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HomeMy Public PortalAbout6143 GOLDEN WEST AVE_Electrical__ WQthat I hCOMPENSATIONDECLARATION 76A669DPW9/89 APPLICATION FOR ELECTRICAL PERMIT I.hereby affirm that I have a certificate of consent to Self insure, 76A663 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.) P❑OIICy NO. Company FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE �r $ — $ LOCALITY ❑ Certified co is filed with the count buildinginspection - 1&2-Family,Sq.Ft. department.Y Y p Multi-family S Ft. — NEAREST /' T P - Y q� CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR ,��/y/�f� 7 PP MAP BOOK 5.3 05 PAGES w PARCEL CERTIFICATE OF.EXEMPTION FROM WORKERS' � n OWNER OR �` ?� PC COMPENSATION INSURANCE Outlets:Rec. Light Sw. �v FIRM NAME First 20 ' (/ MAIL ��J (This section need not be completed if the'work involved by the AAll_ S ����(�(/�{j� permit is for one hundred dollars($100)'or less.) Total No. Additional 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 ry First 20 APPLICANT Total No.—16fAI�-- Additional t lu ADDRESS Date Applicant 15 OR 20A,120V BRANCH CIRCUITS NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers' Compensation 1TO 10 INCLUSIVE EACH provisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMIT D ,07U provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH APPLICANT }. LICENSED CONTRACTORS DECLARATION ADDRESS ' O I hereby affirm that I am licensed'under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH (commencing with Section 7000) of Division 3 o the Business and CITY Tel.No. U Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR -sv Class. Power Apparatus&Large Appliances REG,NUMBER a License Number Lic.Class Size&Type HP,KW,KVA,or KVARDISTRICT NO. PROCE C) Up to 3 Incl. W Over 3 to 10 Incl I FINAL COCL Contractor Date - Over 10 to 50 Incl. DATE .//`�� Z ❑ I am exempt under Sec. Over 50 to 100 Incl. t(/ VALIDATION Over 100 - FINAL B.&P.C.for this reason BY Services,Swbd.,MCC&Panelboards 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.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances - HOME OWNER-BUILDER DECLARATION it h Ci '' B with One Branch Circuit _,"F? I hereby affirm that I am exempt from the Contractor's License Law Sign w for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits _... _. -Gy I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors is not intended'or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , 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 (Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) 'a'JO-1 PLAN CHECKING FEE c`ski Lender's Name PERMIT ISSUING FEE PTA Lender's Address - I certify that I have read this application and state that the above TOTAL FEE /1 / 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-mentioned pr Prtfor ins urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APPLICANT OR AGENT I 91ATE it WORKERS' COMPENSATION DECLARATION zo-ooivDPW aia7 APPLICATION FOR ELECTRICAL PERMIT O 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 DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) Policyn4o.r Company FOR APPLICANT TO FILL IN JOB �/� �*�✓ El Certified Pcopy is hereby furnished. New Residential Bldgs. & Pools EACH NO, FEE ADDRES `fL6 ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY ���� �� tion department. Multi-family Sq. Ft. NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME ® CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLight MAIL COMPENSATION INSURANCE g �Sw.— ADDRESS i c✓??ee �W (This section need not be completed if the work involved by First 20 CITY ' Tel. No. Total No. Additional � 'Yt/ 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 s ''' Additional Date Applicant Ile&0 fy'Yl/t�L/M1070 Total No. CITY No. NOT IC 70 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. Hood — Fan —Other_ CITY Tel. No. OR LICENSED CONTRACTORS DECLARATION LICE Disp. — Room Air Cond. — 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. PROCE BY and Professions Code,and my license is in full force and effect. 0�( Size&Type HP, KW, KVA, or KVAR O License Number Lic. Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE t�J' VA ATION Cc Contractor Date Over 10 to 50 Incl. FINAL O ❑ I am exempt under Sec. Over 50 to 100 Inc. BY 0 B.&P.C. for this reason Over 100 d Services, 0 Am MCC& Panelboards , Date: 0-200 Amp. Under 600 V 6101,1_1� Signature 201 - 1000 Amp. Under 600 V z 0 3 6 5A ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. MainT. Elect. # o 0!0•o 0,2 SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION o -J &7 5 1 hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits o o:0 11 a7 5 v Professions Code): 1, as owner of the property, will do the work and the Misc. Conduits&Conductors 0 0 5:-8'8 structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , 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 laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the,above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of PeOnittee Date WORKERS' COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT �'n�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 t5 c$rtified 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 �j� 0,:,Z) ❑ Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST r7 Residential Swimming PoolsCROSS ST. Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec /�' g � AIL // _�Li ht Sw. 1p/ 3 / COMPENSATION INSURANCE ADDRESS This section need not be completed if the work involved b First 20 ( p Y Total No.— Additional CITY �pG��7-y Tel. No. the permit is for one hundred dollars ($100)or less.) PLAN CHECK 1 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 Date App Total No. Additional CITY T 1. n Fixed Appliances Not Over 1 HP PERMIT NOTIC TO PPLICANT: If, after making this Certificate of APPLICANT 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 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. PROCE and Professions Code,and my license is in full farce and effect. Power Apparatus& Large Appliances Size & Type HP, KW, KVA, or KVAR' V g 0 License Number Lic. Class Up to 1 Incl. FINAL / U Over 1 to 10 Incl. DATE (J/ `� VALIDATIO Ix Contractor Date Over 10 to 50 Incl. FI ❑ I am exempt under Sec. Over 50 to 100 Inc. BY eaa B.&P.C. for this reason Over 100 Services, Swbd., MCC & Panelboards Date: 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V7.7 4'9 ❑ Over 1000 Amp. or Over 600 V 0 0 3 2� = Exemption for Reg. Maint. Elect. o 0 o J z SINGLE FAMILY Temp. Power Pole &Appurtenances o 2 6'-8 7 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 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): F9Misc. Conduits & Conductors LyGy I, as owner of the property, will do the work and the 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 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 /P PERMIT ISSUING FEE U 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 County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permitteb Date I WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT LI I hereby an ffiFi thatM have a certificate of consent to self insure, 76A663 or a certificate 4 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.) Policy Nc:i Company FOR APPLICANT.TO FILL IN JOB ADDRESS 3 N Certified co is hereby furnished. NO. EACH FEE PY Y New Residential Bldgs.&Pools $ $ LOCALITY ❑ Certified co is filed with the count buildin Ins ection 1 &2-Family,Sq.Ft. PY Y 9 P — NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASESSOR SSOR PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWNER FIRM NAME COMPENSATION IN First 2. (This section need not be completed if the work involved by the MAIL permit is for one hundred dollars($100)or less.) Total No. Additional ADDRESS I certify that in the performance of the work for which this permit. CITY ` �• Tel.N-, (q =L(D is issued, I shall not employ any person in any manner so as t0 PLAN CHECK av become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP: provisions of the Labor Code, you must forthwith comply with such PERMIT p y Power Apparatus&Large Appliances APPLICANT IF 4e-Pprovisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR _ADDRESS S` I hefeby affirm that I am'licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY` lc Ter. Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR Class J Over 50 t0 100 Incl. REG.NUMBER d J License NumbOver 100 DISTRICT NO. PROCESSE Q er Lia Class h- ` U Services,Swbd.,MCC&Panelboards Contractor Date -- 0-399 Amp.Under 600 V FINAL � DATE ❑ 400-1000 Amp. Under 600 V ( Z--q VALIDATION V I am exempt under Sec. Over 1000 Amp.or Over 600 V SINAL LLI a B.&P.C.for this reason BRANCH CIRCUIT FEES By Date: 15A,or 20A, 120V,Lighting or Recept. Z_ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint. Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp. Power Pole&Appurtenances l� HOME OWNER-BUILDER DECLARATION _ I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit =30 -R for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits ITEM'S'Code): i i i Et i S. ❑ 1, as owner of the property,will do the work and the structure Misc.Conduits&Conductors CITAL 43 - 80 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). CHECK `i•_a )I.I gg��� s." CONSTRUCTION LENDING AGENCY s_TIE'3N!3E I 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.) 0 0:0 = 0101i;9 ?i't"' PLAN CHECKING FEE _ItS_ �a 's'3_. + Lender's Name / ).13'•,, {j AM u:OCCj ; PERMIT ISSUING FEE S Lender's Address 7 I certify that I have read this application and under penalty of purjury state TOTAL FEE J_$© that the 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-mentioned property for i ection purpose SEE REVERSE FOR EXPLANATORY LANGUAGE 1 SIGNATUR OFTTEE DATE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0610180033 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ' LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 6143 GOLDEN WEST AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801756 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LEMON 5385-020-007 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, C LB 200 AMP PANELS, MCC 1.00 PAN 38.85 TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 10/18/06 JK 04/16/07 OWNER: TEL. NO: FINAL DATE Y: CODE: STERLING, JANE (626) 446-1916- 6143 GOLDEN WEST AV _ TEMP 917801756 DESCRIPTIO - OR UPGRADE SERVICE PANEL TO 200 AMP APPLICANT: TEL. NO: CITY WIDE ELECTRIC (800) 565-3441- 211 N. VICTORY BLVD. SPECIAL CONDITIONS: BURBANK, CA 91502 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE CITY WIDE ELECTRIC (818) 333-1780- 211 N VICTORY BLVD LIC. NO TEMPORARY POWER POLE BURBANK CA 91502 873106 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