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HomeMy Public PortalAbout5447 GOLDEN WEST AVE_Electrical__ WORKERS'COMPENSATION DECLARATION 76A663 1 CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT I Hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGE LE BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.) FOR APPLICANT TO FIL IN JOB d /J D Policy Noompany New Residential Bldgs.&Pools EACH NO. FEE ADDRESS = j $ — Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ LOCALITY 1- Multi-family Sq. Ft. — NEAREST Certified copy is filed with the county building inspection CROSS ST Xdepartment. Residential Swimming Pools OWNER OR FIRM NAME Date Applicant Outlets: Rec. Light MAIL 1 First ADDRESS (,r CERTIFICATE OF EXEMPTION FROM WORKERS' Total No._z5r Additional CITY 1el No. SQL } COMPENSATION INSURANCE PLAN H CK C- APPLICANT 0 (This section need not be completed if the work involved U by the permit is for one hundred dollars ($100) or less.) Lighting Fixture First 20 ADDRESS--------_ O Total No. 1 certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY 0. I' permit is issued, I shall not employ any person in any manner PERMIT W so as to.become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT d OvenDryer`.W.M._ ADDRESS z U) Date Applicant Top _ FAU _W.H. Hood _ Fan _Other_ CITY Tel No. 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 Iass Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRI O. PR SED BY with comply with such provisions or this permit shall be yp deemed revoked. Size&Te HP,KW,KVA,or KVAR �� Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE p�4 VALIDATION, LICENSED CONTRACTORS DECLARATION / Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over 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 Number4271 t?!fCLic.Class 0-200 Amp. Under 600 V 201-1000 Amp. Under 600 V f!' c� f� gfv Contractor ate ® Over 1000 Amp.or Over 600 V L - HOME OWNER-BUILDER DECLA ATION 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 Ell, 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 .9 5.4 A7044, Business and Professions Code). z9 1 CONSTRUCTION LENDING AGENCY # 0 0'0 0 o 2 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub-Total) 2 o o l 7 0 O .issued (Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) 0 0 of '] 0 0 csi Lender's Address PERMIT ISSUING FEE 7 O �Q �02_$O 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 LZ ordinances and State laws Agulating Electrical wiring, and hereby author' re atives his County to enter upon the abov - ntio propert r inspection/ SEE REVERSE FOR EXPLANATORY LANGUAGE Sig tureof Per tee ate 76A663`CE-806(11 /7B) A PLI A I fs'a.@ F ELECTRI IT Y COUNTY OF LOS ANGELES C��y BUILDING AND SAFETY FOR APPLICANT TO FILL IN JOB New Residential Bldgs.&Pools EACH NO. FE-E— ADDRESS 1 &2-Family,Sq. Ft. $ .025 — $ LOCALITY Multi-family Sq. Ft. .02 — NEAREST Residential Swimming Pools 25.00 CROSS ST. ca OWNER OR �u /�l' 6—+d/.. , NAME Outlets:Rec Light Sw. MAIL First 20 .50 ADDRESS OV14C1 Vie' rl .Total No. Additional .30 CITY ¢ : Tel.No ' 33 PLAN CHECK APPLICANT Lighting Fixtures First 20 50 ADDRESS Additional ..30 Total No. CITY Tel. No. Fixed.Appliances Not Over 1 HP PERMIT- - - APPLICANT Range ,. D.W. _ ADDRESS Oven--Dryer W:M.— Top —FAU W.H._ CITY Tel. No. - Hood_Fan _Other_ LICENSE OR DisP.— Room Air Cond. 2'50 REG.NUMB , Class. IH BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA- Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY' ORDINANCES AND.-STATE LAWS Size Type HP, KW, KVA,or KVAR 2 50 REGULATING ELECTRICAL WIRING. Up to.1 Incl. •1 HEREBY CERTIFY THAT I AM PROPERLY•REG'ISTERED AND/OR "U Over 1 to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF �. Over 1.0 to 50 Incl. .1 2.50 CALIFORNIA OR THAT AM THE.,LEGAL OWNER OF THE ABOV Over SO to 100 Inc. E, 25.00 DESCRIBED RESIDENTIAL PROPERTY. � LLL���JJJ Over 10040.00 PERMIT EE SIGNATUR Services" DISTRICT NO. ED Y 0-200 Amp. Under 600 V 1 2.50 /,� 201-1000 Amp. Under 600 V 25.00 Over 1000 Amp.or Over 600V 50.00 O Temp. Power Pole&Appurtenances 10.00 Sign with One Branch Circuit 10.00 C Additional Sign Branch Circuits 2'p0 INSPECTION Y ItAAATION �8 9�i 6 Misc.Conduits&Conductors 10.00 N FO . ON REVERSE z {; 0 0 0 0 ­2Other(See Complete Fee Schedule) SIDE u 2ao3200 a o o32. 0G�' . PERMIT FEE (Sub-Total) 0 2 0 g PLAN CHECKING FEE .' (One-Fourth Permit Fee) O PERMIT ISSUING FEE $7.00 J TOTAL FEE z2o, ~- INSPECTION FINALED' W date: By a. ©s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0603100009 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 35012 LT: 9 5447 GOLDEN WEST AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803219 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8588-020-030 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C G1 OUTLETS-LGT,SW,RECP 4.00 OUT 7.60 TENANT: H2 RES GRBG DISP LT 3HP 1.00 DIS 10.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 46.50 03/10/06 JK 09/06/06 OWNER: TEL. NO: FI L DAT FINAL BY: CODE: CHANG, ERIC (626) 643-8175- 5447 GOLDEN WEST AV TEMP 917803219 DESCRIPTION OF WORK ELECTRICAL FOR KITCHEN AND 2 BATHROOM REMODEL APPLICANT: TEL. NO: SOU CHI MA (909) 630-8066- 3240 E. HILLTONIA DR SPECIAL CONDITIONS: WEST COVINA CA 91792 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SOU CHI MA (909) 630-8066- 3240 E. HILLTONIA DR LIC. NO TEMPORARY POWER POLE - WEST COVINA, CA 91792 482500 B UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508