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Home My Public Portal About5715 GOLDEN WEST 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-8066 insure, or aicertificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 3800, Lab C ) Policy No Company FOR APPLICANT TO FILL IN JOB / /�p/ Certified co s hereby furnished ADDRESS O PY Y New Residential Bldgs & Pools EACH NO FEE 1 & 2-Family, S Ft $ — $ LOCALITY T� C Certified copy is filed with the county building mspec- Y, q /✓ tion department Multi-family Sq NEAREST FT CROSS ST L/ /�� Q•s� Date > Applicant _Residential Swimming Pools FIRM NAOR ME OWNER T �!/✓ i CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw_ i MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed If the work involved by First 20 Total No Additional the permit is for one hundred dollars ($100)or less.) l CITY Tel No PLAN CHECK I certify that in the performance of-the work for which-this APPLICANT' permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Comp cation Laws Lighting Fixtures First 20 ADDRESS Total No Additional `'"�Z ifAppl cont CITY Tel No Date Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If, after making this Certificate of APPLICANT p 6�.61F h Exemption, you should become subject to the Workers' Range_ Heater_D W Compensation provisions of the Labor Code, you must forth- Oven _ Dryer _/_W M — ADDRESS with=comply,with_such provisions or this permit shall be Top _ deemed revoked `- -"" _ _ �`_--' — - - -CITY__TG'__ LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ -- LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Cond REG NUMBER �d OS� Class (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO PRO SSED BY S- and Professions Code,'and my license is in full force and effect IL Size & Type HP, KW, KVA, or KVAR O f4CI Lic Class C'� FINAL t7 License Number Up to 1 Incl /2 ��7 �� Over 1 to 10 Incl DATE L/� VALIDATION 0 Contractor, AS n2011&& ate 6/Z-.Fy Over 10 to 50 Incl V F-1FINAL r� I am exempt under Sec Over 50 to 100 Inc BY �f f "4_44 LU B &P C for this reason Over 100 tom/) Services, Swbd , MCC& PonelboardspoolZ Date 0 -200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V ❑ Over 1000 Amp or Over 600 V Exemption for Reg Maint Eject SINGLE FAMILY Temp Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION Sign with'One Branch Circuit 1 '9 1.2 A w Additional Sign Branch I hereby affirm that I am exempt from the Contractor's License Addl Sn Brh Circuit Lafor the following reason (Section 7031 5, Business and # o o o 0 o 2 Professions Code) E:1o-0 1, as owner of the property, will do the work and the Misc Conduits &Conductors L 2$ 50 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)- 2 o o '0 B 5.p= t, 7044, Business and Professions Code) :1-) � ' CONSTRUCTION LENDING AGENCY 06112-84 hereby affirm that there is a construction lending agency for ` he performance of the work for which This permit is issued PERMIT FEE (Sub-Total) - (Sec 3097, Civ C ) lender's Name' PLAN CHECKING FEE Lnder's Address PERMIT ISSUING FEE l B7 Icertify that I have read this application and state that the - TOTAL FEE 5bove information is correct I agree to comply with all County irdinances and State jaws regulating Electrical wiring, and ereby authorize representatives of this County to enter upon he above-menti pro erty for inspection purposes , SEE REVERSE FOR EXPLANATORY LANGUAGE ji6niture of Permittee Date <yVORKat I COMPENSATION DECLARATION CE-806 10/81 „ APPLICATION FOR ELECT_ RICAL PERMIT, I he(eb 2�firm that I have a certificate of consent to self insure,•' CE-9( I , obi cethficate of workers' Compensation Insurance„or a certified _, COUNTY.OF'LOS ANGELES' BUILDING'AND SAFETY 1' copy thereof(Sec 3800,Lab C), +Policy No 3G'S,; Company,• ��'�h 0- FOR APPLICANT TO FILL,,IN >' ', _ JOB - /• ' ❑ � EACH,,'NO FEE ADDRESS 1� certified copy is hereby,furnished New Residential;Bldgs & Pools I. 'Certified copy is, filed with',the county building inspection. f1 & 2-Family,Sq Ft — LOCALITY e ddeparrtntmen``t ; "� Multi,--family Sq,Ft NEAREST •7��[�/'�t� , CROSS ST Date A lica ,ResideritI I Swimming Pools k „ OWNER OR PP , T 3 �' Mit•,'+ y,,, �'t"� ,i FIRM NAME"';Y yj,�s�" �L�i-J, CERTIFICATE OF EXEMPTION'FROM W + Outlets WRLight r' SW a• . 'ADDRESS .�,'j•� ,(�O(O��+•��S'' �'', COMPENSATION INSURANCE ` i, First 20. ,, r.^ . «(This section need not be completed rt the work involved_by the` 7' i A + - CITY /} Tel`N0 permit,is forgone hundred'dollars ($100)or'less) .. ., Total No T/ 6/ Additional % emir lr, ( % 7 . �e, I certrf 'that m the performance of,the for which this erinif PLAN CHECK' Y P •P APPLICANT' s;issued, I,shall not employ`any.,persoh,in any manner so as to t fbec'ome'sutiject•to the Workers"Ccimpensation Laws ° Lighting,Fixtures First'20; ADDRESS"- '-"ti �'• w +• • Additional: " } Total No �. CITY' ;s c ,Tel No , -,Dater Applicant• Fixed Appliances Not Over 1 HP y 91 J PP PERMIT. NOTICE APPLICANT If afters making, this(Certificate',"of APPLIOANT, Exemption,you should become subject to the'Workers'Compensation Range Heater—.D W ;• ;, �j ! a provisions of the Labor,Code, you,must forthwith comply,with such Oven —• Dryer _.W M —, 'ADDRESS',S 3 saU /`� / �/ t• ,.Provisions.orhthis-permt halP5be�deemei,revoEk`ed ° To R.�.--FAU--;.WH rCITYJ• . ....®-'Tel CICENSE D•CONTRACTORS DECLARATION, HoodFan _'Other_,. I.hereb affirm,that I am licensed urider^- rovisions of Cha te'r•9 s. LICENSE•OR• /' (f_IQ • s Y,• P P Disp —Room Air Cond *'r "b�'•" -REG NUMBER: -Class (co`mmencing with Section 7000) of'Di'vision'3 of the-Business and Professions Code;and myllicense'is in'full force'and effect ' 2 '� 1 }- - DISTRICT NO PROCESSED _ _ Power Apparatus& Large Appliances „ � _ Size& Type,HP,KW,'KVA,or'KVAR % License,Number M .7,Jf Lic O •Class �U' - Up to 1 Incl 4' FINAL ✓J' 0 Over 1 to 10 Incl DATE t Contractor li�Gd��L'7r'i•C3,. ° Date' 7/�/��f FIN- C/ VALID �N ;O O Over 10 to 50 Incl ❑ I am+exempt under Sec, Over 50 to 100 Inc By W',' 12 .. ..- - - - • ' - ' l � a ,� - 0. B&PC for this Over 100 reason' s , Services,Swbd,MCC'& Panelboards Z ' Date 0- 200 Amp'Under 660 V i Signature 201 - 1000'Amp Under 600 V - 7 Over 1000 Amp or:Over 600 V Exemption for Reg Mamt Elect ",” 'r . x• SINGLE FAMILY',-,`„ ' "k Temp Power Pole& Appurtenances N D W HOME OWNER-BUILDER DECLARATION n �,9 4 3l T'A•, ' •�ro•:. Sign with One, Circud - "• , "'.„ .- Thereby affirm that I am exempt from.the Contractor's License Law - r, e for the following,reason,(Section 7031 5, Business and Professions :,-,,,<Additional Sign Branch Circuits,, ',# oa,o`0 0 0 2 ,Code) �'. • ..- o'3 4 5 0 Misc Conduits &'Conductors -a l;a"s owner of tfie property;will do the work and the structure ' ? is not,intended or offered for sale•(Section,7044, Business Other.(See Complete Fee Schedules K o' o',o`.3 4.5 06 , and Professions Code) 21' 88.' CONSTRUCTION LENDING AGENCY Ishereby affirm that°there'is-a construction lending agency fo'r'-the' " ' performance of the•work,for which this permit is issued(Sec 3097, --PERMIT-FEE (Sub-Total) - » �� -• m 'Civ C) PLAN CHECKING FEE Lender's Name y f ERMIT•ISSUING FEE Lender's Address I certify that I have read'this application,and state that the`alioJe ' , 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 66ter.upon`the above-mentioned '- •°' property for in' purposes • b•' SEE REVERSE FOR.EXPLANATORY,LANGUAGE ? Signatur ermittee ° , Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0803100013 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT ILEGAL ID I FEES PAID I BUILDING ADDRESS. 1 ITR 6561 LT 461 I 5715 GOLDEN WEST AV 1 I IFEE DESCRIPTION QUANTITY- UOM AMOUNT TEMP CA 917802504 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET 18587-023-005 IA1 PERMIT ISSUANCE FEE 27 75 1 _ THOMAS PAGE 597 GRID A3 LOCALITY TEMPLE CITY, Cl ILB 200 AMP PANELS, MCC 1 00 PAN 38 85 1 ITENANT I TOTAL FEES 66.60 (ISSUED ON PROCESSED BY PLAN BY: EXPIRES ON I I 103/10/08 SR 09/06/08 1 IOWNER TEL NO. I IFINAL D T$ E ^ FW CODE 1 I LANIGEIN, MARY 15715 GOLDEN WEST AV ITEMP 917802504 1 ID SCRIPTION OF WORK it I I I (UPGRADE THE ELECTRICAL SERVICE TO 200 AMP I I I •I I 1APPLICANT TEL NO I I I ITANNOUS MIKE (626) 818-4778- 1 I I 12694 MEGUTAR DRIVE 1 ISPECIAL CONDITIONS- 1 1PASADENA, CA 91107 1 1 I I I I I I I I I ICONTRACTOR TEL NO t I (APPROVALS DATE INSPECTOR SIGNATURE I ITANNOUS MIKE'S ELECTRIC (626) 797-4780- 1 1 1 12694 MEGUTAR DR- LIC NO ITENPORARY POWER POLE I I I 1PASADENA, CA 91107 509099 C10 I I I I I (UNDERGROUND CONDUIT I I I (ARCHITECT OR ENGINEER TEL NO I IUFER GROUND I I A/6 LIC NO 1 IROUGH CONDUIT I I I I I I I I 1 I IROUGH WIRING 1 I I 1 J MAIN WATER LINE I I I I PLASTIC YIN METAL YIN I I I (UTILITY COMPANY NOTIFIED�I I I I I I I I I I I I I I I I II 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 IREPORT ID DPR265 ROUTE TO. BS0508 I 1 I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0912070027 BUILDING AND SAFETY / LAND DEVELOPMENT, TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT ILEGAL ID: I FEES PAID BUILDING ADDRESS ITR 6561 LT 461 1 5715 GOLDEN WEST AV I IFEE DESCRIPTION QUANTITY UOM AMOUNT I TEMP CA 917802504 I (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET• I 18587-023-005 IAl PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID A3 LOCALITY TEMPLE CITY,,CI I ' IG1 OUTLETS-LGT,SW,RECP 25 00 OUT 45 75 1 (TENANT• IG2 LIGHTING FIXTURES 5 00 LGT 9 75 (ISSUED ON PROCESSED BY. PLAN BY EXPIRES ON I 1 IHS RES WASH MACH LT 3HP 1 00 WAS 10 95 112/07/09 SR 12/07/10 TOTAL FEES 94.20 1 (OWNER TEL NO I IFINAL DATE FINAL BY CODE 1 ILANIGAN, MARY (626) 286-0145- 15715 GOLDEN WEST AV ITEMP 917802504 - I IDESCRIPTION OF WORK' I (ELECTRICAL KITCHEN, BATHROOM #2 AND LAUNDRY ROOM (APPLICANT TEL NO IALVARADO (714) 529-1133- I 1552 LOFT S BREA BL I ISPECIAL CONDITIONS IBREA, CA 92821 ICONTRACTOR TEL NO I - (APPROVALS DATE INSPECTOR SIGNATURE 1 (CALIBER CONSTRUCTION AND RESTORATIO (714) 529-1133- I I I 1552 LOFT S BREA BLVD LIC NO I - 1TEMPORARY POWER POLE I I BREA, CA 92821 915437 B 1 I I I I (UNDERGROUND CONDUIT (ARCHITECT OR ENGINEER TEL NO I 1UFER GROUND I LIC. NO (ROUGH CONDUIT I 1ROUGH WIRING Ib IMAIN WATER LINE 1 I 1 IPLASTIC Y/N METAL Y/N 1 1UTILITY COMPANY NOTIFIED( I 1 1 I I I I I I I I 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 1 I I I I I IREPORT ID. DPR265 ROUTE TO BS0508 I I I I I I