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HomeMy Public PortalAbout6015 ENCINITA AVE_Electrical__ WORKERS'COMPENSATIONDECLARATION 63 V A, PPLICATION FOR ELECTRICAL PERMIT CE •I hereby affirm that IhCE8O6G 12801 have a certificate of consent to self COUNTY OF LOS ANGELES /�. BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800, Lab, C.) FOR APPLICANT TO FILL IN JOB �l f�, --� Policy No. Company ADDRESS �01 S N EN)c,N(t p— New Residential Bldgs.& Pools EACH NO. FEE �• a 'Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY' 'P2 i Multi-family Sq. Ft. — NEAREST Certified copy is filed with the county building inspection CROSS ST 4,0-r_v{^ department. - Residential Swimming Pools OWNER OR FIRM NAME Date Applicant Outlets: Rec fight_ First rst d ADDRESS �' 1Y't F 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel N oo.4J a'J /y COMPENSATION INSURANCE PLAN CHECK a APPLICANT O (This section need not be completed if the work involved L) by the permit IS for one hundred dollars ($IDD) Or less.) Lighting Fixtures First 20 _. ADDRESS It Additional Total No. O I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel U yermit is issued, I shall not employ any erson in any manner PERMIT W /so as to become subject or ers' Com en sation. a,s. Range_ Heater_D.W. APPLICANT ty Z fu� Oven _ Dryer_W.M._ ADDRESS Z Date���5y�Appl icant op — FAU _W.H. Hood Fan —Other— CITY Tel No. NOTICE TO APPLICANT: If, after making this Certificate of Disp. Room Air Cond-_ LICENSE OR Exemption, you should become subject to the Workers' REG. NUMBER Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCESS D BY with comply with such provisions or this permit shall be Size &Type HP,KW, KVA,or KVAR 10, deemed revoked. 0 Up to i Incl. FINAL Over 1 to 10 Incl. DATE _g LICENSED CONTRACTORS DECLARATION Over 10 to 501ncl. ./ , CJ Z VALIDATION I hereby affirm that I am licensed under provisions of Chapter .Over 50 to 100 Inc, FINAL 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 ness and Professions.Code, and my license is in full force and effect. Services 0-200 Amp. Under 600 V License Number Lic. Class 201-1000 Amp. Under 600 V Contractor Date Over 1000 Amp.or Over 600 V '22'64.6A HOME OWNER-BUILDER DECLARATION Temp. Power Pole& Appurtenances Sign with One Branch Circuit # o,e's o e 2 I hereby affirm that 1 am exempt from the 'Contractor's Additional Sign Branch Circuits License Law for the following reason (Section 7031.5, Busi- 2,o • 24, 70 ' ness and Professions Code): 2 7 Q Misc.Conduits& Conductors o,o e 1, as owner of the property, will do the work and the Other (See Complete Fee Schedu le)— structure is not intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub-Total) issued (Sec. 3097.Civ.C.). / Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) ' Lender's Address PERMIT ISSUING FEE U 1 certify that 1 have read this application and state that the TOTAL FEE 70 above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and I,P� u torize esentatives of this County to enter upon above-menti proper y for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Perimitlee Date WORKERS'that Ihave a certATION DECLARATION 76A553 to/et APPLICATION FOR ELECTRICAL PERMIT I he:e6y affirm that I have a certlicate of consent to self insGre, CI=-sosG n ora certificate of Workers Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) �IILIII Policy Na Company FOR APPLICANT TO FILL IN JOB _ ❑ Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRESS OI ). CI ❑ Certified copy is filed with the county Wilding inspection 1 & 2-Family, Sq. Ft. IRDS $ — $ LOCALITY department. Multi-family Sq.Ft. — NEAREST / Residential Swimming Pools CROSS ST. Q_ {r Date Applicant OWNER ORS FIRM NAME JJ V CERTIFICATE OF EXEMPTION FROM WORKERS' / COMPENSATION INSURANCE Outlets:Rec� Light Sw. i MAIL. 1 ADDRESS vV� ' 0_66VG (This section need not be completed If the work involved by the First 20 permit is for one hundred dollars 100)or less.) Total No. Additional r CITY Tel.No. 2W-2-6; I certify that in the performan of the work for whit this permit PLAN CHECK APPLICANT �I is issued, I shall not employ ny perso in r so to become subject to the Workers o pe ati Lighting Fixtures First 20 ADDRESS S0.V6t� —1V ` Total No. Additional - Date is Applicant CITY Tel.No. NOTICE TO APPLICANT: If, after making this C rtificate of Fixed Appliances Not Over 1 HP PERMIT II Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven — Dryer _ W.M._ ADDRESS �' e provisions or this permit shall be deemed revoked. Top — FAU _ W.H. CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ I hereby affirm that I am licensed under provisions Of Chapter 9LICENSE OR (commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Class. Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO _ PROCE E eV Size& Type HP,KW,KVA,or KVAR 5 p License Number Lic.Class Up to 1 Incl. FINAL 0 Over i to 10 Incl. DATE _ _C VALIDATION 0 Contractor Date Over 10 to 50 Incl. ❑ FINAL V am exempt under Sec. Over 50 to 100 Inc. BY LU B.&P.C. for this reason Over 100 G. Services,Swbd.,MCC& Panelboartls D Date: 0- 200 Amp.Under 600 V Z Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V SINGLE FAMILY Temp.Power Pole& Appurtenances 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law A�CT.t 4 for the following reason (Section 703 1.5,Business and Professions Additional Sign.Branch Circuits 307 26.5(t Code): ❑ Misc.Conduits& Conductors 1 ITEMS I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 1044, Business Other (See Complete Fee Schedule) .-.... TOTAL �S a � ry and Professions Code). .. ... .. CHECC:Kk, 26.50 CONSTRUCTION LENDING AGENCY 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 I]000-0001 7119190 Lender's Name PERMIT ISSUING FEE 1911 1 AM 7:34 Lender's thatIAddress r�V I certify that I have read this application and state that the above TOTAL FEE � v information is correct. I agree to comply with all County ordinances and Stale laws regulating Electrical wiring, and hereby authorize - r esenta,IIves of t ounty to r upon the above-mentioned pro erty F i p on >ur sea. SEE REVERSE FOR EXPIANATORY LANGUAGE nature of ermittee – WORKER'S COMPENSATION DECLARATION 260019 DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT 6A663 I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab:C.) A', eI �/^/� P❑olwy No. Company FOR APPLICANT TO FILL IN ADDRESOB S E/V ry / /7 Certified.copy is hereby furnished. New Residential Bldgs.Spools ^� $EACH NO. $ FEE ❑ Y LOCALITY TQM PLE G I T11 Certified co is filed with the count building inspection 1 8 2-Family,Sq.Fl. PY Y 9 p — NEAREST d � I/Q department Multi-family Sq.FL L/!CROSS Si. ( vP �75 Date Applicant Residential Swimming Pools-- ASSESSOR •. MAP BOOK _ PAGE .PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Recight-tSw. G OFIRM NAME �� ��(��C COMPENSATION INSURANCE / Q - First 20 AIL. (This section need not be completed if the work involved by the 2_, ,/ ,h ADDRESS SA IM E permit is for one hundred dollars($100)or less.) Total No. Additional /� I certify that in the performance of the work for which this permit - CITY Tel.NomI�/)�1 01037 Is issued, I shall not employ any person in any manner 50 as to Q PLAN CHECK STI / become subject to the Workers' Compensation Laws.- Lighting Fixtures First 20 Q APPLICANT Total No. 4M Additional ADDRESS Date Applicant 15 OR 20A,120V BRANCH CIRCUITS NOTICE TO APPLICANT: It, after making this Certificate of CITY T.I.No. Exemption,you should become subject to the Workers"Compensation 1 TO 10 INCLUSIVE EACH _ you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMIT provisions of this Labor Code, y p y APPLICANT provisions or this permit shall be CONTRACTORS revoked. 47 OR MORE BRANCH CIRCUITS EACH LICENSED CONTRACTORS DECLARATION �- - - - ADDRESS �- I hereby affirm that I am licensed under provisions of Chapter 9 150R 20A,208V TO 277V LIGHTING EACH EL (commencing with Section 7000) of Division 3 of the.Business and CITY TeL No. 0 Professions Code, and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR Power Apparatus&Large Appliances _ REG.NUMBER class. 0 License Number Lia Class Size&Type HP,KW,KVA,or KVAR DISTRICT NO. / G PROCESSED BY Q - UP to 3 Incl. W Over 3 to 10 Ind. FINAL - d Contractor Date - Over 10 to 50 Incl. DATE ❑ I am exempt under Sec. _ Over 50 to 100 Incl. O J,FINAL Over 100 VALIDATION B.BP.C.for this reason By Services,Swbd.,MCC 8 Panelboards Date: 00 -200 Amp.Under 600 V b Signature 201 -1000 Amp.Under 600 V - - ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. 7 SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARA71ON - - T i I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit H4r I s for the following reason (Section 7031.5, Business and Professions Additional Sign.Branch Circuits - - 33tln Cade: l I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors 1 11 GNI-' is no! intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)_ © TICITAL 1 •=e = ,rri_T and Professions Code). CHEPK CONSTRUCTION LENDING AGENCY - rr,,�� - I hereby affirm that there is a construction lending agency for the CHAK,GE el_IL+ performance of the work for which this permit is issued (Sec. 3097, _PERMIT FEE "(Sub-Total) O Civ.C.) PLAN CHECKING FEE Fint-t IOU1 fl 1:f7i Lender's Name ]i..7 1 y;`I!"S PERMIT ISSUING FEE 'P - _ 1 Fif: Lender's Address certify that I have re this application and state chat the above TOTAL FEE �. tion iS coast agree 1.comply with all County ordinances Did St e 1 s r la mg Elect al wiring, and hereby authorize r press to ve hi C only t enter upon the above-mentioned ,.perry I. in is p ,poses. SEE REVERSE FOR EXPLANATORY LANGUAGE 7- /- 9a- SI URE OF APPLI ANT PAGENT DATE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9610240015 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 5904 LT: 380 6015 ENCINITA AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801935 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 5384-013-024 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY HA FAU LESS 3HP 1.00 FAU 10.80 TENANT: JB AC UNITS +3-1OHP 1.00 AC 19.65 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 58.20 10/24/96 TC 10/24/97 OWNER: TEL. NO: FINAL DATE FINAL BY: c ODE: NALICK DAVID;BONNIE - 'O-�Ll .-ql 6015 ENCINITA AV TEMP 917801935 DESCRIPTION OF WORK NEW HEATING AND A/C SYSTEM APPLICANT: TEL. N0: HUNTINGTON AIR COND. (818) 285-5049- 450 AGOSTINO RD. SPECIAL CONDITIONS: SAN GABR IEC, CA 0 p® .. . U s CONTRACTOR: TEL. N0: HUNTINGTON AIR CONDITIONING, INC. (818) 285-5049- 1. ']l 0 � -G APPROVALS DATE INSPECTOR SIGNATURE 440-450 AGOSTINO ROAD LIC. NO 0 `: E PORARY POWER POLE SAN GABRIEL, CA 91776 644769 C2O - �- sN LE 0m Ci e n(j UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. N0: v..vvv.,JJJI lug I(I( 111 FER GROUND LIC. NO: _ ROUGH CONDUIT Duni ROUGH WIRING MAIN WATER LINE BLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BSO5O8 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0210240020 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285.0488 EXT; LEGAL ID: FEES PAID BUILDING ESS: TR: 5904 LT: 380 6015 ENCINITA AV FEE DESCRIPTION: QUANTITY: LION: AMOUNT: TEMP CA 917801935 ASSESSOR N A ONUMBER: NEAREST CROSS STREET: WOODRUFF 5384-013-024 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY F1 120V, 15/20A BR CKTS 4.00 BR 69.00 TENANT: G1 OUTLETS-LGT,SW,RELP 19.00 OUT 37.05 ISSUED N: PROCESSED LA PIRTS--OV.- G2 S0 :G2 LIGHTING FIXTURES 5.00 LGT 9.75 10/24/02 JK 04/22/03 TOTAL FEES 143.55 OWNER: TEL. NO: FINAL D TEFINAL BY: CODE: VAN LEER;BRIAN & TERRY (626) 285-2031- 7 .1"3 v 6015 ENCINITA AV TEMP 917801935 DESCRIPTION WORK ELECTRICAL FOR KITCHEN REMODEL APPLICANT: 0: SAME AS OWNER SPECIAL CONDITIONS: ian a CONTRACTOR: TEL. N0: • ll APPROVALS DATE INSPECTOR SIGNATURE �j Q� Jy:� SAME AS OWNER - `i TEMPORARY POWER POLE LIC. NO f UNDERGROUND CONDUIT ARCHITECT 0 NGI EER: TEL. NO: -{ ' •�� /� � „� UFER GROUND 7--1^.V� LIC. N0: �_ ' ;-I, 1� �,� ROUGH CONDUIT I �- - ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N r UTILITY COMPANY f D r i REPORT ID: DPR265 ROUTE TO: BS0508