The URL can be used to link to this page

Home My Public Portal About6153 IVAR AVE_Electrical__ WORKERS'COMPENSATION DECLARATION 76A663 10/81 o0 0o p �(� no 0n p n0 2 fo�(�/� I hereby affirm that I have a certificate of consent to self CE-806G , G�11!"I LL,�CG=d��N FOR EL�ECTI1 ALS_ l�LSh�I1V Y insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY �1 or a certified copy thereof (Sec. 3800,-Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB r Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS ��S�3 .L V 4 iZ 1 & 2-Family,-Sq. Ft. $ — $ LOCALITY Certified'copy is filed with the county building inspec- Y,' 9. / tion department. Multi-family Sq. Ft. — NEAREST CROSS ST. Residential Swimming Pools OWNER OR Dare Applicant FIRM NAME R .%70N- i2c="ls(r CERTIFICATE OF EXEMPTION FROM WORKERS' Outl _ etsRec Light Sw. MAIL : _ l COMPENSATION INSURANCE First 20 A ADDRESS i s (This section need not be completed if the work involved by Total No. - CITY Tel. No. the permit is for one hundreclAcillors ($100)or less.) Additional I certifythat in-the performance of the work for which this PLAN CHECK P APPLICANT per-rmit is-issued; I shall not employ any person'in any manner soas to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 .ADDRESS Total No., Additional Date /o� /8'83 Applicant �-�� CITY Tel. No. Fixed Appliances Not Over. L HP PERMIT NOTICE TO APPLICANT- If, aft this Certificate APPLICANT �� 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 provisionsor this permit shall be Top — FAU —W.H. deemed revoked. Hood Fan _Other_ 'CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Ai"r Cond. REG. NUMBER Class. (commencing with Section 7000) of,Division 3 of the Business DISTRICT NO. PROCESSED BY and Professions Code; and my license is in full force and effect. Power Apparatus 8 Large Appliances _ r.. Size &Type HP, KW, KVA, or KVAR' ` pKT_-r—of 'License Number Lic. Class _ Up to 1 Incl. FINAL� DATE // �( ,\-� � Over 1 to 10 Incl. .. b'. VALIDATION Contractor DateOver 10 to 50 Incl'. . ElFINAL U I am exempt under.Sec. Over 50 to 100 Inc. BY 4"�- r8a IU B.&P.C. for this reason Over 100f Services, Swbd., MCC & Panelboards Date: -_200 Amp: Un _ der 6 D Signature 201 - 1000 AmP.•Under 600 V EJ Over 1000 Amp:or Over.600 V f _.'6 0 7.J p Exemption for Reg. Maint. Elect. SINGLE FAMILYT ' 10 0 0 0.6 2 HOME OWNER-BUILDER DECLARATION emp..Power Pole&Appurtenances Sign with One Branch Circuit `L o 0 26.2 5 I hereby affirm that I am ei tempt from the Contractor's License Additional Sign Branch Circuits 0 0 ' Law for the following reason (Section 7031.5, Business and ; 10 2�, ? J Professions Code): v I— ❑ I, as owner of the property, will do the work and.the Misc..Conduits& Conductor3 p e v- D I0, =83 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) I (Sec. 3097, Civ. C.): PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE j 0 Lender's Address I certify that I have read this application and state that.the TOTAL FEES 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 e above-mentioned property for inspection purposes. %, � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date y It(ERS'COMPENSATIONDECLARATION 76A663 CE-806G (2;801 APPLICATION FOR ELECTRICAL PERMIT` CE- 6 ] affirm that 1, have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insi or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,L b.' ) �/ �_ �, UFOR APPLICANT TO FILL IN: JOB _ Policy No�� ,07company � .— -J . EACH NO. FEE ADDRESS t New Residential Blggs.&Pools a Certified copy is hereby furnished. 1'&2-Family,Sq. Ft. $' — $ LOCALITY {�-•� Multi-family Sq. Ft. NEAREST lI�Cj Certified'copy is filed with the county buildin inspection CROSS ST Tde artment. Residential Swimming Pools. ` OWNER OR nod r-_Ye- oa n �9 { FI,'RM NAME Date •Applicant (e6_6 GI( + Outlets: Rec.—Light Sw. MAIL Gx First 20 ADDRESS CERTIFICATE OF EXEMP N FROM WORKERS' Total No. Additional CITY (7 1 Tel No. �. COMPENSATION INSURANCE 'Q ` l f p. PLAN;CHECK 0 (This section need not be completed if the work involved APPLICANT U by the permit is for one.hundred dollars Fixtures First 20 ADDRESS- s ($100) or less.) Additional' • cc Total No.- 0 I certify that in the performance Of the work for which this Fixed Appliances Not Over,1 HP ) CITY - Tel No., permit is issued, I shall not employ any person in,any,manner PERMIT W so as to,become subject to the Workers' Compensation Laws. Range_:Heater=D.W. _ APPLICANT Oven _'Dryer_W.M._ ADDRESS ZIA Z' 'FAU W.H. Date Top Applicant ` Hood _ Fan Cher_ - CITY /�C Tel No. �-770/ NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond._• LICENSE OR � �,. Exemption, you. should become subject to the 'Workers' REG. NUMBE J Class Compensation provisions of the Labor Code:you must forth- Power Apparatus& L"arge Appliances DISTRICT NO. PROCES E BY with comply with such provisions or this permit shall be �� deemed revoked. Size&Type HP,KW, KVA,or KVAR t Up to 1 Incl. �� FINAL ' Over 1 to 10 Incl. DALTE LICENSED CONTRACTORS DECLARATION Over 10 to 50 Inc L- z.�� VALI DATI FIN I hereby affirm that I am licensed.under provisions of Chapter Over 50 to 100 Inc. FI i BY 9 (commencing with Section 7000) of Division 3 of the Busi Over 100 -T 2 9$ 7 pi ness and Professions.Code, and my license is in full force and \effect. f / 'Services, # Q,0 0 ? 0 2 J icense Nu er u is Class 0-200 Amp.Onder�600 V O O . 201-1000 Aip. Under 600-V Contractor � AaLate .�/ Over 1000,Arnp..or Over 600 V. o 2�k ✓rS:°J ' HO OWNER-BUILDER DECLARATION Temp.POWer.Pole&Appurtenances I hareby affirm that I nt 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 EI, as owner, of the property; will do the work and the Other (See Complete Fee Schedule)— structure 'is'riot intended, or_offered for sale. (Section 7044, Business and Professions Code). j CONSTRUCTION LENDING;AGENCY I hereby affirm that there is a construction lending agency for (the performance of the work for which;this permit is PERMIT FEE (Sub-Total) /O issued (Sec. 3097,.Civ.C.). Lender's Name-- PLAN CHECKING FEE (One-Fourth Permit Fee),. Lender's Address PERMIT ISSUING FEE. I certify that;I have read this application and state that the TOTAL FEE y 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 Permittee Date -COUNTY OF LOS ANGELES" TEMPLE CITY # 0508, ELECTRICAL•PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS •EL 0508 0504060012 BUILDING AND SAFETY /.LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: EES PAI D BUILDING-ADDRESS: • TR: 5904 LT: 21 UN: .002 6153 IVAR AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801524 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5386-010-066 Al PERMIT ISSUANCE=_FEE 27.75 THOMAS PAGE:-596 -GRID: H2 LOCALITY: TEMPLE CITY, C G1 OUTLETS-LGT,SW,RECP 16.00 OUT 31.20 TENANT:, G2 LIGHTING FIXTURES 7.00 LGT 13.65 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: HA FAU LESS 3HP 1.00 FAU 10.95 04/06/05 JK 10/03/05 H5 RES WASH MACH LT 3HP 1.00 WAS 10.95 OWNER: TEL. NO: JB AC UNITS +3-10HP 1.00 AC 19:65 FINAL.DATE FINAL BY: CODE: CHEN, JOHNNY/KATHY (626) 291-2228- LB 200 AMP PANELS, MCC 1.00 PAN 38.85 6153 IVAR AV TOTAL FEES 153.00 _ TEMP 917801524 DESCRIPTION OF ORK ELECTRICAL FOR ADDITION & UPGRADE SERVICE TO 200 AMPS APPLICANT: TEL. O: TAO (626) 458-8307- 317 W. LAS TUNAS SPECIAL CONDITIONS: SAN GABRIEL CONTRACTOR:- TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE ALEX TAO AND ASSOCIATES (626) 458-8302- 317 W. LAS TUNAS DR., #208 LIC..NO TEMPORARY POWER POLE SAN GABRIEL, CA 91776 744151B UNDERGROUND CONDUIT RCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING f MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: SS0508