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Home My Public Portal About6148 IVAR AVE_Electrical__ WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) API�LL CA 11 MN FOR En�L ECTMICAL PERNT .I hereby affirm that I have a certificate of consent•to self insure, 76A663 ora certificate of Worker's Compensation Insurance, or a certified _COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copq'the'reof(Sec.'3800 Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB jn ADDRESS El Certified copy is hereby furnished. New Residential Bldgs.&P ole NO. EACH FEE ❑ _ $ $ LOCALITY AI— NEAREST �( Certified copy is filed with the county building inspection 1&2-Family,Sq.Ft. department. Multi-family Sq.Ft. OROs ST. G Date Applicant Residential Swimming Pools - ASSESSOR 6 MAP BOOK .5 PAGE O PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR COMPENSATION INSURANCE Outlets:Rec. Light Sw. FIRM NAME 'First 20 �`� O` (This section need not be completed if the work involved by the MAIL O ADDRESS permit is for one hundred dollars($100)or less.) Total No. Additional I certify that in the performance of the work for which this permit CITY Tel.No. is issued, I shall not employ any person in any manner so as to PLAN become Iect o the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT K s S Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE O APPLICANT: If, 4er ng t Certificate of CITY Tel..No. Exemption,you should becom subject to the W. ers' Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must for ith comply with such PERMIT provisions or this permit shall be deemedf oked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTOR ECLARATION 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. Over 50 to 100 Incl. LICENSE OR Class REG.NUClass. a License Number Lia Class Over 100 - DISTRICT NO. P OC SSED BY O >O e V Services,'Swbd.,MCC&Panelboards Contractor Date 0-399 Amp. Under 600V FINAL DATE O ❑ 400-1000 Amp.Under 600 V ~ I am exempt under Sec. VALIDATION V Over 1000 Amp.or Over 600 V FINAL W_ B.&P.C.for this reason BRANCH CIRCUIT.FEES BY Date: 15A,or 20A, 120V,Lighting of Recept: Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits El Exemption Or More Branch Circuits Exemption for Reg. Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 2 i CM SINGLE FAMILY Temp. Power Pole&Appurtenances 1 HOME OWNER-BUILDER DECLARATION - Branch Circuit ith One Br n wanr. c I hereby affirm that I am exempt from the Contractor's License Law Sig0000'-V''001 5/ /96 for thef lowing reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits der 5169 1 AM10=00 EVI, as owner of the property,will do the work and the structure Misc.Conduits&Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) D 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 (Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE o17,90 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 u n ve-mentioned property for inspection Pur ose �. SEE REVERSE FOR EXPLANATORY LANGUAGE ":� NAT615W P RMITT DATE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0903260020 - BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: - FEES PAID BUILDING ADDRESS: 1 ITR: 5904 LT: 40 6148 IVAR AV - IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917801523 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LONGDEN 1 15384-002-007 - IA1 PERMIT ISSUANCE FEE 27-75 I THOMAS PAGE: ,596 GRID: H2 LOCALITY: TEMPLE_.CITY, Cl I IG1 OUTLETS-LGT,SW,RECP 7.00 OUT 13.65 1. 1 - I (TENANT: 1G2 LIGHTING FIXTURES 2.00 LGT 3.90 IISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 45.30 103/26/09 SR 09/22/09 (OWNER: TEL. NO: IFINAL DATE FINAL BY: CODE: - ITAO ALEX C;MA AI LUN (626) 285-9818- 1 16148 IVAR AV I I - ITEMP 917801523 I IDESCRIPTION OF WORK 1 I (ELECTRICAL FOR ADDITION (APPLICANT: TEL. NO: - ITAO (626) 285-9818- 1 16148 IVAR AVENUE 1 _ ISPECIAL CONDITIONS: I ITEMPLE CITY CA 91780 I 1 :• I I ICONTRACTOR: TEL. NO: - - (APPROVALS DATE INSPECTOR SIGNATURE ITAO, ALEX (626) 285-9818- I 16148 IVAR AVENUE LIC. NO i ITEMPORARY POWER POLE ITEMPLE CITY, CA 91780 NONE I I 1 1 1UNDERGROUND CONDUIT 1 1 1ARCHITECT OR ENGINEER: TEL. NO: I - IUFER GROUND 1 1 LIC. NO: _ IROUGH CONDUIT " IROUGH WIRING 1 1 1 1 - IMAIN WATER LINE 1 IPLASTIC Y/N METAL Y/N 1 - (UTILITY COMPANY NOTIFIEDI I I I I I I I I EXimil'E'�� -,-zo/ro I I I I I I " (REPORT ID: DPR265 ROUTE TO: BS0508 1 COUNTY OF LOSS ANGELES TEMPLE CITY # 0508 YFECTRiCAL-PERRUIk. DEPARTMEIuT OF PUBLIC WORKS 9071 LAS TUNAS .`E L�`050849609230028 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (81'8) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 5904 LT: 40 <6'148jIVAR-AU FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801523 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5384-002-007 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY LA XO AMP PANELS, MCC 1.00 PAN 38.85 TENANT- TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 09/23/96 TC 09/23/97 OWNER: TEL. NO: FINAL DATE FINAL B CODE: TAOALEX C;MA Al LUN (818) 441-9718- 6148 I VAR`AV TEMP 917801523DESCRIPTION OF' RK RELOCATE ELECTRICAL PANEL1900 MP A APPLICANT: TEL. NO: ' SAME AS OWNER SPECIAL CONDITIONS: rr . D �`s CONTRACTOR:- TEL. NO: � D APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER v LIC. NO TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT OR. ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING pU �� C WORKS KS MAIN WATER LINE PLASTIC Y/N METAL Y/N 00� 0 UThTy�OM�AN��I��FIED C rWc REPORT ID: DPR265 ROUTE TO: BS0508