Loading...
HomeMy Public PortalAbout10232 LA ROSA DR_Electrical__ WORKERS'COMPENSATION DECLARATION 76A663 APPLICATION FOR. ELECTRICAL PERMIT •� c/r 71 "" CE-806G 12-801 I I I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELS , - BUILDING AND E Y•• U insure, or a certificate of Workers Compensation Insurance,or - ✓// _ a certified copy thereof(Sec 13800 Lab ,C.) - _ I' FOR APPLICANT'TO FILL IN ' JOB '7 Policy No. Company EACH NO. , FEE ADDRESS f� � IX - New Residential Bldgs&Pools. Wepy"5ho'e" ' y furnished. 1 &2-Family,Sq. Ft. $ _ — $ LOCALITY Multi-family Sq. Ft. ' — NEARESTfiled with t e my buil inspection CROSSST . p Residential Swimming'Pools. � OWNER ORFIRM NAMEOutletsRee_Light_5w.' MAIL%' First. ADDRESSTE OF EXEMPTION FROM WORKERS'- Total No. Additional CITY - - .Tel No. _ COMPENSATION INSLRANCE "* - y d . - PLAN CHECK' APPLICANT 0' ` (This section'need not be completed if the work involved Lightin Fixtures 'First 20 .t ' by the permit is for one hundred dollars ($100) of less.) g- ^ADDRESS Q - - Additional _ .1 certify that in the`perforriante of the work for which this Total No. CITY Tel No: - F- ermit is issued, I shall not employ-an person in an manner Fixed Appliances Not Over 1 HP ., P Y P Y PERMIT .so as to become subject to the Workers'Com pensa tionLaws. Range_ Heater_•D.W. APPLICANT I.11`, .l ' lL��Y•l-S d Oven _ Dryer W.M._ ADDRESS '/O Sae Z Date - Applicant Top . — FAU _W.H. - - )p Hood _ Fan _Other_ 40 ei• Tel No. NOTICE TO APPLICANT'.. If, after making this Certificate of . Disp. Room Air Cond. / LICENSE OR Exemption,- you should become subject to the. Workers' - r REG. NUMBER Class Compensation,provisions of the Labor Code„you musfrforth-. Power Apparatus& Large Appliances DISTRICT NO. PROCES D BY- with comply with such ,provisions or this permit shall be'r _ r/ ' deemed revoked. - Size&'Type HP,KW, KVA,or KVAR Up to 1 Incl. _ - FINAL rj� qj.` LICENSED CONTRACTORS DECLARATION - Over 1 to 101ncl. DATE, VALIDATION - Over 10 to 50 Incl'' 'I herebyaffirm that I am licensed under p FINAL provisions of Chapter Over 50 to 100 Inc. BY I 4 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 ness and Professions,Code, and my license is in full force and - effect. _ Services - License N r - o ' Lic�Class, / 0-200 Amp. Under,600 V IP,Z 7f2- .201-1000 Amp. Under 600N Contra m Dat �] J Over 1000 Amp.or Over 600 V ' s, t ER-B .DECLARATION Temp.Power Pole&Appurtenancesy I' hereby affirm that I am exempt from the Contractor's. Sign with One Branch Circuit nal 5 3 2 3A License Law for the following reason (Section 7031.5, Busi - Additional Sign.Branch Circuits_ , ness;and Professions Code): , `2 - ' Misr.Conduits&Conductors - �• ❑ I, as owner of the property, will do the work and .the Other (See Complete Fee Schedule)— Q eye,e Orj C structure is not'intended,or offered .for sale (Section - - 1 7044, Business and Professions Code). - ' o CONSTRUCTION LENDING AGENCY9 O=e e'e ro S ' I hereby affirm that there, is a construction lending agency 0 .� 9-_T.1for the performance of the work for which this permit' is PERMIT FEE - (Su b-Total), issued (Sec. 3097,Civ.C.). � . - Lender's Name PLAN CHECKING FEE _(One-Fourth Permit Fee Lender's Address PERMIT ISSUING,FEE 1 certify that.I have read this application and state that the TOTAL FEE. ,aboveinformation is correct-.I agree to comply-with alLCounty ordinances laws regulatin lectrical wir” g and - - hereby thorize repres tatives o is C my to to up the ab e-mentioned pr etry fo ins cti n pure es. SEE'REVERSE..FOR EXPLANATORY LANGUAGE - Signature ofTermittee Date - WORKERS'COMPENSATiON.DECLARATION 76A86 6G 12-B01 63 Cr APPLICATION FOR ELECTRICAL PERMIT ' I hereby affirm 'that 1 have a' certificate of consent to self COUNTY OF LOS ANGE LES - BUILDINGANDSAFETY insure, ora certificate of Workers'Compensation.Insurance,or a certified co y thereof .3800, ab[C.) ' fj$ FOR APPLICANT TO FILL IN JOB Policy No©1 /ice �COpzny D / . .ADDRESS New Residential'Bldgs. &Pools EACH NOL ' FEE Certified col;.is hereby furnished.- 1 &2-Family,Sq. Ft. $ $ LOCALITY Multi-family Sq. Ft. — NEAREST 'V/ Certified copy is filed with the county building mspecti CROSS ST - department 't. Residential Swimming Pools - OWNER OR- / [[�� /� FIRM NAME Date�7L. U Applmant J'='�•�� "��"� Outlets: Rec.—Light -Sw. MAIL / 'First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No.. - Adnitional CITY"�� ' 'C G`+ Tel No. L ?7-7 / > COMPENSATION-INSURANCE `' a PLAN CHECK . - O. (This section need not be completed-if .the.work,involved 1 APPLICANT U Lighting Fixtures First 20, ADDRESS by the permit is for one hundred dollars ($100).or less.) Ir Total No. - - O 1 certify that in'the"performance-of the work for which this CITY • Tel No. U Fixed Appliances Not Over 1HP - permit=is Issued; I'shall not employ any person in any manner PERMIT - LLI so as to become subject to the Workers' Compensation s1. "Range_Heater D W. APPLICANT N _�e ' CottL En Oven _ Dryer W.M. - ADDRESS �. Sr_ I _,%, 60- ?��� j,le.l Z Dater/ /.L Applicant /—� •� Top FAU W.H., p Hood Fan —Other 1y1 �; CITY 5f>'R> &p bat e(Tel No.. 2O S,5 5;1-1 NOTICE TO APPLICANT: If,.after making this Certi£icate.of 'Disp. — Room Air Cond.�_ 1. LICENSE OR LS �.ZD(o Class G_ `0, Exemption, you should become. subject' to the Workers' - REG.NUMBER - Compensation provisions of the Labor.Code,.you must forth- Power Apparatus& Large Appliances DISTRICT���JJJ O. PROCESSED BY - with comply with: such provisions or this, shall Abe de "' wied. - Size&Type HP,KW, KVA,or KVAR 3 L Up to 1 Incl. FINAL Over 1 to 10 Incl.' DATE LICENSED CONTRACTORS DECLARATION - (O �O Over 10 to 50 Incl. O VALIDATION- . . 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 - l/ - ness and-Professions.Code,;and my license�is,in full force and •effect. �- Services 01 , License Number,'5'J701/ Lie. Class �1 0-200 Amp. Under 600 V 7 201-1000 Amp. Under,600 V. - Contractor" Date' 4 Over 1000 Amp,or Over 600 V •HOME OWNER;B LLM DECLARATION Temp. Power Pole&Appurtenances: I hereby affirm that- I am exempt 'front the Contractor's Sign with One Branch Circuit. License Law.for the following'reason (Section,7031:5: Busi-. additional Sign Branch Circuits - •,. ness and Professions,Code):' ' Misc.Conduits&.Conductors, _ I, as owner of the property, will do the work and the " Other (See Complete Fee Schedule) s@uct ore is not intended or offered for sale (Section 2 4:23.5 A' - 7044; Business.and Professions Code). , CONSTRUCTION LENDING AGENCY.• " •1 hereby affirm that 'there is a construction lending agency _ r� for the performance of the work for which this .permit is PERMIT FEE .(Sub-Total) :w+ 2 -i 26'5 issued (Sec. 3097,Civ.C_.). - - Lender's Name '. ., PLAN FEE (One�Fourth Permit Fee) � / -a.� X2(1•,5��_ , Lender's Address -PERMIT ISSUING FEE OV_$2 . . W I certifythat I have read this application and state=[hat the TOTAL FEE above information is correctrl agree to comply with all County ordinances and State laws regulating Electrical wiring, and - - •' -hereby authorize representatives of this County to enter upon - - - e ve-mentioned propert r m ect ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee I _ WORKERS'COIC1PENSATION DECLARATION 768663CE 80613 (2-80)" 'APPLICATION FOR. ELECTRICAL. PERMIT - I hereby affirm that Ihave a certificate of consent toself COUNTY OF LOS ANGELES ' BUILDING AND SAFETY insure, or a certificate 61 Workers'Compensation Insdrance,mr • - I' a certified copy thereof(Sec. 3800,'Lab. C.) - --71t IY+(a rQ FOR APPLICANT TO FILL IN JOB ^� I A D.r l� /µ� Policy No�1 ompany TIIT�OC Wc" � 'EACH NO. FEE ADDRESS L Lk e4L) 1 New Residential Bldgs. &Pools Certified copy.is hereby furnished. 1 & 2-Family,Sgl Ft. $ — $ LOCA TN �'�'+ t ' + Multi-family Sq. Ft. — NEAREST Certified copy'is filed with a ounty building,inspection - CROSSST depart ent. - Residential Swimming .OWNER OR z. FIRM NAME 'GO Darr Applicant 'Outlets: Rec)ELight •- Sw:�. MAIL Es First 20 !� AM AIN Llt i3 CERTIFICATE OF EXEMPTION FROM'W RKERS' Total No.. a. , Additional CITY •TeLNo. COMPENSATIONANSURANCF. } PLAN CHE K 0• APPLICANT L) (This section need not be completed if the work involved • ' '7•� 4' 3 — _ U by 'the permit is for one hundred dollars (S100) or less.) Lighting Fixtures First 20 ADD 5 `1 , Total No. ' Additionall � p 1 certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP 1CITV Tel No. 3 =?'If F permit is issued, Ishall not employ any person in any manner PERMIT -1 W so as to become subject to the Workers' Compensation Laws. Range_ Heater_.D.W. APPLICANA fL Oven _ Dryer _ ADDRESS N Date APPlican[ - Top — FAU _W.H. .. - Z Hood — Fan _0ther 87'0, CITY Tel.N NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Roam Air Cond._ 3,� D , "� b-2)LICENSE ORLIJJ Exemption, you should become subject to the Workers' REG. NUMSE13 IrO I - Class. Compensation'provisions of the.Labor Code, you must.forth- Power Apparatus& Large Appliances DISTRICT NO: PROCESS D BY with,comply with,such provisions or this permit shall be Size&Type HP,KW, KVA,".orKVAR + deemed revoked. Up to 1 Incl. FINAL Over I to 10 Incl. DATE LICENSED CONTRACTORS DECLARATION. - Over 10 to 50-Incil - '— — it VALIDATION I hereby affirm that 1 am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL. , '9 (commencing with Section 7000) of Division 3of the Busi- Over 100 BY ness and Professions-Code, and,my license is in full force and, + 1 - effect. - 2• Services- I ' License a Lia Class \� � 0-200 Amp. Under 600 V Z01-1000 Amp. Under 600 V Contract Date Over 1000 Amp or Over'600 V v , HOMEOWNER-BUILDER,DECLARATION - Temp. Power Pole&Appurtenances Sign with One Branch Circuit 'e.J 9 9 5 A. I hereby affirm that am, exempt from the Contractor's Additional Sign Branch Circuits License Law for the following lowing reason (Section 7031'.5, Busi- �s.2 ness and Professions Code): t Misc.Conduits'&Conductors - � e a 260 (] 1, as owner of the.property, will do the.work and the Other (See Complete Fee Schedule)— structure is not intended or offered for sale (Section - (e+a a 26003 7044, Business ar`d Professions Code). e CONSTRUCTION LENDING AGENCY Q.�,l1_8,3. 1 hereby affirm that there.:is a construction lending agency - for the performance of the work for'which this permit is PERMIT FEE (Sub-Total) ' issued (Sec. 3097,Civ.C.). - , Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)' Lender's Address PERMIT ISSUING.TEE_ I certify that I have read this application and state .that the TOTAL FEET a6 0C - 1' above information is correct. I agree to comply with all County - x ordinances and State laws .regulating Electrical witing, and' ' reb authorize representatives of this County to enter upon - - - e a t e-mentioned property for inspection purposes. .(5y1�, SEE REVERSE FOR EXPLANATORY LANGUAGE ' Signa ure of Perlpittee IDE • - - + COUNTY .OF LOS ANGELES • TEMPLE CITY k 0508 'k. SELECTRMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ''EL--0508 98091_80044 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 - PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILD GADDRESS: TR: 13531 LT: 5 10231-LA ROSA.DR" FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP-CA=917803307 ASSESSOR IWFIDRMATION NUMBER: I NEAREST CROSS STREET: GLICKMAN 8585-006-005 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY LA 100 AMP PANELS, MCC 1.00 PAN 38.85 TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED Y: PLAN BY: EXPI SON: 09/18/98 UT 09/18/99 OWNER: TEL. NO: FINAL DATE FINAL CODE: WONG WING TTACK;2HAO LI QIONG (626) 443-6319- 10231 LA ROSA DR A TEMP 917803307 DESLR -T.ION-0 -WU21Z•_----- UPGRADE_OF_NEW-ELECTRICAL-SERV E'PAN EL--100-AMP- APPLICANT: 00-AMP-APPLIC T: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: GE LE S Co CONTRACTOR: TEL. N0: OS Q,NNT APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: UFER GROUND LIC. N0: 1111111 ROUGH CONDUIT ROUGH WIRING 1 � LIC �nJ�OnM U D MAIN WATER LINE {11 v v W uO PLASTIC Y/N METAL Y/N O O UTI Y—COMPANY NOTIFIED O D - `6/7° Service Tha��o< REPORT ID: DPR265 ROUTE TO: BS0508