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HomeMy Public PortalAbout4943 FIESTA AVE_Electrical__ WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT 76A663 I hereby affirm that I have a certificate of consent to self insure, , or a certificate of Worker's ompensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec. 3800 Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB , ADDRESS ❑ Certified copy is hereby furnished. New Residential Bldgs.&P`J NO. EACH FEE �/,1(—� _ $, LOCALITY C2 ❑ Certified co Is filed with the count building inspection 1 &2-Family,Sq.Ft. 4 Q `R PY Y 9 P NEAREST department. _ Multi-family Sq.Ft. CROSS,T. Date Applicant Residential Swimming Pools ASSESSOR O`d"�� p O� MAP BOOK O 1 PAGE O�/ PARCEL „CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light SW. FIRM OWNER OR COMPENSATION INSURANCE ? First 20 MAIL (This section need not be completed if the work involved by the ADDRESS 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 5Y Tel,No. is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional 22 ADDRESS16/ ADDRESS 1 Date ��� plicant VV(itL�C RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY et o. Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR Over 50 to 100 Incl. ^ / Class. }' REG.NUMBER S 1 l& Cj a License Number Lic.Class Over 100 DISTRICT NO. �i R ESSED BY Services,Swbd.,MCC&Panelboards �`n Contractor Date 0-399 Amp.Under 600 V DATE FI 400-1000 Amp.Under 600 V VALIDATION V I am exem t under Sec. Over 1000 Amp.or Over 600 V FINAL W B.&P.C.for this reasonBRANCH CIRCUIT FEES BY ' d Date: 15A,or 20A, 120V,Lighting or'Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits El41 Or More Branch Circuits Exemption for Reg. Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): ❑ F•f Misc.Conduits&Conductors F I C s r I,as owner of the property, will do the work and the structure _ : _�• is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) :— and Professions Code). r' 1 s`li63a CONSTRUCTION LENDING AGENCY i i F EMC _ I hereby affirm that there is a construction lending agency for the i}A 411, � J,3 performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) �_,t >, Civ. C.) :..HECK PLAN CHECKING FEE Lender's Name i#( I '�r rU PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE . f Q!IL."U—=UI I i 0 ZZ that the above information is correct. I agree to comply with all County �•R tiE! ';o.f•;: ordinances and State laws regulating Electrical wiring,and hereby authorize top representatives of this County to enter upon the above-mentioned property `yfor inspection purposes. ! SEE REVERSE FOR EXPLANATORY LANGUAGE `SIGNA URE OF PERMITTEE DATE ORKER'S COMPENSATION DECLARATION 9 DPW(12-91) 76A663 APPLICATION FOR ELECTRICAL PERMIT LI I hereby affirm that I have' 76A66a certificate of consent to self insure, of 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. 39,00 Lab. C.) Policy No. c GC�'�F 919 Company - %t*tel FOR APPLICANT TO FILL IN JOB ADDRESS ereurn Certified copy is hby fished. New Residential Bldgs.&Pools NO. EACH FEE $ $ LOCALITY Certified co is filed with the count building inspection 1 &2-Family,Sq. Ft. PY Y 9 P NEAREST .de L4 I Multi-family Sq.Ft. CROSS ST. Date r y , Applicaht , i{/j� Residential Swimming Pools ASSESSOR 'MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION OM:WORKERS' Outlets:Rec._Light Sw. OWNER OR COMPENSATION INSURANCE FIRM NAME First 20 MAIL ' (This section need not be completed if the work involved by the Total No. Additional ADDRESS permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY Tel.No. is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. _ provisions of the Labor Code, you must forthwith comply with such _PERMIT provisions or this permit shall be deemed revoked. / Power Apparatus&Large.Appliances APPLICANT. © J LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hefeby affirm that I am licensed under provisions'of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY Tel,Tel.No. Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR Class. Class. 0- Over 50 t0 100 Incl. REG.NUMBER `fes � 0- Over Over 100 DISTRICT NO. P SED BY 0 License Number Lic.Class yy77 ` V _7 Services,Swbd.,MCC&Panelboards F NAL L Contractor �/® Date l 0-399 Amp. Under 600 V DATE ❑ lam exempt under Sec. 400-1000 Amp.Under 600 V 1 _ i ~ Over 1000 Amp.or Over 600 V FINAL ,J VALIDATION W B.&P.C.for this reason BRANCH CIRCUIT FEES BY 3 Date: /� 15A,or 2bA, 120V,Lighting or Recept. Z _ 1 To 10 Branch Circuits Signature11 To 40 Branch Circuits If El _ 41 Or More Branch Circuits ^° Exemption fo eg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp. Power Pole&Appurtenances A`-`'--I = HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit i; ;W L'7 I hereby affirm that I'am exempt from the Contractor's License Law - ---- for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): ❑ I, as owner of the property, will do the work and the structure Misc.Conduits&Conductors4th Z.5 =y W= is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ 00 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 (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) 'ti%t i__UJUI. PLAN CHECKING FEE Lender's Name / �s-� � r..,•a: �`' F�sx su:—a PERMIT ISSUING FEE pc(sem Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the above 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 for inspection purpose SEE REVERSE FOR EXPLANATORY LANGUAGE a— ge -Z, /J- A SIGNATURE OIVRMITTEE DAT COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1301110020 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: 1 FEES PAID 1 BUILDING ADDRESS: 1 ITR: 11454 LT: 41 1 1 4943 FIESTA AV I _IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917803817 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I 18590-019-023 1P2 PC RES PV,10KW 153.90 1 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY CAI 1A1 PERMIT ISSUANCE FEE 27.80 1 (TENANT: (P3 INVRTR RES PV,10KW 27.90 (ISSUED ON: PROCESSED BY: PLAN BY: 1 TOTAL FEES 209.60 101/28/13 SR (OWNER: TEL. NO: IFINAL ATE FINAL BY: CODE: 1 ITRINH TONY;LAM KELLY (626) 255-2273- 1 14943 FIESTA AV 1 1 (TEMP 917803817 1 1 nSCRAPTIOM OF WORK I I I IINSTALLATION OF 12 ROOF MOUN ED SOLAR PANELS NO UPGRADE I (APPLICANT: TEL. NO: 1 I 11VEZZY, MICHAEL (951) 300-0788- 1 1 13080 12TH ST 1 (SPECIAL CONDITIONS: (RIVERSIDE CA 92509 1 I I I I I (CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE 1 (ELITE ELECTRIC (951) 681-5811- 1 1 I 19415 BELLEGRAVE AVE LIC. NO (TEMPORARY POWER POLE I IRIVERSIDE CA 92509 418242 1 1 I I (UNDERGROUND CONDUIT I I I 1ARCHITECT OR ENGINEER: TEL. NO: 1 1UFER GROUND I I I I LIC. NO: IROUGH CONDUIT I I I IROUGH WIRING � I I I 1 (MAIN WATER LINE I I I (PLASTIC Y/N METAL Y/N I I I I (UTILITY COMPANY NOTIFIEDI I I I I I I I I I I I I I I I 1 I I I I I I I I I I I I I I I I I I I I I I 1 1* ADDITIONAL DATA ON FILE I I I I 1 1I I I 1REPORT ID: DPR265 ROUTE T0: BS0508 1 I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 c—ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS —EL-0508 9808210017 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 11454 LT: 41 4943 FIESTA AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP—CA 917803817 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 8590-019-023 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY B2 1 OR 2 FAMILY DWELL 640.00 SO 67.20 TENANT: LN OTHER PNL 0-399 AMPS 1.00 PAN 38.85 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES.ON: TOTAL FEES 133.80 08/21/98 UT 08/ /99 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: TRINH TONY;LAM KELLY — 4943 FIESTA AV TEMP 917803817DESCRIPTION OF WOR r ELECTRICAL FOR GUEST HOUSE ONLY A SUB-PANEL APPLICANT: TEL. NO: NGUYEN (626) 918-8906- 1139 GLENVIEW RD. SPECIAL CONDITIONS: WEST COVINA, CA CONTRACTOR: TEL. NO: O APPROVALS DATE INSPECTOR SIGNATURE REACH CONSTRUCTION (818) 282-0042- 419 N. ATLANTIC BLVD., #207 LIC. NO '� TEMPORARY POWER POLE MONTEREY PARK, CA 91754 6957538 U)) UNDERGROUND CONDUIT r� ARCHITECT OR ENGINEER: TEL. N0: / UFER GROUND LIC. N0: ROUGH CONDUIT U ROUGH WIRING �/�1�J\ �� MAIN WATER LINE J J CJ ri PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED 41 REPORT ID: DPR265 ROUTE TO: BS0508