HomeMy Public PortalAbout10350 KEY WEST ST_Electrical__ WORKERS' COMPENSATION DECLARATION CE-806 10/8t APPLICATION FOR ELECTRICAL PERMIT
I he5eby 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 FOR APPLICANT TO FILL IN JOB
Ce ified co s hereb furnished EACH- NO FEE ADDRESS �� �� L• �"" "�
pt' Y New Residential Bldgs 8 Po I
a
Certified copy is filed with the county building mspec_ 1 & 2-Family, Sq,Ft $ —
$ LOCALITY
tioAq
n department Multi-family Sq Ft — NEAREST
7 J $� �QG4>r�C/� ��,� Residential Swimming Pools t,�, OWNER OR OSS ST �`
Date Applicant 'a,` 44 !1 •' t (FIRM NAMEW f-
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw_ �, 7 (MAIL
COMPENSATION INSURANCE' First 20 ADDRESS
(This section need not be completed if the work involved by 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 shrill not employ any person in any manner
so as to.become subject'to the Workers'Compensation Laws Lighting Fixtures First 20 ADDRESS
'
' I I 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
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 Tel No 44-75--7 y'f.
LICENSED.CONTRACTORS DECLARATION Hood _ Fan _Other_
Disp _ Room Air Cond LICENSE OR 3��o Class (�
I,hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER O
(commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO PROC S BY per„
and Professions Code,and m license is in full force and effect
y Size &Type HP, KW, KVA, or KVAR �J f V U
License Number34'6_4""fOL c Class G r Up to 1 Incl FINAL �=
Contractor r�JA LAG,`' Date I'P 't'3 9T Over 1 to l0 lncl DATE ZV, VALI TION
Over 10 to 50 Incl FINALI LU
❑ I am exempt under Sec Over 50 to 100 Inc BY CL
B &P C for this reason Over 100 Z
Date Services, Swbd , MCC 8 Panelboards
0 -200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V
❑ Exemption for Reg Mamt Elect Over 1000 Amp or Over 600 V 932&7 A
SINGLE FAMILY Temp-Power Pole 8 Appurtenances # o 0 0 o.? 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I o 0 8 5 0
I hereby affirm that'I am exempt from the Contractor's License - r
Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits
Professions Code) 0 0 o86505
8 5 0 L)
❑ I, as owner of the property, will do the work'and the Misc Conduits 8 Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 4 Q24-85
7044, Business and Professions Code) t
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
PERMIT ISSUING FEE �U
Lender's Address 404
I certify that I have read this application and state that the TOTAL FEE
above information is correct I agree to comply with.ail County
ordinances and State jaws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
thea ve-mentioned pro erty for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
A4 4
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Si nature ermittee f5ate,
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1205210043
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE. (626) 285-0488 EXT
ILEGAL ID 1 _ FEES PAID BUILDING ADDRESS I
ITR 36735 LT 13 1 10350 KEY WEST ST 1
I IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803476 I
(ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET
18585-018-077 IP2 PC RES PV<10KW 153 90 I THOMAS PAGE 597 GRID C4 LOCALITY TEMPLE CITY,- Cl
I IA1 PERMIT ISSUANCE FEE 27 80 1 I
ITENANT IP3 INVRTR RES PV<10KW 27 90 (ISSUED ON- PROCESSED BY PLAN BY 1
TOTAL FEES 209 60 107/05/12 SR -
(OWNER TEL NO- FIN DATES / FIN CODE
OSOLLO LUIS STHER *'!/
10350 KEY WESTST ST
ITEMP 917803476 I ESC IPTION OF WORK
IP V SOLAR
I
1APPLICANT TEL NO I I I
ISHELDON, CHEYNE (562) 371-4947- I 1
12020 DEL AMO BLVD 1 ISPECIAL CONDITIONS
1
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ICONTRACTOR TEL NO 1 (APPROVALS DATE INSPECTOR SIGNATURE 1
ISUNGATE ENERGY SOLUTIONS (858) 457-4500- 1 1 1
16335 FERRIS SQUARE LIC NO ITEMPORARY POWER POLE I I
ISAN DIEGO CA 92121 790709 B 1 1-1
(UNDERGROUND CONDUIT
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(ARCHITECT OR ENGINEER TEL NO I IUFER GROUNDI
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LIC NO i TROUGH CONDUIT I I
I IROUGH WIRING
I - IMAIN WATER LINE I
IP1,713TIC Y/N METAL Y/N
I
1 (UTILITY COMPANY NOTIFIEDI I 1
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IREPORT ID DPR265 ROUTE TO BS0508 1 I 1 1
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