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Home My Public Portal About10206 DAINES DR_Electrical__ / WORKERS'COMPENSATION DECLARATION 76-663 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, CE-Bose / • ora cerfrficate of Workers; Compensation Insurance,or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec 3800,Lab C) Policy No ' Company ,FOR APPLICANT TO FILL-IN -' JOB - ❑ Certified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE ADDRESS /02 O�o' /AISbk�, ❑ 1 & 2-Family,Sq Ft 37G $ — $ LOCALITY C� Certified copy is filed with the county building inspection — NEAREST department Multi-family Sq Ft ; CROSS S 'Residential Swimming Pools T Date Applicant OWNER OR a• ', •� _ . - �.+ . - s FIRM NAME- I C. kd Ls CERTIFICATE OF-EXEMPTION FROM WORKERS' t6• a w �- MAIL Outlets Re c— Light Sw• o' ADDRESS COMPENSATION INSURANCE - (This section need not be completed if the work involved by the First 20 Total No Z� Adddioral CITY Tel No ,permit is-for one hundred dollars($100)or less), PLAN CHECK I•certify that in the performance of the work for which this'permit - _APPLICANT kis 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 �� S CITY Tel No Date 3 -�-�- Applicant Fixed Appliances Not Over 1 HP PERMIT ,[ NOTICE TO APPLICANT ,If, after making this Certificate of APPLICANT WSJ c\ t aJ Exemption,you should become subject to the Workers'Compensation' ' Range_ Heater W - ` } provisions of the Labor Code, you must forthwith co riply with such Oven Dr W M ADDRESS . u� �� I—PL provisions or this permit shall be deemed revoked Top AU WH _ AA-,A _ L'ICENSE_D'CONTRACTORS DECLARATION, H — Fan Other_ ' CITY AA-,hl Tel No 3T',".-r cici I hereby affirm that I 'am licensed under-provisions of Chapter 9 LICENSE OR (commencing with Section 7000) of Division 3 of the Business and isp — Room Air Cond :_ Zg 162- Professions z 7 Class B " REG NUMBER Professions Code,and my license ism,full force and effect DISTRICT NO /, ,PROCES D By Power Apparatus& Large Appliances _ Y _ -3,7'862--7 Size& Type HP,KW,KVA,or KVAR ✓ G'V License,NumberLicClass Up t>lIncl FINALContractor �qN�S.� �' SDate OveIncl DATE � -- VALIDATIONO Ov to 50 Incl I am exempt under Sec Over 50 to 100 Inc BY A W Over 100 N B&P C for this reason- 9 0 9.4,�A . Z Services, Swbd,MCC& Panel arils Date 0-200 Amp Un 00 V L_' Signature 201 - 1000 Under 600 V _ # o,o.a,a,a 'Z Over.1 Amp or Over 600 V o - 2925 0 Exemption for Reg,Maint Elect t SINGLE FAMILY Temp Power Pole& Appurtenances. a-;° 0 29.255' HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit Y I liereby'affirm that I am exempt from the Contractor's License Law o 02'-8 8- for the following reason(Section 7031 5, Business and Professions Additional Sign Branch Circuits d - Code) El 1, 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) , Civr C)` f_ 75 .PLAN CHECKING FEE:_ ri Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the above , TOTAL FEE d • 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 ` per y or i spection purposes SEE REVERSE•FOR EXPLANATORY LANGUAGE 3 — > _ �d3 Signature of Permittee Date 76A663 DBS SA 11-49 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN � DISTRICT NO. GROUP ZONE PERMIT NO. ELECTRICIAN .,p 1 1 1 oJ� RECEIVED,�BY READY FOR DATE NSBUED ADDRESS �,. _ RECEIVED,,,. FIRST INSPECTION CITY TEL. NO COUNTY ,LICENSE NO. S�L,� EXPIRES BUILDING r PERMIT FEES ADDRESS NUMBER OUTLETS EACH FEE LOCALITY'11 LIGHT SD $ NEAREST_'i, el CROSSiST7 RECEPTACLES 5 �,,• Q FIXTURES 5 OWNER r�11 tv WALL SWITCHES 5 MAIL � ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 CITY TEL. NO. MISC. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS 2.6< NUMBER OF CIRCUITS INITALLED: TOTAL %j APPLICATION AND STATE THAT THE ABOVE IS CORRECT LIGHTS R—PTACLES AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING. NUMBER HORSEPOWER FEE I CERTIFY THAT I POSSESS THE ABOVE VALID LOS NEw MVD. HP avER INC. EACH ANGELES COUNTY LICENSE, OR 1 AM THE, LEGAL OWNER V2 s LESS $ .25 OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. %z 2 .50 SIGNATURE OF 2 5 1.00 PERMITTEEV s is 1.50 INSPECTIOR RECORD 15 50 2.50 50 200 5.00 200 500 10.001 SOO 1 000 15.00 J Q OVER 1000 20.00 Z M.G. SET/FRED. CHANGER-HP E7 WELDERS:AC-KVA GENERATORS - KW I C TRANSFORMERS - KVA TEMP. MOTORS (75% OF DRIG.) MOVED MOTORS (75% OF ORIG.) MISC. SIGNS TYPE: NO.TRANS. TYPE: NO. LAMPS APPROVALS FOR EACH PERMIT: DATE INSPECTOR'S NAME CONDUIT WIRING $1.00 _ FIXTURES $1.00 I WIRING SUPPLEMENTARY .50 FIXTURES POWER / TOTAL FEE $ UTILITY CO.NOTIFIED FINAL WORKERS'COMPENSATIONDECLARATION CE-806G (2-80) APPLICATION- FOR ELECTRICAL PERMIT • I herebyaffirm that 1 have a certificate of consent -to self COUNTY OF LOS ELES I BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,o a certified copy tothereof��Sec 3800, Lab O ) FOR APPLICANT TO FIL 3O �� A Policy N i Company New Residential Bldgs &Pools EA H IND I FEE A RES S '` Certified copy is hereby furnished 1 &2-Family,Sq Ft $ — $ LOCALITY �/f7 Multi-family Sq Ft NEAREST Certified copy is filed with the c my in in c CROSS ST department Residential Swimming Pools OWNER OR 'FIRM NAME Date ' Applic Outlets RecA9_Light Sw 7 MAIL First 20 ADDRESS 7rd CERTIFICATE O EMPTION FROM WORKERS' Total No Additional CIT ` COMPENSATION INSURANCE T— PLAN CHECK Lr� Tel No 1 } APPLICANT - tl (This section need not be completed if the work involved �Q O Lighting Fixtures First 20 U by the permit is for'one hundred dollars ($100) or less.) ADDRESS Total No Additional CC I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No 0 permit is issued, I shall not employ any person in any manner PER so as to become subject to'the Workers' Compensation Laws Range_ Heater—,D W APPLICANT; W. Oven _ Dryer_W M ADDRESS g Date Applicant Top , _ FAU _W H Z Hood _ Fan _Other_ CITY O �, Tel No, NOTICE TO APPLICANT If, after making this Certificate of Disp _ Room Air Cond.— LICENSE OR Exemption, you should become subject to the Workers' REG NUMBE Class — Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO PR D BY with comply with such provisions or this permit shall be ISize&Type HP,KW, KVA,or KVAR y� 1 deemed revoked FINAL c� Up to 1 Incl �� ` Over 1 to 10 Incl DATE t �� . VALIDATION LICENSED CONTRACTORS DECLARATION o Over 10 to 50 Incl - I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL ` r 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY ness and Professions Code, and my license is in full force and effect 3 �g'0� Services License Number Lic Class / ,0 200 n er 0 C%' 201-1000 Amp Under 600 V Contractor —'CDate �._��- Over 1000 Amp or Over 600 V HOME OWNER-BUILDER DECLARATION Temp Power Pole&Appurtenances I hereby affirm that 1 am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031 5, Busi- Additional Sign Branch Circuits ness and Professions Code) Misc Conduits&Conductors ❑ I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— structure is not intended or offered for sale (Section �`,]2 A 7044, Business and Professions Code) 4 - CONSTRUCTION LENDING AGENCY , #'0 0 0 0'0 2 I hereby affirm that there is a construction lending agency for the performance of the' work for which this permit is PERMIT FEE (Sub-Total) 2 0 0 1, 2_00 issued (Sec 3097,Civ C) , Lender's,Name PLAN CHECKING FEE (One-Fourth Permit Fee) "o 0 o 1 2 0 0 6' Lender's Address PERMIT ISSUING FEE _ 0 8 1. 4—8 0• _ I certify that I have re -this application a tat that the TOTAL FEE ` above information" rrect. agree o d all County ordinances a t e law reg tin I ica wiring, and hereby a orize eprese� ativ of s nt to nter upon the ve- i d 6pe or' rp s SEE REVERSE FOR EXPLANATORY LANGUAGE Date WORKERS'COMPENSATIONDECLARATION CE-806G (2-80) APPLICATION. FOR, ELECTRICAL PERMIT CE-806 I 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(Se 3800, Lab C) _7111 K1 ' FOR APPLICANT TO FILL IN ,JOB Policy N OVID Company– VVV�'"' EACH NO FEE ADDRESS U Z ew Residential Bldgs &Pools - , Certified copy is hereby furnished '1 &2Family,Sq Ft $ — $ LOCALITY •• Certified copy is Bled with the'c ty lid Multi-family Sq Ft — NEAREST Residential Swimming Pools CROSS ST department , OWNER OR (�Q FIRM NAME Date _y App4EFtM Outlets Rec_Light Sw MAIL _ First 20 ADDRESS ' CERTIFICATE OF PTION FROM WORKERS' Total No Additional CITY Tel No 7S�/� } COMPENSATION INSURANCE - PLAN CHECK - d '. APPLICANT � e � (This section need not becompleted if,the.work involved Lighting Fixtures First 20 ADDRESS by the permit is for one hundred dollars ($100) or less.) 0� Additional I certify that in the performance'of the work-foi which•this Total No ; CITY Tel No Fixed Appliances Not Over 1 HP � , permit is issued, I shall not employ any person in any manner PERMIT . / `–; so'as to become subject to the Workers' Compensation Laws Range_ Heater_D W APPLICANT d t, Oven _ Dryer_W M. t ADDRESSS/04 - to Date Applicant Top — FAU —WH —,. Z_ Hood,_ Fan _Other_ CITY15 G Tel No , Ov NOTICE TO APPLICANT If, after making this Certificate of Disp _ Room Air Cond-_ LICENSE OR Exemption, you should become subject to the Workers' REG NUMBER4<60j Class Compensation provisions of the Labor Code, you must forth- Power Apparatus&,Large Appliances DISTRICT NO. P ��CESED BY with comply with such provisions or this'permit shall be Size&Type HP,,KW, KVA,or KVAR deemed revoked Up to 1 Incl Over 1 to 10,Incl FINALDATE LICENSED CONTRACTORS DECLARATION • —��e�� VALIDATION Over 10 to 50 Incl I hereby affirm that I am licensed•under provisions of Chapter Over 50 to 100 Inc, FINAL V BY 9 (commencing with Secti6n 7000)of Division 3 of the.Bust- Over 100 ness and Professions Code, and my license-is in full force and effect A License Numb Lic Class 10 1 0-200 Am rider 600 V � ��** Q 201-1 Amp Under 600 V , Contractor "C A Date / �3 Over 1000 Amp or Over 600 V , i HOME OWNER-BUILDER DECLARATION Temp Power Pole'&.Appurtenances I hereby affirm- that I am exempt from theN Contractor's. Sign with One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits, ness and Professions Code) Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)-- t structure is not intended or offered for sale (Section _ 7044, Business and Professions Code). ' CONSTRUCTION LENDING AGENCY '2 2.5,8 A ` I hereby affirm that,,there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097,Civ C) PERMIT FEE (Sub-Total) # o to 0 0 0 2 Lender's Name PLAN CHECKING FEE (One-Fourth Permit,Fee) 2'0•o 1 9.50 Lender's Address PERMIT ISSUING FEE 10:0,-.119,5.0 I certify that I have read is app atton a to tliat the TOTAL FEE Q .9 2'4'-..8 0 above information is ct I agrgge to co all County, ordinances a ate aws re ailati a lr al/wiring, and hereby o pr ent yrto n th entr rop n ores' SEE REVERSE FOR EXPLANATORY LANGUAGE n re of mrttee F - D?e COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0912150023 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT ILEGAL ID FEES PAID I BUILDING ADDRESS ITR. 15862 LT. 2 I 10206 DAINES DR I IFEE DESCRIPTION QUANTITY UOM AMOUNT I TEMP CA 917802707 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET 1 18586-027-002 IA1 PERMIT ISSUANCE FEE 27 75 I THOMAS PAGE 597 GRID B3 LOCALITY TEMPLE CITY, Cl I IG1 OUTLETS-LGT,SW,RECP 5 00 OUT 9 75 I 1 ITENANT IG2 LIGHTING FIXTURES 1 00 LGT 1 95 (ISSUED ON PROCESSED BY PLAN BY EXPIRES ON I IH2 RES GRBG DISP LT 3HP 1 00 DIS 10 95 112/15/09 SR 12/15/10 I IH3 RES DISHWASHR LT 3HP 1 00 DIS 10 95 1 1 (OWNER TEL. NO: IH5 RES WASH MACH LT 3HP 1 00 WAS 10 95 1F AL D TE FINAL BY CODE I TWANG, WANJIE (626) 448-8908- IH7 RES EXHAUST FANS 1 00 EX 10 95 1 /� � 10206 DAINES DR 1 TOTAL FEES 83 25 (l ITEMP 917802707 I I ESCRIPTION OF WORK 1 I (ELECTRICAL FOR KITCHEN AND RELOCATE LAUNDRY ROOM 1 1APPLICANT TEL NO ISAME AS OWNER - I _ ISPECIAL CONDITIONS I I I I ICONTRACTOR TEL NO 1APPROVALS DATE INSPECTOR SIGNATURE ISAME AS OWNER - I I - LIC NO ITEMPORARY POWER POLE I (UNDERGROUND CONDUIT 1 I 1 1ARCHITECT OR ENGINEER- TEL NO 1 1UFER GROUND 1 I LIC NO" IROUGH CONDUIT 1 - 1 IROUGH WIRING I 1 1 IMAIN WATER LINE I 1 1 ' IPLASTIC Y/N METAL Y/N I I I I I I 1 IUTILTTY COMPANY NOTIFIEDI I I I I I I I I I I I I I }1 I I I I I I EXmrll`lED ;;?-o) O 1 I I I I I I I I I IREPORT ID DPR265 ROUTE TO BS0508 I I I I I I