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HomeMy Public PortalAbout5742 GOLDEN WEST AVE_Electrical__ W©rm that COMPENSATION DECLARATION CE-806 to/Bt APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806G insure, or a certificate 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 Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS �'( EJCertified copy is filed with the county building inspec- 1 & 2-Family, Sq Ft $ — $ LOCALITY tion department Multi-family Sol Ft — NEAREST y/ Residential Swimming Pools CROSS ST // d r ! C Date Applicant-- OWNER OR FIRM NAME r 'GfC CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw _ MAIL COMPENSATION INSURANCE ADDRESS ,� { First 20 (This section need not be completed if the work involved by Total No Additional CfTY ��, 7 Tel No t,� the permit is for one hundred dollars ($100)or less.) I certify in e that the performance of the work for which this PLAN CHECK P APPLICANT permit is issued, I shall not employ any pers�pns-t n an manner ' so as to become subject to the Worker 'Con Laws Lighting Fixtures First 20 ADDRESS Total No Additional CITY T Date "-c13�7Appli 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' Range_ Heater_D W — LA Compensation provisions of the Labor Code, you must forth- Oven _ Dryer — W M — t 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 Class REG NUMBER (commencing with Section 7000) of Division 3 of the Business DISTRICT NO `( PROC ED B 00– and Professions Code,and my license is in full force and effect Power Apparatus 8 Large Appliances U 0 Size &Type HP, KW, KVA, or KVAR t U License Number Lic Class Up to 1 Incl FINAL I Contractor Date Over 1 to 10 Incl DATE' r V (DATION Over 10 to 50 Incl FIN W I am exempt under Sec Over 50 to 100 Inc B 0.. U) B 8P C for this reason �over 100 9 6 71.'1 A Z Date Services; Swbd , MCC & Ponelboards 0 -200 Amp Under 600 V #,o,o o 0 0 2 Signature 201 - 1000 Amp Under 600 V ❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V '( -,92550 SINGLE FAMILY Temp Power Pole& Appurtenances o 0 0 2 5 0 U HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License o3.20-87 Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits Professions Code) 1, 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)_ ► 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there is d construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec 3097, Civ C ) PLAN CHECKING FEE Lender's Name ` PERMIT ISSUING FEE (f Lender's Address I certify that I have read this application and state that the TOTAL FEE tS above information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize repr sentatives of this County to enter upon the a e e one roperty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE -7 0 S Signature of Permittee Date COUNTY OF LAS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1212050027 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 - PHONE (626) 285-0488 EXT LEGAL ID- FEES PAID I BUILDING ADDRESS. ITR 6561 LT 455 UN .002 5742 GOLDEN WEST AV I (FEE DESCRIPTION QUANTITY UOM. AMOUNT TEMP CA 917802503 1 ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET LIVE OAK 18587-028-016 IA1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE- 597 GRID A3 LOCALITY- TEMPLE CITY CAI I IC2 SPAS, HOT TUBS, OTHR 1 00 SPA 54 50 TENANT: IG1 OUTLETS-LGT,SW,RECP 8 00 OUT 16.00 JISSUED ON PROCESSED BY. PLAN BY I IG2 LIGHTING FIXTURES 6 00 LGT 12 00 112/05/12 SR 1 IH4 RES RANGE HDS LT 3HP 1 00 HOO 11 00 1 IOWNER:. TEL. NO IH7 RES EXHAUST FANS 4 00 EX 44 00 IFINAL DATE F BY CODE 1 (PIERCE PAUL R (626)' 209-0634- I TOTAL FEES 165 30 I / 1 15742 GOLDEN WEST AV - I _ I � I (TEMP 917802503 I IDtSCRIPTION OF WORK I (ELECTRICAL REPAIRS KITCHEN AND MASTER BATHROOM I I I I (APPLICANT TEL NO I I ISAME AS OWNER - I I I I (SPECIAL CONDITIONS. 1 I I I I I I I I I I I I ICONTRACTOR TEL NO I 1APPROVALS DATE INSPECTOR SIGNATURE 1 ISAME AS OWNER - I I LIC NO I (TEMPORARY POWER POLE I I I I I I I (UNDERGROUND CONDUIT I 1 I I I I I I I (ARCHITECT OR ENGINEER TEL NO I IUFER GROUND I I I - I I I I I LIC NO I IROUGH CONDUIT I I I I I ROUGH WIRING I I MAIN WATER VnE I (PLASTIC Y/N METAL Y/N I I I I I I I I I 1UTILITY COMPANY NOTIFIEDI 1 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 1 (REPORT ID DPR265 ROUTE TO: BS0508 1 I I 1 I I I I I I WORKERS' COMPENSATION DECLARATION 20-0019 DPW 3/87 76A663 APPLICATION FOR ELECTRICAL PERMIT O 76_66 I hereby affirm that I have a certificate of consent to self ce-eoac , insure, or a certificate oT Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or•a certified copy thereof (Sec 3800, Lab C ) Policy No Company FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS F-1Certified copy is filed with the county building inspec- 1 &2-Family, Sq Ft $ _ $ LOCALITY tion department Multi-family Sq Ft NEAREST CROSS ST v� + \ Date Applicant Residential Swimming_Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets RecLight_aSw MAIL 3 COMPENSATION INSURANCE /` /d 2D ADDRESS h (This section need not be completed if the work involved by First 20 { 7 CITY .�e Tel No O the permit is for one hundred dollars ($100)of less.) Total No Additional Wlo PLA I certify that in the performance of the work for which this APPLICANTK permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws Lighting Fixtures First 20 116 ADDRESS, Additional Total No CITY Tel No Date Appl cant Fixed Appliances Not Over 1 HP PERMIT ' NOTICE TO APPLICANT If, after making this Certificate 'of APPLICATION Exemption, you should become subject to the Workers' Range— Heater—D W Compensation provisions of the'Labor Code, you must forth- Oven — Dryer —W M ADDRESS with comply with such provisions or this permit shall be Top FAU —W H deemed revoked Hood — Fan —Other7� !.� n CITY Tel No LICENSED CONTRACTORS DECLARATION Hoo — Room Air C Other L "� 7 LICENSE ORDisp Class I hereby affirm that I am licensed'under provisions of Chapter 9 a REG NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NOO{V{f PRO M:!� , , O and Professions Code,and my license is in full force and effect Size &Type HP, KW, KVA, or KVAR License Number Lic Class Up to 1 Inci FINAL U Over 1 to 10 Incl DATE Z VALIDATION cc Contractor Date Over 10 to 50 Incl FINAL % F- I I am exempt under Sec Over 50 to 100 IncBY LLI0 B&P C for this reason Over 100 - Q_ Services, Swbd , MCC& Panelboards DD Z Date 0- 200 Amp Under 600 V _ Signature 201 - 1000 Amp Under 600 V ❑ - Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V SINGLE FAMILY Temp Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit o$ Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits r� Professions Code) is, I, as owner ofthe property, will do the work and the Misc Conduits &Conductors T w _ structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ __ Business and Professions Code) ' Is1(' � =�' ? CONSTRUCTION LENDING AGENCY �:f�i'.:i■ j:.Lo�s I_hereby_affirm that there is a coristruction lending agency for the performance of,the work for which thiss permiris issued--- -PERMIT-FEE (Sub=Total)__ Z _ 6 (Sec 3097, Civ C ) PLAN CHECKING FEE Lender's Name � V 4 PERMIT ISSUING FEE a,C, _ Lender's Address I certify that I have read this application and state that.the TOTAL FEE above inform tgot I ree to comply with all County ordinances d laking Electrical wiring, and hereby nh s of this County to enter upon the ob e y for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Permittee Date Os WORKERS' COMPENSATION DECLARATION 20-0019 DPW 3/87 .76A663 APPLICATION FOR ELECTRICAL PERMIT O 1•hereby`affirm that I have a certificate of consent to self CE-8066 nsF,fe, or a certificate of'Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec 3800, C ) Policy No s� &omjpony(�_� FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS -7 C. rl v1JQS�^� r F,-3.eertified copy is filed with the county building inspec- 1 8 2=Family, Sq LOCALITY Ft � _ $ *_� LL((D�tion department Multi-family Sq Ft NEAREST -CROSS tv '!2_(2 -9 � ��hcant Residential Swimming Pools OWNERORwp, i�Date ppv r„�N ` CERTIFICATE OF EXEMPTION FROM WORKERS' IL Z FIRM NAME L ll����G Outlets Rec Light Sw_ �� ADDRESS S`7 4 Z CTOI C'A G�JC COMPENSATION INSURANCE /� First 20 �/ (This section need not be completed if the work Involved by Total No "`�- Additional �f / CITY e C C_?[__ Tel No the permit is for one hundred dollars ($100)or less.) 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 Lighting Fixtures First 20 /'7d ADDRESS so as to become subject to the Workers'Compensation Laws Additional 'Total No CITY Tel No. Date Applicant Fixed Appliances'Not Over 1 HP PERMIT ``�� cc�� - NOTICE TO APPLICANT If, after making this Certificate of APPLICATION 1► L•yN� _C.K_C_�t G Exemption, you should become subject to the Workers' 'Range_ Heater—DW Compensation provisions of the Labor Code, you must forth- Oven Dryer —W M i ADDRESS with comply with such provisions or this permit shall be Top FAU ry-W H — C deemed revoked CITY Tl N Hood Fan c�Other_ "/ A �A eo. QCA 7 S7 LICENSED CONTRACTORS DECLARATION ' D a' LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp Room Air Cond — REG NUMBER yJ250 Class �stst'a (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO P SED•BY >_ and Professions Code,and my license is in full force and effect p t1 Size &Type HP, KW, KVA, or KVAR Q Q Q License Number 3�'S I is Class G�0' Up to 1 Incl FINAL U > LA12(t� eZeC- ' / Over 1 to 10 Incl DATE L_Z` VALIDATION 0O Contractor Date ❑ Over 10 to 50 Incl FINAL � I am exempt under Sec Over 50 to 100 Inc BY U Over 100 LLJ B&P C for this reason a 2 2U) Da`'fe �J"`� Service bd MCC& Panelboards i Q Z 00 A Under 600 V — �/Signature - 20 Amp Under 600 V ❑ Over 1000 Amp or Over 600 V Exemption for _ g Maint Eject SINGLE FAMILY �1 - HOME OWNER-BUILDER DECLARATION Temp Power Pole&Appurtenances _ Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License g Law for the following reason (Section 70315, Business and Additional Sign Branch Circuits Professions Code) Misc Conduits&Conductors ❑ I,"as owner of the property, will do the work and the structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ Business and Professions Code) '3: 3 CONSTRUCTION LENDING AGENCY iEC K 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-Total) jihi '3r E F (Sec 3097, Civ C ) PLAN CHECKING FEE Lender's Name PERMIT ISSUING,FEE Lender's Address ?"= ?f, I certify that I have read this application and state that the TOTAL FEE D above information is corfect I agree to comply with all County ordinances and State lav4s regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the ve-menti ed property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 31 /14_9 . Sig re of Per tee Date �' WORKER'S COMPENSATION DECLARATION 76A669 DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT • 76A663 • I hereC�affirm that'l have a certificate of consent to self Insure, I or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec 3800 Lab-C) , r Policy No Company FOR APPLICANT TO FILL IN f JOB ADDRESS S 2 Certified copy is-hereby furnished New Residential Bldgs &Pools $EACH NO $, -FEE LOCALIT ' ❑ Certified copy Is filed with the county building inspection 1&2-Family,Sci Ft department , NEAREST Multi-famdY S9 Ft , CROSS ST Date Applicant Residential Swimming Pools -ASSESSOR MAP BOOK __ PAGE PARCEL CERTIFICATE OF EXEMPTION FROM.WORKERS' OWNER OR 4 Outlets Rec Light SW _FIRM NAME -PW 1, COMPENSATION.INSURANCE _ � ' '.1 ' (ThisFirst 20 MAIL - perm section need not be•completed If the work Involved by,the Total No'� Additional ADDRESS >M permit is for one hundred dollars($100)or less) I certify that in the performance of the work for which this permit CITY Tel No is Issued, I shall not employ any person in any manner so as to PLAN CHECK become,subject to the Workers' Compensation Laws Lighting Fixtures First 20 APPLICANT (:• Total No Additional ADDRESS Date Applicant ,-120V BRANCH CIRCUITS- NOTICE TO APPLICANT If, after 15 OR 20A making this 'Certificate of _ CITY Tel No Exemption,you'should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH PERIT provisions of the.Labor,Code, you must forthwith comply with such 11 TO 40'INCLUSIVE EACH APPLICANT L provisions or this permit shall be deemed revoked 41 OR MORE BRANCH CIRCUITS EACH LICENSED CONTRACTORS DECLARATION, ADDRESS d I hereby affirm that 1 am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH (commencing with Section 7000) of Division 3 of the Business and __ _- _ CITY Tel No 0 Professions Code,and my license is In full force and'effect RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR Power Apparatus&Large Appliances, REG NUMBER Class O License Number Llc Class Size&Type HP,KW,KVA,or KVAR DISTRICT NO O PROCESSED BY F. - Up to 3 Incl 0 W Contractor -Date ' Over 3 to 10 Incl oIANTE - fA Over 10 to 50 InclZ El -1 am exempt under Sec Over 50 to 100 Incl `I�—z VALIDATION 100 Over FINAL / B&P C for tFils reason BY. /// • Date Services,'Swbd,MCC&P,anelboards. • -- 0-200 Amp Under 600 V ' Signature 201 -1000 Amp Under,600•V - ❑ _ _ Over 1000 Amp or Over 600 V + Exemption for Reg Maent Elect SINGLE FAMILY Temp Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATIONSlgn with One Branch Circuit 14r I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and Professions Additional-Sign Branch Circuits Code) _ [ _ C - Conduits&Conductors; _ I, as owner of the property,will do the work and the structure Misc I is not intended or offered for-sale (Section 7044, Business Other(See Complete Fee Schedule) 5:3, r `t and Professions Code) - - -- �• CONSTRUCTION LENDINGNAGENCY 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) Civ C) l - . PLAN CHECKING FEE - I;T!''••-:IM1i{!i __4/ 19- Lender's Name �} PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the above TOTAL FEE information is correct I agree t comply with all County ordinances and/al regulate EI Icalwrong, and hereby authorizeeof thi C u ty o enter upon the above-mentionedprpec s SEE REVERSE FOR EXPLANATORY LANGUAGE 3 '31- ejZ SIGNATURE OP A LICANT OR AGENT DATE '