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Home My Public Portal About6241 GOLDEN WEST AVE_Electrical__ WORKERS' COMPENSATION DECLARATION 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that; CE-806 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, Lob. C.) Policy No /&4 -9 Company d FOR APPLICANT TO FILL IN JOB �� Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS ' Certified 1 & 2-Family, copy is filed with the coup y building inspec- , Sq. Ft. $ _ $ LOCALITY t NEAREST tion part ent. Multi-family Sq. Ft. CROSS ST. /0 1.1/ o (ap L Residential Swimming Pools OWNER OR Date I A licant Applicant. FIRM NAME CERTIFICATE OF EXEMPT FROM ERS' Outlets: Rec Light Sw., MAIL COMPENSATIO INSURANCE ADDRESS 6Lt.f fCFJ� This section need not be completed First 20 ( pleted if the work involved b Y Total No. Additional CITY q Tel. No. I' lp l.J the permit is for one hundred dollars ($100)or less.) that in the performance of the work for which this PLAN CHECK I certify P 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 Total No. Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT pz-L e 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. PROCES Dom_ and Professions Code, and my license is in full force and effect. Power Apparatus & Large Appliances Size &Type HP, KW, KVA, or KVAR- (�) License Number Lic. Class Up to 1 Incl. FINAL f _2% � /s Over 1 to 10 Incl. DATE G/ (/CJ Contractor Date ^ VALID ION El Over 10 to 50 Incl. FINAL W I am exempt under Sec. Over 50 to 100 Inc. BY , d' B.&P.C. for this reason Over 100 Cn Z Date: Services, Swbd., MCC & Panelboards ► 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ID Exemption 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit o 3 8 1.0 A 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 # 0 0 0 o o 2 Professions Code): o - 2S5 I, as owner of the property, will do the work and the Misc. Conduits&Conductors A 0 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 7044, Business and Professions Code). r o o o25,5 0 v CONSTRUCTION LENDING AGENCY 1, 1 3"H 6 I hereby affirm that there is a construction lending agency for Q 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 A,:5 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 gordinanced State laws regulating Electrical wiring, and ize representatives of this County to enter upon oned property for inspectio pure ses. SEE REVERSE FOR EXPLANATORY LANGUAGE er ittee ate . ORKERS' COMPENSATION DECLARATION CE 8066 10i81 APPLICATION FOR ELECTRICAL PERMIT ffirm jhytt I have a,certificate of consent to self insur�, a-ceriificote of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY oi`aa certified copy thereof (Sec. 3800, Lab. C.) Policy No.CC426721 7Company United Pacific FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 6241 Golden West �( 1 & 2-Family, s Ft. 1292.2 922 $ — $ 76.88 LOCALITY Temple City ®i Certified copy is filed with the county building inspec- Y- q — tion department. _ Multi-family Sq. Ft. NEAREST CROSS ST. Residential Swimming Pools OWNER OR Date 4/1/86 Applicant FIRM NAME Youn son Const. CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw.— MAIL COMPENSATION INSURANCE First 20 ADDRESS 885 San Vicente Road (This section need not be completed if the work involved by Total No. Additional CITY Ai Cadia Tel. No. 446_9139 the permit is for one hundred dollars($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the WorkersCompensation Laws. Lighting Fixtures First 20 ADDRESS TAdditional Total No. CITY Tel. No. DateApplicant Fixed Appliances Not Over'l HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT Cobine Electric CO Inc. Exemption, you should become subject to the Workers' Range_ Heater—D.W. — Compensation provisions of the Labor Code, you must forth- Oven _ Dryer _ W.M.— ADDRESS 1607 Chestnut St. with comply with such provisions or this permit shall be Top FAU —W.H. — deemed revoked. Hood Fan _Other_ CITY Alhambra Tel. No. 282-0315 LICENSED CONTRACTORS DECLARATION LICENSE OR 1 hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. — REG. NUMBER 229847 class.C 10 (commencing with Section 7000) of Division 3 of the Business .DISTRICT NOPROCESSED B Power Apparatus & Large Appliances r and Professions Code, and my license is in full force and effect � �i Size &Type HP, KW, KVA, or KVAR' �" O 229847 C10 U License Num _ Lic. Class Up to 1 Incl. FINAL � 11/30/87 . Over 1 to 10 Incl. DATES/�.�� VALIDATION Contracto Date Over 10 to 50 Incl. `�� FINAL 0– El ❑ I am exempt under Sec. Over 50 to 100 Inc. BY Over 100 B.&P.C. for this reason t» Services, Swbd., MCC& Ponelboards Date: 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. MainT. Elect. SINGLE FAMILY Temp. Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit #. Q I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits o O Law for the following reason (Section 7031.5, Business and o ],3$ Professions Code): 0 0 6 ❑ I, as owner of the property, will do the work and the Misc. Conduits & Conductors c 2 1 oz-86 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) 10.50 (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address 87.38 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 ove-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 2/7/86 Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0902110024 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: I FEES PAID BUILDING ADDRESS: ON FILE 6241 GOLDEN WEST AV 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917801705 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I 15385-021-012 1A1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, Cl (G1 OUTLETS-LGT,SW,RECP 40.00 OUT 66.00 ITENANT: JG2 LIGHTING FIXTURES 15.00 LGT 29.25 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: JHA FAU LESS 3HP 1.00 FAU 10.95 102/11/09 SR 08/10/09 IH2 RES GRBG DISP LT 3HP 1.00 DIS 10.95 J JOWNER: TEL. NO: IH3 RES DISHWASHR LT 3HP 1.00 DIS 10.95 1FINAL DATE F NAL BY: CODE: J ICHEN, CHIN (626) 235-2233- IH4 RES RANGE HDS LT 3HP 1.00 HOO 10.95 1 16241 GOLDEN WEST AV IH5 RES WASH MACH LT 3HP 1.00 WAS 10.95 I �� ITEMP 917801705 IH7 RES EXHAUST FANS 1.00 EX 10.95 I ESCRIPTION OF WORK 1 IJB AC UNITS +3-10HP 1.00 AC 19.65 JELECTRICAL FOR REMODEL TOTAL FEES 208.35 (APPLICANT: TEL. NO: 1 ILIM (213) 210-3979- 17250 BANDINI BLVD. ISPECIAL CONDITIONS: ILOS ANGELES CA 90040 1 ICONTRACTOR: TEL. NO: 1 JAPPROVALS DATE INSPECTOR SIGNATURE J ISOUTHERN CALIFORNIA CONSTRUCTION (714) 220-7460- 1 1 18611 E. ROLAND ST. LIC. NO 1 ITEMPORARY POWER POLE I IBUENA PARK, CA 90621 862893 B 1 1 I I 1UNDERGROUND CONDUIT I 1ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND I IJ C ENGINEERING (213) 210-3979- 1 1 12155 VERDUGO BLVD #124 LIC. NO: I IROUGH CONDUIT IMONTROSE, CA 91020 40597 I 1 J IROUGH WIRING IMAIN WATER LINE 1 IPLASTIC Y/N METAL Y/N 1 1 J (UTILITY COMPANY NOTIFIEDI I I I II 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 IREPORT ID: DPR265 ROUTE TO: DS0508 I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT _ DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0812090001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID BUILDING ADDRESS: 1 ON FILE 6241 GOLDEN WEST AV IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917801705 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1 15385-021-012 1A1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, Cl I IE1 TEMP SERV POWER POLE 1.00 TMP 43.65 1 1 (TENANT: I TOTAL FEES 71.40 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 112/09/08 SR 06/07/09 (OWNER: TEL. NO: 1 1FINAL DATE FINAL BY: CODE: 1 ICHEN, CHI-TING _ 1 16241 GOLDEN WEST AV 1 �\ ITEMP 917801705 1 IDES RI O OF WORK �/ I ITEMPORARY POWER POLE (APPLICANT: TEL. NO: 1 11LIOI (714) 220-7460- 1 12505 W. OAK AVE. I (SPECIAL CONDITIONS: IFULLERTON, CA 92833 1 1 11 ICONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE ISOUTHERN CALIFORNIA CONSTRUCTION (714) 220-7460- 1 18611 ROLAND ST #C LIC. NO ITEMPORARY POWER POLE I IBUENA PARK, CA 90621 862893 B I II I (UNDERGROUND CONDUIT 1 ARCHITECT OR ENGINEER: TEL. NO: JUFER GROUND 4 ,11 LIC. NO: IROUGH CONDUIT!/ q f 1 1 IROUGH-WIRING I I I IMAIN WATER LINE 1 IPLASTIC Y/N METAL Y/N I I I UTILITY COMPANY NOTIFIE �, 1 1 1 I I I I I 1 I1 0(,y f� I `tj ec os.t h`6` o 1 I I I I I 1 I I I I I I I I I I I I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508