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Home My Public Portal About9071 EMPEROR AVE_Electrical__ � VJORIjER'S COMPENSATION DECLARATION 20 0019 DPW(12 91) I hettb}'aftmffiat I havaa,cgrNh�ate of consent to self insure, 76A663 _ APPLICATION FOR ELECTRICAL PERMIT or.a certl,cate of Worker's Compeription Insurance, or a certified - COUNT`(OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec-3800 Gab C) ' t POIICy NO Company FOR APPLICANT TO FILL IN ��' ADDRESS ❑ C �J- Certified copy is hereby furnished New Residential Bldgs &Pools NO EACH FEE _ ❑ esiengs — $ $ LOCALITY �IC L, 17,5 Certified copy Is'flled with the county building Inspection 1 &2 Family,Sq Ft — NEAREST department Multi-family Sq Ft CROSS ST L✓a• Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK I PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec —Light Sw FOIPM NAOR MEd v COMPENSATION INSURANCE First 20 _ MAIL (This section need not be completed if the work Involved by the permit is for one hundred dollars($100)or less) Total No Additional ADDRESS s/z::;- I certify that in the performance of the work for which this permit CITY G Tel No is Issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compensation Laws Lighting Fixtures First 20 APPLICANT Total No Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT If, after making this Certificate of CITY Tel 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 I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl (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 Over 50 t0 100 Incl LICENSE Class } REG NUMBER Q Over 100 DISTRICT NO PROCESSED BY Q License Number Lic Class p U Services Swbd,MCC&Panelboards �O - cc Contractor Date 0-399 Amp Under 600 V FINAL DATE _._ �s 0 ❑ 1 am exempt under Sec 400 1000 Amp Under 600V `"'flV�l�is ~ Over 1000 Amp or Over 600 V 'FINAL Over LU B&P C for this reason BRANCH CIRCUIT FEES (q Date 15A,or 20A, 120V,Lighting or Recept, 2 Z_ nVIliffigNen 1 To 10 Branch Circuits . 3 �2 a Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg Maint Elect 15A,20A,208V To 277V Lighting Br Circuits _ ,�+ - SINGLE FAMILY g �} tf T HOME OWNER-BUILDER DECLARATION Temp Power Pole&Appurtenances _ " --; --0' AC4[ ov t ch C a B with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law Sign S.-rV;l0? c`-_ __ _5r-),81 for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits Code) - a 1, ITEM I, as owner of the property,will do the work and the structure Misc Conduits&Conductors u K - TOTAL_�l 55- 91 s not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) /1�t�C�ttr/7LU�. and Professions Code) `CHEC ► 55.881 CONSTRUCTION LENDING AGENCY CHANGE _ .00 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) Civ C) �tt-t 4 '} PLAN CHECKING FEE j _ GOOD —WO1 i�/g2 Lender s Name / - 673337 1 AM 9:33 _ PERMIT ISSUING FEE p�7� Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE O that the above information is correct I agree to comply with all County ordinances and State laws regulati Electrical wiring,and hereby authorize representatives of this County to, upon the above mentioned property for inspection 1 rposes _ SEE REVERSE FOR EXPLANATORY LANGUAGE L-1-JAI-11 J SIGNATU E OF P E DATE 1• '1-1` _ ,_► 1(VORKERS' COMPENSATION DECLARATION ��" 20 nvw3i87 76A663,,, APPLICATION FOR ELECTRICAL PERMIT O irW_re: fffm that I have a certificate of consent to self CE 806G nsure, a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a 1ertrfied ypy thereof (Sec 3800, Lab C ) Policy,No , Company FOR APPLICANT TO FILL IN` JOB ❑Certified copy is �ereby-furntshed New Residential Bldgs R °^^i EACH NO FEE ADDRESS :71 CI-JM FCertified copy is filed with the county building inspec- 1 & 2-Family, Sq Ft $ — $ LOCALITY tion department Multi-family Sq Ft NEAREST Residential Swimming Pools CROSSST Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets RecLightSw MAIL COMPENSATION INSURANCE First 20 ADDRESS (This section need not be completed if the work involved by Total No Additional CITY Tel No the permit is for one hundred dollars ($100)or less ) , \ I certify that in tPLAN CHECK he 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 subject to the Workers'Compensation Laws Additional Date ^� Applicant �Z GcAL4� Total No CITY Tel No NOTICE TO APPLICANT If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to•the Workers' Range— Heater—D W — APPLICATION 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 --VW H — deemed revoked Hood — Fan —Other— CITY Tel No LICENSED CONTRACTORS DECLARATION Disp — Room Air Cond — LICENSE OR ' I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER Class '(commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO ! / PROCESSED BY(L: /� and Professions Code, and my license is in full force and effect //Y Q_ - Size &Type HP, KW, KVA, or KVAR (J 0 License Number Lic Class Up to 1 Incl FINAL U Date —�L Over 1 to 10 Incl DATE !Z „O r VALIDATI4J CC Contractor r-1 Over 10 to 50 Incl FINAL ��iillvv 0 I am exempt under Sec Over 50 to 100 Inc BY U Over 100 o- B&P C for this reason 11 �� Services, SwU) bd , MCC & Panelboards Date v6.200 Amp Under 600 V 01111. Z— Signature 201 - 1000 Amp Under 600 V 0 Exemption for Reg Maint Eject Oyer 1000 Amp or Over 600 V SINGLE FAMILYI - 1 o a 7 5 HOME OWNER-BUILDER DECLARATION emp Power Pole &Appurtenances I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits = ``P��ro``f��essions Code e 0�1 08,755 j, as owner of the property, will do the work and the Misc Conduits&Conductors o &24 -88&24 -88 structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ Business and Professions Code) pool 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) n (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 I 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 N=rty for inspection purposes `! r SEE REVERSE FOR EXPLANATORY LANGUAGE — ;2`/— i ) Signature of Permittee Date ®' A COUNTY OF'LOS ANGRLES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1205210014 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT FEES PAID BUILDING ADDRESS (LEG ON FILE 9071 EMPEROR AV IFEE DESCRIPTION QUANTITY DOM AMOUNT SGAB CA 917752016 ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET ROSEMEAD 15382-011-018 IA1 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID H1 LOCALITY TEMPLE CITY, Cl IG1 OUTLETS-LGT,SW,RECP 2 00 OUT 4 00 1 ITENANT I TOTAL FEES 31 80 (ISSUED ON PROCESSED BY PLAN BY 1 105/21/12 SR I (OWNER TEL NO 1 IFI�fiE FINAL BY CODE I IGHABOUR WAGDY R,ANAAM S (626) 482-2433- I I 1 19071 EMPEROR AV I p l 1 ISGAB 917752016 IDISCRtPTION OF WORK17 11 SWITCH, 1 OUTLET FOR BATHROOM REMODEL I I (APPLICANT TEL NO I I I SAME AS OWNER - I ISPECIAL CONDITIONS I I I 1CONTRACTOR TEL NO 1 (APPROVALS DATE INSPECTOR SIGNATURE I SAME AS OWNER - I I LIC NO ITEMPORARY POWER POLE 1 I (UNDERGROUND CONDUIT I I 1ARCHITECT OR ENGINEER TEL NO 1 IUFER GROUND I LIC NO I IROUGH CONDUIT I II I I ROUG:-, WIRING 1 n qy i MAIN WATER LINE IPLASTIC Y/N METAL Y/N 1 (UTILITY COMPANY NOTIFIEDI I I I I I I I I I I I I I I I I I I I 1 I I I I I I I I I I I I 1 I I I I I I I I (REPORT ID DPR265 ROUTE TO BS0508 I I I I I I 76A663-cE806 9-64 APPLICATION FOR ELECTRIC PERMIT COUNTY OF LOS ANGELES I DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A LAMBIE, COUNTY ENGINEER COLEMAN W JENKINS, SUPT OF BUILDING I LOCALITY ' NEAREST FOR APPLICANT TO FILL IN CROSS ST RECEPT TOTAL NO EACH FEE OUTLETS FIRST 20 $20 $ OWNER LIGHT MAIL A DD'L 10 ADDRESS ` SWITCH OVER 20 TOTAL CITY T L O LIGHTING ! FIRST 20 20 , FIXTURES I ADD'L 10 ELECTRICIAN OVER 2O RANGES CLO DRYERS WTR HTRS ` 100 ADDRESS (S GARB DISP STA COOK CITY DISHWASH AUTO WASH STATE �f SPACE HTRS STA APP (%s H P MAX ) 50 LICENSE NO MOTORS OVER NOT OVER HP DIST CT rqP GROUP NE ROC D BY 0 1 100 O L 1 3 150INSPECTION RECORD CL 3 S 200 a O V 8 15 250 15 50 300 O H so too 500 V Lu SIGNS NO TRANS d. NO LAMPS H L Z SERVICE O 600V NOT OVER 200A 1100 SERVICE O 600V OVER 200 A 1200 SERVICE OVER 600V 500 MISC PERMIT ISSUING FEE 200 SUPPLEMENTARY PERMIT ISSUING FEE 100, TOTAL FEE $ 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES C NTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN F AND INTE D TO RESIDE IN THE ABO DESC ED RESIDENT RPERTY POWER SIGNATURE UTILITY CO NOTIFIED 4 OF PERMITTE �GP FINAL D VAIIDATI JOSEPH C ROOHAN CK MO CASH SUPERVISING ELECTRICAL ENGINEER L%o 1 6 6 5 MAY 14 2 D 4.0 0- � r DBS 5A 25M SETS 2-47 ♦PSIUC ATION FOR 1TE891l,RlSr6t DEPARTMENT OF BUILDING AND SAFETY t9�l�L17 iLLEY 1� Y II 1II11aaY COUNTY OF LOS ANGELES "ELECTRIC WM al FOX CHIEF ENGINEER a DISTRIG�p�p GROUP ZONE PERMIT NO. NAM , a� �t'A,fJ� 1`_ _ 2 ` U ADDRESS n� �� 1 0J/ d U CITY �y �j b1 TEL NO (� �'� CfilV D BY READY FOR DATE ISSUED m COUNTY � ,// �v FIRST INSPECTION CERT NO � EXPIRES 6 APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY (DESCRIPTION OF WORK F r � JO NUMBER OF OUTLETS ON CIRCUITS Y LOCATION BY ROOMS LIGHT OUTLETS SW PLUGS FIXTT.CIRCUIT A B C D E F G H ELRESS Y TEL NO THE LEGAL POSSESSOR OF THE ABOVE LOS COUNTY CERTIFICATEOF Q UA L IFII�CATIO�N. f I / ELECTRICIAN �1 I AM THE LXGAL OWNER OF THE FROPERTY DESCRIBED / / ABOVE OWNER. / I CORIIECTIONS Aed I i 2 J Q _Z L7 O r TOTAL NO OF OUTLETS $ 1 APPROVALS NO OF FIXTURES Is U l DATE INSPECTOR'S NAME NO OF MOTORS H P. $ CONDUIT NO OF SIGNS TRANS $ WIRING NO OF RANGES OR HEATERS $ FIXTURES MISCELLANEOUS $ POWER ! PERMIT FEE $ UTILITYCO NOTIFIED TOTAL FEE `a FINAL '£