The URL can be used to link to this page

Home My Public Portal About4840 CLOVERLY AVE_Electrical__ "WORKERS'COMPENSATION DECLARATION 76-663 tD/et APPLICATION FOR ELECTRICAL PERMIT {l 'i he'I�eby affirm that II have a certificate of consent to self insure, CE-806G u ?r a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY #opy thereof($ec. 3800,Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB Lie ❑ Certified copy is herebyfurnished. EACH NO. FEE ADDRESS 7 oy� C/O VEKL. New Residential Bldgs.& Pools F-1 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY /V7 A21-6 Cfr Certified copy is filed with the county building inspection NEAREST /� department. Multi-family Sq.Ft. ZOW64 ozujf CROSS ST. Date Applicant Residential Swimming Pools OWNER OR n FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec S. Light ; Sw. MAIL 'COMPENSATION INSURANCE d ADDRESS This section need not be completed if the work involved by the la First 20 permit is for one hundred dollars ($100)or less.) Total No./l Additional S CITY Tel.No. X87 ys9 that in the performance of the work for which this permit / PLAN CHECK I certify P APPLICANT is issued, I shall not employ any person in any manner so as to �7 become subject to the Workers'C pensation Laws. Lighting Fixtures First 20 r P ADDRESS n � Additional CITY T . 6_ 8 xd�_.. Total No. Date 6 Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. 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. _ CITYTel.No. LICENSED CONTRACTORS DECLARATION Hood Fan L Other_ C n I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. S?� V LICENSE OR REG.NUMBER Class. (commencing with Section 7000) of Division 3 of the Business and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESSED Y Size& Type HP,KW,KVA,or KVAR G�// 3'( 0 License Number Lic.Class Up to 1 Incl. /•UQ 1 FINAL Over 1 to 10 Incl. DATE y ` VALIDATION Contractor Date Over 10 to 50 Incl. V ❑ I am exempt under Sec. Over 50 to 100 Inc. FINAL BY 1.1 Over 1006' a- BAP.C.for this reason 9 7 a p A to Services,Swbd.,MCC&Panelbo&ds ,yt " Z Date: 0-200 Amp.Under 600 V G(J Poo- Signature 0 0 0 0 0 2 Signature 201 - 1000 Amp. Under 600 V 0 0 3'1'O 0 ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. 0 0 0 31,0 0 5 SINGLE FAMILY, Temp.Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 0604-88 1reby affirm that I am exempt from the Contractor's License Law f the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits de): Misc.Conduits& Conductors 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) ► 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 /l I 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 p perty for inspection purp ses. SEE REVERSE FOR EXPLANATORY LANGUAGE ,C.elk,� ( —4 —a Signature of Permittee Date �dnyRKERS' COMPENSATION DECLARATION CE-806 tout APPLICATION 'FOR ELECTRICAL PERMIT yafh! Jrroriafcertif cairm tte of Workers'lCompennsal oificate of n Insurancnt to e{ CE-806G COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C. Policy No. Company FOR APPLICANT TO FILL IN JOB '/8 vo / Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS y Pol ❑ LOCALITY— T�m Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ $ � �T /� tion department. Multi-family Sq. Ft. NEAREST Residential Swimming Pools CROSS SOWNER T. Z T. Lr7u�G1C- Q L!.(lIR Date Applicant FIRM NAME e {I—{ {Z, CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light ) Sw.J- AIL COMPENSATION INSURANCE First 20 1 ADDRESS (This section need not be completed if the work involved by Total No. Additional CITY Tel. No. �'M 6 rt I the permit is for one hundred dollars (;100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit 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. DateLly— g5 Applicant Fixed Appliances Not Over 1 HP PERMIT 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.— ADDRESS with comply with.such provisions or this permit shall be Top FAU —W.H. — deemed revoked. Hood Fan _Other_ CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions-of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER Class. } (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PRO S D BY � and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances L 6 �� 0' Size &Type HP, KW, KVA, or KVAR' /� License Number Lic. Class Up to 1 Incl. FINAL Over 1 to 10 Incl DATE Contractor Date VALI ATION W ❑ Over 10 to 50 Incl. FINAL / //,, I am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 Z Date: Services, Swbd., MCC& Panelboards 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V El Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. ;2 TJ 3 a SINGLE FAMILY Temp. Power Pole& Appurtenances # 0 0 0 0 0 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License I 0 0 1 i,25 La for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits P 0,04,255 r fessions Code): o I, as owner of the property, will do the work and the Misc. Conduits&Conductors Other See.Com tete Fee Schedule)— ► 1.04=85 er structure is not intended or offered for sale (Section ( P, ' 7044, Business 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE 5 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 Ae above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date , r WORKERS'COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806G ^irrBwr,4,9r a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB 1,B 7 c� Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS -'Y ® Ct01116JeC. ❑ Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY ^�—�,zT k tion department. - Multi-family Sq. Ft. 'NEAREST i CROSS ST. LOW t+QL QZ Q S H (( Residential Swimming Pools OWNER OR. p //�► Date Applicant FIRM NAME 6 i 1'I Am 1 1aV' Z ' CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE First 20 ADDRESS (This section need not be completed if the work involved by Total No. CITY Tel. No. the permit is for one hundred dollars ($100)or less.) Additional PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit 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 F�-_'65 ' Total No. CITY Tel. No. Date/O— / Applicant (ll CCC..///.bl�rc.cL. -- Fixed Appliances Not Over 1 HP PERMIT 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.— ADDRESS with comply with such provisions or this permit shall be Top _ FAU —W.H. — deemed revoked. Hood Fan _Other_ CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG. NUMBER Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PR SSED BY and Professions Code, and my license is in full force and effect. Power Apparatus & Large Appliances Size &Type HP, KW, KVA, or KVAIR License Number Lic. Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE z� 7� VALIDATION Contractor Date ❑ Over 10 to 50 Incl. A A �/� " — 1== I am exempt under Sec. Over 50 to 100 Inc. BY Over 100 B.BP.C. for this reason to Services, Swbd., MCC & Panelboards ,^ Date: 0 - 200 Amp. Under 600 V J Signature 201 - 1000 Amp. Under 600 V a9 0 9 Q 8 A Over 1000 Amp. or Over 600 V ❑ Exemption for Reg. Maint. Elect. # o o 0 0 0 2 SINGLE FAMILY Temp. Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION e Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): o - 25.50 ❑ 1, as owner of the property, will do the work and the Misc. Conduits& Conductors structure. is not intended or offered for sale (Section Other (See.Complete Fee Schedule)— ® o 0 - 2 a 5 0 6 c.a 7044, Business and Professions Code). J Q 1 7-84 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name Q PERMIT ISSUING FEE Lender's Address 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 above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1206050001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: ! FEES PAID I BUILDING ADDRESS: ITR: 11454 IT: 24 BL: .001 I I 4840 CLOVERLY AV I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ! TEMP CA 917803808 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18590-020-025 IA1 PERMIT ISSUANCE FEE 27.80 1 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY, Cl I IJX MOTORS, LT 3 HP 1.00 MOT 15.30 1_ 1 ITENANT: I TOTAL FEES 43.10 11SSUED ON: PROCESSED BY: PLAN BY: 1 I I 106/05/12 SR 1 I (OWNER: TEL. NO: 1 INAL DATE F;NAL BY: CODE: 1 LEE, JUSTIN (626) 429-0846- 1 ! 1 14840 CLOVERLY AV ! ITEMP 917803808 rftSCRIPTION OF WORK 11 NEW 20 AMP CIRCUIT FOR ELECTRIC GATE MOTOR 1 I ! I I (APPLICANT: TEL. NO: I 1 1 IVEGA ELECTRICAL, IRINEO A (626) 321-5450- 1770 W ALTADENA DR I ISPECIAL CONDITIONS: ! 1ALTADENA, CA 91001 I ! I ! I I ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE ! 1VEGA ELECTRICAL (626) 321-5450- 1-- 1770 W. ALTADENA DR. LIC. NO I ITEMPORARY POWER POLE I I 1ALTADENA, CA 91001 856365010 * I 1 ! ! I (UNDERGROUND CONDUIT ! !ARCHITECT OR ENGINEER: TEL. NO: 1UFER GROUND I�I LIC. NO: ! IROUGH CONDUIT 1 I I 1 IROUGH WIRING I I ! I IMAIN WATER LINE I I 1 I IPLASTIC YIN METAL YIN 1 ! ! I I (UTILITY COMPANY NOTIFIEDI I I I I I I ! I i I I ! I I ! i ! I I I I ! I I I I i I I I I I I I I I I I I I I 1* ADDITIONAL DATA ON FILE I I ! ! 1 (REPORT ID: DPR265 ROUTE TO: BS0508 1 I 1 1 I I I I I I