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HomeMy Public PortalAbout10712 DAINES DR_Electrical__ WORKERS' COMPENSATION DECLARATION CE 86a total APPLICATION PPLI • A TION FOR ELECTRICAL CL ECTRIC p p PERMIT hereby affirm atll have a certificate of consent to self CE806GPY ''kkaaY9 UCI If' L•l IG IL6 II 11'l Y91L PERMIT II � . insure, or ace is a of Workers' Compensation Insurance, COUNTY OF LOS ANGELES _ BUILDING AND SAFETY or a cenified� py ereof�Sec. 3800, ab. G) _ Polic No i. �� �� ❑ y omPany FOR APPLICANT TO FILL IN - -�. JOB Certified copy is hereby furnished. //// New Residential Bldgs. 8 Pools EACH NO, FEE ADDRESS M !� Certified copy is filed with the con nty" N ' i- e 18 2-Family, Sq. FL $ _ $ LOCALITY > LtL NEAREST ! •r' tign depyrf ent Multi-family Sq. Ft, CROSS.ST. L Residential.Swimming Pools OWNER OR Date /� Applicant - FIRM NAME CERTIFICATE OF EXEMPTI -FROMtWORKER Outlets: Rec_Light_Sw._ 'MAIL COMPENSATION INSURANCE ADDRESS �C� First 20 (This section need not be completed if the r less.) ed by Total No. - Additional CITY ._ Tel. No. the permit is for one hundred dollars ($100)or less.) I certifythat in the performance of the work for which this-1 PLAN CHECK P APPLICANT CA 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 jffla-De / Total No. Additional - CITY _ ^ Tel. No. Fixed Appliances Not Over 1 HE � PERMIT a f�� % Date Applicant �f SDI 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)7of Division•3 of the Business DISTRICT NO. PROCESSED BY ( and.Professions Code, a it my license is in full force and effect. Power Apparatus Large Appliances _ d 9 7� Size B Type HP. KW, KVA, or KVAR' Q O License Number- Lic. Class ,rte' - Up to I Incl. FINAL ,gyp Contract - ' -j pate. - Over 1 to 1D Incl. DATE O �/6'•—y VALIDATION - O l Over 10 to 50 Incl. FINAL GGG- �l _ 1— El❑ om exempt under Sec. - .Over 50 to 100 Inc. BY _ lu B.BP.C. for this reason Over 100 ! Z Date: Service MCC 8 Ponelboards D - 0"'200 Am U r 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp, or Over 600 V , Exemption for Reg. Mainz. Elect. SINGLE FAMILY Temp. Power Pole &Appurtenances _ z3 5-0.8 A .HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # o•e e a e 2I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits t Law for the following reason 45ection 7031.5, Business and 2 r• - 2550 Professions Code): ❑ I, as owner of the property, will the work and the e o e2 5 5 0 v structure is not intended or offered Misc. Conduits VCo�ductors d for sale (Section Other (See Complete Fee Schedule)_ _ L� L , - Y 7044, Business and Professions Code). IVB �.8 F1 '5—.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 E 'PERMIT FEE e(Sub-Total) - (Sec. 3097, Civ:C.). PLAN CHECKING FEE - Lender's Name PERMIT ISSUING FEE r. Lender's Address 1 certify that I have* d this application and state that the TOTAL FEE. _ above infarma 'e�' correct. I agree to comply with all County ordina nc s n tat gulating Electrical wiring, and hereby- arize re ntaI ves of this County to enter upon - '- th n top ty form in purposes. ' el�' A SEE REVERSE FOR EXPLANATORY,LANGUAGE_ - - Si azure Per ee Date �J7 DEC -WORKERS'COMPENSATION certificate cafe of co'se, CE-E 70181 , APPLICATION FOR ELECTRICAL ECTRIC p E PElmMIT I hereby affirm that I have a certificate of consent to self' CE-Bd6G' P9rIr IL YY pal FOR IG IL IG II II'( 'b P9 p. Ir IG V(MVi p insure, or a.,, rtifi ate,of Workers Compensation Insurance, COUNTY OF LOS ANGELES T BUILDING AND SAFETY or a,certifie o thereof (Sec. 3800, Lab.C.) Policy No Company a1A?, `t0� FOR(sRPLICANT TO.FlLL IN. JOB --0712 �� Certified copy is hereby furnished. New Residential Bidgs. & Pools EACH NO. FEE ADDRESS Cl g _ g LOCALITY y� L- r d. er'tied copy'is filed with the c "din inspec- 1 8 2-Family, Sq. Ft. /-!� `C. ���/ r �7 - ti depa'rtmen't Multi-family Sq. Ft. — NEAREST Z�• Residential Swimming Pools OWNER OR ' Date Applicant / /� .FIRM NAME ©5 �N H CERTIFICATE OF EXEMPTION FROM WOR S' -5w(^' MAL f Outlets: Rec�lighf ADDRESS ��s1H COMPENSATION INSURANCE a2U t7 '1 This section need not be completed if the work inbolved b First 20' i ( R T Total Na. CITY _ Tel. No. the permit is for one hundred dollars($100)or less:) Additional PLAN CHECK n 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 ' sods to become subject to;the Workers'Compensation Laws Lighting,Fi xtures 'First 20 ADDRESS. .6/Z rYt (y>.rc-a o7- Total No.� Additional CITYel. o. Date Applicant ' DC-f/TASTN s lb `C. 4Lel�oc NOTICE TO APPLICANT:,If, after making this Certificate of Fixed Appl iances Not Over I HP PERMIT 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 FALL 7W.H. — _ deemed revoked. Hood _ Fan _ Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATIONLICENSE OR p �i 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 OCE ED BY , i and Professions Codend my license s in full force and effect. Power Apparatus 8 Large Appliances. `_` !1 a� Size & Type HP, KW, KVA, or KVAR' ✓ O License Number_ R 7/8 Lic. Clos Z Up to 1 Incl. - L FINAL V Contractor 46•�f�rYS� dte �r2'J Over I to 10 Incl. DATE - VALIDATION O ❑ , Over 10 to 50 Incl. FINAL I v v u I am exempt under Sec ,Over 50 to 100,1nc BY W d B.BP.C. for this reason Over 100 / - H Services, Swbd., MCC 8 Panelboards © /��,�� Z Date: 0 - 200 Amp. Under 600'V— - Signature 201 - 1000 Amp. Under 600'V - Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp..Power Pole 8 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 F1 8 2.7 A Law for the following reason (Section 7031.5, Business and Professions Code): # a -1. • e 2 I, as owner of the property, will red the work and the 2 •'e. 9,00 structMisc. Conduits B Conductors ure is not intended or offered for sate (Section Other (See Complete Fee Schedule)_ I 7044, Business and Professions Code). D 'o o'o v Q 0 06"� CONSTRUCTION LENDING AGENCY I.hereby affirm that there is constructionlending agency for. _. . 0'61 Q 7;-84. the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 0 .-. - (Sec.,3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE (] Lender's Address � - I certify that I h ve read this application and state that the TOTAL FEE above inform n is correct. I agree to comply with all County - I ordinance d State laws regulating Electrical wiring, and hereb an tleprese rives of this County to enter upon the ve- i n ro erty for inspection urposes. ' ' SEE REVERSE FOR EXPLANATORY LANGUAGE .. .. Si natur r tee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0304070019 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL S PAID BUILDING ADDRESS: TR: 13613 LT: 7 10712 DAINES DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802819 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: EL MONTE 8573-003-012 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY SLB 200 AMP PANELS, MCC 1.00 PAN 38.85 TENANT: TOTAL FEES 66.60 ISSUED : PROCESSED Y: PLAN Y: EXPIRES ON: 04/07/03 JK 10/04/03 OWNER: TEL. NO: FINAL DATE U FINA BY CODE: OSPINA DARIO;GLORIA (626) 575-0101- 10712 DAINES DR TEMP 917802819 D SCRIPTION OF WORK UPGRADE SERVICE PANEL TO 200 AMP APPLICANT: EL. N0: FIDEL VALDOVINOS (213) 719-1799- 3616 FLORAL DR SPECIAL CONDITIONS: LA CA CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE VALDOVINOS ELECTRIC (213) 269-9711- 3616 FLORAL DR. LIC. NO TEMPORARY POWER POLE LOS ANGELES, CA 90022 631058 UNDERGROUND CONDUIT R HI T OR ENGINEER: T L. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: SS0508