HomeMy Public PortalAbout10318 KEY WEST ST_Electrical__ WORKERS' COMPENSATION DECLARATION 10/81 APPLICATION FOR ELECTRICAL PERMIT
I.hCE-806G affirm that I have a certificate of consent to self CE-806G 7�
Cure, ora certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY 'u{
or a certified copy thereof (Sec. 3800, Lab. C.)
Policy No. �0
Company FOR APPLICANT TO FILL IN JOB rr ra �J�
'
Certified copy is hereby furnished. New Residential Bldgs. & Po I EACH NO. FEE ADDRESSE111 � y- W
Q
1 & 2-Famil S Ft. $ — $ LOCALITY �" G(
Certified copy is filed with the county building inspec- Y- 4 —
tion depa tment. Multi-family Sq. Ft. NEAREST
/� ��.� CROSS ST.
Date Applicant �` `� , Residential Swimming Pools OWNER OR
.FIRM NAME S G�
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL
COMPENSATION INSURANCE ADDRESS
seon neenot completed if the work involved b First 20
(Thisctid t b
p Y Total No. Additional CITY Tel. No.
the permit is for one hundred dollars ($100)or less.)
that in the performance of the work for which this PLAN CHECK
I certify P 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 KQCA4_,)eA LCC�C all G
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 ,t ,eA Tel. No.y ^yS'7
LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_
LICENSE OR / GO
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER ��j `�� tO Class. (i
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCES Y C'
Power Apparatus & Large Appliances
and Professions Code,and my license is in full force and effect. d� O�
�
Size &Type HP, KW, KVA, or KVAR' c
License Number 12.60 63rO Lic. Class c f � Up to 1 Incl. FINAL n=
Contractor A", (A &ec7r ate l 3 5'5— Over 1 to 10 Incl. DATE ���� VAII TION
❑ Over 10 to 50 Incl. FINA W
I am exempt under Sec. Over 50 to 100 Inc. FI
B.&P.C. for this reason Over 100
Date: Services, Swbd., MCC & Panelboards
0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
DOver 1000 Amp. or Over 600 V �3 2 a 1 A
Exemption for Reg. Maint. Elect.
SINGLE FAMILY Temp. Power Pole &Appurtenance's # o 0 0 o b 2
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 ° ° 8 7. 1 4
Low for the following reason (Section 7031.5, Business and
Professions Code): x
� � � � 87, 1 4�
1, 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)_ ► I Q 2(�=85
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)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name 6, J)
PERMIT ISSUING FEE (J v
Lender's Address /
I certify that I have read this application and state that the TOTAL FEE0 If
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
her y authorize representatives of this County to enter upon
the bove-ment oned pro ty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
L61,
gnat of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9808280003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 36735 LT: 8 10318 KEY WEST ST
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803476
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
8585-018-072 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, C
G1 OUTLETS-LGT,SW,RECP 4.00 OUT 7.80
TENANT: G2 LIGHTING FIXTURES 2.00 LGT 3.90 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
TOTAL FEES 39.45 08/28/98 VG 08/28/9
OWNER: TEL. NO: FINAL DATE FINAL BY CODE:
RYKER, BETH (626) 448-6304-
10318 KEY WEST ST
TEMP 917803476 DESCRIPT ON OF WORK
ELECTRICAL FOR BATHROOM REMODE
APPLICANT: TEL. NO:
S & N CONSTRUCTION (626) 792-2020-
P. 0. BOX 93194 SPECIAL CONDITIONS:
PASADENA, CA 91109 -
CONTRACTOR: TEL. NO: �/ n�9 APPROVALS DATE INSPECTOR SIGNATURE
S & N CONSTRUCTION (626) 792-2020-
P. 0. BOX 93194 LIC. NO -`i � �� TEMPORARY POWER POLE
PASADENA, CA 91109 684541B
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. N0: - 7 ���/�-� \�,���� UFER GROUND
LIC. N0: � ��lllllll �� ROUGH CONDUIT
ROUGH WIRING
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
REPORT ID: DPR265 ROUTE TO: BS0508