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Home My Public Portal About10345 LA ROSA DR_Electrical__ WORKERS' COMPENSATION DECLARATION CE-806 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 T r �„ BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ' Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH ' NO. FEE ADDRESS 10345 La Rosa Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. R. 164 + $ — $ 5752 LOCALITY Temple City tion department. Multi-family Sq. Ft. — NEAREST Residential Swimming Pools CROSS ST. Arden Date Applicant OWNER OR FIRM NAME Fairhaven Development CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLight_Sw. MAIL 9088 Las Tunas COMPENSATION INSURANCE First 20 ADDRESS (This section need not be completed if the work involved by Total No. Additional CITY Temple City Tel. No. 286-3636 the permit is for one hundred dollars ($100) or less.) I certifyperformance of the work for which this PLAN CHECK that in the P erAPPLICANT Martin Electric permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. ighting Fixtures First 20 ADDRESS 1560 N. Lassen ��__�� otal No. Additional Dote7 'q��Applicont//lee:^ > R .ef CITY Ontario Tel. No. 982-7880 NOTICE TO APPLICANT: If, after making this Certificate of axed Appliances Not Over 1 HE PERMIT Exemption, you should become subject to the Workers' 'Range_ Heater—O.W. — APPLICANT Martin Electric Compensation provisions of the Labor Code, you must forth- Over .— Dryer — W.M.— ADDRESS 1560 N. Lassen with comply with such provisions or this permit shall be Top _ FAU —W.H. — deemed revoked. Hood _ Fan _Other— TY Ontario Tel. No. — UCENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp7880 . _ Room Air Cond. REG. NUMBER 304982 Class. (',-10 (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESSED BY and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances Iry Is. �/ Size &Type HP, KW, KVA, or KVAR' Sri 4 O License Number�� ( � a�- Lic Class —� Up to 1 Incl. FINAL ;5 V ^ DATE Conit„ Z4'</ �� 6T�d� — O ��J O'er to 101ncl. � .r � .p VALIDATION O Over 10 to 50 Incl. 4 OFINAL /� {~j I am exempt under Sec. Over 50 to 100 Inc. BY - _ (-4-4-4-4 d B.&P.C. for this reason Over 100 U _ Z Date: Services, Swbd., MCC&Ponelboards ► 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V Exemption far Reg. Maint. Elect ' SINGLE FAMILY Temp. Power Pole&Appurtenances N HOME OWNER-BUILDER DECLARATION c 4 0 4,O A Sign with One Branch Circuit I hereby affirm that I exempt from the Contractor's License Additional Sign Branch Circuits r ° ° 0 0 - 2 Low for the followingg r reason (Section 7031.5, Business and ' Professions Code): 2 0 - 6802 as owner of the property, will the work and the Conduits& Conductors ^ 6 8.0 2 s structure is not intended or offered Misc.d for sale and Other (See Complete Fee Schedule)_ Poo � s 7044, Business and Professions Code). 08. 01 —8 v CONSTRUCTION LENDING AGENCY 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 PERMIT ISSUING FEE 10 50 Lender's Address I certify that I have read this application and state that the TOTAL FEE 8. 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-men oned roperty for ins ection purposes. ' f SEE REVERSE FOR EXPLANATORY LANGUAGE r 144 Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 8508160006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL IO: FEES PAID BUILDING ADDRESS:• ' TR: 37580 LT: 5 10345 LA ROSA DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803402 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8585-018-046 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597GRID: C4 LOCALITY TEMPLE-CITY, C G1 OUTLETS-LGT,SW,RECP 4.00 OUT 7.80 TENANT: G2 LIGHTING FIXTURES 1.00 LGT 1.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON.: TOTAL FEES 37.50 08/16/05 SK 02/12/06 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: CHAD LU TANG (626( 452-9093- j `� 10345 LA RO SA DR l/ TEMPLE CITY CA 91780 - DE CR TIOF WORK 3 OUTLETS, 1 LIGHT, 1 SWITCH APPLICANT: TEL. NO: HIPOLITO (909) 594-7547- 786 PINEFALLS AVE SPECIAL CONDITIONS: WALNUT, CA 91789 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE WEST COAST CUSTOM ROOMS (909) 594-7547- 786 PINEFALLS AVE LIC. NO TEMPORARY POWER POLE WALNUT CA 91789 471619BHIC UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9901 LAS TUNAS EL 0508 0811160006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91980 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 37580 LT: 5 10345 LA ROSA DR 1 IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ( TEMP CA 917803402 ASSESSOR INFORMATION NUMBER: 1 I NEAREST CROSS STREET: ARDEN 18585-018-046 1A1 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, C1 1 1G1 OUTLETS-LGT,SW,RECP 4.00 OUT 7.80 I 1 TENANT: ICE LIGHTING FIXTURES 7.00 LGT 13.65 JISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I 1 1H1 RES ELEC OVEN LT 3HP 1.00 OVE 10.95 111/18/08 SR 05/17/09 1 1H2 RES GREG DIEP LT 3HP 1.00 DIS 10.95 1 I 10WNER: TEL. NO: IH4 RES RANGE ADS LT 3HP 1.00 HOO 10.95 F NALATEE� FINAL CODE: CODE: 1YUHUEI TANG, THOMAS TRUONG- (626) 452-9093- IH7 RES EXHAUST FANS 1.00 EX 10.95 1 ��✓'- /\'j 110345 LA ROAS DR. I TOTAL FEES 93.00 1 TEMPLE CITY CA 91780 DEISCRIPTION OF WORK (ADDING NEW RECCESSED LIGHTS (7) ADD 4 ELECTRICAL OUTLETS, IRE-LOCATE PHONE JACK AND MICROWAVE/OVEN FOR KITCHEN REMODEL APPLICANT: TEL. NO: WENHUA CHID (626) 926-4016- 16448 OAK AVE. 1 1SPECIAL CONDITIONS: TEMPLE CITY CA 91780 -I CONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE SUNYUAN SUPPLY INC. (626) 926-4016- 1 1 16448 OAK AVENUE LIC. NO (TEMPORARY POWER POLE ITEMPLE CITY, CA 91780 799540 C10 UNDERGROUND CONDUIT I 1 1 (ARCHITECT OR ENGINEER: TEL. NO: 1 IUFEA GROUND 1 I I I I 1 LIC NO: I 1R0UGH CONDUIT I 1R0UGH WIRING / 1 MAIN WATER LINE PLASTIC YIN METAL YIN 1 1 1 DTIL ITY COMPANY NOTIFIED( I I I I I I I I I I II II II I II I II II I I II II 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 I II 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 REPORT ID: DPR265 ROUTE T0: BSO508 I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY $ 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1110060025 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91980 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 37580 LT: 5 10345 LA ROSA DR I IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ( TEMP CA 919803402 ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET: ARDEN 18585-018-046 1A1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, Cl IJX MOTORS, LT 3 HP 1.00 MOT 15.40 TENANT: TOTAL FEES 43.20 11SSUED ON: PROCESSED BY: PLAN BY: 110/06/11 SR OWNER: TEL. NO: FINAL 12ATE FI AL BY: CODE: TRAM, LYNN (213) 739-7393- M- 110345 LA ROSA DR. I TEMPLE CITY CA 91780 DESCRIPTION PTION OF WORK (ELECTRICAL MOTOR FOR A GATE OPENER 1APPLI CANT: TEL. NO: 1 1 III SAME AS OWNER - (SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO ITEMPORARY POWER POLE IUNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: IUFER GROUND I I I I 1 LIC. NO: ROUGH CONDUIT IROJGH WIRING I II I MAIN WATER LINE PLASTIC Y/N METAL Y/N I_ II 1 I UTiL1TY COMPANY NOTIFIED( I I I I I I I II I 1 III I II I I II I I I I I II I I II I II I I I I I I I I 1 III II- I II I I I 1 I I I I { I I II REPORT TD DPR265 ROUTE TO: SS0508 I I I II 1 1