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Home My Public Portal About4906 ENCINITA AVE_Electrical__ WORKERS'COMPENSATION DECLARATION -663 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent,to self insure, CE-806G or a certificate of Workers Compensation Insurance, 6r a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof (Sec 3800 Lab C) Policy Noi-- Company l ' '- ••"•"� FOR APPLICANT TO FILL IN JOB ADDRESS F1 Certified NO FEE Certified copy is hereby furnished New Residential Bldgs & Po Is 1 & 2-Family,Sq F $, —1$ LOCALITY r Certified copy is fled with the county budding inspection NEAREST "I""' /� depart pen Multi family Sq Ft CROSS ST v Applicant Residential Swimming Pool OWNER OR Dat FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS Outlets ReLight Sw MAIL /y'I/- COMPENSATION INSURANCE ADDRES L (This section need not be completed if the work Involved by the First 20 Total No Additional CIT � 7 Tel No � permit Is for one hundred dollars($100) or less) PLAN CHECK I certify that in the performance of the work for which this permit APPLICANT 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 Additional bV Total No CITY Tel No Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT If, after making this Certificate of PERMIT Exemption,you should become subject to the Workers Compensation Range_ Heater_ DW _ APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W M _ ADDRES provisions or this permit shall be deemed revoked Top — FAU _ WH CIT`rr� C' � Tel No LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ 1 hereby affirm that I am licensed under provisions of Chapter 9Disp — Room Air Cond LICENSE OR Class (commencing with Section 7000) of Division 3 of the Business and REG NUMBER Professions Code,and my license is in full force and effectPower Apparatus& Large Appliances DISTRICT No ^� PROCE D BY Size& Type HP,KW,KVA,or KVAR . U / U License Number/ FINAL LIc Class Up to 1 Incl ("' Over 1 to 10 Incl DATE J Contractor Date VALIDATION Over 10 to 50 incl V FINAL ❑ i am exempt under Sec Over 50 to 100 Inc BY d Over 100 B&P C for this reason N Date Services,Swbd,MCC& Panelboards p� ® Z 0- 200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V ❑ Over 1000 Amp or Over 600 V Exemption for Reg Maint Elect SINGLE FAMILY Temp Power Pole & Appurtenances 7 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law ACCTe for the following reason(Section 7031 5, Business and Professions Additional Sign Branch Circuits s Code) 1307 46.30 ❑ I,as owner of the property,will do the work and the structure Misc Conduits & Conductors 1 ITEMS is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ® _ and Professions Code) TOTAL 46 m 30 CONSTRUCTION LENDING AGENCY CHECK 1t6.31 I hereby affirm that there is a construction lending agency for the CHANGE .00 performance of the work for which this permit is issued(Sec 3097, PERMIT FEE (Sub-Total) Civ C) PLAN CHECKING FEE Lender's Name DCVO-0001 31/15 9[1 PERMIT ISSUING FEE - Lenders Address ` ?410 1 AM vo 15 1 certify that I have read this application and state that the above TOTAL FEE b 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 proper riS�pection urp es SEE REVERSE FOR EXPLANATORY LANGUAGE S ure o Perm e Date WORKERS'COMPENSATION DECLARATION -663 io/81 CAL PERMIT {� I hereby affirm that I have a certificate of con;ent to seC APPLICATION FOR ELECTRICAL self insure, CE-806G _ L J ora certificate of Workers' Compeosation Insurdnce, or a certified COUNTY OF LOS ANGELES fe)g � � BUND SAFETY copy thereof($ecc 388j00 Lab C) !�j j J�)�� Policy No wcompany f: � ![� ■ FOR APPLICANT TO FILL C JOB Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS Certified copy is filed with the county building inspection 1 & 2-Family,Sq Ft $ — $ LOCALITa� department Multi-family Sq Ft NEAREST If CROSS ST Date Applicant �� ResidentialSwimmingPools OWNER OR Outlets ReC S.L Light $yy f FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKER � MAIL COMPENSATION INSURANCE V ADDRESS �f First 20 � (This section need not be completed if the work involved by the Total No -�1-- Additional ,' CIT!/ Tel No permit is for one hundred dollars ($100)or less) PLAN CHECK 1 certify that in the performance of the work for which this permit APPLICANT 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 '''�' Additional Total No f CITY Tel No Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If, after making this Certificate of M to Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D W APPLICAN� provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W M _ ADDRESS provisions or this permit shall be deemed revoked TopFAU _ WH LICENSED CONTRACTORS DECLARATION TT Fan Other_ Hood L CITY - Tel No 0127 I hereby affirm that I am licensed under provisions of Chapter 9Disp Room Air Cond 0 LICENSE OR _JilW Class (commencing with Section 7000) of Division 3 of the'Business and REG NUMBS Professions Code,and my license is in full force and effectPower Apparatus& Large Appliances DISTRICT N PR SSED By Size & Type HP,KW,KVA,or KVAR l/ v License Number Lic Class _ Up to 1 Incl FINAL / U Over 1 to 10 Incl DATE �-��/ VALIDATION Contractor Date Over 10 to 50 Incl / V E] FINAL Q I I am exempt under Sec Over 50 to 100 Inc BY !// 1.1 0 B&PC for this reason Over 100 N Services, Swbd,MCC & Panelboards ® Z Date 0- 200 Amp Under 600 V IT 00 Signature 201 - 1000 Amp Under 600 V ❑ - Over 1000 Amp or Over 600 V Exemption for Reg Maint Elect SINGLE FAMILY Temp Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ` I hereby affirm that I am exempt from the Contractors License Law ACC S for the following reason (Section 7031 5,Business and Professions Additional Sign Branch Circuits ,a 4 Code) 7307 7O o Q0 ❑ Misc Conduits & Conductors I,as owner of the property,will do the work and the structure I ITEMS is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) ® and Professions Code) TOTAL 70 - 90 CONSTRUCTION LENDING AGENCY C,HEC K 70.50 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) CHANGE eN1 Civ C) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender s Address 2409 1 AM 8:Ir- -I certify that I 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 property�ofermi inection purpos SEE REVERSE FOR EXPLANATORY LANGUAGE Si Date " COUNTY OF LOS ANGELES TEMPLE CITY # 0508 `EL_'ECTRICAL PERMITa DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL"0508-9710090019 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: -LEGAL ID: S PAID BUILDING TR: 1238 LT: 110 49,06-ENCINITA=AV 9 FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP`CA 917803705 ASSESSOR INFORMATION NL)MBER: NEAREST CROSS STREET: 8590-030-011 Al PERMIT ISSUANCE-FEE 27.75 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 2 00 OUT 3.90 T HA FAU LESS 3HP 1.00 FAU 10 80 I PROCESSED Y: EXPIRES JB AC UNITS +3-10HP 1 00 AC 19.65 10/09/97 UT 10/09/9 TOTAL FEES 62.10 OWNER: TEL. NO FINAL DATE FINAL BY,j2ql /��C E: HALL RICHARD J;LINDA (818) 285-6653- O 4906 ENCINITA AV TEMP 917803705 D R T 0OF WORK I ELECTRICAL FOR NEW HEATING AND AIR CO TIONING SYSTEM APPLICANT: O: CONNOR AIR CONDITIONING (626) 285-6653- SPECIAL CONDITIONS: LES .g CONTRACTOR: L. N O�_ APPROVALS DATE INSPECTOR SIGNATURE CONNONOR AIR CONDITIONING AND REFRIG (818) 286-3157- 4931 NORTH ENCINILIC. NO C TEMPORARY TEMPLE CITY, CA 91717 80 C20 & C38 UNDERGROUND CONDUIT ARCHITECT0 ENGINEER: L. �I F GRO LIC. NO: ROUGH CONDUIT ROUGH WIRING r (�(� IOU �C 1�(J�� MAIN WATER LINE t(- y !� yy jJ �1 PLASTIC Y/N METAL Y/N 0 p UTILFTY COMPANYNOTIFIED d c^ 0 � 1, oa o �� z 9�C� * ADDITIONAL DATA ON FILE REPORT ID: OPR265 ROUTE TO: BS0508