HomeMy Public PortalAbout9461 KENNERLY ST_Electrical__ WORKERS' COMPENSATION DECLARATION 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have CE-806G a certificate of consent to self CE-806G
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copyt,hereof (Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
ADDRESSV61 /J�ivL f ��
Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE
❑
1 8 2-Family, Sq. Ft. $ $ LOCALITY 3LG'
Certified copy is filed with the county building inspec- — L`/'71 ' l^//
p y — NEAREST
tion department. Multi-famil Sq Ft. CROSS ST.
Date Applicant Residential Swimming Pools OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL
COMPENSATION INSURANCE Outlets: Rec Light Sw._ ADDRESS
First
(This section need not be completed if the work involved by Total No. Additional CITY C f71 7 - Tel. No; Jd-"__ ,?_?
the permit is for one hundred dollars ($100)or less.)
I certifythat in the of the work for which this PLAN CHECK
e performance APPLICANT
permit is issued, I shall not employ any person in any manner
so as to become subject to the Worke s'Compensation Laws. Lighting Fixtures First 20 ADDRESS
7 Total No. Additional
CITY I. No.
Date/-- Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after g thi ertificate of APPLICANT
Exemption, you should becom 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. 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 Air Cond. REG. Class.
NUMBER
(commencing with Section 7000) of Division 3 of the Business .DISTRICT NOPIR 5 BY
Power Apparatus& Large Appliances -�
and Professions Code,and my license is in full force and effect.
Size & Type HP, KW, KVA, or KVAR' f V
License Number Lic. Class Up to 1 Incl.
FINAL ��pp
Over 1 to 10 Incl. t7ATE ✓C/'
Contractor Date VAL ATION
❑ Over 10 to 50 Incl. FIN W
I am exempt under Sec. Over 50 to 100 Inc. BY
B.&P.C. for this reason Over 100 Z
Date: Services, Swbd., MCC& Panelboards �
0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
aExemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION 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
Professions Code):
ra
I, as owner of the property, will do the work and the Misc. Conduits &Conductors
structure is not intended or offered for sale (Section Other (See.Complete Fee Schedule)— ► 6 4 4 TA
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY # o;0 0 0 0 2
1 hereby affirm that there is a construction lending agency for ;( o;o
( f O
the performance of the work for which this permit is issued PERMIT FEE Sub-Total) .
o 'o0 5 0
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE 1,3 1-�-8 7
Lender's Name
Lender's
PERMIT ISSUING FEE Q
I certify thhatat Is
have read this application and state that the TOTAL FEE 1
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 bove-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
nature ermittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9709100015
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 15890 LT: 6 9461 KENNERLY ST
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803836
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: CLOVERLY
8590-012-022 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY, C
G1 OUTLETS-LGT,SW,RECP 3.00 OUT 5.85
TENANT: G2 LIGHTING FIXTURES 1.00 LGT 1.95 ISS ED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
TOTAL FEES 35.55 09/10/97 VG 09/10/98
OWNER: TEL. NO: FINAL DATE FINAL BY: C
EVANS JAMES R;ROBIN B (818) 286-7416- lo-t3
9461 KENNERLY ST
TEMP 917803836 DESCRIPTION OF WOR
ELECTRICAL FOR NEW BATH
APPLICANT: TEL. NO:
MASTER BUILDERS (818) 841-7022-
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
MASTER BUILDER (818) 841-7022
1005 VIA CARMELITA LIC. NO ��, �� -; TEMPORARY POWER POLE
BURBANK, CA 4144768
./
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. N0: r . �� UFER GROUND
LIC. NO: ROUGH CONDUIT
ROUGH WIRING
r„. MAIN WATER LINE
PLASTIC Y/N METAL Y/N
i o - UTILITY COMPANY NOTIFIED
\\,' \
17
REPORT ID: DPR265 ROUTE TO: BS0508