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Home My Public Portal About6109 HART AVE_Electrical__ • WORKERS' COMPENSATION DECLARATION 2o-ooieDPW 3ie7 n ��n ��0� FOR �� ,�,�,�,�� L,hereby affirm that I,.have a certificate of consent to self .GE806 (^� �L Fr' ire, pr a-certificate of Wdrkers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS v certified copy thereof (Sec. 3800, Lob. CC..) Policy No. Company -��'f%i� /�✓� FOR APPLICANT TO FILL IN SOB ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH _,NO,1 FEADDRESS 45/0 f� copy y g . p y q r LOCALITY Certified co is filed with the count building inspec- 1 &2-Family, S Ft. ` ' D $ �� ❑ $ �% _ +F'�� 6_17-t ISI tion department. Multi-family Sq. Ft. NEAREST J �,+ �� Residential Swimming Pools CROSS ST. Date• Applicant OWNER OR .,.- FIRM NAME /,yam/( CE IFICATE OF EXEMPTION FOM WORKERS' Outlets: Rec Light Sw._ MAIL `� COMPENSATION INSURANCE ADDRESS V L7 G�// / )A"'°='�J�✓(�/ �L6 (This section need not be completed if the work involved by First 20 'CITY the permit is for one hundred dollars($100)or less.) Total No. Additional /jl( Y� � Tel. No./-7/ 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 Additional Date Date Applicant Total.No. CITY Tel. No. NOTICE TO 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. CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood Fan —Other— Dis Room Air Cond. — LICENSE OR I hereby off irm that I am licensed under provisions of Chapter 9 p� REG. NUMBER(commencing with with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. R.50CESSED BY >_ and Professions Code,and my license is in full force and effect. �� J a- �, Size &Type HP, KW, KVA, or KVAR Q License Number Lic. Classes U �e,� Up to 1 Incl. FINAL C� cc Contractor&u/%►�- * �1 '' Dtt; 17-1,711 J Over 1 to 10 Incl. DATE l Z VALIDATION 0 Over 10 to 50 Incl. FINAL ( F- ❑ I am exempt under Sec. Over 50 to 100 Inc. gY U W B.&P.C. for this reason Over 100 11 D U fe Services, Swbd., MCC& Ponelboards Z W 0-200 Amp. Under 600 V — Signature '`n 201 - 1000 Amp. Under 600 V EJ Over 1000 Amp. or Over 600 V Exemption for Reg. aint. Elect. SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole &Appurtenances 1 hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit .:(, s Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits _. Professions Code): Ell,'as owner of the property, will do the work.and the Misc. Conduits 8 Conductors structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ D T I; L t_l Business and Professions Code). - m Oct CONSTRUCTION LENDING AGENCY I hereby affirm that there is a.construction lending agency for `A the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) CHHNi"h E (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's AddressTOTAL FEE /�' 0.0 3 AM I certify that I have read this application and state 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 t above-m ntioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si natur of Permittee ate Os COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1011030025 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: - - LEGAL ID: I FEES PAID BUILDING ADDRESS: 1 ITR: 5904 LT: 221 1 1 6109 HART AV I I _1.FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: 1 TEMP CA 917801629 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: GARIBALDI - 5384-008-023 IS3 ADDTNL ELECT PLAN CK 1.00 HOU 109.40 I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl Al PERMIT ISSUANCE FEE 27.80 1 (TENANT: IJX MOTORS, LT 3 HP 1.00 MOT 15.40 (ISSUED ON: PROCESSED BY: PLAN BY: 1 TOTAL FEES 152.60 111/24/10 SR (OWNER: TEL. NO: 1 IFINAL DATE FI/NAL/ d CODE: I IMARSRON, LARRY (626) 276-8000— 16109 HART AV I. O w/ ITEMP 917801629 - I 1 CRIPTION OF WORK .1 I I IROOF MOUNT PV SOLAR 20 PANELS 1 INVERTER I (APPLICANT: TEL, NO: 1 I IPERKINS, SHAWN (951) 532-2394— I 11452 POMONA RD. 1 ISPECIAL CONDITIONS: ICORONA, CA 92882 1 1 I. I I I ICONTRACTOR: TEL. NO: 1 - 1APPROVALS DATE INSPECTOR SIGNATURE 1MOHRPOWER SOLAR INC. (951) 736-2000— I I I 11452 POMONA ROAD LIC. NO 1 ITEMPORARY POWER POLE ICORONA, CA 92882 _ 661434C46 1 I I (UNDERGROUND CONDUIT 1ARCHITECT OR ENGINEER: TEL. NO: 1 - IUFER GROUND 1 LIC. NO: 1 IROUGH CONDUIT I I I TROUGH WIRING "v IMAIN WATER. LINE (PLASTIC YIN METAL Y/N I I )UTILITY COMPANY NOTIFIEDI I 1 I I I I I I I I I I I I I I I I I 1 I I I 1 I I IREPORT ID: DPR265 ROUTE TO: BS0508 I I 1 I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 - ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1011150035 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 5904 LT: 221 1 6109 HART AV I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917801629 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1 15384-008-023 1A1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl I JHA FAU LESS 3HP 1.00 FAU 10.90 1 1 ITENANT: JJB AC UNITS +3-10?P 1.00 AC 19.70 JISSUED ON: PROCESSED BY: PLAN BY: I TOTAL FEES 58.40 111/15/10 SR 1 I I I I TOWNER: TEL. NO: IFINAL DATE FIN CODE: IMAASON, LARRY (626) 483-7719- I 1 J 16109 HART AV I I/� _( ITEMP 917801629 1 I ESCRI TTON OF WORK 1 1 11NSTALL ELECTRICAL FROM (E) SUB-PANEL TO (1) NEW ALL CONDENSI TOR AND RECONNECT TO (E) ELECTRTAL FOR CONDENSOR CHANGE OUT I 1APPLICANT: TEL. NO: 1 1ADD (1) NEW FAU CIRCUIT UPSTAIRS ATTIC T CONTRERAS, CARRA (626) 286-3157- 1 14931 N. ENCINITA AVE T ISPECIAL CONDITIONS: I ITEMPLE CITY CA 91780 1 I I I I ICONTRACTOR: _EL. NO I 1APPROVALS DATE INSPECTOR SIGNATURE JCONNOR AIR CONDITIONING - (626) 286-3157- 14931 ENCINITA AVE LIC. NO ITEMPORARY POWER POLE I I 1 (TEMPLE CITY, CA 91780 - 403735 C2O I 1 11 T I TUNDERGROUND CONDUIT I I 1 I I I I I I JARCHITECT OR ENGINEER: TEL. NO: T IUFER GROUND I I I I I 1 1 1 LIC. NO: I (ROUGH CONDUIT I I I I I I I I 1 1 (ROUGH WIRING I I T I I I I I I I I JMAIN WATER LINE 1 1 1 1 1 IPLASTIC Y/N METAL Y/N I 1 1 I I I I I I 1 1UTILITY COMPANY NOTIFIEDI 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 (REPORT ID: DPR265 ROUTE TO: BS0508 I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS - 9701 LAS TUNAS EL 0508 1011100038 BUILDING AND SAFETY/ LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I ITR: 5904 LT: 221 I I 6109 HART AV I I.FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917801629 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: GARIBALDI I 15384-008-023 IA1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl I ILB 200 AMP PANELS, MCC 1.00 PAN 38.80 1 1 (TENANT: I TOTAL FEES 66.60 (ISSUED ON: PROCESSED BY: PLAN BY: I 111/15/10 SR (OWNER: TEL. NO: I (FINAL ATE FI L BY: CODE: IMARSTON, LARRY (626) 276-8000- I I . 1 16109 HART AV I I "' - I ITEMP 917801629 ( I AAvscRiFTibN OF WORK I I. (UPGRADE ELEC PANEL FROM 100 AMP TO 200 AMP I I i I (APPLICANT: TEL. NO: I I I IDIRECT ELECTRIC CO. (951) 965-1014- 142103 -RIO NEDO #107 I ISPECIAL CONDITIONS: ITEMECULA, CA 92590 I I I I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IDIRECT ELECTRIC COMPANY (951) 965-1014- I 1 I 142103 RIO NEDO #107 LIC. NO ITEMPORARY POWER POLE I I ITEMECULA, CA 92590 872782 C10 I 1 I I (UNDERGROUND CONDUIT I I I I (ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND 1 1 1 LIC. NO: I IROUGH CONDUIT I 1 I IROUGH WIRING I I I I IMAIN WATER LINE I IPLASTIC YIN METAL YIN - I (UTILITY COMPANY NOTIFIED( 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 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 IREPORT ID: DPR265 ROUTE TO: BS0508f,.I.: I I I I I I