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Home My Public Portal About10153 LA ROSA DR_Electrical__ " affirm that COMPENSATION DECLARATION 176A663 awara7 APPLICATION FOR ELECTRICAL PERMIT 20-001 hereby,affirm, that f have a certificate of consent to self CESo insure, or a certificate of Workers',Compensaiion Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ,c ora certified copy Thereof (Sec. 3600, Lab. C.)- - Policy No. Company - FOR APPLICANT TO FILL IN JOB n / I O L� UCertified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADLDRESS /Vj V Certified copy is filedwith the county building inspec- 1 8 2-'Family, Sq. Ft. $ — $ LOCALITY i m L �• lion department.' Multi-family Sq. Ft. — NEAREST CROSS ST. Residential Swimming Pools ✓V' Date Applicant _ r OWNER OR n 1A FIRM NAME C `"1 CERTIFICATE OF EXEMPTION FROM WORKERS' '� � Z �� 't-_ MAIL Outlets: Rec_Light_Sw. � COMPENSATION INSURANCE � �O � Lt'L ADDRESS /J� First 20 (This section need.not be completed if the work involved by Total No. -7 Additional x G'CJ - ;j �j 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'beco_me subject to the Workers'Compensation Laws. Lighting Fixtures First 20ADDRESS ' Additional U Dote - Applicont, - Total No.� CITY Tel. No. NOTICE TO ,APPLICANT: If, after mthis Certificate of fixed Appliances Not Over 1 HP PERMIT aking Exemption, you should become subject to the Workers' Range_ Heater—D.W. — APPLICATION Compensation provisions of the Labor Code, you most forth- Oven _ Dryer —W.M.— ADDRESS with -comply with such provisions or this permit shall be Top FAU W,H. — deemed revoked. -Hood — Fan Other_ CITY Tel. No. - I LICENSED CONTRACTORS`DECLARATION -Disp. _ Room Air Cone. — /O LICENSE OR " I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER Class. (commencing with Section 7000)of Di"vision3 of,the Business Power Apparatus 8 Large Appliances DISTRICT NO, P_ROgSSED BY d and Professions Code,and my license is in full force and effect. Size 8 Type HP, KW, KVA, or KVAR �J �ILz�+ 4J U License Number Lic. Class U Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE I.z �•Z VALIDATION CoNractorDate❑ Over 10 to 50 Incl F- U .I am exempt under Sec. Over 50'to-1170 Inc. FINAL - W 8.8P.G. for this reason Over 100 d Services, Swbd., MCC 8 Panelboards Date: \ Z 0.- 200 Amp. Under 600 V - — Signature 201 - 1000 Amp. Under 600 V - •- O Exemption for Reg. Moint. Elect. Over 1000 Amp, or Over 600 V SINGLE FAMILY HOMEOWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits L^jt%• ,� e.�: Professions Code): I, as owner of the property, will do the work and the Misc. Conduits.&Conductors — structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ ® i i p�li 65, I Business and Professions Code).' `-,iEi-i.` 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.). - • - t PLAN CHECKING FEE 147 11 Lender's Name PERMIT,ISSUING FEE m tc 1 t?tis Lender's Address TOTAL FEE j ry I certify that I have read this application and state that the 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 m nti ed property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signal a of Permit ee Date - ti es WORKERS' CI have ATIONicate of corse .z000wDPW a1ar APPLICATION FOR ELECTRICAL PERMIT O 0W1 ' hereby affirm that haver certificate of consent to self [L-8CKG insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lob. C.) Policy No. Company. FOR APPLICANT TO.FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS 1005 LOCALITY (( Cfutr Certified copy is filed with the county building inspec- 1 8 2-Family, Sq. Ft. $ — $ ewe l ` 1 tion department. Multi-family Sq. Ft. - — NEARESSST a ' 1 Residential Swimming Pools CROST. Lay.. Date Applicant OWNER _ IJ - - FIRM NAME 'l Y CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL Outlets: Rec—Light_Sw._ COMPENSATION INSURANCE ADDRESS (h. OO�F ( completed if the work involved b This section need not be com First 20 - g. Y 1 CITY Tel. No. _ C the permit is for one hundred dollars ($100)or less.) Total No. Additional PLAN CHECK I certify'thai 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 Additional Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HE PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION Exemption, you should become subject to the Workers' Runge— 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. Hood — Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION ^ Dis _ Room Air Cond. _ LICENSE OR -. hereby affirm that i am licensed under provisions of Chapter 9 p .REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. P SSED BY > and Professions Code,and my license is in full force and effect i CL - . . Size 8 Type HP, KW, KVA, or KVAR 0 License Number Lic. Class Up to 1 Intl. FINAL U Over 1 to 10 Incl DATE Z, VALIDATION Contractor Date Over 10 to 50 Incl. F– ❑ FINAL I am exempt under Sec. Over 50 to 100 Inc. BY LU B.BP.C. for this reason Over 100 a- Services, Swbd;'MCC 8 Panelboards11011. U)Dote: 0- 2D0 Amp. Under 600 V a� Z Signature _ 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Mainz. Elect. SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances hereby affirm that exempt from the Contractor's License Sign with One Branch Circuit i=ir_1. Law for the followingg r it reason (Section 7031.5, Business and Additional Sign Branch Circuits 1'.a Pro scions Code): _7Q1 I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intendedor offered for sale(Section 7044, Other(See Complete Fee Schedule)_ Business and Professions Code). 1101 Til;r� � 70 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) iA('�0= ,III( (Sec. 3097,Civ.,C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address 9 7 I certify that I have read this application and state that the TOTAL FEE 70 above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical 9, and , hereb outhori , representotives of this Co o enter upon r th d property for ins ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig Lure of Permittee Date �' COUNTY OF LOS ANGELES TEMPLE CITY, # 0508 ELECTRPCAL PERMITDEPARTMENT OF PUBLIC WORKS - 9701 LAS TUNAS - EC 0508 0504180966'_'l ° - BUILDING AND SAFETY/ LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: _ _ - LEGAL ID: FEES PAID BUILDTRGADDRESS: TR: 10821 LT: 13 BL: .001 - - 10153 LA ROSA DR ' FEE DESCRIPTION: QUANTITY: UDM: AMOUNT: TEMP'CA 917803305 ASSESSOR INFORMATION NUMBER: NEARESTCROSS.STREET: BADWIN 8585-007-021 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 .LOCALITY': TEMPLE CITY-, C B2 1 OR 2 FAMILY DWELL 640.00 SQ 67.20 TENANT: - TOTAL FEES 94.95 IS ED 0 C D LAN BY: EXPIRES N: 04/18/05 JK; 10/15/05 MER: TEL. N0: FI L D E - F,1 NAL BY: C 0 1CHING MU 0153 LA ROSAIDR CHIEN WANG (626) 448-4887- TEMP 917803305 E RI IO ORI..• ELECTRICAL-FOR GUEST k APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS:- CONTRACTOR: ONO TIONS:-CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO TEMPORARY POWERPOLE UNDERGROUND- ONDUIT ARCHITECTOR ENGINEER: T D: UFER GROUND CHU, JACK (626) 448-4887- 130 EVERETT LIC. NO: ROUGHCONDUIT MONTEREY PARK, CA 91755 NONE ROUGH N RIN -- MAIN WATER LIME PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTI RM REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES - TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0504180005 BUILDING-AND-SAFETY-/ LAND DEVELOPMENT - TEMPLE CITY CA 91780 - PHONE: (626) 285-0488 EXT: LEGAL ID: - FEES A SS: TR: 10821 LT: 13 BL: .001 10153 LA ROSA DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803305 SS NEAREST CROSS STREET: BADWIN 8585-007-021 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4- LOCALITY: TEMPLE CITY, C F1 120V, 15/20A BR CKTS •3.00 BR 51.75 G1 OUTLETS-LGT,SW,RECP 17.00 OUT 33.15 ISSUED 0N: PROCESSED 8 L XP ON: G2 LIGHTING FIXTURES 6.00 LGT 11.70 04/18/05 JK 10/15/05 H5 RES WASH MACH LT 3HP 1.00 WAS 10.95 OWNER: TE 0: H7 RES EXHAUST FANS 1.00 EX 10.95 FINA DA FINAL BY: CODE: CHING MU YU;PIAO CHIEN WANG (626) 448-4887- TOTAL FEES 146.25 Z O� sib 10153 LA ROSA DR TEMP 917803305 ESC F ELEC RI CAL FOR NEW GAR APPLICANT: EL. . SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. 0: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NOEMYPOWER POLE UNDERGROUND CONDUIT ENGINEER:ARCHITECT OR CHU, JACK (626) 448-4887- F GROUND 130EVERETT LIC. NO: ROUGH CONDUIT MONTEREY PARK, CA 91755 NONE S� R0-U-ffFVrR7NG MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITYCOMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508