The URL can be used to link to this page

Home My Public Portal About9845 LA ROSA DR_Electrical__ WORKERS'COMPENSATIONDECLARATION 63 CEBO6G 12-801 APPLICATION FOR ELECTRICAL PERMIT {� CE LJ I hertiby, affi`r'm- that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate.of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,rLab.C.) ..� FOR APPLICANT TO FILL IN JOB p Policy No. Company New Residential.Bldgs. &PoolsrCH NO. FEE ADDRESS Certified copy is hereby furnished. 1 &2-Family.Sq. Ft. — Is LOCALITY L — Certified copy is filed with the cou nty,building inspection Multi-family Sq. Ft. NEARESTCROSS ST department. Residential Swimming Pools OWNER OR .FIRM NAME ( Dale Applicant Outlets: Rec._Light_ Sw MAIL $ l 20 CERTIFICATE OF EXEM P.T[ON,FAOM WORKERS' Total No. AdditionalCITY f Tel No. Z COMPENSATION.INSURANCE PLAN CHECK C (This section need not be completed if the work involved APPLICANT U by the permit is for one hundred dollars (5100) or less.) Lighting Fixtures First 20 ADDRESS Total No. Additional Cr I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No./ - 0 - permit-is issued, I shall not employ any person in any manner PERMIT W . so as to become subject to the Workers' Compensation Laws. ..Range_ Heater_D.W. _. APPLICANT 6. - Oven _ Dryer _W.M. _ ADDRESS Z Z 1\Date 71WO Applicant Top — FAU _W.H. _ Hood Pan _Other_ CITY r Tel Na. 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 Compensation provisions of the Labor Code, you must forth- Power Apparatus & Large Appliances DISTRICT NO, P E ED BY with comply with such provisions or this permit shall be Size&Type HP,KW,'KVA,or KVAR deemed revoked. - v t/ Up to-1 Incl. ' FINAL Over 1 to 101ncl. •.� LICENSED CONTRACTORS DECLARATION _ Over 10 to 50 Incl. DATE VALIDA ON - I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL lJ I ` By , 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 L' _ effect. - Services /p�� 0-200 Amp. Under 600 V License Number Lic. Class 201 1000 Amp. Under 600 V Contractor Date Over 1000 Amp,or Over 600,V - 4 ,HOME OWNER-BUILDER DECLARATION 20362A Temp. Power Pole& Appurtenances. ' I hereby affirm that ,I am exempt from the Contractor's Sign with One Branch Circuit - #.e ..e'e e 2 License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits •'• ness and Professions Code): � I - 2 19:5 0 • Misc.Conduits& Conductors Ve • . 1 9.5 0 ' 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 _ 7044, Business and Professions Code). o7_1 5—8.1 - CONSTRUCTION LENDING AGENCY ' I hereby affirm that there is a construction lending agency for the performance of the woik for which this permit is issued (Sec.3097,Civ.C.). t PERMIT FEE (Sub-Total) Lender's Name PLAN CHECKING FEE (One-,Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE I certify that 1 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 ` COUNTY OF LOS ANGELES TEMPLE CITY 4 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1005180018 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 29535 LT: 9 9845 LA ROSA DR I ( 1FEE DESCRIPTION: QUANTITY: COM: AMOUNT: TEMP CA 917803952 (ASSESSOR INFORMATION NUMBER: I ' NEAREST CROSS STREET: BALDWIN 18589-008-037 jS3 ADDTNL ELECT PLAN CK 1.00 HOU 109.35 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl I IA1 PERMIT ISSUANCE FEE 27.75 ITENANT: 1SY MOTORS, 5HP 1.00 MOT 19.65 (ISSUED ON: PROCESSED BY: PLAN BY: 1 TOTAL FEES 156.75 105/25/10 SA OWNER: TEL. NO: F�/Ty'VAL///.��DATE FINAL BY: CODE: GUBRAN, ROBERT (626) 215-8850- 2j��CC� `/'y/�j�/ 19845 LA ROSA DR l ( N ITEMP 917803952 1. IDESCRIPTION OF WORK 1 INSTALLATION OF ROOF-MOUNTED 5.4B KW PHOTOVOLTAIC ARRAY 1APPLICAN T: TEL. N0: I I I FRYKENHERG, APRIL M (626) 203-6093- 1308 W. MONTEREY AVE (SPECIAL CONDITIONS: 1 IPOMONA, CA 91768 1 I I I I CONTRACTOR: TEL. NO: 41 1APPROVALS DATE INSPECTOR SIGNATURE ENERGY EFFICIENCY SOLAR INC. (909) 865-8561- 1 1 1306 W MONTEREY AVENUE LIC. NO I TEMPORARY POWER POLE IPOMONA CA 91768 827074 C46 I I IUNDERGROUND CONDUIT I I (ARCHITECT OR ENGINEER: TEL. N0: JUFEA GROUND I ' LIC. NO: ROUGE. CONDUIT ROUGB WIRING I I I 11 I II (MAIN WATER LINE (PLASTIC Y/N METAL YIN II I I I I I 1UTILITY COMPANY NOTIFIED( I f 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 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 IRE PORT ID: DPR265 ROUTE T0: H50508 I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0711200027 �- BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL'ID: FEES PAID BUILDING ADDRESS: ITR: 29535 LT: 9 9845 LA ROSA OR I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ( TEMP CA 917803952 1ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: BALDWIN 18589-008-037 1A1 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl I F1 120V, 15/20A BR CKTS 4.00 BR 69.00 I TENANT: IF2 208, 277V LGT BR CKT 4.00 BR 109.20 JISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I IG2 LIGHTING FIXTURES 13.00 LGT 25.35 111/20/07 SR 05/18/08 ILS 200 AMP PANELS, MCC 1.00 PAN 38.85 I OWNER: TEL. NO: I TOTAL FEES 270.15 IF AL(DATE FINAL B CODE: GUBRAN, ROBERT (626) 215-8850- 19845 LA ROSA DR r 000 TEMP 917803952 (DESCRIPTION OF WORK ' ELECTRICAL FOR ADDITION, REMODEL AND UPGRADE SERVICE PANEL ITO 200 AMP (APPLICANT: TEL. NO: IXHUU (626) 758-8089- ISPECIAL CONDITIONS: I I I II I CONTRACTOR: TEL. NO: 1APPROVALS DATE INSPECTOR SIGNATURE IROSERT S GUBRAN (626) 215-8850- I 19845 LA ROSA DRIVE LIC. NO ITEMPORARY POWER POLE ITEMPLE CITY, CA 91780 NONE (UNDERGROUND CONDUIT (ARCHITECT OR ENGINEER: TEL. NO: JUPER GROUND PETER LEE ENEGINEER ING (626) 280-9NO: 18748 E. VALLEY BLVD. LIC. N0: RGUGH CONDUIT I ROSEMEAD, CA 91770 S3948 TROUGH WIRING / . (MAIN WATER LINE PLASTIC YIN METAIA /N VYI I (UTILITY COMPANY NOTIFIEDI I I 11 I I I 11 I I I I I I I I I I I I 1 REPORT ID: DPR265 ROUTE TO: DS0508 I I I I I I