HomeMy Public PortalAbout9838 DAINES DR_Electrical__ WORKERS'COMPENSATION DECLARATION ) -663
C ,D�81 -APPLICATION FOR' ELECTRICAL PERMIT, '
I hereby atflrm that I have a certificate of consent to self Insure,
CE-806G
orin certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS'
ANGELES BUILDING AND SAFETY
copy thereof(Sec 3800,Lab C)
Policy No I. Company• FOR APPLICANT TO FILL IN JOB ' *'
'D ADDRESS 9838 DAINES DR. ,
Certrf(ed copy,is he furnished• EACH NO FEE••
_ ,. New Residential Bldgs & Pools
1 & 2=Famd S Ft $ — $ LOCALITY
Certified'copy is filed with'the county building inspection Y. q
depart6ient Multi-family Sq Ft ---- — NEAREST
CROSS ST GOLDEN WEST/ BALDWI'N
',Date Applicant Residential'Swimming Pools OWNER OR,
• - FIRM NAME DAV I D S, & ANN M. HARRIS
CERTIFICATE OF EXEMPTION FROM WORKERS' 28 7 MAIL
Outlets Rec Light — Sw —
• '; <. COMPENSATION INSURANCE > ADDRESS 9838 DAINES DR,
First 2075 20 15, 00
(This section need not be completed If the work Involved by the, CITY I No
permit is for'one hundred dollars ($100)or less.) Total No 35 Additional' .50 15 7.5 TEMPLE CITY CAL I (818)285-012
- PLAN CHECK
h certrfy that'6 the performance of the work for which tt is permit e p 7� APPLICANT
i§ issued,.) shall not employ,any person in any manner.so as'to •• _ '
become subject-to the Workers'Compensation Laws Lighting'Fixtures First 20 -'-'- ADDRESS
DAVJ D 5. A I S Additional -----
_1_`�(�• Total No _ CITY hel No
Date - Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT If, after,•^making this ' rtificate,of APPLICANT A
Exemption,you should become�sublect to the Workers;Compensation - Range_ Heater_,DW
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 WH
CITY Tel No
LICENSED CONTRACTORS DECLARATION` Hood — Fan Other_
I hereby,affirm-that I am licensed under provisions of Chapter 9 Disp -"Room Air Cond 3.50 1 3. 50 LICENSE OR,
(commencing with Section 7000),of Division 3 of the Business and REG NUMBER' Class
Professions Code,and my license is in full force and effect DISTRICT NO PROCESSED BY
Power Apparatus& Large Appliances
` Size& Type HP, KW,KVA,or_KVAR �� O
License Number Lic Class X Up to 1 Incl /4.00 1'" 4. 00 FINAL` +,2 „0
i Over 1 to 10 Incl -=--- DATE/
ff�
'Contractor• Date _____ _ VALIDATION 0
Over 10 to 50 Incl _-___
;I,am exempt under Sec Over 50 to'100 I BY AL W
B&PC for this reason Over 100 ----- (L
Services,Swbd',MCC& an i oa�ds N
Dates' 15_00 2* 30. 00 �Z. -
/ — 0- 200 Amp U er V
Signature 20 t- 1000,Amp• er 00 V "
❑ Over 1000 Amp or er 600 V. ----- =
Exemption foJNE
Main E ct *NEW MAIN & SUBPANEL �`
N FAMILY Temp Power Pole& Appurtenances
HOME BUILDER DECLARATION I hereby affirm thatexempt from the Contractor's License Law Sign with One Branch Circuit' �5 A��� _
for the following reason (Section 7031 5,Business and Professions Additional Sign-Branch Circuits ----- AC .T
i- 7�
Code) _ �_ JM7, 759-.
1.5
''�
Misc Conduits&Coriductors1 ITEtiS
® 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) ----- = ti
and Professions Code) — - /(MCK TOOT L/ n•l J 75 m 7-5,,-
_ `
• "CONSTRUCTION LENDING• AGENCY _
I hereby affirm that there is a construction lending agency for the r4(uNIt7L :sVtl
performance of the work for which this permit is issued(Sec 3097, PERMIT FEE (Sub-Total)
Civ C)
i PLAN CHECKING FEE �; n ��nn
Lenders Name i 0000—ml 5/16/89
PERMIT ISSUING FEE xtG4 1 1 ►Itis 1.�t
Lender's Address
I certify that l 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
propAV forSmsgctioR i urposes
U H SEE REVERSE FOR EXPLANATORY LANGUAGE
r5s 1=�9
Sig at of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0807300019
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ITR 13805 LT 79 1 9838 DAINES DR
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917802636
(ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET
8588-017-016 IA1 PERMIT ISSUANCE FEE 27 75 I THOMAS PAGE 597 GRID A3 LOCALITY TEMPLE CITY, Cl
I IF1 120V, 15/20A BR CKTS 4 00 BR 69 00 I 1
ITENANT IG1 OUTLETS-LGT,SW,RECP 17 00 OUT 33 15 (ISSUED ON PROCESSED BY PLAN BY- EXPIRES ON 1
IG2 LIGHTING FIXTURES 6 00 LGT 11 70 107/30/08 SR 01/26/09 I
1H2 RES GRBG DISP LT 3HP 1 00 DIS 10 95 1
(OWNER TEL NO 1H3 RES DISHWASHR LT 3HP 1 00 DIS 10 95 IFINAL DA FINAL BY- CODE. 1
(HARRIS, ANN MARIE - 1H4 RES RANGE HDS LT 3HP 1 00 HOO 10 95
19838 DAINES DRIVE 1H7 RES EXHAUST FANS 1 00 EX 10 95 - 1
ITEMPLE CITY CA 91780 TOTAL FEES 185 40 DESCR PTI N OF WORK
I 1 IELECTRICA, FOR KITCHEN AND BATHROOM REMODEL
(APPLICANT TEL NO-
1O-LEARY (626) 287-0927- 1 1
15823 AGNES AVENUE I ISPECIAL CONDITIONS 1
ITEMPLE CITY CA 91780
ICONTRACTOR J TEL NO 1 - (APPROVALS DATE INSPECTOR SIGNATURE
ITOM O'LEARY CONSTRUCTION (626) 287-0927- I 1 1
15823 AGNES AVENUE LIC- NO I ITEMPORARY POWER POLE 1
ITEMPLE CITY, CA 91780 489354 B-1 I I 1
UNDERGROUND CONDUIT I
ARCHITECT OR ENGINEER TEL NO: I IUFER GROUND 1 I
LIC NO IROUGH CONDUIT 1
1 I 1ROUGH WIRING 1�
MAIN WATER LINE I 1
PLASTIC YIN METAL YIN I 1
1 I UTILITY COMPANY NOTIFIEDI I 1
IREPORT ID DPR265 ROUTE TO BS0508 1 1
i
+(i
COUNTY OF LOS ANGELES TEMPLE CITY �„ # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0506060025
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE. (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
TR- 13805 LT 79 9836 DAINES DR
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917802636
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET BALDWIN
8588-017-016 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE. 597 GRID A3 LOCALITY TEMPLE CITY, C
HA FAU LESS 3HP 1 00 FAU 10 95
TENANT. JB AC UNITS +3-10HP 1.00 AC 19.65 ISSUED ON: PROCESSED BY: PLAN BY EXPIRES ON
LA 100 AMP PANELS, MCC 1 00 PAN 38 85 06/06/05 JK 12/03/05
TOTAL FEES 97 20
OWNER TEL NO FINAL DATEF L BY CODE
��S
MORCK HARRY M;DORIS TRUSTEES (310) 373-7533- - //�y
23209 LADEENE AV _ �i
TORR 905054441 DESCRIPTION OF WORK
UPGRADE ELECTRICAL PANEL 100 AMPS, FORCE AIR UNIT, AC UNIT
APPLICANT TEL NO.
MENDIETA ELECTRIC (626) 309-1338-
225 ALABAMA ST SPECIAL CONDITIONS.
SAN GABRIEL CA 91775
CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE
MENDIETA ELECTRIC (626) 309-1338-
225 ALABAMA ST LIC NO TEMPORARY POWER POLE -
SAN GABRIEL, CA 91775 551372/C10 -
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER TEL NO. UFER GROUND
LIC NO ROUGH'CONDUIT
ROUGH WIRING
MAIN WATER LINE
PLASTIC YIN METAL YIN
UTILITY COMPANY NOTIFIED
- REPORT ID- DPR265 ROUTE TO BS0508