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Home My Public Portal About5341 ENCINITA AVE_Electrical__ WORKERS' COMPENSATION DECLARATION 10/81 CE-806G APPLICATION FOR ELECTRICAL PERMIT (hereby affirm that I have a certificate of consent to self CE-806 insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY , i D or a certified copy thereof (Sec. 3800, Lab. C.) �� FOR APPLICANT TO FILL IN JOB l Policy No. ompony � ADDRESS Ind Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE S — Certified copy is filed with the county building inspec- 1 & 2-Family, q� Ft. $ $ LOCALITY tion depa tment. Multi-family Sq. Ft. CROSSNEARESST. / �1 A Residential Swimming Pools OWNER OR Date Applicant? t� FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec>�Light"'L' Sw.f✓ MAIL (, � COMPENSATION INSURANCE ADDRESS (This t be completed if the work involved b iFirst 20 ( s section neenop T Total No.JS n� Additional CITY Tel. No. the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. oVAdditional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT Exemption, you should become subject to the Workers' Range_ Heater—D.W. — Compensation provisions of the Labor Code, you must forth- Oven Dryer — W.M.— ADDRE with comply with such provisions or this permit shall be Top FAU —W.H. — �� rf deemed revoked. Hood Fan _ Other_ CITY C_A �\0 f Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR � I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCES$ED�Y Power Apparatus& Large Appliances / LL �{/// and Professions Code, and my license is in full force and effect. ,Q� U Size & Type HP, KW, KVA, or KVAR' ��JJ License Number �- Lir. Class_ Up to 1 Incl. FINAL �= _ O �� Over 1 to 10 Incl. DATE _ /4� VALID TION V Contract ate `�G� Over 10 to 50 Incl. ❑ FIN L LLI I am exempt under Sec. Over 50 to 100 Inc. a� Over 100 B.&P.C. for this reason 4 31.3 A z Date: Services, Swbd., MCC& Ponelboards 0 -200 Amp. Under 600 V # o o o 0 o 2 Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V I o;° 19.5 0 Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole & Appurtenances o.o o-1 9.505 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 0 3.2 7-8 6 1 hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and 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 Other (See Complete Fee Schedule)_ 7044, 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 ,1 yl PERMIT ISSUING FEE (� U 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 l�ereb ju thorize representatives of this County to enter upon Ila a e the 'io ed property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE on r Signature of Permittee f Date WORKERS' CI have a certificate R co'nsT 76-663 '10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent. to.self C�806G• , insure, or a certificate of Workers' Compensation Insurance,' COUNTY OF LOS ANGELES 77, ` BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB Certified co is hereby furnished. EACH NO. FEE ADDRESS . 5341 ENCINITAS PY Y New Residential Bldgs. & ools ❑ 1 & 2-Family, S Ft. 2000 $ . 04 — $ 80 LOCALITY TEMPLE CITY Certified copy is filed with the county building inspec- Y. q• tion department. Multi-family Sq. Ft. — NEAREST Residential Swimming Pools CROSS ST. OLIVE OWNER O Date Applicant FIRM NAM�'AIRHAVEN DEVELOPMENT CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS 9089 LAS TUNAS This section need not be completed if the work involved b First 20 ( p Y Total No. CITY Tel. No. the permit is for one hundred dollars ($100)or less.) Additional _ Y P A PPLALICANTK MARTIN ELECTRIC I certify that in the performance of the work for which this permit 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 1560 N. LASSEN Total No. Additional 9-'21=84 MARTIN ELECTRI CITY ONTARIO Tel. No. _ Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT MARTIN ELECTRIC Exemption, you should become subject to the Workers' Range_ Heater—D.W. — Compensation provisions of the Labor Code, you must forth- Oven _ Dryer — W.M.— ADDRESS-1560 N. LASSE with comply with such provisions or this permit shall be Top _ FAU —W.H. — deemed revoked. Hood _ Fan _Other— CITY ONTARIO Tel. No.982_7g LICENSED CONTRACTORS DECLARATION LICENSE OR 3 0 4 9 8 2 Class Room Air Cond. REG. NUMBER . I hereby affirm that I am licensed under provisions of Chapter 9 Disp. C-10 (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESSE BY and Professions Code,and my license is in full force and effect. Power Apparatus & Large Appliances Size &Type HP, KW, KVA, or KVAR' +J O License Number 3 0 4 9 8 2 Lic. Class C-10 Up to 1 Incl. FINAL MARTIN ELECTS 9-21-84 Over 1 to 10 Incl. ' ,,3 _.®S� Contractor DATE VALIDATION ❑ Over 10 to 50 Incl. FINAL 1 am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 Date: Services, Swbd., MCC& Panelboards 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 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit y I hereby affirm that I am exempt from the Contractor's License t 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 Other (See Complete Fee Schedule)— Poo. 7044, Business and Professions Code). I 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 10 0 *k Lender's AddressSJ o o �► �b I certify that I have read this application and state that the TOTAL FEE O o o (ED above information is correct. I agree to comply with all County go Cn -O 10 CL, ordinances and State laws regulating Electrical wiring, and 6 SDS gED >!hereby authorize representatives of this County to enter upon 00 Q Cr! d the bove-mentioned property or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE CH Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1304150015 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: 1 FEES PAID 1 BUILDING ADDRESS: ITR: 7796 LT: 30 1 1 5341 ENCINITA AV 1 I IEEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917803115 1 (ASSESSOR INFORMATION NUMBER: I INEAREST CROSS STREET: 15388-008-033 IA1 PERMIT ISSUANCE FEE 27.80 1 .THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CAI ILB 200 AMP PANELS, MCC 1.00 PAN 38.90 1 1 (TENANT: 1P2 PC RES PV<1OKW 153.90 (ISSUED ON: PROCESSED BY: PLAN BY: 1 I IP3 INVRTR RES PV<IOKW 27.90 104/15/13 SR 1 1 1 TOTAL FEES 248.50 1 1 (OWNER: TEL. NO: I IF AL TE FI CODE: 1 ICHIDAN, CAO (626) 684-0060- 1 1 1 15341 ENCINITA AV I I - ITEMP 917803115 1 IbESCPIPTIO& OF WORK 1 ISOLA2 SYSTEM ROOF MOUNTED 15 PV 4.9 KW AND UPGRADE SERVICE I IPANEL TO 200 AMP 1 1APPLICANT: TEL. NO: 1 1 1 ICAMPBELL, SCOTT (951) 300-0768- I 1 1 13080 12TH STREET 1 ISPECIAL CONDITIONS: 1 IRIVERSIDE CA 92507 1 1 I ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE 1 ISOLARMAX RENEWABLE ENERGY PROVIDER, (626) 965-4286- 1 1 1 13080 12TH ST. LIC. NO I ITEMPORARY POWER POLE I I I IRIVERSIDE, CA 92507 9720481 1 I I 1 1UNDERGROUND CONDUIT I I I I I I I I 1ARCHITECT OR ENGINEER: TEL. NO: 1 1UFER GROUND 1 LIC. NO: IROUGH CON IT 1�/1 I I IROUGH WIRING I IMAIN WATER LINE I I IPLASTIC YIN METAL YIN 1 1 I 1UTILITY COMPANY NOTIFIEDI 1 I i I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I -1 IREPORT ID: DPR265 ROUTE TO: BS0508 1 1 1 I I I I I I