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HomeMy Public PortalAbout8830 HERMOSA DR_Electrical__ WORKERS' COMPENSATION DECLARATION CE-806 lO,BI APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I 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, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ` _ Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS Certified copy is filed with the county building inspeo 1 8 2-Family, Sq. Ft.— $ — $ LOCALIT d� tion department. Multi-family Sq. FL 'NEAREST CROSS ST. .� ` A Date Applicant Residential Swimming Pools G OWNER % FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec LightSw. I MAIL i S COMPENSATION INSURANCE I ADDRESS (This section need not be completed if the work involved by First 20 Total No. Tel. the permit is for one hundred dollars ($100)or less.) Additional CITY c ..�� I certify that in the performance of the work for which this PLAN CHECK / permit is issued, I shall not employ any person in any manner APPLICANT so as to become subject to theWork f'npe tion L ws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel. No. Date�_Applican Fixed Appliances Not Over 1 HE PERMIT NOTICE TO APPLICANT: If, after making Itis Certificate of APPLICANT Exemption, you should become subject to the Workers' Range_ Heater_D.W. — �G�� 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 CITY Tel. LICENSED CONTRACTORS DECLARATION L Other— Room Air Card. LICENSE OR 1 hereby affirm that I am licensed under provisions of Chapter 9 p' REG. NUMBER Class�T�f (commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESSED BY Y and Professions Code, and my license is in full force and effect. / Size 8 Type HP, KW, KVA, or KVAR' 1 O License Number.� .� �� Lic. Class / U �„ Up to 1 Incl. FINAL -T Contract;4y ter f/�/ Date Over 1 to 10 Incl. DATE ir„'fG p VALIDATION 0 ❑ Over 10 to 50 Ind:. c.� V./ F FINAL am exempt under Sec Over 50 to 100 Inc. BY rVu B.BP.C. for this reason Over 100 Date Services, Swbd., MCC 8 Panelboards Q� ► `-y'O - ? 0 -200 Amp. Under 600 V I Signature 201 - 1000 Amp. Under 600 V F-1Exemption 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 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 Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended ar offered for sale (Section Other (See Complete Fee Schedule)_ , 7044, Business and Professions Code). =5 0 5'5'A CONSTRUCTION LENDING AGENCY a o2 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) Q o 0 3 � �5 (Sec. 3097, Civ, C.). PLAN CHECKING FEE Lender's Name o 0 0 51.253 PERMIT ISSUING FEE © 0 9.0 8—8 3 Lender's Address 1 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 lows r Jim g Electrical wiring, and . here thorize represe e this County ro enter upon the a-menti p ty insp ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE jV Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY N 0506 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1104280007 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 3623 LT: 109 8830 HERMOSA DR I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: I TEMP CA 917801815 ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET: ROSEMEAD 15387-010-022 1A1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl G1 OUTLETS-LGT,SW,RECP 15.00 OUT 29.10 (TENANT: 1G2 LIGHTING FIXTURES 10.00 LGT 19.40 (ISSUED ON: PROCESSED BY: PLAN BY: TOTAL FEES 76.30 104/28/11 SR OWNER: TEL. NO: IFINAL D E FINAL BY: CODE: IWONG, RAYMOND (626) 383-6131- n'1 18832 HERMOSA DR ITEMP 917801815 1 ID SCRI ION OF WORK 1 (REWIRE EXISTING HOUSE 1APPLICANT: TEL. NO: LOUIE, ANNIE H (626) 623-0233- 15554 TEMPLE CITY BL. (SPECIAL CONDITIONS: ITEMPLE CITY CA 91780 I 1 CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATDRE 1ESCOTO CONSTRUCTION CORP. (626) 278-5808- I IPO BOX 2267 LIC. NO (TEMPORARY POWER POLE IBELL GARDENS, CA 90202 844444 I IUNDERGROUND CONDUIT I ARCHITECT OR ENGINEER: TEL, NO: IUFER GROUND I LIC. NO: I IROUGH CONDUIT I I I IROUG4 WIRING (MAIN WATER LINE PLASTIC Y/N METAL Y/N I �JUTILITY COMPANY NOTIFIED I I I III I I � I I I 1 III II 1 III III II I I I I I I I I I I I I III I I I II III II I I II II I I I I I I I I I I I I I I I I IREPORT ID: DPR265 ROUTE T0: 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 1103150019 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 3623 LT: 109 0830 HERMOSA DR I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917801815 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET: ROSEMEAD 15387-010-022 1A1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl I IF1 120V, 15/20A BR CKTS 5.00 BR 86.60 1 1 TENANT: IF2 208, 277V LOT BR CRT 1.00 BR 27.30 JISSUED ON: PROCESSED BY: PLAN BY: 1 I G1 OUTLETS-LGT,SW,RECP 10.00 OUT 19.40 03/15/11 SR 1 102 LIGHTING FIXTURES 6.00 LOT 11.60 IOWNER: TEL, NO: HA FAN LESS 3HP 1.00 PAU 10.90 E FINAI B CODE: WONG, RAYMOND (626) 383-6131- H1 RES ELEC OVEN LT 3HP 1.00 OVE 10.90 18832 HERMOSA DR IH2 RES GREG DISP LT 3HP 1.00 DIS 10.90 ` ITEMP 917801815 IH3 RES DISHWASHR LT 3HP 1.00 DIS 10.90 ID CRIPTION OF WORK IH4 RES RANGE HOS IT 3HP 1.00 ROO 10.90 (ELECTRICAL FOR NEW ADDITION, KITCHEN REMODEL, HVAC SYSTEM IHS RES WASH MACH IT 3HP 1.00 WAS 10.90 AND UPGRADE SERVICE PANEL TO 200 AMP APPLICANT: TEL. NO: IH9 RES APPL LT 3HP 1.00 RES 10.90 I ILOUIE, ANNIE H (626) 623-0233- JS AC UNITS 13-1OHP 1.00 AC 19.70 I 15554 TEMPLE CITY BE. ILB 200 AMP PANELS, MCC 1.00 PAN 38.80 (SPECIAL CONDITIONS: TEMPLE CITY CA 91760 TOTAL FEES 307.50 I ICONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE IES COTO CONSTRUCTION CORP. (626) 278-5808- PO BOX 2267 LIC. NO ITEMPORARY POWER POLE BELL GARDENS, CA 90202 844444 1 I (UNDERGROUND CONDUIT I I I (ARCHITECT OR ENGINEER: TEL, NO: IUFEA GROUND LIC. NO: IROUGH CONDUIT II I I I (ROUGH WIRING • MAIN WATER LINE (PLASTIC YIN METAL YIN I I I h�I I UTILITY COMPANY NOTIFIED zoll� 1 II II II 1 �1 1 I I I III I I I I II 1 1 I 1 1 1 I 111 I II I (III I I I II I II I I I 1REPOAT ID: OPR265 RCUTE T0: BS 0508