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Home My Public Portal About10330 KEY WEST ST_Electrical__ WORKERS' COMPENSATION DECLARATION 10/81 APPLICATION FOR ELECTRICAL PERMIT ,I..hereby,'affirm that I have 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 copy thereof (Sec. 3800, Lab. C.) Policy No. —Company Company FOR APPLICANT TO FILL IN JOB ADDRESS j 3dv � Certified copy is hereby furnished. New Residential Bldgs. & P s .. EACH NO. FEE — g _ g LOCALITY �� G Certified copy is filed with the county building inspec- 1 8 2-Family, Sq. Ft. G NEAREST tion department. Multi-family Sq. FL CROSS SL 14 Date 23 8SApplicant c4aca � d'A GT-. Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw. MAIL COMPENSATION INSURANCE ADDRESS need completed if the work involved b First 20 (This section nd not bm 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 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 TAdditional Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT A"8C 1A FCeCAk C- 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 1/7,2,ri- J with comply with.such provisions or this'permit shall be Top — FAU —W.H. — deemed revoked. Hood _ Fan _Other— CITY 1 A Tel. No.ugC75 76 LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. NUMBER 3O Class. C,—to } (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PRO D BY n- Power Apparatus& Large Appliances /' and Professions Code, and my license is in full force and effect. YP �"' V(� U Size &Type HP, KW, KVA, or KVAR' (J License Number 32206(0 Lic. Class 4:2_60Up to 1 Incl. FINAL Contractor f` �'�Date f'D g3 Over I to 101nc1. DATE _ �J V IDATION ❑ Over 10 to 50 Incl. FINA U W I am exempt under Sec. Over 50 to 100 Inc. BY n- N 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 3 2 a 5 A 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 # 0 0 0 0 0 2 Law for the following reason (Section 7031.5, Business and Professions Code): ) - 8650 ❑ 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)_ , 0 0 o 86506 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 �q PERMIT ISSUING FEE (f Lender's Address I certify that I have read this application and state that the TOTAL FEE 6 L 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 ab ve-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �0 23 g Jr Si oture o ermittee Date COUNTY OF` LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1101240004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: 1TR: 36735 IT: 10 10330 KEY WEST ST I 1FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917803476 (ASSESSOR INFORMATION NUMBER: 1 I NEAREST CROSS STREET: HALIFAX 18585-018-074 lAl PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, Cl 1 1G1 OUTLETS-LGT,SW,RECP 26.00 OUT 47.00 1 TENANT: 1 TOTAL FEES 74.80 JISSUED ON: PROCESSED BY: PLAN BY: 101/24/11 SR (OWNER: TEL. NO: 1 1F AL DATE FIN L Y: CODE: 1 1TRAN, WILLIAM (626) 862-1778- 1 110330 KEY WEST ST 1, 1TEMP 917803476 1 IDE77CRIPTION OF WORK 1 (ADD 26 LIGHT FIXTURES (APPLICANT: TEL. NO: 1 1WENDT, RON (626) 497-6320- - 1 1 (SPECIAL CONDITIONS: 1CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE 1 1WENDT AND SONS CONSTRUCTION (626) 497-6320- 1 1 1 16149 LOMA AVENUE LIC. NO 1 1TEMPORARY POWER POLE I I I 1TEMPLE CITY, CA 91780 432646 1 1 1 (UNDERGROUND CONDUIT (ARCHITECT OR ENGINEER: TEL. NO: 1 IUFER GROUND 1 1 1MONTENEGRO, PEDRO (626) 786-4359- 1 1 1 1 18660 MISSION DR LIC. NO: 1 1ROUGH CONDUIT 1 1 1ROSEMEAD CA 90065 55345 1 1 1 1 1 1 IROUGH WIRING I I I I 1 I (MAIN WATER LINE PLASTIC YIN METAL YIN 1 (UTILITY COMPANY NOTIFIEDI I I I I I I I I I I I I I I I I I I I I I I I I I I 1 I I I I I I I I I I I 1 I I I I I I I I I I I I I I I I I 1 1REPORT ID: DPR265 ROUTE TO: BS0508 I I I I I I ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1011240020 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: ITR: 36735 LT: 10 I 1 10330 KEY WEST ST (FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917803476 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: HALIFAX 18585-018-074 IA1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, Cl 1 'F2 208, 277V LGT BR CKT 00 BR 109.20 I I (TENANT: IG1 OUTLETS-LGT,SW,RECP 10.00 OUT 19.40 (ISSUED ON: PROCESSED BY: PLAN BY: I I 1G2 LIGHTING FIXTURES 18 00 LGT 34.90 111/24/10 SR I 1H2 RES GRBG DISP LT 3HP1.00 DIS 10.90 I I (.OWNER: TEL. NO: IH3 RES DISHWASHR LT 3HP 1.00 DIS 10.90 IFI AL DATE F NAL BY: CODE: I ITRAN, WILLIAM (626) 862-1778- IH4 RES RANGE HDS LT 3HP 1.00 HOO 10.90 I [ I 1 110330 KEY WEST ST ILN OTHER PNL 0-399AMP5 1.00 PAN 38.80 I ITEMP 917803476I •OTAL FEES 262.80 (DESCRIPTION OF WORK 1 (ELECTRICAL FOR KIT cEN, TWO BATHROOMS REMODEL AND SUB-PANEL I (APPLICANT: TEL. NO: I � �� 100 AMP ARLO-w,r� of _1 ` 1 IWENDT, RON (626) 497-6320- I ! 1 CJJ 1 1 1 ISPECIAL CONDITIONS: I 'CONTRACTOR: TEL. NO: I 'APPROVALS DATE INSPECTOR SIGNATURE IWENDT AND SONS CONSTRUCTION (626) 497-6320- 16149 LOMA AVENUE LIC. NO I ITEMPORARY POWER POLE ITEMPLE CITY, CA 91780 432646 I I 1 1 I (UNDERGROUND CONDUIT I I I 'ARCHITECT OR ENGINEER: TEL. NO: 1 1UFER GROUND I I I I I I LIC. NO: 1 IROUGH CONDUIT I I I I I I IROUGH WIRING I I 1 1 1 IMAIN WATER LINE I I 1 I I IPLASTIC Y/N METAL Y/N I I I 1 ' (UTILITY COMPANY NOTIFIEDI I 1 I I I I I I 1 I I I 1 i I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 I I I I I I