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Home My Public Portal About5624 HALLOWELL AVE_Electrical__ • ' \pIORKERS'COMPENSATION DECLARATION 76A663 DPW 9 87 APPLICATION FOR ELECTRICAL PERMIT O I ;'iereby 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.) Policy No. Company FOR APPLICANT TO FILL IN JOB �) ❑Cehified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS ❑Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST 'Residential Swimming PoolsCROSS ST. Dote Applicant OWNER OR V� r FIRM NAME CERTIFICATE OF EXEMPTION"FROM WORKERS' � , O MAIL Outlets: Rec Light Sw._ i 90 Z ��Qc etc l • COMPENSATION INSURANCE ADDRESS First 20 (This section need not be completed if the work involved by Total No. Additional CITY j�� /� �" Tel. No.�y� j 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 anyp rson in any anner so as to bec e ub•ect to the Workers'Com ens Laws. Lighting Fixtures First 20 ADDRESS Comp Additional Total No.� CITY Tel. No. Date Applicant a ' Fixed Appliances Not Over 1 HP PERMIT F NOTICE O PPLICANT: 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 fC 7-- with comply with 1 such provisions or this permit shall be Top — FAU W.H. — deemed revoked. CITY /�,/Lf Tel.Hood — Fan Other— No. LICENSED ��, — LICENSED CONTRACTORS DECLARATION LICENSE OR Q G I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. — REG. NUMBER( ar/©J Class.c_ZO (commencing with Section 7000)'of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY >_ and Professions Code,and my license is in full force and'effect, 11 Size &Type HP, KW, KVA, or KVAR G� 00 License Number yG Lic. Class Up to 1 Incl. FINAL Contractor C/ '��Date fl Over 1 to 10 Incl. DATE /;�7® VALIDATION El 10 to 50 Incl. FINAL' f I_I am exempt under Sec. Over 50 to 100 Inc. BY �, � - W 7� B.&P.C. for this reason Over 100 dU)Services, Swbd., MCC& Panelboards , Z C-., 0-200 Amp. Under 600 V — Signature 201 - 1000 Amp. Under 600 V i ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION 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 _ Professions Code): ❑ I, as owner of theproperty, will do the work and the Misc. Conduits& Conductors 3,-V_ Other See Complete Fee Schedule)— Business structure is not intended or offered for sale(Section 7044, ( P )— Business and Professions Code). , )0-TA.L 48 Lo 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) CHN AGE (Sec. 3097, Civ. C.). _ / PLAN CHECKING FEE bC 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 Fe the abo e-mentione property for inspection p SEE REVERSE FOR EXPLANATORYLANGUAGE ignatu ofPer 'ittee ©s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0501100001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 12392 LT: 19 BL: .001 5624 HALLOWELL AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ARCD CA 910078419 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LIVE OAK 8586-013-025 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B3 LOCALITY: TEMPLE CITY, C G1 OUTLETS-LGT,SW,RECP 8.00 OUT 15.60 TENANT: G2 LIGHTING FIXTURES 3.00 LGT 5.85 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 49.20 01/10/05 JK 07/09/05 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: NASSAR, CHARBEL (626) 447-9481- '/ l� 5624 HALLOWELL AV l C : ARCD 910078419 DESRIPTION OF WOR 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