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Home My Public Portal About6012 HART AVE_Electrical__ K;at I COMPENSATION DECLARATION 76-663 to/si APP C nMON FOR I�p 2� TMICA 'PI�RI��I�Tj rm that I have a'certificate'of consent.to•*elf insure, CE-806G L4 �M(L�u II�J fill I�L�Lr—l� Il L� LS u�u II rfificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS.ANGELES BUILDING AND SAFETY tl-reof(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 ❑ CertifiLOCALITY$ed — o ` - copy'is-,filed with the county building .inspection 1 & 2-Family,Sq.Ft. $ - ��✓�� NEAREST department Multi-family Sq.Ft. CROSS,ST: Residential Swimming,Pools - - OWNER OR � ` Date Applicant -q Light Sw. .+' FIRM,NAME '" f��. ,,,-,. �,� 4- •ev Z Outlets:Rec CERTIFICATE OF EXEMPTION FROM WORKERS' 4Z MAIL L y V COMPENSATION INSURANCE 1, ADDRESS (This section need not be completed if the work involved.by the First 20•. permit is for one hundred dollars($100)or less.) Total No. 7-�' Additional ~sJ CITY j Tel.No. :{ I certify that in the performance of-the work for.which this-permit . PLAN CHECK101, APPLICANT 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 •G' Z o ♦' /l 2 Additional Date / APPlicant ` Total No. CITY "teC Tel.No. ' NOTICE TO, APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP. - , Exemption,you should become subject to the Workers'Compensation Range_ Heater_ .DW. APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M.— ADDRESS f� S>, provisions or this permit shall':be deemed revokedi Top — FAU W.H. LICENSED CONTRACTORS DECLARATION_ CITY Hood Fan Other �z Tel.No.4� Z I hereby affirm that I am licensed under.provisions of Chapter 9 LICENSE Disp. -- Room Air Cond.. d!�%J Class./6 (commencing with Section 7000) of bivislon 3 of the Business and REG.NUMBEROR Professions Code,and'my license is in full force and effect. Power A DISTRICTX. PROCESSED BY pparatus& Large Appliances ` a �y Size& Type HP,KW,KVA;or KVAR �! �- License Number Class Class �- ` �� ,�� Up to 1 Incl., FINAL Over 1 to 10 Incl. J G Contractor td� to DATE D VALIDATION ❑ Over 10 to 50 Incl. F- FINAL I am exempt under Sec. Over 50 to 100 Inc. BY, W Over 100 B.&P.C.for this reason Cn Services,Swbd.,MCC&Panelboards Date: 0-200 Amp.Under 600 V OC —3 201•- 1000 Amp.Under'600 V Over 1000 Amp.or Over 600 V El Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit, • I hereby affirm that I am exempt from the:Contractor's License Law ACCT 04 for the following reason (Section'703 1.5,Business and Professions Additional Sign Branch Circuits Code):, 3307 Misc.Conduits 4-Conductors y !9.50 050 I,as owner of the property,will do the work and the•structure.' d� is not,intended or offered for sale (Section 7044,Business Other(See Complete Fee Schedule),_ 4�I�rp� and Professions Code). ., _.... . _.._.TOM i i,� 79 o 50 CONSTRUCTION LENDING AGENCY CMCK 79o5 . 1 hereby affirm that there is•a construction lending agency for the I�I�Iph� rtT performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) _ . GP S, .0 Civ. C.). , • PLAN CHECKING FEE d �' �� Lender's Name d PERMIT.ISSUING FEE �0- O Lender's Address -�i 4374 1 O 9931 f certify that I have read this application and state that the above TOTAL FEE CJ 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 proper�t for inspeectiioonIppurposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ' Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 10181 CE-806 APPUC�Q�00Hf FOR ELECT TMICAd Mmrr 1 �( ,.by affirm that I have a certificate of consent to self CE-806G sure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY a certified copy thereof (Sec. 3800, Lab. C.) Policy No.//0` 7r1Company 6t-?A-( FOR APPLICANT TO FILL IN JOB ADDRESS 3 'V Certified'copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ❑ — Certified copy is filed with the county building inspec- 1 8 2-Family„ $ $ LOCALITY CSq. Ft. L� , tion department. Multi-family Sq. Ft. — 'NEAREST Date 2--.2!2t&Y Applicant Z; Residential Swimming Pools OWNER OR g-2 FIRM NAME lJ I Lk-$TB CERTIFICATE OF EXEMPTION FROM WORKERS' '1— MAIL Outlets: Rec Light Sw. ADDRESS COMPENSATION INSURANCE y t N1J This section need not be completed if the work involved b First 20 ( p y Total No. Additional CIT Tel. No.��l Y� the permit is for one hundred dollars($100)or less.) I certifythat in the pe of the work for which this PLAN CHECK 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 TAdditional Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over l HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT70A U 00 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 1,06 2 N. ! Q u a-•- with comply with such provisions or this permit shall be Top FAU . —W.H. — CITY Tel, No 67 ,V deemed revoked. Hood _ Fan _Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR qy/,g8 p I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER �v. Class. (commencing with Section 7000) of Division 3 of the BusinessDISTRICT NO. PROCESSED BY and Professions Code, and my license is in full force and effect. Power Apparatus& Large Appliances �_- Size &Type HP, KW, KVA, or KVARO License Number Lic. Class ' Up to 1 Incl. 7' "6 FINAL i� r Over 1 to 10 Incl. DATE VALIDATION 0 Contractor Date❑ Over 10 to 50 Incl. FINALr� v I am exempt under Sec. Over 50 to 100 Inc. BY �.`V 0. B.&P.C. for this reason Over 100 Services, Swbd., MCC & Panelboards D la f Date: 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V w ❑ 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 �5_9 3 3 8 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.o o 0 0,2 , Professions Code): i , . - ❑ 1, as owner of the property,.will do the work and the Misc. Conduits&Conductors ,2 0 o 1 9,.2 5 structure is not intended or offered for sole '(Section Other (See Complete Fee Schedule)_ 7044, Business and Professions Code). D oto o 9,2'5'H CONSTRUCTION LENDING AGENCY o302-84 I hereby affirm that there is a construction lending agency for p 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 g ature of Per ittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0712140014 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID BUILDING ADDRESS:: 1 ITR: 5904-' LT: 340 I 6012 HART AV IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917801914 I (ASSESSOR INFORMATION NUMBER: I I NEAREST-'CROSS STREET: 1 15384-014-009 IA1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl I 1G1 OUTLETS-LGT,SW,RECP 2.00 OUT 3.90 I I (TENANT: 1G2 LIGHTING FIXTURES 1.00 LGT 1.95 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1 I TOTAL FEES 33.60 112/14/07 SR 06/11/08 1OWNER: TEL. NO: I IFINAL DATE FINAL BY: CODE: 1 ILOEW WILLIAM;DEBORAH K;HEINZ (626) 286-1417- 16012 HART AV ITEMP 917801914 1 (DESCRIPTION OF WORK I I 1 12 OUTLETS AND 1 LIGHT FIXTUA FOR BATHROOM REMODEL I I I I I (APPLICANT: TEL. NO: I I I IHOME SWEET HOME IMPROVEMENT (800) 994-9798- 114925 94-9798 114925 MAGNOLIA BLVD I ISPECIAL CONDITIONS: I ISHERMAN OAKS 91403 1 I I I I I I ICONTRACTOR: TEL. NO: I j.� - (APPROVALS DATE INSPECTOR SIGNATURE I IHOME SWEET HOME IMPROVEMENT (800) 994-9798- I I I 114925 MAGNOLIA BLVD. LIC. NO I ITEMPORARY POWER POLE I I ISHERMAN OAKS, CA 91403 742384 B I I I I I I (UNDERGROUND CONDUIT I I (ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND I I 1 LIC. NO: I IROUGH CONDUIT I I IROUGH WIRING I 'I I I I I I I I 1 IMAIN WATER LINE I I I IPLASTIC YIN METAL YIN I I I I I I I I I I (UTILITY COMPANY NOTIFIED( 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 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 I I I I I I 1 IREPORT ID: DPR265 ROUTE TO: BS0508 1 1 I I