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HomeMy Public PortalAbout5020 FIESTA AVE_Electrical__ WORKERS'COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that,I have a certificate of consent to self CE-806G ihisure, or a'certificote of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 3800, Lab. C.) Policyry �C ompany l FOR APPLICANT TO FILL IN JOB 1:1 Certified co is hereby furnished. EACH NO. FEE ADDRESS PY Y New Residential Bldgs. & Pools 9 Certified copy is filed with the ounty buildiZiec- 1 & 2-Family, Sq. Ft. $ _ $ LOCALITY ee� tion department. Multi-family Sq. Ft. NEAREST Residential Swimming Pools CROSS ST. SA Date Applica t OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FRO WORKERS' � MAIL Outlets: Rec Light Sw._ COMPENSATION INSUR NCE First 20 ADDRESS (This section need not be completed if the work involved by Total No. Additional CIT C Tel. No g!G, ( the permit is for one hundred dollars ($100) or less.) that in the performance of the work for which this PLAN CHECK I certify P 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. Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICAN 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. — deemed revoked. Hood Fan _Other_ CITY 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 Power Apparatus & Large Appliances DISTRICT NO. PROCE ED BY and Professions Code,and my license is in full force and effect. !f Size &Type HP, KW, KVA, or KVAR U License Number. Lic. Class Up to 1 Incl. FINAL 6J Over 1 to 10 Incl. DATE L –,r _ Vq' 1DATION Contractor Date Over 10 to 50 Incl. FIN u ❑ I am exempt under Sec. Over 50 to 100 Inc. BY ear B.&P.C. for this reason Over 100 � Services, Swbd., MCC & Ponelboards Date: 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V❑ 222 5 9 A Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. '# 0 0 0 0 0 2 SINGLE FAMILY Temp. Power Pole & Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ( o o 1 5.25 1 hereby affirm that I am exempt from the Contractor's License its Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and 1 2 5 Professions Code): o o 0 ❑ 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)_ 8 5 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-Totol) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE J 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 hereby authori�reprentatives of this County to enter upon th above-menroperty for inspection purposes. _ SEE REVERSE FOR EXPLANATORY LANGUAGE gnat re of Permittee Date j JRKERS'COMPENSATIONDECLARATION CE866G (2-80) APPLICATION FOR ELECTRICAL PERMIT y a£fidrn that I have a certificate of consent to self COUNTY OF LOS ANGELES ]-� G' BUILDING AND SAFETY I or a certificate of Workers'Compensation Insurance,or / / rtified copy thereof(Sec. 3800, Lab.C.) FOR APPLICANT TO FILL IN JOB Policy No. Company New Residential Bldgs.&Pools EACH NO. FEE New S TVA 4V_EE Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY TE E] Multi-family Sq. Ft. — NEAREST / n A Certified copy is filed with the county building inspection CROSS ST („ ,4 ii department. Residential Swimming Pools OWNER R / AME Date - Applicant Outlets: Rec.—Light—Sw. MADRESS .First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Gp Tel No. COMPENSATION INSURANCE PLAN CHECK d (This section need not be completed if the work involved APPLICANT 0 by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS Total No. Additional O I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. H permit is issued, I shall not employ any person in any manner PERMIT U so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT = L�( d Oven _ Dryer_W.M._ ADDRESS 5C) "__ Z Date-h7� �°Applicant a Top FAU —W.H.. Hood _ Fan —Other_ CITY777� 4,ff IfTeI No. 12,96,-8 64 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. PROC SSED BY with comply with such provisions or this permit shall be deemed revoked. Size&Type HP, KW, KVA,or KVAR ©� - Up to 1 Incl. B �y FINAL Over 1 to 10 Incl. ` DATE LICENSED CONTRACTORS DECLARATION i1/s Over 10 to 50 Incl. - 7 U V VALIDATION I hereby affirm that I am licensed under provisions of ChapterOver 50 to 100 Inc. FINAL 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY ness and Professions.Code, and my license is in full force and effect. Services License Number Lic.Class 0-200 Amp. Under 600 V �a 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 VsaProfessions Code): Misc.Conduits&Conductors 227 8 5 A 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 7044, Business and Professions Code). # 0 0 0 0 o 2 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 2 0 0 2 9.50 for the performance of the work for which this permit is issued (Sec. 3097,Civ.C.). PERMIT FEE (Sub-Total) �� 0 0 0 2 CJS 5 0 v Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) 0,2 4—8 0 Lender's Address PERMIT ISSUING,FEE 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 hereby authorize representatives of this County to enter upon the above-raentioned property for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE ignature of P . ittee DA e WORKERS'COMPENSATION DECLARATION 76A663 10/81 "F C gATFOR ELECTRICAL PERMIT I heFeby affirm that I have a certificate of consent to self insure, CE-806G dk8 f� Gdd� KON 0�8 L� ,cir a certificate of Workers' Compensation,insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereon(Soc.3800,Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ... ❑ S 7 (jl �9 Yt3 Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRES ❑ 1 & 2-Family, Sq.Ft. $ — $ LOCALITY Certified copy is filed with the county building inspection. department. Multi-family Sq.Ft. — NEAREST CROSS ST. Date Applicant Residential Swimming Pools. OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' 0 ��-(,°',► /� Outlets:Rec Light Sw. J MAIL ' COMPENSATION INSURANCE � � �� D ADDRESS (This section need not be completed if the work involved by the First 20 b permit is for one hundred dollars($1.00)or less.). Total No. t Additional CITY W Tel.No. Z�l� I certifythat in the performance of the work for which this permit PLAN CHECK ' p APPLICANT 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 a ADDRESS Additional q iTotal No. CITY Tel.No. Date Applicant z`� 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'Compensation Range_ Heater_ D.W. _ provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS `�� V1 V-S(,Q t fy Y provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. CITY ;,a..�., b,+a d, Tel. No. LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ 1 hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER ER .53� �" Class. Gil Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PR CE SED BY p a! a Size& Type HP,KW,KVA,or KVAR License Number I3K' 144 Lic.Class C L 9 Up to 1 Incl. FINAL V ^ r Over 1 to 10 Incl. DATE 0' Contractor ��"�'� Date ��1 0 _!t f VALIDATION O ❑ Over 10 to 50 Incl. FINAL I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C.for this reason Over 100 n Services, Swbd.,MCC& Panelboards ► Z � Date: —0- 200 Amp.Under 600 V r' Signature 201 - 1000 Amp.Under 600 V Over 1000 Amp.or Over 600 V ❑ Exemption for Reg.Maint.Elect. e� Lp® 4 p _ 1 p SINGLE FAMILY Temp.Power Pole& Appurtenances ' HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit y 1 hereby affirm that I am exempt from the Contractor's License Law {'l--.7 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& Conductors Tg;�;'? is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) ' and Professions Code). , ,H)_ ?;. C. CONSTRUCTION LENDING AGENCY 4--HECX 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) --I— (� ! •d, L =1�{ Civ.C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address d –"y.4 _ F; I certify that I have read this application and state that the above TOTAL FEE �O. 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 purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS' COMPENSATION DECLARATION 76-663 10/81 APPLICATION FOR ELECTRICAL PERMIT I thereby affirm that I have a certificate of consent to self insure, CE-806G `fl or,'a cc;tificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY coayrthe,%iof(Sec.3800,Lab.C.) �`-T�-�-r-cT rZZW-D Polidy No.� ompany FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS ❑ Certified copy is filed with the county building inspection 1.& 2-Family,Sq.Ft. $ — $ LOCALITY NEAREST department. Multi-family Sq.Ft. CROSS ST. Date / Applicant —=`_ Residential Swimming Pools OWNER OR CERTIFICATE OF EXEMPTION FROM WORKERS' i / FIRM NAME Outlets:Rec— Light-_ Sw. � MAIL �r COMPENSATION INSURANCE s ,o ADDRESS ,S"b aP r�T' (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. 1� Additional r d CITY Tel. No. I certify that in the performance of the work for which this permit PLAN CHECK is issued, I shall not employ any person in any manner so as to APPLICANT become subject to the Workers'Compensation Laws. Lighting Fixtures {] First 20 ADDRESS Total No._� Additional CITY Tel.No. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT 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 provisions or this permit shall be deemed revoked. Top FAU W.H. �� "' 6 CITY-e4:7 - Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ a I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE O �% (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER 11 Class. Professions Code,and my license is in full force and effect. DISTRICT No.+ PROCESSE BY Power Apparatus& Large Appliances a(/, Size& Type HP, KW,KVA,or KVAR d' V Q. License Number Lic.Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE Contractor Date VALIDATION 0 ❑ Over 10 to 50 Incl. I am exempt under Sec. Over 50 to 100 Inc. BY AL J� W B.&P.C.for this reason Over 100 ✓ � d Services, Swbd.,MCC& Panelboards ® N Z Date: 0- 200 Amp. Under 600 V 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 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law — s for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits hi ? r*• Code): {-iC 59.00 Misc.Conduits & Conductors I,as owner of the property,will do the work and the structure HEN'S is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) 1 Hti S.D and Professions Code). T j j I AL 59 - 00 CONSTRUCTION LENDING AGENCY .[74 r ° 1=1 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) -1A 4t�E °til, Civ. C.). c PLAN CHECKING FEE Lender's Name 13 ilk f}F(7—( F 1[E 1 11/ 19,:; ' PERMIT ISSUING FEE Lender's Address Mi6 t9 1 r f° 47 I certify that I have read this application and state that the above TOTAL FEE ° 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 purposes. � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1208030002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: ! FEES PAID I BUILDING ADDRESS: 1 ITR: 13329 LT: 56 5020 FIESTA AV 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803818 1 (ASSESSOR INFORMATION NUMBER: I INEAREST CROSS STREET: 18590-018-018 IA1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY CAI I IF1 120V, 15/20A BR CKTS 1.00 BR 17.30 (TENANT: I TOTAL FEES 45.10 (ISSUED ON: PROCESSED BY: PLAN BY: ! i 108/03/12 SR i !OWNER: TEL. NO: 1 (FINAL DATE FINAL BY: CODE: IHUANG, HELEN - I 15020 FIESTA AV I I (TEMP 917803818 (DESCRIPTION OF WORK I 1 IELECI'RIC GATE I I IAPPLICANT: TEL. NO: I EXPRED ISAME AS OWNER I I ! ^ (SPECIAL CONDITIONS: 1 i J ! (CONTRACTOR: TEL. NO: U (APPROVALS V DATEJ INSPECTOR SIGNATURE (SAME AS OWNER - I I LIC. NO ! (TEMPORARY POWER POLE I I I i (UNDERGROUND CONDUIT I ! I I I� I ! I (ARCHITECT OR ENGINEER: TEL. NO: ! IUFER GROUND ! ! I I I LIC. NO: IROUGH CONDUIT I I I I ! I (ROUGH WIRING I I I ! ! I I I (MAIN WATER LINE ! I PLASTIC YIN METAL YIN I I ! I (UTILITY COMPANY NOTIFIEDI 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 i I I-REPORT ID: DPR265 ROUTE TO: BS0508 ! ! ! COUNTY OF LOS ANGELES TEMPLE CITY - # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1301220046 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID I BUILDING ADDRESS: ITR: 13329 LT: 56 5020 FIESTA AV I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917803818 ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 18590-018-018 IA1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY I I TOTAL FEES 27.80 TENANT: I (ISSUED ON: PROCESSED BY: PLAN BY: 101/22/13 SR OWNER: TEL. NO: FI AL Y: CODE: HELEN HUANG 626 297 -7568 1 15020 FIESTA AV I ITEMP 917803818 I jDtA'RrPTIO14 OF WORK 1 IROOF MOUNTED SOLAR PANELS 14 PV 4.6 KW CHANGE CONTRACTOR 1 ISEE ALSO EL 1212240023 (APPLICANT: TEL. NO: 1 I 1 11VEZZY, MICHAEL (951) 681-5811- 1 13080 12 TH STREET ISPECIAL CONDITIONS: RIVERSIDE CA92507 CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE CHAMPION ELECTRIC (951) 276-9619- 1 1 13950 GARNER RD LIC. NO ITEMPORARY POWER POLE IRIVERSIDE CA 92501 744374 1 I 1 1 UNDERGROUND CONDUIT I I I (ARCHITECT OR ENGINEER: TEL. NO: IUFER GROUND _ I I � 1 LIC. NO: 1 IROUGH CONDUIT I I IROUGH WIRING I I I IMAIN WATER LINE 1 ' I (PLASTIC Y/N METAL Y/N I I I (UTILITY COMPANY NOTIFIEDI 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 I I* ADDITIONAL DATA ON FILE I I I I I I I I I 1 (REPORT ID: DPR265 ROUTE TO: BS0508 I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT ` DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1212240023 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: I FEES PAID I BUILDING ADDRESS: 1 ITR: 13329 LT: 56 I i 5020 FIESTA AV 1 IFEE DESCRIPTION: QUANTITY: DOM: AM0UNT: 1 TEMP CA 917803818 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1 18590-018-018 1A1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY I IP2 PC RES PVa1OKW 153.90 1 (TENANT: 1P3 INVRTR RES PV<1OKW 27.90 (ISSUED ON: PROCESSED BY: PLAN BY: I TOTAL FEES 209.60 112/26/12 SR I TOWNER: TEL: N0: 1 (FINAL /yI BY: CODE: 1HUANG, HELEN (626) 297-7568- 1 1 15020 FIESTA AV 1 1 ITEMP 917803818 1 S RIPTIO OF WORK IROOF MOUNTED SOLAR 14 PV 4.6 KW I I 1APPLICANT: TEL. NO: 1 ICAMPBELL, SCOTT - 1 I I (SPECIAL CONDITIONS: 1 I I I I I I I I ICONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1ELITE ELECTRIC (951) 681-5811- 1 1 19415 BELLEGRAVE AVE LIC. NO 1 ITEMPORARY POWER POLE 1 1 1 IRIVERSIDE, CA 92509 418242 I 1 I I I I 1UNDERGR0UND CONDUIT I I I I I I I I (ARCHITECT OR ENGINEER: TEL. NO: I 1UFER GROUND I I 1 IROUGH CONDUIT LIC. NO: 1 I I Ire/M I TROUGH WIRING 1 " IMAIN WATER LINE I I IPLASTIC YIN METAL YIN I I I I I I I I I I 1UTILITY COMPANY NOTIFIED( 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 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 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 I I I I I I I T I* ADDITIONAL DATA ON FILE 1 I I I I I I I I I I I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 I 1 1 I I I I I I I