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Home My Public Portal About9011 HERMOSA DR_Electrical__ WORKERS'COMPENSATIONDECLARA7[ON GA6 CE E8636G (2 80) APPLICATION FOR ELECTRICAL PERMIT - 1 hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELE LDING AND SAFETY _ insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.CJ FOR APPLICANT TO FILL IN SOB Policy No. Company AD ESS New Residential Bldgs. &Pools' EACH N FEE Certified copy is hereby furnished. $ — $ LOCALITY c 1 & 2-Family,Sq. Ft. ❑ Multi-family Sq. Ft. NEAREST Certified copy is filed with the county building inspection CROSS ST department. Residential Swimming Pools OWNER OR FIRM NAME JEU( y FueppG� r* Date Applicant Outlets: Rec._Light_ Sw._ MAIL First 20 ADDRESS 0 it CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY /� '(_ Tel No. COMPENSATION INSURANCE a PLAN CHE (This section need'not be completed if the work involved APPLICANT O by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS U Total No. Additional cc I certify that in the performance of the work for which this CITY Tel No. 0 permit is issued, 1 shall not employ an person in an manner Fixed Appliances Not Over 1 HP P D Y Y p Y PERMIT r () so as to become subject to the Workers' Compensation Laws. Range_ Heater—D.W. _ APPLICANT ( p W Oven _ Dryer—W.M.` ADDRESS Q� ' ' rA Dat Applicant Top — FAU _W.H. _ �/ Z Hood — Fan —Other— CITYi Q Tel No. /y'� NOTICE TO APPLICANT: if, after making this Certificate of Disp. _ Room Air Cond.— Exemption, you should become subject to the Workers' REG. NUMBER Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. P SSED BY with comply with such provisions or this permit shall be ' Size&Type HP, KW, KVA,or KVAR deemed revoked. 1✓ Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE VALID ION LICENSED CONTRACTORS DECLARATION � Over 10 to 50 Incl. r I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL \ p BY @/t 9 (commencing with Section d my is Division 3 ll the Busi- and Ovp� O V �-•�—� ness and Professions Code, and my license is in full force and effect. t Services License Number Lic.Class 0-200 Amp. Under 600 V 201-1000 Amp. Under 600 V Contractor. Date Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): 1, as owner of the Misc.Conduits& Conductors "'YYY property, will do the work and the 3 2 9.9 a Other (See Complete Fee Schedule)— structure is not intended or offered for sale (Section 7044, Business and Professions Code). . - # 0 0 0 0 0 `Z CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency 2 0 0 1 9.50 for the performance of the work for which this permit is issued (Sec. 3097,Civ.C.). PERMIT FEE (Sub-Total) . 0 0 0 1 9,5 0 5 _ Lender's Name PLAN CHECKING FEE' (One-Fourth Permit Feel Lender's Address - 204-. 80 • PERMIT ISSUING FEE I certify that 1 have read this application and state that the TOTAL FEE 9 above information is correct.1 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 �. A / R10 Signature of Permittee Date Wm that I have a cNSATIOIJ DECLARATION CE-663 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, CE-8066 or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND.SAFETY - copy thereof(Sec.3800,Lab.C.) .�Q Policy Nof"15--ft Company � ' u`R� FOR APPLICANT TO FILL IN .SOB Certified copy is herebyfurnished. EACH NO. FEE ADDRESS G�1 - - S New Residential Bldgs.&Pools - ,I� Certified copy is filed with the count pection 7 & 2-Family,Sq.FL $ — $ LOCALITY :P1 department Multi-family Sq. Ft. NEAREST ,^+ Residential Swimming Pools '- CROSS ST Date % Applicant OWNER OR ^ FIRM NAME CERTIFICATE OF EXEMPTION.FROM ORKERS' � X� MAIL COMPENSATION INSURANCE Outlets:RecLight Sw / / ...- ApDRE55De (This section need not be completed if the work involved by the First 20 Ez E permit is for one hundred dollars($100)or less.) Total Nc.7.3 Additional CITY �' r Tel.No. I certify that in the performance of the work for which this permit PLAN CHECK 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 Additional Total No. CITY Tel:No. .. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If,. atter making this Certificate of Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. APPLICANT provisions of the Labor Code, you mus[ forthwith comply with such Oven _ Dryer _ W.M. ADDRESS provisions or this permit shall be deemed revoked. Top _ FAU _ WH.. / �-✓/ 'LICENSED CONTRACTORS DECLARATION Hood — Fan .� Other_ ? ,CITY p� I hereby affirm that'I-am licensed under provisions of Chapter 9 UCENSEOR DiSp. Room Air GOntl. REG.NUMBER Class. (commencing with Section 7000)of Division 3 of the Business and � �� xf Professions Code,and my license is in full force and effect. DISTRICT NO. SED BY Power Apparatus 8 Large Appliances n Size 8 Type HP,KW,KVA,or KVAR 0 License.Nu r G / Lic.Class �j Up to 1 Incl. FINAL I U Q r (' Over 1 to 10 Incl. DATE I Z�2 Q _4 VALIDATION 0 Co - Date Over 10 to 50 Incl v U ❑ FINAL am empt under Sea Over 50 to t001nc. BY ILLI BAP.C.for this reason Over 100 N DateServices,Swbd.,MCC &Panelboards , Z : 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. A1.:(;r s SINGLE FAMILY Temp.Power Pole&Appurtenances _'KI7 13.1b ei11 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit r F I hereby affirm that I am exempt from the Contractor's License Law }, j S CN''- for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits _ =- Code): I<<i RL -1-06- U_s Misc.Conduits & Conductors !jE l 1+-Iy Il5 I,as owner of the property,will do the work and the structure C "C'-�' is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ► e r•� ___ _. `0(c- �1 and Professions Code). CONSTRUCTION LENDING AGENCY " I hereby affirm that there is a construction lending agency for the performance of the work far which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) `7 civ.C.). 111 - �____H!� . PLAN CHECKING FEE - Lender's Name PERMIT ISSUING FEE Lenders Address I certify that I have read this application and state that the above TOTAL FEE b information is correct. I agree to comply with all County ordinances and State laws re ting Electric wiring, and hereby authorize representatives t s Counl enter upon the above-mentioned property for pe es. SEE REVERSE FOR EXPLANATORY LANGUAGE D Ignature o ittee Date - COUNTY OF LOS ANGELES TEMPLE CITY # 0508ELECTRICAL PERMIT, DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL<0508.9705050027-- BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAIDBUILDING-ADDRESS: TR: 5904 LT: 169 - C9011-HERMOSA7DR-' - FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801836 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 5384-016-019 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY C2 SPAS, HOT TUBS, OTHR 1.00 SPA, 54.45 TENANT: TOTAL FEES 82.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 05/15/97 TC 05/15/98 OWNER: - TEL. N0: FINAL DATE FINAL BY: /J _"PDE: REYNA JOSEPHINE M - - /! _ -�/ 9011 HERMOSA DR D / TEMP 917801836 DESCRIPTION OF WORK ELECTRICAL FOR PREFAB SPA APPLICANT: TEL. NW QUALITY 4 LESS (909) 595-7283- SPECIAL CONDITIONS: l CONTRACTOR: TEL. N0: ` APPROVALS DATE INSPECTOR SIGNATURE QUALITY 4 LESS (909) 595-7283- 20537 STARSHINE RD. LIC. NO _ �;.'� ' p TEMPORARY OL WALNUT, CA 91789 695475 B UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. N0: i ^ I ROUGH CONDUIT -�I(IL ROUGH WIRING i MAIN WATER LINE Win' �\ ✓ PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508