HomeMy Public PortalAbout8756 GARIBALDI AVE_Electrical__ COMPENSATION DECLAMT}ON 78A8" 10181 APPLICATION FOR ELECTRICAL PERMIT
�' tier m that I hese a certt:loate of oo.,t to sw k.,m CE�oet�
§. U
�tloefe of Workers' Conrperlearion mrarrce, or a ceftMed COUNTY OF LOS ANGELES BUILDING AND SAFETY'
Copy (Sea 3800,1sb.C.)
Policy NO = ry roR n,PPucAtrr-ro FLL w ADORE88 f-
�Afaof- ST
r ' CertfW copy.is*.by fried- New ReeOwtld Bbo .d Pole ENCI I NO. FEE LOCAIJTY
1 8 2-FRrr�y,Sq.Ft,
$
Certified Copy fa'flled vJfththe comfy buildtnG Yrepeotlon
¢epertrrlerrt Murd-famly Sq_FL
ApatePAI f Reefderrtkd Swimming Pooh
rzyR
CEf F7F ATEt1F QEMPMON'FP6M WORK EF#S" 0uuetx Rec1L ugm sw-. r1j,E
coMl?�NsarION wauPU11J(E 16
�. f
.y��QQ Fhst"20 .
(Thb Mctbh rv*ed n¢�be�ornpieted M,thd work nvotmd by the Total N0.�l Additib-,vd C T Tel,Mf0
p�rrr$tJ*.for oar.Ffurvrfr i ddlon(*im of�)
f perm-that In.the o*kmrarrc6 of the work,fpr which able permR .
la.lmuc4 I she➢ not empty any pe*A'tn arty mrinw so ae to
b--ne,eA*d W the Worimte' Leve Light V FIxWree First 20 ADDRESS
-i
Tp
f r .
Date I tal Na Addltbrrel CffY Tel.N0.
NCIC� Tom'APPWC NTi'tf, eller!t : m kk V this CerttM1oeSe of fixed App" Over 1 HG APftIG�N7 ( .
Emdiptlon,ypu should become adJect to-b-*Worffera'•O°rnponsabpo- Ranpb Heater_ Q-W-�
• provkdona.of the Labor,_CcQ*�r rr�st fortFlvvtth °ort1PtY with such Oven � Dryer_ W-k ADDRESS
of.this permit shah be deemed_revoked. lap y FAU _ WJ-I.
LICEfySED oQN7RACV)Rs DECLAPJ.01Oty Hopd Fan' — Othff_ G7YPAA lel
Ir
I•hereby pMrm tt Jam,licensed,under,provfebrr8,of Chapter 9 Dom 'Roan Ak Cdf1d.' REG.NuweERQR �I O � Q
(obmmw-c mow h SecOm 7000)'of DN*oR 3 of the.D*ness and
Proteeebne Code,and my'Ilcense A)n full force arld Effect. P�Apparatus 8 Large AWL-0— DfSTFtlOT N0. PROLE 01'
Stze S Type 1-P;KW,'K%i? or KNA R 1
Lxerr9e tJinlber~ [tpL4 Lib Cha— Fie UA to 1 Ira FINAL
�.�t 1 '�! "Q%w l to 40 Ind. DATE
ConfYW r-A t LT T��H p{' Date CNI r 10-jo to frwl.
1 arra exempt under$eG-{.. ' Quer 60 tp 100-Uro. �
BdP.a for this reason T a'ar 100
- 4 Servlcee,Swbd;MCC 8 Par"boeids ► VTC.!
A A4 0-20Q,AriSp-Under 800 u .9
S$gneture Q - _ 20'1'- 1000 Anrp.Under 600 V
bar 1000 Amp.or Over 600 v ;18 9 6,2 A
fi Emmptbn for R*q..MA1nL EYeot f ° 6,6 0,0 2
31NGLG FAMILY Term Polver Pule h Appurtenerroee
HqK OWNER-BUILDF-R QECN Sign�One Branch C" 4 Q 50IALW
I hereby afiti,n tm t I am eraArtpi fr M the Con-tn c $ LjOw4eAdditional sly�rar,ch °.o a Q 5.a S.
far the 1dbwUp teaaoii(SetOm 7031.6, Bushreoq and fpiebrb
'Code):
' 0 1,as owner'of the prlc, r ,'wd do the work and the WBC-Cordr�d caxiGatorn Q 2 1 2'-$8
Is rttrt"Interded.or'offw d for sale (Sedfon 7044, Buakvas Other(S.Cornpiete Fee Scheduia}�- ►
and Prgfeaaions Codeh
PDNSTRU.CTI N LENDING AGENCY
1 hereby aNirr}r that there to a conwLx%on Ierld v agency for the
performenoe of the work for which thls,permft is issued(Sea 3091, PERMFr FEE (Sub-total)
PLAN CHECKING FEE
Lenders Name
P!Ff C ISSUING FEE•,
Leaders Addraee, IUmL FEE
6wft that I have read biA'aAdloation and e>ate ttret the above
YfdormalJon is oorrecL I errr
ptBe to copfy with all Countyrerr
ordYroea
and Steba laws re Aallnp Elect wlrirU Wd hereby authortre _
repraw attves of the County to erdHr upon the above-rnantloned
purpose& � SEE REVERSE FOR EXPLANATQRY LANODUAOE
Permutes pate
WORKER S'COMPENSATIONDECLARACE-808G. CE�OtiG (2-80)
APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm tint I have a certificate of consent to self COUNTY OF LOS ANGELES '�
"fl
sa ^ (J BUILDING AND SAFETY
insure, or ■ certificate of Workers'Compensation Insurance,or / `
e certified copy thereof(Sec.3800,Lab.C.)
FOR APPLICANT TO FILL IN JOB
Policy No. Company Nero Residential Bldgs.&Pools EACH NO. FEE ADDRESS
❑ Certified copy Is hereby furnished. 1 &2-Famlly,Sq. Ft. $ $ LOCALITY
❑ uMulti-famlly Sq. Ft.
Certified copy is filed with the county building Inspection CRO99 ST
department. Residential Swimming Pools OWNER OR
FIRM NAME
Date Applicant Outlels: Rec._Light Sw.
MAIL
— ADDRESS hf>0 05
first 20
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No. }
COMPENSATION INSURANCE PLAN CHECK # ^'
(This section need not be com leW If the work Inyoh+ed APPLICANT '
t
Fi
Lighting xures First 20
by the permit is far one ha dollars (;100) or len.) LigAdditional ADDRESS
Total No. U
I certify that In the performance o7 the work for which this Fixed Appliances Not Over 1 HP CITY Tel No.
permit is Issued, I shall not employ any person In any alanner PERMIT t
so as to become subject to the W an' Compensation Laws. Range_Heater_D.W. P CANT
Oven _ Dryer_W.M._ ADDRESS fn
36 Z
Date-� Appticant Top _ FAU _W.H.
Hood _ Fen _Other CITY Tsl No. _Q a
If
NOTICE TO APPLICANT: If, after making this Certificate of Dlsp. _ m RooAir Condom- LICENSE
Exemption, you should become subject to the Workers' REO.NUMBER ' Class C% 0
Compensation provlrlons of the Labor.Code, you must forth- Power Apperatus& Large Appliances DISTRICT NO.
with comply with such provisions or this permit'shall be --:=
Size&Type HP,KW, KVA,or KVA O�
deemed revolted. Up to 1 Incl. o
Over 1 to 10 Incl. FINALDATE
LICENSED CONTRACTORS DECLARATION Over 10 to 60 Incl. r VALIDA IQN
I hereby afnrm that I am licensed under provisions of Chapter Over 60 to 100 Inc. FINALS ` - •
9 (commencing with Section 7000) of Divislon 3 of the Bust- Over 100 BY �t--i
ness and Professiom.Code, and my license Is Ln hill force and
effect. JJ Services
License NumberL_ Llc.Clans ��� ¢ Amo. Under 6
)�� 701-1000 Amp. Under 600 V
Contractor k{,& (-q�_ Data T Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances 1Q [ 1. 4 A
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit
i
h Ci
B
Sign Branch Circuits
License Law for the following reason (Section 7031.5, Bull- Additional ,
nes and Professions Code): o 'o 2a,50
Mlsc.Conduits&Conductors .2`G' .
I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— o 'o 0 2 C v
structure is not Lntended or offered for rale (Section
7044, Business and Professions Code). [1 2 — 0 4
CONSTRUCTION LENDING AGENCY'
I hereby affirm that there Is a construction lending agency
for the performance of the work for which this permit la PERMIT FEE (Sub-Total)
Issued(Sec.3097,Civ.C.). `9
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE
I certify that I bave read thls application and state that the TOTAL FEE — }
above information Is correct.I agree to comply with all County
7
ordtrunces and State laws regulating Electrical wiring, and
hereby authorize representatives of thLs County to enter upon
the abo mentioned property,1, f mpaetion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
_.
Sljnsture of Permlttae Dnte
r , COUNTY OF LOS ANGEI.Ry TEMPLE CITY G 0508 EIE=CAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TMULS EL 0508 0903190006
BU=ING AND SA171M / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 ETT:
LEGAL ID: FEES PAID BUILDING ADDRIZS8:
TR: 5903 LT: 66 IIF: .003 8756 GARJMALDI AV
FEE DESCRIPTION: QUANTITY: DOl4: AMOUNT: SCAB CA 917752618
ASSFSSOR INFORMATION NUMBER: NEAREST CROSS STREET: BURTON
5386-008-036 Al PERHIT ISSUANCE FEE 27.75 TPCHAS PAGE: 596 GRED: G2 LOCALTTY: TEMPLE CITY, C
JI MOTORS, LT 3 HP 1.00 MOT 15.30
TENANT: TOTAL FEES 43.05 ISSIIID ON: PROCESSED BY: PLAN BY: ECPIRES ON:
03/19/09 SR 09/15/09
OWNER: TEL. NO: FINAL DATEp�■ /�{ BY: CODE
HUNG, }IIC7�7P.T.i.E Y (626) 458-8049- CAP
8756 GAR�TnI AV
SCAB 917752618 DF69CRIPTIOiN OF NORI
F7.E=CAL GATE ACROSS DRIVEWAY
APPLICANT: TEL. NO:
SAME AS OWNER
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS 0WNER -
LIC. NO TEMPORARY POWER POLE
UNDERGROUND CONDUTT
ARCHITECT OR ENGINEER: TSL. NO: UFER GROUND
LIC. NO: ROUGH CONDUIT
ROUGH f1IIZaA3
KUM WATER T.nac�
PLASTIC Y/N METAL Y/N
UrTI = COMPANY NOTIFIED
i
REPORT ID: DPR265 ROUTE TO: B90508