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Home My Public Portal About10918 DAINES DR_Electrical__ WORKERS'COMPENSATION,DECLARATION 76AS CE E8636G (2 80) APPLICATION FOR ELECTRICAL PERMIT � . .1 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 e a certified copy-thereof IS FOR APPLICANTTO FILL IN \ Policy ✓ o pang ' ' ADDRESSY 5 � �d I New Residential Bldgs.&Pools EACH NO. FEE Certified copy is hereby furnished. /' '"' 1 &2-Family,Sq. Ft. $ — $ LOCALITY ® . Multi-family Sq. Ft. NEAREST Certified copy is filed with the county buil di inspection CROSS�ST s;�,^/%f �J department. Residential Swimming Pools P OWNER OR--• 4 FIRM NAME Y Date Applicant �� / Outlets: Rec.21-ight_Sw. < MAIL - CERTIFICATE OFEXEM EXEMPTION FROM WORKERS' _ First 21 _ _ ADDRESS COMPENSATION INSURANCE Total No. l Additional CITY/t Tel No. Q2{�{C4'•ff'rjif5/ } PLAN CH CK \ 1 (This section need not be completed if the work involved I APPLICANT by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS - 2 Total No. Additional O I certify that in the performance of the work for which this CITY Tel No. 1-- permit is issued, I shall not employ an Fixed Appliances Not Over 1 HP L) P p y y person in any manner , PERMIT _ so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. I or APPLICANT F Ld' c N Oven _ Dryer_W.M._ ADDRESS n' Date Applicant Top _ FAU _W.H., Hood _ Fan _Other_ // CITU f J�i11�P-i�G. Tel No. 29,5-49vq NOTICE TO APPLICANT: If, after making this Certificate of Dis i tr/ LICENSE OR Exemption, I p. L Raom Air Cond._ p you should become subject to the Workers' REG. NUMBE Seib Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PR EBY with comply with such provisions.or this permit shall be deemed revoked. Size&Type HP,KW, KV A,or KVAR Up to 1 Incl. _ ' FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE �� —�� - VALIDATION Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL ^ 9 (commencingwithSection 7000) of Division 3 of the Bust- Over 100 BY ' ness and Professions.Code, and my license is in full force and effect. Services License Number_ '"c �Lic. Class 0-200 Amp. Under 600 Vj/ 7(� 201-1000 Amp. Under 600 V Contractor Date Over 1000 Amp.or Over 600 V HOME OWNER BUILDER DECLARATION Temp. Power Pole &Appurtenances I hereby affirm that I 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): r�27 9, 5 A Misc.Conduits&Conductors ' 1, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— #t. 0,. o e 2 structure is not intended or offered for sale (Section. F < . 7044, Business and Professions Code): 2 0.7- 0 CONSTRUCTION LENDING AGENCY 1 hereby affirm.that there is a construction lending agency I 3Q70 5 for the performance of the work for which this permit iso:0 0 issued (Sec. 3097,Civ.C.). PERMIT FEE (Sub-Total) 2 9—8 2 Lender's Name - PLAN CHECKING FEE (One-Fourth Permit Feel ' Lender's Address PERMIT ISSUING FEE - 1 certify that I have read this application and state that the TOTAL FEE above information is correct. 1 agree to comply with all County ordinances and State laws reguIA.19 Electrical wiring, and hereby authorize representatives (this County to enter upon the ab ye-mentioned pr4tfpec[ion purposes. ,� SEE'REVERSE FOR EXPLANATORY LANGUAGESignature of PermittDate WORKER'S COMPENSATION DECLARATION �6A663 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT - I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec. 3800 Lab.C.).. PoliOy No. Company FOR APPLICANT TO FILL IN JOB C" ADDRESS ❑ Certifietl co Is hereby furnished NO. EACH FEE 'LOCALITY PY V New Resitlential Bldgs.&Pools - ❑., Certified co is filed the count building ins ection i&2-Family,Sq.Ft. — $ $ PY Y 9 P NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant- Residential Swimming Pools i, ASSESSOR pg �9 ,MAP BOOK .� /9 PAGE �� PARCEL 1&9// CERTIFICATE OF EXEMPTION FROM WORKERS' LI �p C r OWNER o l _ Outlets:Ree. Light SW. IRM NAM �Q! COMPENSATION INSURANCE _ .-_ --.- - -' --'First 20- " _ a ✓ra-' ---- - - - - _ _ ;_ ._, _...�. _ - MAIL (This section need not be completed if the work Involved by the Total No. Additional L ADDRESS permitisfor one hundred dollars($100)or4ess.) I certify that in the performance of the work for which this permit CITY �� TOL No./{.{��_ is issued, I shall not employ any person in any manner so as to �T PLAN CRECK become subject to the Workers' Compensation.Laws. r Lighting Fixtures First 20 12• V APPLICANT C/ 2 qo Total No. Additional ADDRESS Date '/ �" _ `Applicant n 1 RESIDENTIAL APPLIANCES NOT.OVER 3 HP. C' NOTICE TO APPLICANT: If, after mak this Certificate of CITY T.I.No. Exemption,you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT ' provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT ' LICENSED CONTRACTORS DECLARATION Size&Type HP, KW,KVA,or KVAR ADDRESS ` 0 I hereby affirm that 1'am licensed under provisions of Chapter 9 �-/� Over 3 to 101nd. (commencing with Section 7000) of Division.3 of the Business and CITY Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. - LICE �. REG.N OR G rj Class.�-�O 0— Over 50 to 100 Incl. REG.NUMBER o O ry(� 7 Over 100 DISTRICT NO. PROCESSED BY O License NumberS�a O / Lia Class C D p V Services,Swbd.,MCC&Panelboards Contractor Date p .�!�/J 0-399 Amp'Under 600 V FIINAE 0 Cyy ❑ I am exempt under Sec. 400-1000 Amp.Under 600 V -� -�7 ALIDATION W Over 1000 Amp.or Over 600 V .FINAL a B.&P.C.for this reasonBY U) BRANCH CIRCUIT FEES Date: 15A,or 20A, 120V,Lighting or Recept. / Z 1 To 10 Branch Circuits Signature I I To 40 Branch Circuits ' ❑ - 41 Or More Branch Circuits Exemption for Reg.Mont..Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances _ _ _ _ HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit (-t-I•4 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): - _ .j.'•IJ8 ❑ 1 ITEMS I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) D TOTAL 121 - 05 and Professions Code). ''ff CONSTRUCTION LENDING AGENCY lt��l Gt 1.0.5 I hereby affirm that there is a construction lending agency for the - CHANGE .PILI perforroance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) - .. Civ. C.1.� " PLAN CHECKING FEE .! (�` {`- Or Lender's Name ��1i U01 ! :.t m7' PERMIT ISSUING FEE p`(p// 0 10100—JO 1 Eft `4 �cr Lender's Address / 0 .. I certify that I have read this application and under penalty of purjury state TOTAL FEE that the 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 - forin ection purpose . 'SEE REVERSE FOR EXPLANATORY LANGUAGE 9-~.2 3 -93 SI A URE PERMITTEE DATE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9901 LAS TUNAS EL 0508 0905040009 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: +LEGAL ID: FEES PAID BUILDING ADDRESS: (TR: 10896 IT 28 BL: B UN: .003 10918 DAINES DR I (PEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 919802920 ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET: SANTA ANITA 18513-017-019 1A1 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY, Cl F1 120V, 15/20A BR CKTS 1.00 BR 17.25 1TENANT: G1 OUTLETS-LGT,SW,RECP 3.00 OUT 5.85 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I IH4 RES RANGE LEE LT 3HP 1.00 HOD 10.95 105/04/09 SR 10/31/09 TOTAL FEES 61.80 1 OWNER: TEL. NO: IF NNAAL DATF. FIN BY: CODE: BLANKENBAKER GEORGE (626) 448-8914- 110910 DAINES DR 1TEMP 917802920 JDESCRIPTIOIV OF WORK ADD 3 NEW GROUNDED WALL RECEPT OUTLETS & 1 RANG HOOD CONNECTION 1APPLICANT: TEL. NO: ISTP ENTERPRISES INC. (626) 287-7544- I5454 TEMPLE CITY BL SPECIAL CONDITIONS: TEMPLE CITY CA 91780 CONTRACTOR: TEL. NO: 1APPR0VALS DATE INSPECTOR SIGNATURE ISTP ENTERPRISES, INC. (626) 287-7544- 15454 TEMPLE CITY BLVD. LIC. NO ITEMPORARY POWER POLE 1TEMPLE CITY, CA 91780 598157BC36 UNDERGROUND CONDUIT I 1PRCHITE CT OR ENGINEER: TEL. NO: I INFER GROUND I I I I LIC. NO: TROUGH CONDUIT 1 111 IR0UGH WIRING (MAIN WATER LINE (PLASTIC Y/N METAL Y/N 1UTILITY COMPANY NOTIFIEDI I I I I I_ I 111 I I I I I 11111 11111 I I I I 11111 11111 I I I I III I ' III � 111 111 II 111 I I I 111 REPORT ID: DPR265 ROUTE TO: BS 0508