HomeMy Public PortalAbout5004 GOLDEN WEST AVE_Electrical__ WORKER'S I COMPENSAnON DEConsenoN 76AIM DPW(,2-a,) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm ifiat I have n certificate of consent to eel} Insure, ��
or a cerdflcate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DN.
copy th*reof(Sec.3800 Lab.C.) i
Pdby No. Compar y FOR ,xi To 1,11 IK , - . DOF—a O D Q L
❑ Certified copy Is hereby fumhhed. New Realdert el Bldgs.h Poona NO. 1EAPH � L i1 8 2-Family,Sq.FL i
❑. dwertnen t 114pd with the oou ty bulking Inspection Multi-farnRy Sq.Ft. gaose.T. cs
Da App6cam Residential Swimming P0043MAPA 2 p Z
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Ught S1w. L Kms" L
OWNER OR
COMPENSATION INSURANCE FtRAI NAME
First 20 MAL 0 �Q� M
(This section need not b�completed tf the work Involved by the 1Dp} gg (J
permit Is for one hurtdred'dollare($1 DO)or less.) T0�No. �
I oertlfy that In the performance of the work for which this permit CrfY`—' k No,
is Issued, I shall not employ any person In any manner.so as to Pt.1N CHECK
become subject to the Worker' Compensation Laws. LIghtinq Fbcturee First 20 APPLICANT I L / L:
Total No. AddRbnsl ADDRESS 0 (64 PP W7—
Date Ap~ RESIDENTIAL APPLIANCES NOT OVER 3 HP. f
NOTICE TO APPLICANT: IT, after making this Certificate of CITY f� C,
Exemption,you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP. PEFMT
provisions of the Labor Code, you must forthwith comply with suchLIG1PrT �/V ay
provisions or this permh shall be deemed revoked. P—Apparatus Large Appliances
LICENSED CONTRACTORS DECLARATION Stze S Type HP,KW,KVA,or KVAR ADDRESS �b AS N
I hereby affirm that I am Ilceneed Under provisions of Chapter 8 Over 3 to 10 Ind. / /�,�
(commencing with 8ectlorl 7000) of Division 3 of the Business and CITY / /•( C Tal.NoZ37 S 4
Profeeaions Code,and my Iloense Is Ip full force and effect. Over10 to 6o Ind. LK�OR Cissa d
Over 60 to 100 Ind. REQ.NUMBER
Over 100 DUITA}CT NO. BY Q
Lk»nae Number Lic.Claw y
board. ' O
ContreciDr ^ (b ^ Data • eco V 7 xtr
TE F-
❑ I am em -1000 Amp.Under 600 V pt under Sec. 400 �lj✓j
exVALIDATION LI
LU
Over 1000 Amp.or Over 600 V FAL
B.BP.C.for this meson BRANCH CIRCUIT FEES BY (n
Dabs: 16A,or 20A,12oV,Llghting or Focept.
Z
1 To 10 Branch Ciroufts
ftnaWre 11 To 40 Branch Ctra�s
41 Or More Branch Ctroulte i
❑ Exemption fpr Reg.Maim.Elect. 15A.20A,206V To 27N Br.CtaiRa r
SINGLE FAMILY Temp.Power Pole 8 Appurbnancee 1 .T
HOME OWNER-BUILDER DECLARAMN --* nr1`` 6:.45
I hereby affirm that I nm exempt hom the Contractor's with One Branch Ciroutt ��03 actor's License Law �ti�
for the following reason (Section 7031.6, Business and Professions Additional Sign Branch Circrdta
code): 1 I `
IX I,as owner of the r Misc.Conduit Conductors TOTAL 63 - 45
property,will do the work end the structure �
Is not Intendbd or offered for sale (Section 7044, Buelnasa Other(See Compote Fee Schedule)
t L7
and Professions Code). , t��.���lyy���e}R'�� � �7ti•'4yyC1
CONSTRUCTKJN LENDING AGENCY �.-i-AHGE •UV
I hereby afflrm that there Is a construction lending agency for the
performance of the work for which this permit Is Issued (Sec. 3087, PERMIT FEE (Sub-Totaf) 3
ctv.C.) M1 11194
PLAN CHECKING FEE
Lenders Name 1 AM 10:49
PERMIT ISSUING FEE
Lender's Address
I certffy that I have read this epplkcation and under pwxlty of purjury state TOTAL FEE ter
that the above information Is correct. I agree to comply with all County
ordlnanoes and State taws regulating Electrics]wlrirp,and hereby authortze
ropree wtattyee of It*County to eater upon the above-mandoned property
for I P-7.- 1 -2 SEE REVERSE FOF)E)Gt NATORY LANGUAGE
80aRATUF�E OF PBUdTTEE �T 0.17E
COUNTY OF LOS ANIKIES TEMPLE CITY $ 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORl.S 9701 LX9 TUNAS EL 0508 0911240007
BU=INVG AND SAF-I'Y / LAND DEVEIAPM= TEMPLE CITY CA 91780
PHONE: (626) 285-0488 ETP:
LEGS ID: FEES PAID BIDING ADDRESS:
TR: 9481 LT: 1 UN: .002 5024 GOLDEN WEST AV
FEE DESCRSPTION: QUANTITY: DOM: AMDUNT: TEMP CA 917803934
ASSESSOR I2TFORM&=ON NUMBER: NEAREST CROSS SST:
8589-022-002 Al PERMIT ISSUANCE FEE 27.75 T`,"4X6 PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C
LB 200 AMP PANELS, MCC 1.00 PAF 38.85
TENANT: TOTAL FEES 66.60 ISSUED ON: PROCPi9SED BY: PLAN BY: EXPIRES ON:
11/24/09 SR 11/24/10 -
054=: TEL. NO: FINAL F BY: CODE:
DO, TONY (626) 643-2218-
5024 GOLDEN WEST AVE
TALE CITY CA 91780 CAIPTI OF WORZ
UPGRADE SERVICE 200 AMP PANEL
APPLICANT: TEL. 190:
YEE (626) 215-8283-
3242 1EL2URN AVE. SPECIAL CONDITIONS:
ROSEMEAD CA 91770
CONTRACTOR: TEL. 190: APPROVALS DATE INSPECTOR SIGNATURE
JOHN YEE (626) 215-8283-
3242 KEIZURN AVE LIC. 190 T24PORARY MATER POLE
ROSfiiEAD, CA 9177Q 741290 C10
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. NO: LIFER GRODM
LIC. NO: ROUGE. CONDUIT
R.000H WIRING
MAIN WATER I,=
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED 7�
REPORT ID: DPP-265 ROUTE TO: 880508