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Home My Public Portal About10435 LA ROSA DR_Electrical__ WORKERS'COMPENSATION DECLARATION 76A663 ,Diel APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-8066 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 Certified copy is hereby furnished. New Residential Bldgs. 8 Pools. EACH NO. FEE ADDRESS 10435 La Rosa 18 2-Family, LOCALITY Certified copy is filed with the county building inspec- y, Sq. Ft. 192.6 $ — $ 6 Temple City tion department. Multi-family Sq. Ft. — 'NEAREST CROSS ST. Arden Residential Swimming Pools OWNER OR Date Applicant FIRM NAME Fairhaven Development CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE ADDRESS Outlets: Rea_ ght_sw.First 20 9088 Las Tunas (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.) that in the performance of the work for which this PLAN CHECK I certify P APPLICANT Martin Electric permit is issued, I shall not employ any person"in any manner so as to become subject to the Workers'Coompensation Laws. Lighting Fixtures First 20 ADDRESS 1560 N. Lassen ('!.q -� ZT Totol No. Additional a Z9J cc C wCC clry Ontario rel No.982-7880 Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this ertificate of APPLICANT Martin ELectric ` Exemption, you should become subject to the Workers' Range_ Heoter_D.W. _ Compensation provisions of the Labor Code, you must forth- Oven _ Dryer — W.M.— ADDRESS 1560 N_ T.nqqpn with comply with such provisions or this permit sholl be Top _ FAU —W.H. CITY Tel. No. deemed revoked. Ontario 982-7880 LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other— EGLICESE NOR Disp. _ Room Air Cond. Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER 304982 C-LO ( (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 Y / L �w ` aa Size 8 Type HP, KW,.KVA, or KVAR' U O o License Number Yy&'?` Lic. Class �/" 1V Up to 1 Ind. FINAL ` Over l to l0 incl. DATE — —�? VALIDATION Contra Af✓j14 1;F9&rP-1C V0 Date Over 10 to 50 Incl. FINAL t— ❑ 1 am exempt under Sec. Over 50 to 100 Inc. BY B.BP.C. for this reason - Over 100 ` Z Date: Services, Swbd., MCC 8 Ponelboords Boo'0 - 200 Amp. Under 600 V 4;!-e (!��6�517 Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole 8 Appurtenances _ HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits - Law for the following reason (Section 7031.5, Business and Professions Code): as owner of the property,.will do the work and the s (j p a 4 A Misc. Conduits 8 Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , . 7044, Business and Professions Code). # e a o 2 2 CONSTRUCTION LENDING AGENCY j o o 7 7 9 � 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) - •a a a 7 7 9 (Sec. 3097, Civ. C.). PLAN CHECKING FEE U O ) _8 3 Lender's Name PERMIT ISSUING FEE 10 -0 Lender's Address '7 I certify that I have read this application and state that the TOTAL FEE above informotion 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 inspeU,ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date DEC TION WORKERS' Ihave COMPENSATION cafe of corse CE-806 iD/BI APPLICATION FOR ELECTRICAL PERMIT I hA'eby orf i�.m,that I have a certificate of consent to self CE-8066 inrerev,or•a4';ificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified ccoppyrthheer(reeoop,(Sec 3800, . C) s P❑ollcy No..4,[ r""(-ompany FOR APPLICANT TO FILL IN JOB D Certified co is hereby furnished. EACH NO. FEE ADDRESS / PY Y New Residential Bldgs. 8Pools ❑ LOCALITY �7 Certified copy is filed with the county building inspec- 4-Family, Sq. Ft. 06O $ — $ 7 fl tion de ortm nL Multi-family Sq. Ft. A� — NEAREST /*ZW Residential Swimming Pools K pC�ROp5IE5 g5�T. r0'� Date Applicant 1— R I IRM NAME Ct 1 CERTIFI ATE OF EXEMPTION FR ORKERS' Outlets: Rec Light Sw., MAIL COMPENSATION INSU NCE gg ,�,� First 20 r ' ADDRESS n (This section need not be completed if the work involved by Total No.—S—H Additional CITY Tel. No. the permit is for one hundred dollars ($100)or less.) PLAN CHECK 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 become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No:_y__ Additional ' CITY Tel. No. Date Applicant Fixed Applionces Not Over I 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. Hood Fan Other_ CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR hereby affirm that am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG. NUMBER Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PRO SED BY and Professions Code,and m license is in full force and effect. Power Apparatus 8 Large Appliances 64 Size Size 8 Type HP, KW, KVA, or KVAR t U 0 License Number Lic. Class Up to I Incl FINAL /' V y� Over 1 to 10 Incl. DATE- /J VAUQJ1ON o Contractor care Over 10 to 50 Incl. ❑ FINA exem I am oder Se<. Over 50 to 100 Inc. B a B.BP.C. for this reason Over 100 N� Services, Swbd., MCC 8 Ponelboards -_21 0 1. 3 A Date: 0 -200 Amp, Under 600 V ► e e'e e e Signature 201 - 1000 Amp. Under 600 V - 2 ❑ Over 1000 Ami or Over 600 V ), • • 21.75 Exemption for Reg. Maint. Elect. SINGLE FAMILYTemp. Power Pole 8 Appurtenances 5 HOME OWNER-BUILDER DECLARATION 'e I • 2 i.7 5 Sign with One Branch Circuit ' hereby affirm that exempt from the Contractor's License �� Law for the followingg r Additional Sign Branch Circuits ( ,1.0 6-84 reason (Section 7031.5, Business and t Professions Code): . ❑ 1, as owner of the property, will do the work and the fisc. Conduits 8 Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 7044, Business and Professions Code). 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.). 25 PLAN CHECKING FEE - Lender's Name PERMIT ISSUING FEE O ' Lender's Address i certify that I have read this application and store 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-mention d property for inspection purp ses. SEE REVERSE FOR EXPLANATORY LANGUAGE /6 atu of Permittee ate COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0106220004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL D: - FEES PAID BUILDING q D TR: 37580 LT: 11 10435 LA ROSA DR FEE DESCRIPTION: QUANTITY: LOM: AMOUNT: TEMP CA 917803481 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ARDEN 8585-018-052 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 15.00 OUT 29.25 TENANT: G2 LIGHTING FIXTURES 2.00 LGT 3.90 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRE N: H2 RES GRBG DISP LT 3HP 1.00 DIS 10.95 06/22/01 JK 12/19/01 H3 RES DISHWASHR LT 3HP 1.00 DIS 10.95 OWNER: TEL. N0: H4 RES RANGE HDS LT 3HP 1.00 HOD 10.95 FINAL DATE FINAL BY: CODE: WONG; SALLY (626) 229-2993- JB AC UNITS +3-10HP 1.00 AC 19.65 �(!, p�_J Z 10435 LA ROSA DR TOTAL FEES 113.40 TEMP 917803481 DE5CR16 0 OF WORK ELECTRICAL FOR CONVERSION FROM ENCLOSED PATIO TO KICTHEN APPLICANT: TEL. NO: SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. N0: i - APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO - TEMPORARY POWER POLE BR CONDUIT L ARCHITECT OR ENGINEER: UNDERg TEL. N0: UFER GROUND LIC. NO: ROUGH CONDUIT I ROUGH WIRING Zi c MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508