Loading...
HomeMy Public PortalAbout6047 IVAR AVE_Electrical__ ti 7/ � WORKERS OMPENSATION DECLARATION 76A663 10/81Zi� APPUCQIMON FOR ELECT �C AL G°'L�QMT, :reby affirm that I have a certificate of consent to self CE-806G nsure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING ARID SAFETY or ace fled copy thereof (Sec. 3800, C.) �S / S FOR APPLICANT TO FILL IN JOB T� Policy o. Company .Y ❑. Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 7 A . Certified copy is filed with the cou fy building inspec- 1 & 2-Family, Sq. Ft. g — $ LOCALITY tion de ariment. Multi-family Sq. Ft. — NEAREST CROSS ST. Date Applica Residential Swimming Pools OWNER OR FIRM NAME' CE TIFICATE OF EXEM N FROM WOR S' Outlets: Rec Light Sw._ MAIL ADDRESS . COMPENSATI INSURANCE First 20 (This section need not be completed if the work involved by Total No. Additional CITY l Tel. IN 7, 33 the permit is for one hundred dollars ($100)or less.) I certifythat in the'performance of the work for which this PLAN CHECK P 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 Additional Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT �•� � NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT SIV���/J / 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 �� with comply with.such provisions or this'permit shall be Top — FAU —W.H.' — deemed revoked. CITY Tel. No. Hood Fan _.Other_ S7112— LICENSED, al)Z LICENSED,CONTRACTORS DECLARATION LICENSE OR ,� ` Disp. — Room Air Cond. REG. NUMBER a-��u V Class I hereby affirm that I am.licensed under provisions of Chapter 9 }� (commencing with Section 7000) of Division 3 of the Business DISTRICT NQ PROCESSED BY t b- and Professions Code,and my license is in full force effect. Power Apparatus& Large Appliances 0 Size Type HP, KW, KVA, or KVAR' L License Number ic. Class «<(((JJJ qS U to 1 Incl. FINAL Over 1 to 10 Incl. DATE Contractor a VALID TION Over 10 to 50 Incl. FINAL W lam exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over Services, Swbd, MCC&Panelboords 7J 4 8 9 A z Date: 0 -200 Amp. Under 600 VD o o o 0 o Signature 201 - 1000 Amp. Under 600 V # 2 ❑ Over 1000 Amp. or Over 600 V V ( 0 0 2 2 5 Exemption for Reg. Maint. Elect. SINGLE FAMILY. Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION 0 0 0 25255 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 8 5 Professions Code): ❑ 1, as owner of the property, will do the work and the Misc. Conduits & Conductors Jor structure is not intended or offered for sale (Section Other (See.Complete Fee Schedule)_7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY / G� 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.). Lender's Name PLAN CHECKING FEE PERMIT ISSUING FEE Lender's Address 5 c I certify that I have read this application and state that the TOTAL FEE J abCNE ve information is rrecI. I.agree to comply with all County ordinances and S t laws regulating Electrical wiring, and her uthoriz r resentatives of this County to enter upon th abo me ned property for inspection purpo s. SEE REVERSE FOR EXPLANATORY LANGUAGE / 18, rs Si f Permit; ate w 'WORKERS' COMPENSATION DECLARATION 76A669oPw9 87 APPUCAIMN FOR ELECT TRECAd PERMY F I hereby affirm that I have a certificate of consent,to self :CE eo 3G insure, or a cert4icate•of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or o celtified copy,thereof (Sec.'3800, Lab. C..) PoltCy No. Company FOR APPLICANT TO FILL IN JOB / �,J7 J ❑Certified copy is hereby furnished" New Residential Bldgs. & Pools EACH NO. FEE ADDRESS !® 1 A Y�'Y ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST l CROSS ST. Residential Swimming Pools �jAL D I Date' Applicant OWNER OR �. FIRM NAME O A'1 LO&A i/ CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light First 20 Sw._ MAIL ` / s COMPENSATION INSURANCE ADDRESS &D7s,7 /� �vA�C (This section need not be completed if the work involved by Total No. Additional CITY '77G Tel. Na,_ b 63 the permit is For one hundred dollars ($100)or less.) I certify that in the performance of the work for which this PLAN CHECKAPPLICANT 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 Additional p / Date �2�irJr�r' Total No. CITY Tel. No. pp� � (/ Alicant /� • NOTICE TO APPLICANT: If, afte making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—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. CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood — Fan —Other Disp. Room Air Cond. — LICENSE OR Class. I hereby affirm that I am licensed under provisions of Chopter•9 i" REG. NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO, PROCESSED BY and Professions Code,and my license is in full force and effect. Size &Type HP, KW, KVA, or KVAR QQ O License Number Lic. Class _Z Up to 1 Incl. 01 FINAL U Over 1 to 10 Incl. DATE VALIDATION Ir Contractor Date Over 10 to 50 Incl. 0 E] FINAL I am exempt under Sec. Over 50 to 100 Inc. U BY UL B.&P.C. for this reason Over 100CL D Date: Services, Swbd., MCC& Panelboards Z Z 0-200 Amp. Under 600 V — Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Main t. Elect. SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances I hereby affirm that'I am exempt from the Contractor's License Sign with One Branch Circuit Low for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): ❑ I, as owner of the property, will dMisc. Conduits&Conductors -•R r. o the'work and the .3.1E structure is not.intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ Business and Professions Code). D,, i_( t l -0 0 CONSTRUCTION LENDING AGENCYEC I hereby affirm that there is a construction lending agency for CK the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) i_:tl-i M,%7i (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lend'er's Name 2 - PERMIT ISSUING FEE �✓ `lI'-s-''=1'-y Lender's Address - 1 I certify that I have read this application and state that the" TOTAL FEE E + - above information is correct. I agree to comply with all County ordinances and State laws regulating'Electrical'wiring, and t hereby authorize representatives of this County to enter upon t, ve-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ©s signature of Permittee Date' �VOR,KjRw COMPENSATION DECLARATION ' " }� 20-0019 DPW 3/87 Qp����Q��O� ��� CdCC��G�OC�ad p�Q �� I h'eretiy,d` um that 1 have a certificate of consent to self ce aboac O nsi e,'or a certificate of Workerg' Corpp ensation Insurance, COUNTY OF LOS ANGELES . DEPT. OF PUBLIC WORKS certified copy thereof (Sec. 3800, Lab. C.) Pollcy No' Company FOR APPLICANT TO FILL IN B n�/, i/� p Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE DDRESS (/`T V /� Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY 1 tion,department. Multi-family Sq. Ft. — NEAREST ^�l ��' Residential Swimming Pools CROSS ST. Date Applicant "y WNER Ofd•-" IRM NAME (:)t" 1JC� CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec�Light�S\VA AIL COMPENSATION INSURANCE ADDRESS This section need not be completed if the work involved b ? } First 20 % ( P y Total No.'�d— "Additional CITY Tel. No. the permit is for one hundred dollars ($100)or less.) I certifythat in the performance-of the work for which this PLAN CHECK P 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 — / WEAv� Total No. Additional CITY Tel. No. ' Dat Applicant Fixed Appliances Not Over 1 HP ERMIT /�� NOTICE TO APPLICANT: If, after making this Certificate of RMIT TION Exemption, you should become subject. to the Workers'' Range— Heater—D.W. PPLICQ Vw&PV Compensation provisions of the Labor Code; you must forth- Oven' — Dryer —W.M._ ADDRESS 4i-04( VAR with complywith such provisions or this permit shall be Top — F.AU,1 W.H. — Hood'— Fan —Other_ �LE e/ ���' 1633 deemed revoked. ' CITY'^' Tel. No LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. _ REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY >_ and Professions Code,and my license is in full force and effect. 11 ' Size &Type HP, KW, KVA, or,KVAR J 0 License Number -Lic. Class Up to 1 Incl. ,FINAL U Contractor Date Over-1 to 11D incl.. DATE j I q VALIDATION QOver 10 to 50 Incl. FINAL I am exempt under Sec. Over 50 to 100 Inc. BY U` P B.&P.C. for this reason Over 100 a_a yZ Date: Services, Swbd.,, MCC& Panelboards Z 0,- 200-Amp. Under 600 V — Signature 201 - 1000 Amp. Under`600 V Exemption for Reg. Maint, Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances 2 I herebyaffirm that I am exempt from the Contractor's License Sign with One Branch Circuit a p il :7oa Law for the-following reason (Section 7031.5, Business and Additional Sign Branch Circuits �C Professions Code): _3307. I,.as owner of the property, will do the work and the~ Misc. Conduits&Conductors 1 ITEMIS structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— ¢� 1,'13' � 5 Business and Professions Code), CONSTRUCTION LENDING AGENCY CHECK 18.75 I herebyaffirm that there is a construction lending agency for 9 9 Y ,.;C Hll+IvE oIC� the performance of the wor.k'for:~which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ.C.). PLAN CHECKING)FEEEi101010-1136ce c/1`�7v Lender's Name j `"`' PERMIT ISSUING FEE �° �� 8.28 Lender's Address � 1�.:` I 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 laws regulating Electrical.wiring,.and hereby authorize representatives of this County to enter upon the ove-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ©s WORKER'S COMPENSATION DECLARATION ` 20-0019 DPW(12-91)76A663 APP U CATIOVFOR ELECT ICA LPERNT �J I hereby affirm that I have a certificate of consent to self insure, or a certll`icate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.,3800 Lab.C.) Policy No. 'Company FOR APPLICANT TO FILL IN JOB ❑ ADDRESS (Q 7 Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY 1 &2-Family,Sq.Ft. — $ $ Certified copy is filed with the county building inspection _ NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR p �7 MAP BOOK �r�Q �p PAGE d /�� PARCEL Q 1 CERTIFICATE OF EXEMPTION FROM WORKERS' EI OR Outlets:Rec._Light Sw. FIRM NAME ✓ WEA COMPENSATION INSURANCE Additional io MAIL LNI/ � �I/� (This section need not be completed if the.work involved by the Total No. .. Additional AODREss EJ'-(' /V VF-i permit is for one hundred dollars($100)or less.) 7633 I certify that i6 the performance of the work for which this permit CITY. Tel.No. r S is issued, I shall not employ any person in any manner so as t0 PLAN Cibecome subject:WtthWorkers' Com tion Laws. Lighting Fixtures First 20 APPLICANT Total No.' Additional �I .10 ADDRESS -� Date A APPlican YI�t-YA,' / `� I 1k A 4 R 3 HP. �d NOTICE TO APPLICANT: If, ter making this Certificate of CITY Tel.No. Exemption,you should become subject to.the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith I with such PERMIT provisio p ns or this permit shall'be deemed revoked.comply y Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS'DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of.Chapter,9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR Over 50 to 100 Incl. REG.NUMBER Class. a Over 100 - DISTRICT NO. CESSED BY -O License Number Lic.Class ,✓� Services,Swbd.,MCC&Panelboards a D 0-399 Amp.Under 600 V FINAL Q Contractor - Date DATE ❑ 400-1000 Amp.Under 600 V 4 f� I am exempt under Sec. VALIDATION W Over 1000 Amp.or Over 600 V FINAL B.&P.C:for this reasonBRANCH CIRCUIT FEES BY f/1 Date: 15A,or 20A,120V,Lighting or Recept. Z_ 1 To 10 Branch Circuits Signature 41 To 40 Rranch Circuits F 741 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,21 208V To 277V Lighting Br.Circuits ,! SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit' - -- e I hereby affirm that I am exempt from the Contractor's.License Law 9 +,>:S;L; 36. for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits -`' _ Code): T I E€s I,as owner of the property,will do the work.and the structure Misc.Conduits&Conductors r J�\ P P Y, I_~ is not intended or offered for sale (Section.7044, Business Other(See Complete Fee Schedule) L 36 = 75 r and Professions Code). D HE C L 36.75! CONSTRUCTION LENDING AGENCY •i 1±�'•-3 ,I ;t I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, PERMITTEE (Sub-Total) Civ.C.) PLAN CHECKING FEE Lender's Name ij / _ U PM '47 Lender's PERMIT ISSUING FEE Of f0 Lender's Address / I certify that I have read this application and under penalty of purjury state TOTAL FEE that the 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 in tion Zoses. . <p SEE REVERSE.FOR EXPLANATORY LANGUAGE SI NATURE OF PERMITTEE DATE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0008020016 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 5904 LT: 121 6047 IVAR AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801522 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 5386-011-071 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 5.00 OUT 9.75 TENANT: G2 LIGHTING FIXTURES 2.00 LGT 3.90 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 41.40 08/02/00 UT 01/30/01 OWNER: TEL. NO: FINAL DATE FINAL BY: E: WEAVER TOM L;DARLENE G (626) 286-7633- ggme 6047 IVAR AV TEMP 917801522 DESCRIPTIUN OF WORK ELECTRICAL FOR RESIDENTIAL GARAGE APPLICANT: TEL. NO: SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: G1 1,E S Co APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: /J UFER GROUND LIC. NO: / 1111111 ROUGH CONDUIT LROUGH WIRING FURSIUC WO - n nSMAIN WATER LINE ILfvu<I`JK<� PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED O 0 O '01o REPORT ID: DPR265 ROUTE TO: BSO5O8