HomeMy Public PortalAbout9108 HERMOSA DR_Electrical__ WORKERS'COMPENSATION DECtARATION 76AB63 10/81
I hereby affirm that I have a certificate of consent to self insure, GE-906G APPLICATION FOR ELECTRICAL PERMIT ' .
or a certificate of Workers' Compensation Insurance, or a certified -- COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof (Sec.3800,Lab.C.) r.
Policy No Company FOR APPLICANT TO FILL IN ' 'JOB /�(+,./�
❑ Certified copy is hereby furnished. EACH - NO.. FEE ._ ADDRESS`1 '44 'l1L$•A
- New Residential Bldgs.8 Pools
❑ Certified copy is 'filed with the county building inspection 1 & 2-Family,Sq.Ft. $ — S- LOCALIT'r%_1E:M%OL,E; GI -
.department. ... - Multi-family Sq.FL — NEAREST
Date �AppliCanf
CROSS ST.". -
Residential Swimming Pools OWNER OR
- _ FIRM NAME:
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:RecLightSw.— MAIL
COMPENSATION INSURANCE - 3 (,I ADDRESS (J IL
(This section need not be completed if the work involved by the. First 20 _ -
CITV� ,1� CAWTel.No.,
, permit.is for one hundred dollars($100) or less.). - Total No. Additional �t L�
' I certify that in the performance of the work,for which this permit. =
YJ PLAN CHECK-° • . i
. is issued, I Shall not employ an _ APPLICANT '
p y y person in any manner so as to
become subject to the,Worke Lighting Fixtures First 20- ADDRESS •- _ .
(� Total No. Additional
Date P T AIDCITY
Appliances Not Over i HP CITY Tel.No.
` -
NOTICE O APPLICANT:- If, after making this Certificate of PERMIT
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICANT L
Provisions of the Labor Code, you must forthwith comply with such Oven Dryer _ W.M._ ADDRESSr,O Q
provisions or this permit shall be deemed revoked. Top FAU _ W.H.._
LICENSED CONTRACTORS DECLARATION Head Fan _ Other_ CIT �� G�-tJ7e1.No. �'•- Q
,thereby,affirm that I am licensed under,.provisions of. Chapter 9 'LICENSE OR /� n
Disc, ROOM Ain Conch REG.NUMBER 3Cp�L� Class.- C�O
(commencing with Section 7000) of Division 3 of the Business and i -
Professions Code,and my'liceri is in full force and effect. .DISTRICT NOPR ED BY
Power Apparatus&Large Appliances , LZL%
CT / Size& Type HP,KW,KVA,or KVAR bJ•/ �� C�F//�v.,^"_�' 1
Licen ? •�f v Lie.Class `10 Up to 1 Incl. FINAL - V
Date
_ ! Over 1 to 10 not. DATE VALIDATION
C • (� - Over 1 0:0 to 50 Incl - - - .. OF
or -
❑CFINAL C.7
I am exempt under Sec. Over 50 to 700 Inc. BY W
BAP.C. for this reason Over 100' - N'
Services,Swbd.,MCC &Panelboards 2 Z
--
Date: 0- 200 Amp.Under 600 V, ' 340
Signature -201 1000 Amp. Under 600 V
Over 1000 Amp.or Over 600 V -
Exemption for Reg.Mains.Elect.
SINGLE FAMILY Temp.Power Pole& Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit y
I hereby affirm that I am exempt from the Contractors License Law
for the following reason(Section 7031.5,Business and Professions - Additional Sign Branch Circuits
Code): 3307 -4.111
❑ - Misc.Conduits& Conductors
1,as owner of the property,will do the work and the structure IT j'(;_:
isnot intended or offered for see (Section 7044, Business Other(See Complete Fee Schedule)
and,Professions Code). - `. , '-TOTA(. ,44 22
CONSTRUCTION LENDING AGENCY - (,.1y'KA - ilt.22
I hereby affirm that there is a construction lending agency for the CHANGE .[Ut
performance of the work for which this permit is issued(Sec.3097, •PERMIT FEE - (Sub-Total) -
Civ.C.):.
..
Lender's Name PLAN CHECKING FEE Ijl]I,fl I_IuL)1 I�I lift�I
PERMIT ISSUING FEE
Lender's Address CIO 1-1 1 - AN 10:14
I certify that I,have mad this application and state that the above TOTAL FEE a• ,
information is correct. I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and herebyauthorize
tative of the y' enter upon the above-mentioned
property for insp do rpos
.SEE REVERSE.FOR EXPLANATORY LANGUAGE
Signa ure of Date
COJNTY OF LOS ANGELES TEMPLE CITY N 0508 ELECTRICAL PERMIT
DEPARTMENT OF.'PUBLIC-WORKS 9701 LAS TUNAS EL 0508 1210110054
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: FEES PAID 1 BUILDING ADDRESS:
ITR: 5905 LT: 87 9108 HERMOSA DR
I IEEE DESCRIPTION: . QUANTITY: DOM: AMOUNT: I TEMP CA 917801918 T
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
15387-016-033 1A1 PERMIT ISSUANCE FEE- _ 27.80 I THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY CAI
H7 RES 'EXHAUST FANS_- 3.00 EX 33.00
TENANT: 'TOTAL FEES 60.80 TISSUED ON: PROCESSED BY: PLAN 5Y:
1 (110 /11/12 SR T
TOWNER: TEL. NO: IFINAL DATE FINAL Y: CODE:
IMAO, YI (626) 205-8866-
19108 HERMOSA DR I
ITEMP 917801918 IDEESCRI TION OF WORK
1 (INSTALL NEW FAN AND REPLACE GFCI OUTLET
I
(APPLICANT: TEL. NO:
LI, GUANG J (626) 672-8360-
1522 W WINNIE WAY ISPECIAL CONDITIONS:
TARCADIA CA 91007
I I I 1
CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE
1LI, GUANG JIN (626) 672-8360- 1 1
522 W. WINNIE WAY LIC. NO ITEMPORARY POWER POLE
ARCADIA, CA 91007 688406 B
I IUNDERGROUND CONDUIT
(ARCHITECT OR ENGINEER: TEL. NO: T 1UFER GROUND
LIC. NO: T ROUGH CONDUIT
1 TROUGH WIRING yZV
y
Y
MAIN WATER LINE
' - PLASTIC YIN METAL YIN
I I I
(UTILITY COMPANY NOTIFIEDI
1 II I- II I I
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1 I I I I I
I II I I I 11
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I I I I I
' 1RE2O1ZT ID: DPR265 ROUTE T0. BSO509 T
I I I I I I
r COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508.9905200044
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
GAL S PAID BUILDINGADDRESS:
TR: 5905 LT: 87 9108 HERMOSA DR
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801918
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: HART
5387-016-033 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY
G1 OUTLETS-LGT,SW,RECP 25.00 OUT 45.75
WANT: G2 LIGHTING FIXTURES 5.00 LGT 9.75 ISSUED ON: PROCESSED BY-- PAN BY: EXPIRES ON:
HA FAU LESS 3HP 1.00 FAU 10.80 05/20/99 UT 11/16/99
H2 RES GRBG DISP LT 3HP 1.00 DIS 10.80 /
OWNER: TEL. NO: H3 RES DISHWASHR LT 3HP 0.00 DIS 0.00 FINAL DATE FINAL B - CODE:
MA JENNY S;JACK TING-SHEN (626) 285-2768- H7 RES EXHAUST FANS 2.00 EX 21.60
9108 HERMOSA DR JB AC UNITS +3-10HP 1.00 AC 19.80 77
TEMP 917801918 TOTAL FEES 146.25 UI,5LKIPliUN OF WORK
ELECTRICAL FOR ADDITION
APPLICANT: O:
LEE (626) 289-3391-
232 W. MISSION DR. SPECIAL CONDITIONS:
SAN GABRIEL, CA
PryGELES CO
CONTRACTOR: TEL. NO: OS U�T APPROVALS DATE INSPECTOR SIGNATURE
LEES CONSTRUCTION CO. 818289339
232 W MISSION DR LIC. NO TEMPORARY POWER POLE
SAN GABRIEL CA 91776 612929
/ UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. NO: / UFER GROUND
LIC. N0:// ROUGH CONDUIT
ROUG ING
�D U O U C (0[R'H U S PLASTMAIN IICTER Y/NL(RE METAL Y/N
UTILITY COMPANY OT D
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Gb�/c
Service That
REPORT ID: DPR265 ROUTE TO: BS0508