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HomeMy Public PortalAbout9805 HOWLAND DR_Electrical__ n WORKERS' COMPENSATION DECLARATION 10/81 APPLICATION FOR ELECTRICAL PERMIT 'H hereby off CE-806 irr; that I have a certificate of consent to self CE-806G •inz-4e or a cerfificotb 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 JOBr� rU' S F O VJ IA No Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS _I ❑ Certified copy is filed with the county building inspec- 18 2-Family, Sq. Ft. $ $ — $ LOCALITY '—'jE "(n' C ; tion department. Multi-family Sq. Ft. — NEAREST 11 _ o C c c ResidentialSwimmingPools CROSS ST. 1--V O(c'TH A� _a AnlrR OW r� C Date Applicant OWNER OR _ ) /' -I FIRM NAME �OJIt�, I lY R.�^(•R I�7�S CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecZhi � IL 'MALi COMPENSATION INSURANCE g Sw'First 20 ADDRESS "j $ o S pow iA N d Q (This section need not be completed if the work involved 6y Total No. CITY Tel. No. I F the permit is for one hundred dollars ($100)or less.) Additional EN: t C^ C( 1 ,b certify that in the performance of the work for which t HECK PLAN APPLICANT C, d N Z HIO f2 permit is issued, 1 shall not employ any person in any manner pp so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS / O 0S 14 pw 1.94 Additional Total No. Date Applicant - CITY %c e �i Fixed Appliances Not Over 1 HE PERMIT / NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT I, aN2 A o /e A� A Exemption, you should become subject to the Workers' Range_ Heater—D.W. _ Compensation provisions of the Labor Code, you must forth- Oven — Dryer _ W.M.— ADDRESS US OW IA 144/ cr'R• with comply with such provisions or this permit shall be Top — FAU —W.H. — ) deemed revoked. Hood _ Fan _ Other_ CITY 0 ,Z I �t'T Tel. No, 7�S� LICENSED CONTRACTORS DECLARATION LICEN OR I hereby affirm that I am licensed under provisions of Chapter 9 Dis p' — Room Air Cond. Class.REG. NUMBER }; (commencing with Section 7000) of Division 3 of the Business power Apparatus 8 Large Appliances rR� P SED BY O and Professions Code, and my license is in full force and effect. O U Size 8 Type HP, KW, KVA, or KVAR' License Number Lic. Class � Up to 1 Incl. FINAL Over 1 to 70 Incl DAT i �.�!,] Contractor Date !/ 'J VALIDATION V Over 10 to 50 Ind. FI W ❑ I am exempt under Sec. Over 50 to 100 Inc. / B.BP.C. for this reason Over 100 _ Z Services, Swbd., MCC 8 Ponelboards Date: 0 - 200 Amp. Under 600 V Signature _ I ' 201 - 1000 Amp. Under 600 V g 5 6'a'6 A ❑ - Over 1000 Amp. or Over 600 V Exemption to, Reg. Maint.•Elect. i# e is o o,o2 SINGLE FAMILY' Temp. Power Pole &Appurtenances e e e e is 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit t s I hereby affirm that I am exempt from the Contractor's License e 24 Q QAdditional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and o e e 'Z(L Q Q'.FJ Professions Code): I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors ( Q1 7-8 6 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— ► 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 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) (Sec. 3097, Civ_ C.). x 3 I PLAN CHECKING FEE Lender's Nome PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE above information is correct. I agree to comply Wth all County ordinances and State laws regulating Electrical wiring, and hereby W orize repres ntatives of this County to enter upon thea ave mentioned op ry for spedion purposes. -----//� SEE REVERSE FOR EXPLANATORY LANGUAGE g attre of Per itte Date WORKERS'COMPENSATIaNDECLARATION xaamvDPW aie> APPLICATION FOR ELECTRICAL PERMIT O I hereby affirm that 1 have a certificate of consent to self CEA80sG �flsure, or a certificate of Workers' Compensation,Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or acertified copy thereof (Sec. 3800,Lab. C.) Pohcy IJo. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO, FEE ADDRESS � v�_o Certified copy is filed with the county building inspec- 1 8 2-Family, Sq. FL $ — $ LOCALITY -tir Z_& G/ tion department. Multi-family Sq. Ft. — NEAREST Date Applicant Residential Swimming Pools OWNERSOR �OG ed'1T� FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec __'� Light�Sw. MAIL COMPENSATION INSURANCE First 20 ADDRESS L O (This section need not be completed if the work involved by Total No. Additional CITY Tel. No. OS' the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in :he 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 r Additional / Dote�L2 "Applicant Total No. CITY Tel. No. NOTICE TO APPLICANT: If, after makin this Cerlificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heoter_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. Hood — Fan —Other_ CITY Tel. No. LICENSED CONTRACTORS DECLARATION Disp. — Room Air Cond. — LICENSE OR Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PR ESSED BY Y and Professions Code,and my license is in full force and effect. O Il Size 8 Type HP, KW, KVA, or KVAR a License Number Lic. Class `���c1 O Up to I Incl. FINAL / Contractor Date Over I to 10 Incl DATE/ 7 J/ VALIDATION 0 OOver 10 to 50 Incl. FINALLL--FF�� am exempt under Sec. Over 50 to 100 Inc. BYW 8.8P.C. for this reason Over 100 d Date: Services, Swbd., MCC 8 Ponelboards , Z 0- 200 Amp. Under 600 V — Signature 201 - 1000 Amp. Under 600 V Exemption for Reg. Mainz, Elect. 1000 Amp. or Over 600 V. _y SINGLE FAMILY Temp. Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION ( H�_ I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit 1 TEtI, Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits �'j`�'jj '? j0 Professions Code): V Misc. Conduits 8 Conductors CHECK I- �cs_I I, as owner of the property, will do the work and the Y structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , CHANCE •{JI Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for fl[I!l_! ], LL% Sy(I the performance of the work for which this permit is issued PERMIT FEESub-Total �j -.:•++ (Sec. 3097, Civ. C.). ( ) a O 415- 1 `r^:L l l I:117 PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address 3r JO I certify that I have rend this application and state that the TOTAL 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 the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Per tittee Date (Bs DECIL WORKERS Chove ATIONcate . APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that'll-have a certificate o < , 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. 8 Pools EACH NO. FEE ADDRESS ❑ Certified copy is filed with the county building inspec- 1 8 2-Family, Sq. Ff. $ — $ LOCALITY Ti tion department. Multi-family Sq. Ft. — NEAREST Residential Swimming Pools CROSS ST. L OL �N Date—Applicant OWNER OR , / FIRM NAME GG /vdo CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec_LightSw._ 'MAIL CC COMPENSATION INSURANCE ADDRESS ( P T This section need not be completed if the work involved b First 20 y'.p _ e. the permit is for one hundred dollars($100) or less.) Total No. Additional CITY Tel. No.Z 7 1,f3I 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 mo er APPLICANT so as to b come ubject to the Workernsanon w . Total No. Additional Lighting Fixtures First 20 ADDRESS CITY Tel. No. Dot,/?7//'7/(fApplicant Fixed Appliances Not Over 1 HP PERMIT / NOTICE A TO PLIC NT: If, after making this Certificate of APPLICANT GO L✓EZ.cif IZ Exemption, you should become subject to the Workers' Range_ Heater—D.W. _ ' Compensation provisions of the Labor Code, you must forth- Oven — Dryer — W.M.— ADDRESS 171& 5. / W//✓ �.0 with comply with such provisions or this permit shall be Top _ FAU —W.H. — deemed revoked. CITYL. Tel. No. 7a LICENSED CONTRACTORS DECLARATION Hood _ Fon — Other- - O O I hereby affirm that Disc. Room Air Cond. LICENSE OR Class. am licensed under provisions of Chapter 9 REG. NUMBER ,c+—/(� (commencing with Section 7000) of Division 3 of the Business DISTRICT NOP SED BY and Professions Code,and m .license is in full force and effect. Power Apparatus 8 Large Appliances © } O%r 0 > (�/ O Size 8 Type HP, KW, KVA, or KVAR' r O(,J O AL License Number') C1 V G� Lic Class Up to 1 Incl V �J � FINAL p ContractoxQu'/��L`r r—+�%✓/Date c/ / Over 1 to 101nt1. DATE / _ VALIDATIO 0 ❑ Over 10 to 50 Incl. TINA r0 ~ am exempt under Sec. Over 50 to 100 Inc. BY W B.BP.C. for this reason Over 100 Z Date: Services, Swbd., MCC 8 Ponelboords 0 -200 Amp. Under 6D0 V 1 2 4 3 A Signature 201 - 1000 Amp. Under 600 V e o s ° ° 'L F1Exemptionfor Reg. MaiOver 1000 Amp. or Over 600Maim. Elect. ( ° ° ° 550 u SINGLE FAMILY Temp. Power Pole 8 Appurtenances ° ° 5 5 0 ct HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ,( Z 18+84 1 hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Low for the following reason (Section 7031.5, Business and Professions Code): ❑ I, as owner of the properly, will do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY �O ^ '/X17 A� I hereby affirm that there is a construction lending agency for r/ 7Z� r�",Y'{/ d"� �V the performance of the work for which this permit is issued � PERMIT FEE (Sub-Total) �/11 _ (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name ^^ _ PERMIT ISSUING FEE /O /OV �a , OO _Lender's Address s _ �,�j Y eP_1, I certify that I have read this application and state that the TOTAL FEE ••__// above information is correct. I agree to comply hall County Q ordinances and State laws regulating Electr I wiring, and' GlTLI d,G{�� C� CZ�O� hereby authorize representatives of t s C ty to enter upon the bovp e-mentia 21 property fore on purposes. \�/!vJ//L/ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dote , WORKERS COMPENSATION DECLARATION 76"663 '°'e' CE-Bose APPLICATION FOR ELECTRICAL PERMIT . I hereby gfi)U that I have a certificate of'Consent to self insure,, ora certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY 1�Opy thereof (Sec.3800.Lab. C.) - • Policy'No: Company FOR APPLICANT TO FILL IN JOB �® ❑ •' ADDRESS Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ❑ -Certified copy is, filed with the county building inspection. 1 & 2-Family, Sq.FL $ — $ LOCALITY i department. Multi-family Sq. Ft. NEAREST CROSS ST. Residential Swimming Pools " OWNER OR • Date Applicant FIRM NAME - 0<1 CERTIFICATE OF EXEMPTION FROM WORKERS' - MAIL Outlets:Rae .Light Sw. U A COMPENSATION INSURANCE ADDRESS (f {This section need not be completed if the work involved.by the First 20 permit is for one hundred dollars I$100)'Or fess.) Total No. Additional CITY Tel. N ;271 certify that in the performance of the work for which this permit. PLAN CHECK is issued, I shall not employ any person'in any manner so as to APPLICANT become subject to the Workers Compensation Laws. Lighting Fixtures First 20 ADDRESS ' Additional Total No.--t— CITY _ Tel.No. Date Applicant I Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of . PERMIT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ 4W _ APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven — Dryer _ W.NL— ADDRESS provisions or this permit shall be deemed revoked. Top — FAU _ W.H. CITY Tel,No. LICENSED CONTRACTORS DECLARATION Hood.— Fan _ Other— I hereby affirm that I am licensed under provisions of Chapter 9 - LICENSE OR :gommencing with Section 7000) of Division 3 of the Business and Disp. — Room Air,Cond: REG.NUMBER class. _ Professions Code,and my license is in full force and effect DIS, T NO. PR ED BY //�p••y�` { Power Apparatus 8 Large Appliances ' License Number 'Co Lic.Class '77 /�f ' Size & Type HP, KW, KVA,or KVAR (/x Up to 1 Incl FINAL U lam, IA Over 1 to 10 In . DATE _ O Contract to / J VALIDATION E] Over 10 to 50 Incl. FINAL I � _ H am exempt under Sec. Over 50 to 100 Inc. By BARG. for this reason Over 100 C-/ - O. to Services,Swbd.,MCC& Panelboards Z Da e: 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. SINGLE FAMILY Temp.Power Pole & Appurtenances „ , 2 'HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACCT.: I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits .2 3307 20 5u Code): Jv ' ❑ I,as owner of the property,will do the work and the structure Misc.Conduits & Conductors 1 ITEMS is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ TOTAL 20 a SQ and Professions Code). S.. ., CONSTRUCTION LENDING AGENCY CHECK 20.c0 I hereby affirm that there is a construction lending agency for the CHANGE .DU performance of the work for which this permit is issued(Sec.3097, PERMIT FEE _ (Sub-Totat) Civ. C.). PLAN CHECKING FEE 13000--Owl 10718789 Lender's Name PERMIT ISSUING FEE 6284 1 AM11:41 Lender's Address I certify that I have read this application and'state that the above TOTAL FEE CQ06 01 information is correct.I agreeto comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize ' representatives of this County enter uponn� the above-mentioned - - proper for ins p chop p poA� SEE REVERSE FOR EXPLANATORY LANGUAGE Siarfiallure of P6rmfftee Raid— COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1301310040 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 265-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 12830 LT: 8 1 9805 HOWLAND DR FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917803233 ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET: GOLDEN WEST 18589-004-010 JAI PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY CAI 02 LIGHTING FIXTURES 1.00 LOOT 2.00 TENANT I TOTAL FEES 29.80 JISSUED ON: PROCESSED BY: PLAN BY: 01/31/13 SR 1 1 OWNER: TEL. NO: I IFINAL DATE FINAL^BY: CODE: 1HUYNH, KIEN (626) 716-8248- 1 1��// ( 1 9805 HOWLAND DR \`/�` ITEMP 917803233 EEPT IO OF WORK REPLACE LIGHT FIXTURE APPLICANT: TEL. NQ: INGO, CHINN V (626) 242-0364- 1333 TOCINI DRIVE 1SPECIAL CONDITIONS: DUARTE CA 91010 CONTRACTOR: TEL. N0: 111 APPROVALS DATE INSPECTOR SIGNATURE I IC S C J CONSTRUCTION CO (626) 242-0364- 1333 TOCINO DRIVE LIC. NO TEMPORARY POWER POLE 1DUARTE CA 91010 748982 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: IDLER GROUND I LIC. NO: IROUGH CONDUIT I I IROUGH WIRING IMAIN WATER LINE PLASTIC YIN METAL YIN 111 - (UTILITY COMPANY NOTIFIED 1 1 1 REPORT IDP DPR26S ROUTE TO: H50508 I - I