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Home My Public Portal About6229 ENCINITA AVE_Electrical__ WORKERS'COMPENSATIONDECLARATION - 76A66 CE863 G (280) APPLICATION FOR ELECTRICAL- PERMIT I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANG ELES •--�� BUILDING AND SAFETY insure, or a certificate of Workers' Compensation Insurance,or / a certified copy thereof(Sec. 3800, Lab.C.) r I/ , Policy No. Company FOR APPLICANT TO FILL IN ADDRESS ��W 9 N /.r ./) I New Residential Bldgs.&Pools EACH NO. FEE Certified copy is hereby furnished. 1 & 2-Family,Sq. Ft. $ — $ LOCALITY Multi-family Sq. Ft. — NEAREST Certified.copy is filed with the county building inspection �r- CROSS ST Residential Swimming Pools O RWNER OR M N ME /J 't7 I, -7-1kafiX Date Applicant Outlets: Rec.—Light—Sw. MAIL a 9 i C N' I!/ First 20 ADDRESS CERTIFICATE'OF EXEMPTION FROM WORKERS' Total No. Additional CITY •fir T No. COMPENSATION INSURANCE 57 PLAN CHECK 1 (This section need not be completed if the work involved. APPLICANT O by the permit is for one hundred dollars (SI00) or less.) Lighting Fixtures First 20 ADDRESS Total No. - Additional cc I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. 0 permit is issued, I shall not employ any arson in any manner PERMIT L) so as to become subject to t4afterma o ensation L S. Range_ Heater_D.W. APPLICANT ,7 0, Oven _ Dryer_W.M._ ADDRESS ur Z �a2 c=/ Top FAU _W.H. 1� ate Applicant CITY .Tel No. ' \ Hood — Fan _Other_ NOTICE T APPLICANT: If, this Certifrc to of Disc. _ 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. PROCE ED BV with comply with such provisions or this permit shall be Size&Type HP, KW, KVA,or KVAR deemed revoked. ->.rt� v Up to 1 Inc]. - FINAL Over 1 to 10 Ind. - DATE /� �ZZ _P/ VALIDATION LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. / a I hereby affirm that 1 am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000) of Division 3 of the Busi- BY Over 100 ness and Professions.Code, and my license is in full force and effect. Services License Number Lic.Class 0.200 Amp. Under 600 V 201-1000 Amp. Under 600 V Contractor Date Over 1000 Amp.or Over 600 V ' HOME OWNER-BUILDER DECLARATION Temp.Power Pole& Appurtenances I hereby affirm that 1 am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits . ness and Professions Code): Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— —923 9. 5 A structure is not intended or offered for sale (Section t 7044, Business and Professions Code). o 0 ole e2 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency 2 °•° 2 3"5 0 for the performance of the work for which this permit is i 1 issued (Sec. 3097.Civ.CJPERMIT FEE (Sub-Total). - a o s 2'3 5 0.5 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Feel ) 221 —$ Lender's Address PERMIT ISSUING FEE SL I certify that I have read this application and state that the TOTAL FEE •j �� above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby author'Ae representatives of this County to enter upon the ab ire-me T=tyspec[ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE i Ignature ermittee Date WORKERS' COMPENSATION DECLARATION 76An rIO/BI Thereby affirm that I have a certificate of coiseht to self CE-806, APPLICATION mP ICp4B® aFOR ELECTRICAL ECTRICpL P2 ® IT insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS ❑ Certified copy is filed with the county building inspec- 18 2-Family, Sq. Ft. $ — $ LOCALITY NEAREST lion department. Multi-family Sq. m CROSS ST. -/ Date Applicant Residential Swimming Pools OWNER OR p / FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' <z G(,ci IL COMPENSATION INSURANCE - Outlets: Rec Light Sws�_ r = ESS r This section need not be completed If the work involved b � // First 20 ( P 9 Total No.LL— Additional CITY 9 �" Y Tel. No. the permit is for one hundred dollars ($100)or less.) I certify that in the performance of the work for which this APPLICANTK 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. 3 Additional 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.— ADDRESS With comply with such provisions or this permit shall be Top — FAU —W.H. CITY Tel. No. deemed revoked. Hood _ fan _Other— 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, PROC SED BY and Professions Code, and m license is in full force and effect. Power Apparatus 8 Large Appliances 7 ) 0 Y Size 8 Type HP, KW, KVA, or KVAR �7' O-�` 0 License Number Lic. Class Up to 1 Incl. FINAL V Over 1 to 10 Incl. DATE �`/7-�3 VALIDATION 0 Contractor Date Over 10 to 50 Incl FINAL❑ am exempt under Sec. Over SO l0 100 Inc. BY �•yr- h-�-�.aJ a- B.BP.C. for this reason Over 100 Date: Services, Swbd., MCC 8 Panelboords D 0 - 200 Amp. Under 600 V Signoiure 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Moint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits 2 8 1 2 3 A Law for the following reason (Section 703).5, Business and Professions Code): #ro s e e o 2 ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors ' ' ' structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ D 2% e 1 R.90 7044, Business and Professions Code). 4 sus s I o,9 0 El CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 1207-82 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 r I certify that I hove read this application and state that the TOTAL FEE above information is correct. I agree to comply with all County ordinances and Stale 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 Signature of Permiu a Dale c COUNTY OF LOS ANGELES TEMPLE CITY J# 0508 . . ELECTRICAL PERMIT DEPARTMENTOFPUBLIC WORKS- '9071 LAS TUNAS - EL 0508 9706230004 " BUILDING AND SAFETY / LAND DEVELOPMENT - TEMPLE CITY CA - PHONE:.(818) 285-0488 EXT: - GA ID: S PAID BUILTING.ADDRESS: TR: 5904 LT: 282 - - - -6229 ENCINITA AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801640 - - ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: - 5384-011-021 Al PERMIT ISSUANCE FEE 27-75 THOMAS PAGE: 596. GRID: J2 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 6.00 OUT 11.70 ' TENANT: . G2. LIGHTING FIXTURES -- 2-00 LGT 3.90 SSUED'ON: PROCESSED : PLAN B EXPIRES ON: TOTAL FEES 43.35 06/23/97 , TC 06/23/98 OWNER: - _ TEL. NO: FINAL DATE FINAL BY: CODE: . - HOTTINGER KENNETH R;KATHIE:J (818) 285-4788- 6229 ENCINITA AV TEMP 917801640 - 59S R-I6 ON OF WORK - _" - ELECTRICAL FOR NEW ADDITIONS . At3PLI CANT: TEL- N0: S.& L CONSTRUCTION , .. (818) 286-5096-- SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: ®e APPROVALS DATE INSPECTOR SIGNATURE S & L CONSTRUCTION (818)-286-5096- /(41e 5826 BURTON AVE. LIC. NO ®� �j TEMPORARY POKER.POLE _ SAN GABRIEL, CA 91775 503799 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. - O: UFER GROUND / 'LIC. NO: - - ROUGH CONDUIT ROUGH ��yy IR- .. " _ II �d'8-'U Ld. Ff Q'RK�yii..�J MAIN,LIAT ER LINE PLASTIC.Y/N . METAL Y/N ' UTILITY COMPANY OT L D 4 eic� REPORT ID: DPR265 ROUTE TO: BS0508