HomeMy Public PortalAbout9855 ESTRELLA AVE_Electrical__ WORKERS'COMPENSATIONDECLARATION 768A6 (D80)63
CE 6G APPLICATION FOR ELECTRICAL PERMIT {�
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I hereby affirm that 'I have a certificate of consent to self COUNTY OF LOS ANGELS e BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or ``
a certified cop thereof(Sec. 3800, Lab.C.)
Policy No. 4 j2872 o80ny State Comp. Fun FOR APPLICANT TO FILL IN JOB
ADDRESS 9855 'Estrella Temple C t
New Residential Bldgs.& Pools FACNO. FEE >' p y
Certified copy is'hereby.furnished. v/,&2-Family,Sq. FC — S LOCALITY Temple City
Multi-family Sq. Ft. — NEAREST Baldwin
Certified copy is filed with the county buil 'ng inspection CROSS ST
de artment. ���rrr Residential Swimming Pools OWNER ORi • zFIRM NAMELo1S I�aSOn
DatesApplicant Outlets: Rec.3Light Sw. MAIL -
First20 ADDRESS 9855 Estrella
.CERTIFICATE OF EXEMPTION FROM WORKS S Total No. Additional CITY Temple- City TO No. 2
COMPENSATION INSURANCE }
PLAN CHECK 1
(This section need not be completed if the work involved - APPLICANT Dwyer Constr. Ci0 e O
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS P.O. BOX 493 2
Additional c
Total No. 8—V 9 9 O
1 certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Alhambra CiaeTel No. 44 O7
permit is issued, 1 shall not employ any person in any manner PERMIT Thomas E. Dwyer W
so as to become subject to the Workers' Compensation Laws.' Range_ Heater—D.W. _ APPLICANT a
Oven _ Dryer_W.M._ ADDRESS Same aS above z
Date Applicant I Top FAU _W.H.
1 Hood Fan _Other_ CITY if Tel No. Same
NOTICE TO APPLICANT: If, after making this Certificate,ofLICENSE OR
Disp. _ Room Air Cond._ REG. NUMBER Class
Class BI
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PR S D Y
with comply with such provisions or this permit shall be
Size&Type HP,KW, KVA,or KVAR
deemed revoked. (�
Up to-1 Incl.
Or 1 to 10 lnpl. DIATEL
LICENSED CONTRACTORS DECLARATION VALIDATI
Incl.Over 10 to 50
..
1 hereby affirm that I am licensed under provisions of Chapter / Over 50 to 100 Inc. FINAL
IAL f
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. 2/� �� Services
License Number 34- �!3 Lic.Class_— 0-200 Amp. Under 600 V � s
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 I 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 t 5 2 3,2 A
El 1. as owner of the property, will do the work and the Other (See Complete Fee Schedule)— '
structure is not intended or offered for sale (Section eZ
7044, Business and Professions Code). , ,
CONSTRUCTION LENDING AGENCY e e
I hereby affirm that there is a construction lending agency •2, z 350 .
for the performance of the work for which this permit is PERMIT FEE (Sub-Total) e.o e x
issued (Sec. 3097,Civ.C.). 3 5 Q o
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
05. 1 2-8'1
Lender's Address PERMIT ISSUING FEE
I certify that I have read this application and state that the TOTAL FEE
above information is correct. 1 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 for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Pate
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0204150020
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 DUPLICATE
PHONE: (626) 285-0488 EXT:
LEGAL D: FEES PAID _ BUILDING AD S:
TR-. 16712 LT- 9 � 9855 ESTRELLA AV
--
FEE DESCRIPTION: QUANTITY: UOM:_ _ AMOUNT_:_ __ TEMP CA 917801417 - _
SS SS INFORMATION R: ' NEAREST'CROSS STREET: LONGDEN -` -- --
5383-023-009 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: Al LOCALITY: TEMPLE CITY
G1 OUTLETS-LGT,SW,RECP 35.00 OUT 59.25
TENANT: G2 LIGHTING FIXTURES 10.00 LGT 19.50 ISSUED ON: PROCESSED B AN EXPIRES ON:
H2 RES GRBG DISP LT 3HP 1.00 DIS 10.95 04/15/02 . JK 10/12/02
H4 RES RANGE HDS LT 3HP 1.00 HOD 10.95
S
OWNER: TEL. NO: H7 RES EXHAUST FAN1.00 EX 10.95 FINAL DATE FINAL BY CODE:
YIN HOU C;JU Y (626) 300-8733- JS AC UNITS +3-10HP 1.00 AC 19.65 /
9855 ESTRELLA AV TOTAL FEES 159.00 4, 16 16-2 l�
TEMP 917801417 DESCRIPTION UF WORK
ELECTRICAL FOR ADDITION
APPLICANT: TEL. 0:
TSENG'S CONSTRUCTION - _ - ,
-" - - - SPECIAL CONDITIONS: - -
PNGELES CO
CONTRACTOR: TEL. NO: SOS APPROVALS DATE INSPECTOR SIGNATURE
TSENG'S CONSTRUCTION (626) 378-8570-
12029
12029 SAN RIO ST LIC. NO TEMPORARY E
EL MONTE CA91732 458578 B
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. UF�fOUND
LIC. NO: ff 1111111 ROUGH CONDUIT
WIRING I1Z /-
YY v
IPI7 I1(� 11 �C X1 //,1 n O (1/J (� MAIN WATER LINE
llll U IL��JG II li_. V\1\JIl IU.-.UC IIJK\1 \�J PLAS_T IC Y/N METAL Y/N
TI ITY_CO_MPANY NOTIFIED
O Olt
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---- - ---- Service Tha<
REPORT ID: DPR265 ROUTE TO: BS0508