HomeMy Public PortalAbout9509 KENNERLY ST_Electrical__ WORKERS'COMPENSATION DECLARATION 76-606G 10i81
CE-806G APPLICATION FOR 'ELECTRICAL- PERMIT. .
I hereby affirm that I have a certificate of consent to,self insure,
or a,certificate of Workers' Compensation Insurance, or a certified COUNTY OF,L-OS ANGELES BUILDING AND SAFETY
6opy thereof(Sec 3800,Lab 'C) ;
Policy No - Y ' Company FOR APPLICANT J6 FILL IN ... " JOB' Cs/W
❑- Certified copy,is hereby furnished EACH NO FEE ADDRESS r
New Residential Bldgs &Pools 'e
$ — $ LOCALITY.' G�
❑'"Certified copy is filed with the'county`budding inspection 1 & 2 Family, Sq Ft —
department '• Multi-family Sq Ft CROSS ST i_
NEAREST ��,
Residential SwimmingPools
•. //��� ' /(�(i
Date Applicant ' _
FIRM NAME
CERTIFICATE OF'EXEMPTION•FROM•WORKERS' 4{ Outlets Rec� Light Sw',' AIL
COMPENSATIOWINSURANCE, t ill///// ADDRESS 01< `
a This section need not be completed if'the work involved b the First 20
( P Y ;CITY .� � Tel No2w<21'
Total No Additional,, r
permit is for one hundred dollars($100)•or less.) .� , . -
certify that in the performance of the work for which-this permit APPLICANT CHECKPLAN
67
s;issued, I shall;;not employ,any person,in an man r so as to
become subject to thej Workers'Com ensa ws Lighting Fixtures• First 20; ADDRESS f + y
�f Total No Additional CITY Tel No
Date v Ap ant 'Fix'ed Appliances Not Over 1 HP PERMIT.'
NOTICE''T ,A LI ANT If, 7afte mak, his Certificate. o C C'
Exemption,you should become subject to Workers'Compensation Range_ Heater_ DW APPLICANT'
(-
'provisions,of,the;Labor Code, you;must forthwith comply with such Oven _ Dryer WM ADDRESS
provisions or this permit shall be deemed revoked Top — FAU W H._ CITY _ Tel No
i LICENSED CONTRACTORS DECLARATION Hood — Fan Other_
I hereby affirm that I am licensed under provisions of Chapter 9' Dis — Room Air Cond .( ' LICENSE OR n / Class�1D
(commencing with Section 7000) of Division 3 of the Business and p l/ REG NUMBER `I
i Professions,Code,and my license is in full force and effect Power Apparatus& Large Appliances, DISTRICT N
/`�j� Size &•Type HP, KW,KVA,or KVAR . 0
License Number Lic Class J� Up to 1 In FINAL
DATE VALIDATION
Over 1 to 10 Incl fY0'
Contractor Date Over 10 to,50 Incl FIN ///JJJ U
1 ❑ I am exempt under Sec, Over 50 to 100 Inc BY / Lu
Ovef 100 ' [� O.
' B&P C for-this reason U)
JL
Services, ,MCC& Panelboards ACCT. Z
Date nder 600 V FX
Signature - 1000 Amp Under 600 V' r 2?.75
" Over 1000 Amp or Over 600 V l 1 I 1 _
Exemption for .
❑ •Reg Maint Elect•
' .
I SINGLE•FAMILY' � Temp P.ower,.Pole& Appurtenances -IY ~
)-11 L 29 . 75
HOME OWNER-BUILDER DECLARATION;, Sign with One Branch Circuit '
rS I hereby affirm that I am exempt from the Contractor's License Law ' s 29°7•'
/// for the following reason(Section 7031 5, Business and Professions, Additional Sign Branch Circuits r - '
Code)
❑ • ' , £
1,-as owner.•of the property,will do the work and the,structure? Misc Conduits Conductors
i is not intended or offered for sale (Section 70,44, Business Other (See'Complete Fee Schedule),_ i 39
and,Professions Code)
{� � � �'t
l29t 1 M l f 4'x'7
CONSTRUCTION`LENDING AGENCY
1-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) r
PL-AN CHECKING FEE - -n
Lender;s4Name = ;
PERMIT--ISSUING FEE.
Lender's Address 9 "
I certify that I have read this-application and state that the above TOTAL FEE / 73
_,-
information is correct 'I agree to comply with'ali County ordinances "
and State laws re hng Electrical wiring, and hereby authorize ,
v thi C ty,to,enter upon the above-mentioned
pro rt r 1 io pos
SEE REVERSE FOR-EXPLANATORY LANGUAGE -
5Signatur Permittee D to
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0204120031
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: _ FEESPAIDBUILDING =
TR: 13620- LT: 36 - _ - J9509 KENNERLY ST -
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803.838
A R: - - - - - ---- - -----NEAREST CROSS STREET- CLOVERLYu - - ---- -- J --
8590-013-021 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY
E1 TEMP SERV POWER POLE 1.00 TMP 43.65
TOTAL FEES 71.40 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
04/12/02 JK 10/09/02
OWNER: TEL. NO: fINA DATE CODE:
WONG; TONY (626) 288-2651-
T509 KENNERLY
EMP 917803838ST -e-MON _T
TPP
APPLICANT: TEL. NO:
LAC CONSTRUCTION CORP
SPECIAL CONDITIONS:
�r�yGIEO ES CO
CONTRACTOR: TEL. NO: ®�9 ��� APS OJALS DATE INSPECTOR SIGNATURE
LAC CONSTRUCTION CORP. (626) 443-8901-
4037 ARDEN DR #5 LIC. NO TEMPNARY POWER POLE
EL MONTE CA 91713 B
UNDERGROUND CONDUIT
ARCHITECT OR • LIFER 11R D
PETER LEE ENGINEERING (626) 280-9000- -
8748 VALLEY BL. STE. L LIC. N0: OZ T
ROSEMEAD, CA 91l/70 NONE 11111]1
- ROUGH WIRING -
IN
ATER
NE
PLAST1iC Y/NLIMETAL Y/N
COMPANYUTILITY
6 �0° �►
El ell
Z.
' SepviceTba ;gid
* ADDITIONAL DATA ON FILE
; o
REPORT, ID: DPR265 ROUTE TO: BS0508
41
�J
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0205070017
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 13620 LT: 36 9509 KENNERLY ST
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803838
ASSESSOR OR A NEAREST CROSS STREET: CLOVERLY
8590-013-021 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY
82 1 OR 2 FAMILY DWELL 2500.00 SQ 262.50
TENANT: TOTAL FEES 290.25 ISSUED ON: PROCESSED BY: PLA EXPIRES ON:
05/07/02 JK 11/03/02
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
WONG; TONY (626) 288-2651-
9509 KENNERLY ST
TEMP 917803838 DESCRIPTION OF WORK
ELECTRICAL FOR ADDITION & REMODEL
APPLICANT:
LAC CONSTRUCTION CORP SPECIAL CONDITIONS:
CONTRACTOR: TEL. O: APPROVALS DATE INSPECTOR SIGNATURE
LAC CONSTRUCTION CORP. (626) 443-8901-
4037 ARDEN DR #5 LIC. NO ` R POLE
EL MONTE CA 91713 B
' UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER:
UFER-- 'i GR
PETER LEE ENGINEERING (626) 280-9000-
8748 VALLEY BL. STE. L LIC. N0: ' --- �--� � ;- -� I i ,, ,
ROUGH Co DUI
ROSEMEAD, CA 91'770 NONE ;
- ROUGH WIRINGk�L
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
* ADDITIONAL DATA ON FILE
REPORT ID: DPR265 ROUTE TO: BS0508