issued, I shall not employ any person in any manner NT so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional O Date 's �- Applicant �� 's�^'^•',�`-'�``''� Total No. 3 CITU Tel. No. NOTI E TO APPLICANT: If, after making this Certificate of Fixed Applionces,Not Over 1 HP PERMIT y /� Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION aCU G ZCCG-T• 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 G,-Tel. No. W7 - d LICENSED CONTRACTORS DECLARATIONLICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. NUMBER Classe /Q (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESSED BY r and Professions Code,and my license is in full force and effect. Q d /3a �_ /O Size 8 Type HP, KW, KVA, or KVAR ��Qt�f�,s,.�e� Q License Number Lic. Class Up to 1 Ind. FINAL U �iQ7Pt E E4iSi �'O/I'�' 6 3Q- 9� Over 1 to 10 Incl DATE O _ .-/U VALIDATION ontrac or ate Over 10 to 50 Incl �V Z ❑ am exempt under Sec FINAL U Over 50 to 100 Inc. BY UJI B.BP.C. for this reason Over 100 a Z 30-�� Services, Swbd., MCC 8 Ponelboards O Z Date: 0- 200 Amp. Under 600 V 000, Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Mainz. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit !:,.? F Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits -- - Professions Code): ---' ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors - -1- D structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ 00. TOO s_ . Business and Professions Code). _ 40 CONSTRUCTION LENDING AGENCY i-Dietl'; .`s�{.y2 I hereby affirm that there is a construction lending agency for '" E. •_ the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE �� O Lender's Address '=�f�' 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 ab o -mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Perni Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0306050006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL FEES PAID BUILDING ADDRESS: TR: 13805 LT: 4 9951 BROADWAY FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802635 ASSESS R INFORMATION UMBER: NEAREST CROSS STREET: BALDWIN 8588-015-004 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 30.00 OUT 52.50 TENANT: G2 LIGHTING FIXTURES 9.00 LGT 17.55 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 97.80 06/05/03 JK 12/02/03 OWNER: TEL. N0: FINAL DATE FINAL BY: �C DE: 99 STEVEN Y AND DONNA Y (626) 286-8228- 9951 H6-8228- ��. /L 9957 BROADWAY L G TEMPLE CITY 91780 D SCRIP ION UF WORK ELECTRICAL FOR ADDITION APPLICANT: TEL. NO: SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPEC OR SIGNATURE SAME AS OWNER - LIC. NO TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND ABLE DESIGN AND CONSTRUCTION CO. (909) 869-0732- 20160 PASEO DEL PRADO #H LIC. NO: ROUGH CONDUIT WALNUT, CA. 91789 668681 B ROUGH WIRING (o MAIN 3 r MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTI I O REPORT ID: OPR265 ROUTE TO: SS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0306090007 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 13805 LT: 4 9951 BROADWAY FEE DESCRIPTION: QUANTITY: UGM: AMOUNT: TEMP CA 917802635 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BALDWIN 8588-015-004 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY HA FAU LESS 3HP 1.00 FAU 10.95 TENANT: JB AC UNITS t3-10HP 1.00 AC 19.65 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 58.35 06/09/03 JK 12/06/03 OWNER: TEL. NO: FINAL JE FINAL BY: CODE:,- LO;STEVEN Y AND DONNA Y (626) 286-8228- �(��/ 9951 BROADWAY f TEMPLE CITY 91780 Uh�LKIPT ON OF WORK ELECTRI AL FOR HVAC SYSTEM APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO TEMPORARY OWER POLE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. UFER GROUND ABLE DESIGN AND CONSTRUCTION CO. (909) 869-0732- 20160 PASEO DEL PRADO #H LIC. NO: ROUGH CONDUIT WALNUT, CA. 91789 668681 B ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE T0: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0309040013 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL D: FEES PAID BUILDING ADDRESS: TR: 13805 LT: 4 9951 BROADWAY ASSESSOR FEE DESCRIPTION: QUANTITY: LOM: AMOUNT: TEMP CA 917802635 INFORMATION NEAREST CROSS STREET: BALDWIN 8588-015-004 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY LB 200 AMP PANELS, MCC 1.00 PAN 38.85 TOTAL FEES 66.60 ISSUED ON: PLA Y: EXPIRES N: 09/04/03 JK 03/02/04 OWNER: TEL. 0: FINAL DATE FINAL BY: CODE: LO;STEVEN Y AND DONNA Y (626) 286-8228- y 9951 BROADWAY >� � TEMPLE CITY 91780 U§ R W I i uhr OF WORK UPGRADE SERVICE PANEL TO 200AMPS APPLICANT: L. 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 ENGINEE : TEL. N0: U ER GROUND ABLE DESIGN AND CONSTRUCTION CO. (909) 869-0732- 20160 PASEO DEL PRADO #H LIC. NO: ROUGH CONDUIT WALNUT, CA. 91789 668681 B ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY 0 D REPORT ID: DPR265 ROUTE TO: BS0508