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Home My Public Portal About11025 GREEN TREE LN_Electrical__ WORKERS' COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I herel7Y affirm that I have a certificate of consent to self CE-806G insure, or a certificate of Workers' Compensation Insurance, fNew COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.)Poli � Campany A—CX: )Cabnf`SFOR APPLICANT TO FILL IN JOB ADDRESSCertified copy is hereby furnished. Residential Bldgs. & Pools EACH NO. FEE 1 & 2-Famil S Ft. $ — $ LOCALITY C 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 Applicant FIRM NAME f� CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS �I This section need not be completed if the work involved b First 20 ( tiP 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 Total No. Additional CITY Tel. No.. Date Applicant Fixed Appliances Not Over I HP PERMIT n NOTICE TO APPLICANT: 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 . V i with comply with such provisions or this permit shall. be Top FAU —W.H. CITY k Tel. o. b deemed revoked. Hood _ Fan _Other_ 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. PROC SSED BY and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances I/ A � ��}}JI � Size &Type HP, KW, KVA, or KVAR' oC� O License Number�2u-/�C�( Lic. Class C —(� Up to 1 Incl. FINAL U D Over 1 to 10 Incl. ATE �'� _ VALIDATION Contractor��'1� t�.Z lur, Dat Over 10 to 50 Incl. FI L l� I am exempt under Sec. Over 50 to 100 Inc. BY � B.&P.C. for this reason Over 100 Date: Services, Swbd., MCC & Panelboards ► 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 ;2 2 3 4, 1 '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 # o a o o a 2 Professions Code): I, as owner of the property, will do the work and the Misc. Conduits&Conductors Vo 104,02 „ structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ o ° 1 0 U = 7044, Business and Professions Code). , 0 2 c) CONSTRUCTION LENDING AGENCY 062 7 -85 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 1 Lender's Address I certify that I have read this application and state that the TOTAL FEE Q 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 ab ve-mentioned perty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sign tur o ermittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT Y %EPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL.0508 9907070008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY. CA 91780 PHONE: (626)285-0488 '.EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 43111 LT: 6 11025 GREEN TREE LN FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803676 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET ALD IN 8573-031-057 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GR OCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 6.00 OUT 11.70- TENANT: 1.70TENANT: TOTAL FEES 39.45 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 07/07/99 UT 01/03/00 OWNER: TEL. NO: FINAL DATE FINAL BY: , .. ODE: MINGHETTINO GERALD (818) 401-3629- 11025 01-3629 11025 GREEN TREE LN TEMP 917803676 DESCRIPTION OF WORK INSTALL 6 GFIC OUTLETS - HOUSING R HAB APPLICANT: TEL. NO: CONTRACTORS DISCOUNT GLASS & REMOD. (626) 852-1473- 620 W. ALOSTA AVE. SPECIAL CONDITIONS: GLENDORA, CA % LEIS ,CONTRACTOR: .CONTRACTOR: TEL. NO: o�GiV APPROVALS DATE INSPECTOR SIGNATURE CONTRACTORS DISCOUNT GLASS AND MIRR (818) 963-0390- G �� 730 E. BENNETT LIC. NO TEMPORARY POWER POLE GLENDORA, CA 91741 645403 * / r UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. N0: - �'�, '� �� UFER GROUND LIC. NC. 1( L1111111 �, ROUGH CONDUIT ROUGH WIRING J MAIN WATER.LINE. PLASTIC Y/N .METAL Y/N - - - -- UTILITY COMPANY NOTIFIED ;1 Vert t* *.ADDITIONAL DATA ON FILE REPORT ID: DPR265 ROUTE TO: BS0508