HomeMy Public PortalAbout9150 HERMOSA DR_Electrical__ WORKERS'GeOMPENSAT.°" DEGLARATIGN CE863 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING ANOSAFET
insure,.or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec. 3800,Lab. C.)
192-71-3080-2 FOR APPLICANT TO FILL IN JOB
Policy No. Company In%hC EACH NO. FEE ADDRESS 9150 Hermosa
Of the West New Residential Bldgs.&Pools
Certified copy is hereby furnished. 1 & 2-Family,Sq. Ft. $ $ LOCALITY 'Temple City
Certified copy is filed with the count -buildin Multi-family Sq. Ft. — NEAREST L Tunas
y g inspection
department. CROSS ST Residential Swimming Pools OWNER OR
4-6-81 Edwards Eldetric FIRM NAME
Date Applicant Outlets: Rec.—Light—Sw. MAIL
First 20 ADDRESS
CERTIFICATE OF EXEMPTION FROM WORKERS',. Total No. Additional CITYTel No. -
COMPENSATION INSURANCE CL
PLAN CHECK a'
APPLICANT O
(This section need not e completed if [ work involved U
by the permit is for one hundred dollars
($100) or less.) Lighting Fixtures First
Additional ADDRESS cc
Additional
Total No. - O
f certify that in the performance of the work for which thisCITU Tel No'. .f
Fixed Appliances Not Over 1 HP U
permit is issued, 1 shall not employ any person in any manner � � PERMIT W
so as to become subject to the Workers' Compensation Laws. Range_ Heater—D.W. APPLICANT Edwards Electric d
N
Oven Dryer_W.M._ , 1 ADDRESS z
Date Applicant Top FAU _W.H._.
Hood Farr _Other_ CITY Arcadia Tel No 447=5096
NOTICE TO APPLICANT: If, after making this Certificate of Disp. Room Air Cond._ LICENSE OR
Exemption, you should become subject to the Workers' - REG.NUMBER - class c-1 n '
Compensation provisions of the Labor Code, you must forth- Power Apparatus&'Large Appliances DISTRICT NO. PROCESSED BY
with comply with such provisions or this permit shall be '
deemed revoked. Size&Type HP, KW, KV A,or KVAR
Up to 1 Incl - -
FINAL /
/
LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE / VALIDATION
Over 10 to 50 Incl.
I herebv affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL '
9 (commencing.with Section 7000) of Division 3 of the Busi- Over 100 BY
ness and Professions.Code. and my license is in full farce and `
effect. I Services
License Number 257191 - Lic. Class C-10 0.200 Amp, Under 600 V
EddElect July 1982 201-1000 Amp. Under 00
Edwards Contractor ��t� '''•• Over'1000 Amp.or Over
600 V r .
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):
Misc.Conduits&Conductors - -
❑ 1, as owner of the property, will do the work and theY Other (See Complete Fee Schedule)—
structure is not intended or offered for sale (Section 94,7 Q 4 A
7044, Business and Professions Code). # e e e • e•2
CONSTRUCTION LENDING AGENCY
l hereby affirm that there is a construction lending agency "
for the performance of the work for which this permit is e' e'o o is a p 2
issued(Sec. 3097,Civ.C.). PERMIT FEE (Sub-Totall
Lender's Name PLAN CHECKING FEE "(One-Fourth Permit Fee) U•%l 4'-8 1
Lender's Address PERMIT ISSUING FEE
I certify that I have read this application and state that the TOTAL FEE r NO 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
th -mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Z _ 4-6=81
Signature OV Permittee Date - -
COUNTY OF LOS ANGELES TEMPLE CITY # OSOn 00i'.Tr;i CAL PERMIT
DEPARTME!:T CF PUBLIC 'WORKS 9701 LAS TU?30 0410010002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CIT%' 7"SC
PHONE: (6Zbi 285-0488 EXT:
LEGAL ID: --- ---�—FEES PAID '- —BUILDING---i " ---- ---
TR: 5905 LT: 80 '( 9150 HERMOSA D'R
FEE DESCRIPTION: UA.NT iTY: UOM: :'.!NT: TEMP CA
559E-0OP. INFORMATION NUMBER: ..I i NEAREST CRCC- .STREET: ENCINITA
5387-016-026 a1 PERMIT ISSUANCE 'FEE 27.?� I THOMAS PAGE: 596 CkiD: H3 LOCALITY: TEMPLE CITY, C
_ ____ ILA 100 AMP PANELS, MCC 1.00 PAN 38.85
TENANT: ! "TOTAL FEES A5,60 TISSUED ON: PROCESSE3" o PLAN BY: EXPIRES ON:�
10/01/04 J- 03/30/0`
__ _
OIJNER: TEL. N0: (FINAL DA -- AL BY: CGDE--
GP,AJEDA, MICHELLE (b26) 285-958c-
TEMP HERMOSA DR -----__-I���D_
TEMPLE CITY CA 91780 'vESCRIPT Wi.:.:,
iELECTRICAL SERVi : :.!PGRLDE TO 100 AMPS
APPICANT: TEL. N0: !
!:,AME AS OWNER -
SPECIAL CONDITIO,; _--- ----
I I I
(CONTRACTOR: TEL. NO: -__—I (APPROVALS .,.,.L INSPE:^
SAME AS OWNER - !
LIC. NO I iEMPOkARY FOPE-1 -7 , ---
I JUYDERCROUND C
� I �
'71RItiG
I ;U7i.LL1 Try—ca. tiC:Iri E7 -_-=I- �'--
I_.-_.
I
I I
REPORT ID: DPR265 ROUTE TO: 9SO508 — — 4