Loading...
HomeMy Public PortalAbout8766 BURGHARDT RD_Electrical__ WORKERS' COMPENSATION DECLARATION CE-806 tDiel APPLICATION I�11'SO IC p TION FOR ELECTRICAL ECTRIC p p ImERM IT I hereby affirm that I have a certificate of consent to self CE-RO6G P91r Ir IL 'i.YY 0 tlCl Ir Y'l IG IL �r.r Y Y'( P91L Ir lG tl'(CV6 0 insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES c, BUILDING AND SAFETY or a cer ified co y thereof (Sec. 380&, tab. CJ Policy No. Company /',�SS�IQ�i'7 FOR APPLICANT TO FILL IN JOB ¢j,••v .r Certified copy is hereby furnished. New Residential Bldgs. 8 Pools —$,0 EACH - NO. FEE ADDRESS jf 74/ Certified copy is filed with the county building inspec- 1 8 2-Family, Sq. FC Z41eo S 03 — $ LOCALITY tion department. Multi=family Sq. m NEAREST Residential Swimming Pools CROSS ST. Dale Applica t OWNER OR i FIRM NAME CELE T PE EXEMPTION FROM WORKERS' Outlets: Rec—LightEMAIL COMPENSATION INSURANCE ADDRESS s section need not be completed if the work involved b First 20 _ (ThitiP Y Tel. No. the permit is for one hundred dollars ($I00)or lass.) Total No. Additional CITY I certify that in the performance of the work for which this PLAN CHECK permit is issued, I shall ploy any person in any manner APPLICANT so as to become subjectt to to th the Workers'Compensation Lows. Lighting Fixtures First 20 ADDRESS Total No. I Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT /J NOTICE TO APPLICANT: If, after making this Certificate of 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.— ADDRESSA L with comply with such provisions or this permit shall be Top _ FAU —W.H. — deemed revoked. CITY C Tel. No.o'r� LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other— Disp. _ Room Air Cone. LICENSE OR A .•L Class. + I hereby off irm that I am licensed under provisions of Chapter 9 REG. NUMBERS7/ 3lQ (commencing with Section 7000) of Division 3 of the Business .Power Apparatus 8 Large Appliances DISTRICT NO. PROCESS BY Y and Professions Code,and my license is in full force and effect. [� d / �� Size 8 Type HP, KW, KVA, or KVAR' J 'v O License Number-?57/`1/J-2 Lic. Class�Le Up to 1 Incl. FINAL _/^ �y V Conir for / Date�� 7 Over I to 10 Incl. DATE Q."(,Q —�{ VALIDATION O Over 10 to 50 Incl., FINAL ���''''''777 V 10- ❑ I 1 am exempt yad r Sec Over 50 to 100 Inc. BY ( ��e,,,��e uVi B.BP.C. for this reason Over 100 v rp Services, Swbd., MCC 8 Panelboards D �� ',f - Z Dote: _ 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V A 7 5 0 A ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Mainz. Elect. 1 # o e e e e 2 SINGLE FAMILY Temp. Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 2 e - 7.7. 0.0 1 hereby affirm that I am exempt from the Contractors License additional Sign Branch Circuits x Law for the following reason (Section 7031.5, Business and q o o a 7 7,0 0 5 Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors 1 21 4-83 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ D 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 1 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) (Sec. 3097, Civ. C.). PLAN CHECKING FEE -- . Lender's Name PERMIT ISSUING FEE - 0 Lender's Address I certify that I have read this application and state that the TOTAL FEE [ 7, O2 above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby a rile representatives fthis County to enter upon - they ovk—_ntio ed proper o inspection purpos�e}s. SEE REVERSE FOR EXPLANATORY LANGUAGE ./ S' gy of Permittee WORKERS'COMPENSATION DECLARAITION 76CE-663 ,D,B, APPLICATION FOR ELECTRICAL PERMIT {� I hereby affirm that 1 have a certificate,of consent to self insure, cE-eoaG LJ or a certificate of Workers' Compensation Insurance, or a.certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thp+••of(Sec.-3800,Lab.C.) - 7olicy No Y 00 Y Company4J6 _ FOR APPLICANT TO FILL IN - JOB �/'�/•(� ^ �y2 - ❑ Certified copy-is hereby furnished. • New Residential Bldgs.& Pools 'EACH , NO.- 'FEE ADDRESS 1 8 2-Family.Sq.Ft. $ — $ LOCALITY - r Certified Copy is filed with the county building inspection _ NEAREST - department. / Multi-family Sq. ST Ft. 5.0� Residential Swimming Pools CROSS O Date Applicant �. OWNER OR FIRM NAME _ .• p r.//�IC. �-(,/ CERTIFICATE OF EXEMPTION FROM WORKERS' � MAIL / Outlets:Rec L'ght Sw. — COMPENSATION INSURANCE •/ / / ADDRESS:' �D First 20 (Ttiisuiecliomneed,not be com leted if the work involved ti the jy(,� p Y Total No. Additional - CITY permit is for one.hundretl dollars ($100)or less.) [:� G( ( / Tel.less.), ' Xiff I certify that in the performance of the work for which this permit - , . PLAN NJAPPLICANi CHECK - - ,is,issued. Ishall not.employ any person in any mannerso-as to /.�3 become subject to the Workers Comppeen1saation`Laws Lighting Fixture First 20: ADDRESS Addi —� I N IVJ�/� `TR7V 'Total No. CITY ` - Tel.No. Date Applicant T NOTICE.TO APPLICANT: If,.. after making this "Certificate of Fixed Appliances Not Over 1 HP PERMIT .1�-0.9 G, Exemption,you should became subject to the Workers'Compensation Range' Heater_ D.W. _ - APPLICANT IU N erflprovisions ofthe.Labor Code,you must forthwith comply with such Oven _h/_ Dryer _ W.M._ ADDRESS �-�0- x provisions or this permit shall bedeemed revoked. Top FAU W.H. • LICENSED CONTRACTORS DECLARATION Hood - Fan Other G, CITY _ r JJ� Tel No.•-c�.F ' ;hereby affirm.that.] am licensed under,provisions•of Chapter 9 _ 'LICENSE OR 1 (commencing with Section 7000) of Division 3 of the Business and Disp. Room Air Cond. �yy• 'Class. REG.NUMBER Professions Code,and my license is in full force and effect. ADISTRICT NO. - - PROCESSED BY Power Apparatus 8 Large Appliances . - e Size 8 Type HP,KW,KVA,or KVAR U License Number Lic.Class (� - Up to 1 Incl. FINAL / / r Contractor �T'v� �N (�L/d Over 1 to 10 line[. DATE vv.Date y —. VALIDATION ❑ I, _ Over 10 to 50 Incl FINAL _ _. am exempt under-Sec. _ Over 50 to 100 Inc. BY ., _ W B.&P.C.for this reason Over 100 - N . - Services,Swbd.,MCC'& Parielboards D - Z Date:'^ 0,- 200 Amp.Under 600 V .Signature� 201`- 1000 Amp.Under 600 V ❑ it Over 1000 Amp.or Over 600 V - Exemption for Reg.Maint:Elect. ._. SINGLE FAMILY Temp.Power Pale_&Appurienance5 �- HOME OWNER-BUILDER DECLARATION Sign.with One Branch Circuit 'T.A Thereby affirm that I am exempt from the Contractor's License Law rt4lv for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits - -, 54 .it Code): d,SD, - - I,as owner of the property,will clothe work and Misc.of & Conductors the structure _ is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) D , Lt�TAi - 54 ® 26 and Professions Code). 11 CONSTRUCTION LENDING AGENCY {{gEh.n _14..fe I hereby affirm that there is•a construction lending agency for the NAPE= .1111 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE' (Sub-Total) Civ. C.T. PLAN CHECKING FEE .011130-0001: V3L3I'i 1- Lender's Name / PERMIT ISSUING FEE- 9250 .j AM 7.�q M Lender's AddI have that 6 Icertify that ave read this application and state that the above TOTALFEE information is correct. I agree to comply with all County ordinances - and-State laws regulating Electrical wiring, and hereby authorize .r ' " •• representatives of this County to enter upon the above-mentioned , property for inspectiori purposes. ' SEE REVERSE FOR EXPLANATORY LANGUAGE - - - - •- .-- Signature of Permittee Date - DEC TION 76A66 Worm that have COMPENSATION cafe of corse CE-806 ID/BI APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-8066 insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certfedcopy thereof (Sec_38 Policy No. s - � �j(S2op0 �� 7.) 5many. FOR APPLICANT TO FILL IN JOB ADDRESS �6G Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE r _ Certified copy is filed with the county building inspec- I & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-fomily Sq. Ft. — NEAREST CROSS ST. Residential Swimming Pools ]CITY ER OR ' Date Applicant NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec_Light_Sw._ COMPENSATION INSURANCE First 20 ESS (This section need not be completed If the work involved by Total No. Tel. No. the permit is for one hundred dollars ($100)or less.) Additional CHECK I certify that in the performance of the work for which this CANT permit is issued, shall not theemployWo anyker person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 RESS Total No. Additional Tel. No. Dote Applicant Fixed Appliances Not.Over 1 HP PERMIT S c Exemption, you should become subject to the Workers' Range_ Heater_D.W. NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT Compensation provisions of the Labor Code, you must forth- Oven _ Dryer _ W.M._ ADDRESS jir6 c with comply with such provisions or this permit shall be Top _ FAU —W.H. — �� y ` deemed revoked. Hood Or CITY 0 V t e No.7Z2-3 D-GI V LICENSED CONTRACTORS DECLARATION _ Fan _ LICENSE OR Dista. Room Air Cond. REG. NUMBER Class. © I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PR SSED BY >_and Professions Code, and my license is in full force and effect. p, rT _ Size 8 Typ e HP, KW, KVA, or KVAR' 5. V /� License Number z •)- ( Lic Class I Up to 1 Incl. DATE '/ 3 Over 1 to 10 Incl. �( 'G �j VALIDATION O Contractor a Over 10 to 50 Incl. U ❑ FINAL 1 am exempt underSec. Over 50 to 100 Inc. BYWIL B.&P.C. for this reason Over 100 W Date: Services, Swbd., MCC& Ponelboords D 0 - 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp, or Over 600 V Exemption for Req. Mainz. Elect. 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 9 6 5.G.5 A Law for the following reason (Section 7031.5, Business and ; Professions Code): #Is e'e a e 'Z El y I, as owner of the property, will do the work and the Misc. Conduits& Conductors q/ e a structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ D ,Ar 2 5 5 G 7044, Business and Professions Code). `o Is a2 5 Lj G v CONSTRUCTION LENDING AGENCY I hereby affirm that there is aconstruction lending agency for ) ),G ) —8,3 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) - n (Sec. 3097, Civ. C. I, JPLAN CHECKING FEE Lender's Name IL arll v PERMIT ISSUING FEE Lender's Address S - L rc' �� 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 oulhoriz �ntatiyes of this County to enter upon he above-men ed ror inspection pu uses. SEE REVERSE FOR EXPLANATORY LANGUAGE Signaturd of Permittee Dat ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0910140012 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID BUILDING ADDRESS: IBX: 164 PG: 31 PG 2 8766 HURGHARDT RD I IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: 1 SGAB CA 917752650 (ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET- 15386-012-070 1A1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl IG1 OUTLETS-LGT,SW,RECP 10.00 OUT 19.50 1 TENANT: IG2 LIGHTING FIXTURES 16.00 LGT 31.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1H2 RES GREG DISP LT 3HP 1.00 DIS 10.95 110/14/09 SR 10/14/10 JH3 RES DISHWASHR LT 3HP 1.00 DIS 10.95 1 OWNER: TEL. N0: IH4 RES RANGE HDS LT 3HP 1.00 HOO 10.95 (FINAL DATE FINAL Y. CODE: IYIP, KONG (626) 309-1479- 1 TOTAL FEES 111.30 1 1 18766 BURGHARDT RD SGAB 917752650aESC�i PTION OF WORK I i iELECTRICAL FOR KITCHEN REMODEL 1 APPLICANT: TEL. NO: IREN H ZHU (626) 808-2704- 1 18631 HERMOSA DR. SPECIAL CONDITIONS: SAN GABRIEL CA 91775 I I I 1 I CONTRACTOR: TEL. N0: (APPROVALS DATE INSPECTOR SIGNATURE J R TECH CONSTRUCTION (626) 808-2764- 18631 HERMOSA DR LIC. NO ITEMPORARY POWER POLE SAN GABRIEL CA 91775 750490 H UNDERGROUND CONDUIT I ARCHITECT OR ENGINEER: TEL. NO: JUFER GROUND I I � LIC. NO: ROUGH CONDUIT I I I IROUGH WIRING MAIN WATER LINE (PLASTIC YIN METAL YIN I � I UTILITY COMPANY NOTIFIEDI I I I I I I I I I I I I IREPORT ID: DPR265 ROUTE TO: BSE508 I I I I I I