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Home My Public Portal About6013 GOLDEN WEST AVE_Electrical__ 1 g� a, f WORKERS''COMPENSATION DECLARATION 76.4653}] to'[" APPLICATIO FOIA �ELECTROCAL PERMIT o firm,that lave a certificate of consent to self CL 806�y insur or'a::ertifiznte of Workers'Jompensation Insurance, (((( COUNTY OF LOi ANGELES_ BUILDING AND SAFETY or q,certified.?'opy thereof (Sec. 380 Lab. .) Policy No.–,—Company FOR APPLICANT TO FILL IN JOB ' ') _ It _ 1 QCerjified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS v ,� Cer^ified copy is filed with the county building inspec- 1 & 2-Family, Sq.'Ft. $ — $ LOCALITY i tion department. Multi-family Sq. Ft. — 'NEAREST �� Residential Swimming Pools CROSS ST. d Date Applicant OWNER OR r'� pp q (� FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: R' Light Q_Sw. MAIL .� COMPENSATION INSURANCE 1 ADDRESS First 20 - (This section need not be completed if the work involved by Total No. Additional CITY Tel. No. the permit is for one hundred dollars (5100)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 Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of k Exemption, you should become subject to the Workers' Range�'Heater ''r- D.W. APPLICANT Compensation provisions of the Labor Code, you must forth- Oven i!f Dryer' W.M. ADDRESS with comply with such provisions or this permit shall be Top — FAU —W.H. q. r 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. REG. NUMBER Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PRO E SED BY and Professions Code, and my license is in full force and effect. Power Apparatus 8 Large Appliances 0. Size& Type HP, KW, KVA, or KVAR' 1 0 License Number Lic. Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE Contractor Date 1 VALI TION 0 Over 10 to 50 Incl / fa FINAL. 763 U I am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 Date: Services, Swbd., MCC & Ponelboards 0 -200 Amp. Under 600 V iS d ► Signature 201 - 1000 Amp. Under 600 V Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V #z 1 o o o 2 SINGLE FAMILY Temp. Power Pole &Appurtenances 0 0 81.50 _ HOME OWNER-BUILDER DECLARATION o 0 0 Sign with One Branch Circuit (J 2 2 1 J Q I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): ro LTJ al, as owner of the property, will do the work and the Misc. Conduits& Conductors structure is not intended or offered for sale (Section Other (SeeComplete Fee Schedule)_ pool7044, Business and Professions Code). 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 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 I�ws regulating Electrical wiring, and hereby authorize repr sentatives of this County to enter upon /Ae lbove-mentioned r�perty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE UA t Sig re Of Permit ee Date f – :f 1 WORKERS'COMPENSATION DECLARATION 76-663 10/61 APPLICATION FOR ELECTRICAL PERMIT _ {� I_hereby aff�m that I have a certificate of consent to self insure, CE-Bose u or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY co0y;,4hereof(Sec. 3800,Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB � y QEACH NO. FEE ADDRESS6013 (SOLZE�V L06!5" AVE. Certified copy is hereby furnished. New Residential Bldgs.& Pools ❑ 1 & 2-Family,Sq.Ft. $ — $ LOCALITY"1�H(�LC I C�17ga Certified copy is filed with the county building inspection — NEAREST ` , department. Multi-family Sq.Ft. W00- R 0 F F CROSS ST. Date Applicant Residential Swimming Pools OWNER OR �] FIRM NAME O 0 l 4 CERTIFICATE OF EXEMPTION FROM WORKERS' � MAIL COMPENSATION INSURANCE Outlets:Rec Light Sw. -5 ADDRESS .(This section need not be completed if the work involved by the �t First 20 permit is for one.hundred dollars($100)or less.) Total No. ,Additional CITY ;b'7_r 03 I certify,that in the performance of the work for which this permit PLAN CHECK is issued, I shall not employ any person in any man so as to APPLICANT become subject to the Workers'Co nsation Laws. il, Lighting Fixtures First 20 ADDRESS Total No. AdditionalCITY Tel.No. Date Applic t Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certifi to of Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M. — ADDRESS S i provisions or this permit shall be deemed revoked. Top FAU _ W.H. CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood Fan — Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER Class. Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY Size & Type HP,KW,KVA,or KVAR V License Number Lia Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE,�14 VALIDATION Q Contractor Date Over 10 to 50 Inc]. FINAL/_ - U ❑ I am exempt under Sec. Over 50 to 100 Inc. BY ) W y (LB.&P.C.for this reason Over 100 V Z Services,Swbd.,MCC& Panelboards Date: 0- 200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V El Exemption 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. """"""""".""""" SINGLE FAMILY Temp.Power Pole & Appurtenances 2 HOME OWNER-BUILDER DECLARATIONi qr g I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit ACC TUT for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits 7 38075 Code): I,as owner of the property,will do the work and the structure Misc.Conduits& Conductors __ 1 1➢M is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ ® TOT- 38.75 5 and Professions Code). //++t�1��1i // ��aa CONSTRUCTION LENDING AGENCY 4tiECK °8®75 1 hereby affirm that there is a construction lending agency for the _ C ®00 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) Civ.C.). PLAN CHECKING FEE pft^p6_ l q f 6/89 89 Lender's Name tldfiLfU"' 7/ ®1 p7 PERMIT ISSUING FEE 5521 �1dS. AN g»13, Lender's Address !t!1 I certify that I have read this application and state that the above 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 Cmy to enter upon the above-mentioned pro y or inspection loses. SEE REVERSE FOR EXPLANATORY LANGUAGE ure of Permitlee Date !? COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0302250048 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 6561 LT: 94 6013 GOLDEN WEST AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801719 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: WOODRUFF 5385-019-010 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY F1 120V, 15/20A BR CKTS 1.00 BR 17.25 TENANT: G1 OUTLETS-LGT,SW,RECP 12.00 OUT 23.40 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: G2 LIGHTING FIXTURES 4.00 LGT 7.80 02/25/03 JK 08/24/03 HA FAU LESS 3HP 1.00 FAU 10.95 OWNER: TEL. NO: JB AC UNITS +3-10HP 1.00 AC 19.65 FINIAL DATE FINA BY- CODE: SAPIA DANNY K;TERESA L (626) 287-1032- TOTAL FEES 106.80 6013 GOLDEN WEST AV TEMP 917801719 DESCRIPTION OF WORK ELECTRICAL FOR ADDITION APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING �- MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508