Loading...
HomeMy Public PortalAbout10300 KEY WEST ST_Electrical__ WORKERS' COMPENSATION DECLARATION CE 806G I0 /81 APPLICATION FOR ELECTRICAL PERMIT [J t'hPrehy.gffirm that I have a certificate of consent to self II insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY 'IJi or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. & Poo EACH NO. FEE ADDRESS �J �Dd g Aq —Is bu VV LOCALITY r1-elA (Q G Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. — tion department. Multi-family Sq. Ft. NEAREST CROSS ST. Lam„ Date Applicant �I,/�/ 23 �y �CA�A t�GT Residential Swimming Pools OWNER OR (�YpJ�� G Gu^ FIRM CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL NAME COMPENSATION INSURANCE ADDRESS seecompleted if the work involved b First 20 (This section need not be com p y Total No. Additional CITY Tel. No. the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this 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 Total No. Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT (A► 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 Hood Fan _ Other_ Tel. No. 4 47 57 51 _ LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER 25-d3 ro Class.4:�,--c0 (commencing with Section 7000) of Division 3 of the Business DISTRICT.VO. PR SED Q� Power Apparatus& Large Appliances and Professions Code, and my license is in full force and effect. h v O� C7 Size &Type HP, KW, KVA, or KVAR' ✓ ` V License Number32C2©SIP Lic. Class �'��� Up to 1 Incl. FINAL �c>rt✓T 23 �� Over 1 to 10 Incl. DATE r �� VALIDATION Contractor Date Over 10 to 50 Incl. FI W 1-11 am exempt under Sec. Over 50 to 100 Inc. 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 ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole & Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 327. 5 A I hereby affirm that I am exempt from the Contractor's LicenseAdditional Sign Branch Circuits # o o o o o 2 Law for the following reason (Section 7031.5, Business and Professions Code): F11, as owner of the property, will do the work and the Misc. Conduits& Conductors 1 o o 9Q 50 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , 0 0 - 9Q505 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I Q 2 4 v 8 5 1 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.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address q I certify that I 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 her by authorize representatives of this County to enter upon th above-mentioned proper for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE `e ez 3 � Sign./Ir. igna a of'Permittee D to COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0412130036 BUILDING AND SAFETY / LAND DEVELOPMENT - TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 36735 LT: 5 10300 KEY WEST ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803476 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8585-018-069 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, C F1 120V, 15/20A BR CKTS 1.00 BR 17.25 TENANT: JM TRANSFORMERS LT 3KVA 1.00 XFM 15.30 ISSUED ON: PROCESSED BY: PAN BY: EXPIRES ON: TOTAL, FEES 60.30 12/13/04 JK 06/11/05 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: QUAN SHIRLEY G;QUAN CHARLENE J 10300 KEY WEST ST 7 TEMP 917803476ES IPTIO OF WORK INS ALLAT ON OF (PV)SOLAR ELECTRIC SYSTEM INCLUDING (1) 2.5 KWATT INVERTER AND (14) 167 WATT PANELS APPLICANT: TEL. NO: ENERGY EFFICIENCY SOLAR (909) 865-8561- 308 W. MONTEREY SPECIAL CONDITIONS: POMONA, CA 91768 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE ENERGY EFFICIENCY SOLAR (909) 865-8561- 308 W. MONTEREY LIC. NO TEMPORARY POWER POLE POMONA, CA 91768 827074 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 J