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HomeMy Public PortalAbout5758 GOLDEN WEST AVE_Electrical__ WORKERS'COMPENSATION DECLARATION 20-0019DPW3/87 APPLICATION FOR ELECTRICAL PERMIT herety':affirm that I have a certificate of consent to self ce 8006G insi&ie; or a certificate of 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 SOB ElCertifiedcopy is hereby furnished. New Residential Bldgs. &AoPls EACH NO. FEE ADDRESS 7D / //f/. El Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. �dL'J $ —is I LOCALITY tion department. Multi-family Sq. Ft. — NEAREST Cp Date' Applicant Residential Swimming Pools CROSSOWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec�LLight Sw. MAIL COMPENSATION INSURANCE First 20 ADDRESS (This section need not be completed if the work involved by Total No. /l Additional CITY 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 l ��� so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 514p ADDRESS A✓ Additional Date Date ` / Applicant �t L4Total No. CITY Tel. No. / - NOTICE TO APPLICANT: If, after makig Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M._ ADDRESS with comply with such provisions or this permit shall beTop FAU —W.H. — deemed revoked. Hood — Fan —Other— CITY el. No. LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. — REG. NUMBER Class. (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. /� a Size &Type HP, KW, KVA, or KVAR / U T/ Q License Number Lic. Class Up to 1 Incl. FINAL U Contractor Date Over 1 to 10 Incl. DATE /® —��.G� VALIDATION 0 ❑ Over 10 to 50 Incl. FINAL I 1-- I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C. for this reason Over 100 0- Z Services, Swbd.,/MCC & Panelboards W Date: 0-200 Amp. Under 600 V — Signature 201 - 1000 Amp. Under 600 V OExemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole&Appurtenances ` HOME OWNER-BUILDER DECLARATION ',,. L I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit FF Law for he followingreason Section 7031.5, Business and Additional Sign Branch Circuits Profe ions Code): I, as owner of the property, will do the work and the Misc. Conduits& Conductors i s It-I•-_' structure isnot intended or offered for saleSection 7044, Other (See Complete Fee Schedule)_ E"I s ( ► (+. E ii 26 m f` : Business and Professions Code). �" :I _ CONSTRUCTION LENDING AGENCY CHEC' I hereby affirm that there is a construction lending agency for --HANSE ,I f1,i the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). 'PLAN CHECKING FEE k 5/1-7 Lender's Name - PERMIT ISSUING FEE - lender's Address _�7';'r L AM - 31i.; 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 ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentione propert for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ,5-e /7' Signature of Permittee Date ©s c WORKERS' COMPENSATION DECLARATION 76A0t9oFw9 87 APPLICATION FOR ELECTRICAL PERMIT O I hereby affiriln tM6t 11have a certificate of consent to self, ce 806G insure, or a certificate of 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 El Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY d C 'Zy tion department. Multi-family Sq. Ft. NEAREST CROSS ST. Residential Swimming Pools OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec__q_Light-Sw. �` MAIL j COMPENSATION INSURANCE ADDRESS �� t This section need not be completed if the work involved b First 20 ( P Y Total No. Additional CITY 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 so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Total No. CITY Tel. No. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION 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. CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood — Fan —Other— Disp. Room Air Cond. LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT U.9, PRO SED BY >_ and Professions Code,and my license is in full force and effect. d Size &Type HP; KW, KVA, or KVAR tom'tom' Q License Number Lic. ClassU Up to 1 Incl. FINAL n Contractor Date Over 1 to 10 Incl. VALIDATION 0 ElOver 10 to 50 Incl. FINAL ( 9 / F_ I am exempt under Sec. Over 50 to 100 Inc. BY (J�J W B.&P.C. for this reason Over 100 t1 ®Services,•Swbd., MCC& Ponelboards Z Date: 0-200 Amp. Under 600 V Z Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. �`1}C 3 1aLS.@ SINGLE FAMILY Temp. Power Pole &Appurtenances �� i r F-; HOME OWNER-BUILDER DECLARATION # �,���`.= • Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License p --_•4 �-�q Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits TOT jai, � 1 - 00 Professions Code): r-}•{ _ ,110 �'1E_K ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors CU)• Other See Complete Fee Schedule)— o_� I structure is not intended or offered for sale(Section 7044, ( P - -- Business and Professions Code). CONSTRUCTION LENDING AGENCY '`� fyll I hereby affirm that there is a construction lending agency for `�t1 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) HAM (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address 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 ordinances and State laws regulating Electrical,wiring, and hereby authorize representatives of this unty to enter upon thea e-mentio prop fo sp io purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sign re A Permittee Date ©s WORKERS;COMPENSATION DECLARATION 2o-oot9DPW 3ie7 APPLICATION FOR ELECTRICAL PERMIT erO {. eOj`affirm that I have a certificate of consent to sell ce s06c sure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a c•Frtilied"copy thereof (Sec. 3800, Lab. C.) ' Policy'No. Company FOR APPLICANT TO FILL IN JOB 11-Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 5n GQQp� I.Q ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Fes= $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST moi' l Residential Swimming Pools CROSS ST. OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec 4 Light.LS> MAIL COMPENSATION INSURANCE First 20 / ADDRESS (This section need not be completed if the work involved by Total NS� Additional CITY 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 so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional oTotal No. — CITY Tel. No. �r Date (1 - ��-� Applicant SCJ`(c�f,'L.Q�.�"s 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 —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. _ Room Air Cond. REG. NUMBER Class. I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. P O €SSED BY d and Professions Code,and my license is in full force and effect. Size &Type HP, KW, KVA, or KVAR L�j tG-�st(fo 0 License Number Lic. Class Up to 1 Incl. FINAL U Contractor Date Over 1 to 10 Incl. DATE 10 ,3�fl VALIDATION � F-1 Over 10 to 50 Incl. FINAL ` ~ I am exempt under Sec. Over 50 to 100 Inc. gY C) W B.&P.C. for this reason Over 100 t1 Services, Swbd., MCC & Panelboards Z Date: 0- 200 Amp. Under 600 V — Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Mainz. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances i HOME OWNER-BUILDER DECLARATION A. I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit ; ,v. Law for the following 'reason (Section 7031.5 Business and Additional Sign Branch Circuits i- t Professions Code): ---• ` ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors L 1 k`I' structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , -IT _ .._,• s Business and Professions Code). .'Yii` CONSTRUCTION LENDING AGENCY - ='• - 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) (Sec. 3097, Civ. C.). PLAN CHECKING FEE -r 1^I-t- r- Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEES /tJ above 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 enter upon the above-mention property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE c 5 (5s f P to r it ee ©s COUNTY OF LOS ANGELES TEMPLE CITY #.0508 ,ELECTR,ICAL PERMIT, DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 97061_80001 BUILDING AND SAFETY/• LAND DEVELOPMENT.1 TEMPLE CITY CA - - PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAD -BUILDING ADDRESS: TR: 6561 LT: 454 ;.5758 GOLDEN WEST AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: LEMP CA-91-7802503 ASSESSOR INFOR A ON NUMB R: NEAREST CROSS STREET: 8587-028-013 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY B2 1 OR 2 FAMILY DWELL 2601.00 So 273.11 TENANT: TOTAL FEES 300.86 ISSUED ON: PROCESSED BY: PLA BY: EXPIRES ON: 06/18/97 TC 06/18/98 OWNER: TEL. N0: FINAL DATE,•, FINAL B CODE: RICHARDS STEPHEN B;CORRIE J (818) 500-6728 5758 GOLDEN WEST AV TEMP 917802503 ESCRIPTION OF WOR . ALL ELECTRICAL FOR NEW ADDITION AN INTERIOR REMODELINGA . APL CAN : TEL. 0: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: - APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO / %'i TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT OR GINEER: TE 0: ' UFER GROUND THE WREN GROUP (818). 564-2650- 44 W. BELLUVUE DRIVE LIC. N0: ROUGH CONDUIT SUITE 6 C21565 PASADENA, CA 91105 ROUGH WIRING rv ' MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 "ELECTRICAL PERMIT,). DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS 'EL-0508 9704240001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDR §S- TR• 6561 LT: 454 5758-GOLDEN WEST?AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802503 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8587-028-013 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY _ E1 TEMP SERV POWER POLE 1.00 TMP 43.50 TENANT: TOTAL FEES 71.25 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 04/24/97 TC . 04/24/98 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: RICHARDS STEPHEN B;CORRIE J 1 1 ZD 5758 GOLDEN WEST AV TEMP 917802503 DESCfi.'.PTION OF WORK TEMPORARY POWER POLE FOR RESIDENTIA REMODEL APPLICANT: TEL. N0: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPRU'JALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NOEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. N0: UFER ]ROUND LIC. N0: ROUCi CONDUIT ROCU !i WIRING MAIN WATER LINE PLAS'!'IC Y/N METAL Y/N UT1L*iTY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508