HomeMy Public PortalAbout10360 KEY WEST ST_Electrical__ WORKERS'COMPENSATIONDECLARATION 76A663 APPLICATION FOR ELECTRICAL PERMIT �z
CE-806G (2-80)
•I hereby' affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES C BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec 3800;Lab C)
FOR APPLICANT TO FILL IN JOB
' New Residential
Policy No Company Bldgs &Pools rEEACH NO FEE • ADDRESS
Certified`copy is hereby furnished 1 &2-Family,Sq Ft 'i]0 — $ � LOCALITY j
Multi-family Sq Ft —
Certified co IF
CR A
NEAREST14
x
copy>s Bled with the county building inspection Residential Swimming'Pools
department OWNER ORFIRM NAME ,
Date ,Applicant Outlets Rec—Light Sw AMAIL
DDRESS
First 20
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional CITY - Tel No
COMPENSATION INSURANCE }
PLAN CHECK d
APPLICANT
(This section need not be completed if the work involved- _ 0
by the, permit is for one hundred dollars ($100) or les''§.) Lighting Fixtures First 20 ADDRESS
Total No Additional cc
1 certify that iri the performance of the work for which'this Fixed Appliances Not Over 1 HP CITY Tel No
permit is issued, I shall not employ any person in any manner PERMIT• y►' , W
so as to become subject-to the Workers' Compensation Laws ' Range_ Heater•_D W APPLICANT "7 S a
Oven Dryer_W M r ADDRESSZ
DatetlC~lg / Applicant — lqTSXI,)
Top FAU _W.H
Hood = Fan _Other_ CITY 0/V
T��10 Tel,No 7,0 �7 �
NOTICE TO APPLICANT If,,after making this Certificate'o Disp Room Air Cond._ LICENSE OR
Exemption, you should become subject to the Workers' REG NUMBER Class C/ V
Compensation provisions of the Labor Code,,you must forth- Power Apparatus&,Large-App liances DISTRICT NO PROCE SED BY
with,comply with such provisions or this permit,shall•be Size&Type HP, KW,-KVA,or KVAR
'deemed revoked 6,G i '
-Up to 1-Incl
�l FINAL ,
Over 1 to 10 Incl DATE //• QQ
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl •PrP'_U� VALI DATION
I hereby affirm'that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
BY
9 (commencing with Section 7000) of Division 3 of the Busi- Over 100
ti
ness and Professions Code, and my license is in fu 11 force and
effect.• Services /
34�/�f'rr� Lic Class ���� 0-200 Amp Under 600 V ��9�
License Number 201-1000 Amp. Under 600 V r
Contractor/ !NrLno��,SO&wlte ��''� �'�' Over 1000 Amp or Over 600 V s
HOME OWNER-BUILDER DECLARATION Temp Power Pole&Appurtenances
Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's Additional Sign Branch Circuits
License Law for the following reason (Section 7031 5, Busr- ,
ness and Professions Code) ;
Misc"Conduits&Conductors
❑ I, as owner'of the property, will do the work and the Other (See Complete Fee Schedule)— -21 80,8 A
structure is not intended or offered for sale (Section
7044, Business and'Professions Code). #•o b o 0 o 2
CONSTRUCTION LENDING AGENCY _
I hereby affirm that there is a construction lending agency r 2 0;0 5 2 2 5
for the performance of the work for which this permit is PERMIT FEE (Sub-Total)
issued(Sec 3097,Civ C) °'O 'O 5 2 2 5 p�('
Lender's Name PLAN CHECKING FEE (One-Fourths Permit Fee)
Lender's Address PERMIT ISSUING FEE J#7 I VO 2'-8
I certify that I have read this application and state that the TOTAL FEE
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 above-mentioned property for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
` COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1403310067
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT.
ILEGAL ID I FEES PAID I BUILDING ADDRESS: 1
ITR 37579 LT: 12 I I 10360 KEY WEST ST I
I _IFEE DESCRIPTION QUANTITY UOM AMOUNT: ( TEMP CA 917803476 I
(ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET HALIFAX I
18585-018-033 IA1 PERMIT ISSUANCE FEE 27 80 I THOMAS PAGE 597 GRID C4 LOCALITY: TEMPLE CITY CAI
I _ILB 200 AMP PANELS, MCC 1 00 PAN 38 90 1_ I
(TENANT. I TOTAL FEES 66 70 (ISSUED ON PROCESSED BY PLAN BY I
103/31/14 SR I
(OWNER. TEL NO I IFINAL DATE FI BY CODE 1
ISHUE, CHIA CHI (626) 818-8768- I
110360 KEY WEST ST
(TEMP 917803476 I 1DESCRIPTION OF WORK
(UPGRADE EXISTING ELECTRICAL SERVICE FROM 100 TO 200 AMP I
(APPLICANT: TEL NO I
SAME AS OWNER i (SPECIAL CONDITIONS I
I I I I
ICONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE I
SAME AS OWNER -
I
LIC NO 1 ITEMPORARY POWER POLE I I
I I? 11 I
(UNDERGROUND CONDUIT I
(ARCHITECT OR ENGINEER TEL NO '1 IUFrR GROUND I I I
LIC. NO I IROUGH CONDUIT 1 1
1 IROUGH WIRING I I
IMA1N WATER LINE I I
IPLASTIC Y/N METAL Y/N I I I
(
(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 I I I I I
I 1 I I I I
I I I I I I
I IREPORT ID DPR265 ROUTE TO BS0508 I I I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508- ELECTRICAL PERMIT -
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0905060027
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 -
PHONE (626) 285-0488 EXT
LEGAL ID. FEES PAID BUILDING ADDRESS
ITR 37579 LT 12 10360 KEY WEST ST
IFEE DESCRIPTION. - QUANTITY UOM- AMOUNT TEMP CA 917803476 -
(ASSESSOR INFORMATION NUMBER I II NEAREST CROSS STREET
18585-018-033 1A1 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE: 597 GRID C4 LOCALITY TEMPLE CITY, Cl
I IJ7 OTH PWR APP +10-50HP 1 00 PWR 46 05
ITENANT I TOTAL FEES 73 80 (ISSUED ON. 'PROCESSED BY PLAN BY EXPIRES ON 1
105/06/09 SR 11/02/09
OWNER TEL NO IFINAL DATE FINAL BY CODE
ISHUE CHIAYI TR - -
110360 KEY WEST ST
,TEMP 917803476 IDESCRIPTION OF WORK
ELECTRICAL FOR SOLAR PANELS
(APPLICANT TEL NO
AMERICAN HOME CRAFT INC. (957) 445-8373-
11251 POMONA RD _#107 ISPECIAL CONDITIONS-
CORONA, CA 92882 -
I
ICONTRACTOR: TEL NO I JAPPROVALS DATE INSPECTOR SIGNATURE 1
(AMERICAN HOME CRAFT, INC (957) 445-8373- 1
11251 POMONA ROAD SUITE 107 LIC NO ITEMPORARY POWER POLE'
(CORONA, CA 92882 790709 I 1 1 1
- (UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER TEL. NO. I IUFER GROUND I I I
1 LIC NO IROUGH CONDUIT 1 1
IROUGH WIRING I I I
- IMAIN'WATER LINE
PLASTIC Y/N METAL Y/N
(UTILITY COMPANY NOTIFIED
' EXPIRE®
1REPORT ID DPR265 ROUTE TO BS0508
1