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HomeMy Public PortalAbout9053 EMPEROR AVE_Electrical__ r si Vnirm that COMPENSATION DECLARATION 76A663 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT O �I hereby affirm that I have a certificate of consent to self �cE aoeG insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified,copy thereof (Sec 3800, Lab C ) Policy No Company FOR APPLICANT TO FILL IN JOB ? I, ry�y I' Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS DSJ EM E2,V A V _ f Certified copy is filed with the county building inspec- 1 8 2-Family, Sq Ft $ $ LOCALITY_ ' r tion department Multi-family Sq Ft NEARESTcRoss S 0501 C1IFE Q Residential Swimming Pools OWNER OR V 50 Date Applicant K�N a �) `, ►�-}-�: FIRM NAME go �/V /�I CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light��w MAIL COMPENSATION INSURANCE �D ADDRESS �J 3 - First 20 �y/� p ^,q (This section need not be completed if the work involved by Total No Additional `J CITY N 6e l-EL No 3D ' tel o 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 Lighting Fixtures First 20 ADDRESS so as to become sublect to the Workers'Compensation Laws Additional �M' Total No CITY Tel No Date Applicant IAIO D � Fixed Appliances Not Over 1 HP i PERMIT NOTICE TO APPLICANT If, after making this Certificate of APPLICATION �Exemption, you should become-sublect to the Workers' Range— Heater—D W — Compensation provisions of the Labor Code, y6u 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 Disp — Room Air Cond -7c Class I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO PROCESSED BY d and Professions Code,and my license is in full force and effect Size &Type HP, KW, KVA, or KVAR 0 License Number Lic Class Up to 1 Incl FINAL V Over 1 to 10 Incl DATE VALIDATION 0 Contractor Date Over 10 to 50 Incl ❑ FINAL 0 I am exempt under Sec Over 50 to 100 Inc BY W B &P C for this reason Over 100 a Date Services, Swbd , MCC& Panelboards , Z Z 0-200 Amp Under 600 V n Signature 201 - 1000 Amp Under 600 V Q 6 k4 1 ❑ Exemption for Reg Mamt Elect Over 1000 Amp or Over 600 V o 0 7j a 7 5 / SINGLE FAMILY o o 3 7 55 HOME OWNER-BUILDER DECLARATION Temp Power Pole &Appurtenances I here_by affirm that I am exempt from the Contractor's License Sign with One Branch Circuit 'o 9, 1 9-r 8 8 Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits Professions Code) ❑ I, as owner of the property, will do the work and the Misc Conduits&Conductors structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ 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 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 ©s SigMture Permi to Date 11 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1111100015 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT FEES PAID I BUILDING ADDRESS LEG ON FILE I 9053 EMPEROR AV IFEE DESCRIPTION QUANTITY UOM AMOUNT I SGAB CA 917752016 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET I 15382-011-013 1A1 PERMIT ISSUANCE FEE 27 80 I THOMAS PAGE 596 GRID H1 LOCALITY TEMPLE CITY CAI ILA 100 AMP PANELS, MCC 1 00 PAN 38 80 ITENANT I TOTAL FEES 66 60 (ISSUED ON PROCESSED BY PLAN BY 111/10/11 SR (OWNER TEL NO i - (FIN ATE F BY CODE IONAMI MAYUMI (626) 826-7206- ,,`j 19053 EMPEROR AV I I��I ISGAB 917752016 IDESCRI TION OF WORK 1 ICHANGE OUT EXISTING 100 AMP I I I I APPLICANT TEL NO I ISAME AS OWNER I I ISPFCIAL CONDITIONS 1 I I I I I ICONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE 1 (SAME AS OWNER - I I- LIC NO I ITEMPORARY POWER POLE I I I I I j 11 I (UNDERGROUND CONDUIT I 1 I I (ARCHITECT OR ENGINEER TEL NO IUFERR GROUNDNI I IY I LIC NO 1 IROUGH CONDUIT1 �1 I I I I I I IROUGH WIRING 1 I IMAIN WATER LINE 1 I IPLASTIC YIN METAL YIN 1 I I I (UTILITY COMPANY NOTIFIEDI I I I I I I I 1 I II I I I I I I I j I I I I 1 j I I I I I I I I I I I I I I (REPORT ID DPR265 ROUTE TO BSO508 I I I 1 I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 4EL=ECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS _ _EL 0508-9810220007 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE- (818) 285-0488 EXT. LEGAL FEES PAID BUILD G_A DRESS. , ON FILE 9053--EMPEROR AV FEE DESCRIPTION QUANTITY: UOM: AMOUNT- SGAB CA 917752016 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET. ROSEMEAD 5382-011-013 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE- 596 GRID: H1 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 2 00 OUT 3 90 TENANT, G2 LIGHTING FIXTURES 1.00 LGT 1.95 ISSUED ON- PROCESSED BY: PLA S ON: TOTAL FEES 33 60 10/26/98 UT 10/26/99 OWNER: TEL. NO. FINAL DATE FINAL BY: ONAMI MAYUMI 9053 EMPEROR AV Gz SGAB 917752016 UE-SC-RI-PT-ION-OF-WORK--------.ELECTRICAL FOR-NEW-BATHROOM--(2N - HROOM)- C NT TEL. NO' SAME AS OWNER - p� SPECIAL CONDITIONS: OGE ES CONTRACTOR TEL NO: - ®� �'lY�m APPROVALS DATE INSPECTOR SIGNATURE SAME AOWNER LIC NO TEMPORARY POWER UNDERGROUND CONDUIT ARCHITECT OR ER: TE O: UFER GROUND LIC. NO: 1111111 ROUGH CONDUIT ROUGH IN PI U O L C WY O PLASTICTER Y/NLINE METAL Y/N UTILITY COMPANY ED o° o O � REPORT ID- DPR265 ROUTE TO. BS0508