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Home My Public Portal About9903 LA ROSA DR_Electrical__ WORKERS'COMPENSATIONDECLARATION 76A66 CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SA ETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800, Lab. C.) . V FOR APPLICANT TO FILL IN 'OB Policy No. Company New Residential Bldgs.&Pools EACH NO, FEE ADDRESS Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY — L Multi-family Sq. Ft. — NEAREST Certified copy is filed with the county building inspection Residential Swimming Pools CROSS ST l department. OWNER OR FIRM NAME C.i GAJ Dale Applicant Outlets: Rec._Light_Sw._ MAIL First 20 ADDRESS 4 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITYC p el No. 6 ? COMPENSATION INSURANCE PLAN C IL APPLICA T O (This section need not be completed if the work involved U by the permit is for one hundred dollars (5100) or less.) Lighting Fixtures First 20 ADDRESS Total No. Additional ccp I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. U 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_ Hearer_D.W. APPLICANT 0- N OVen _ Dryer_W.M._ ADDRESS Date Applicant. Top _ FAU X W.H. — Hood _ Fan _Other_ CITY NOTICE TO APPLICANT: If, after making this Certificate of Dista. _ 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. PR CES D BY with comply with such provisions or this permit shall be revoked. Size& Type HP,KW, KVA,or KVAR deemed Up to 1 Incl. FINAL Over 1 to 10 Ind. =L+ LICENSED CONTRACTORS DECLARATION - DATE �^- �Z VALIDATION Over 10 to 50 Incl. I hereby affirm that 1 am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY ness and Professions Code, and my license is in full force and effect. - _Services License Number Lic. Class 0-200 Amp. Under 600 V 201-1000 Amp. Under 600 V Contractor Date Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp. Power Pole& Appurtenances 1 hereby affirm that I am exempt from 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): K�/ Misc.Conduits& Conductors S 4 8 n. IXI 1, as-owner of the property, will do the work and the Other (See Complete Fee Schedulel— structure is not intended or offered for sale (Section 14*o 0 0 0 0 '2 7044, Business and Professions Code). - CONSTRUCTIONLENDINGAGENCY jlc o ) 450 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE o,o C ) Q issued (Sec. 3097,Civ.C.). I=Fd�/ Lender's Name PLAN CHECKING FEE, -.*0rtg6 h Pegrmit Feel 04 O G�8 G Lender's Address PERMIT ISSUING FEC Iry 1 certify that I have read Ithis 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 [he ayov -m ned properly r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WGRKEIi S'CGMPE"SAT'°" DEGLARA•"°" 7GA6 CE E66B6G (2-80) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm 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, Lab. ) J Q r Cf}' a.sa� 7 � �yr�r. FOR APPLICANT TO FILL IN JOB Policy N2 Company New Residential Bldgs.&Pools EACH INO.1 FEE ADDRESS Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — S LOCALITY Multi-family Sq. Ft. — NEAREST r Certified copy is filed with the co ty uildin sp ion Residential Swimming Pools CROSS STcta��• department. OWNER OR I � �y./ FIRM NAME UJ 1 Date Y-.72�T ADPlicant Outlets: Rec.—Light Sw. MAI ADDRESS First 20 CERTIFICATE OF EXEMPTIO ROM WORKERS' Total No. Additional CITYTel No. COMPENSATION INSURANCE } • PLAN CHECK'/ (L (This section need not be completed if the work involved APPLICANT OU by the permit is. for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS Total No. Additional cc o. 0 Fixed Appliances Not Over 1 HP permit is issued, I shall not employ any person in any mannerPERMIT W so as to become subject to the Workers' Compensation Laws. Range Heater_D.W. _ APPLICANT t1 Oven ' Dryer_W.M._ ADDRESS to Z Uate Applicant Top _ FAU _W.H. — Hood Fan _Other_ CITYOe TeI No. S NOTICE TO APPLICANT: If, after making this Certificate of Dista. Room Air Cond-x_ o7•tSd d LICEN EOR / h Exemption, you should become subject to the Workers' REG.NUMBERClass V Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCE SED)3Y with comply with such provisions or this permit shall be v deemed revoked. Size&Type HP,KW, KVA,or KVAR _ !' G 0 Up to 1 Incl. t� FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. GATE r ry+— ^n?� VALIDATION Over 10 to 50 Incl. Cl V I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 BY �-- ness and Professions Code, and my license is in full force and f effect. I I Services License Number Lic.Class 0-200 Amp. Under 600 V 201-1000 Amp.Under 600 V Contractor Date Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole& Appurtenances I hereby at that I am exempt from 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): ;94 8 9.0 A Misc.Conduits& Conductors I, as owner of the property. will do the work and the Other (See Complete Fee Schedule)— # 0.0 00 o '2 structure is not intended or offered for sale (Section ' 7044, Business and Professions Code). 2 0 0 1 4 5 0 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency e,0 0 145006 for the performance of the work for which this permit is PERMIT FEE (Sub-Total) t issued (Sec. 3097,Civ.C.). - S6 0 Q 2 2-81 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE I certify that I have read this application and state that the TOTAL FEE S above information is correct. 1 agree to comply with all County , ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon - the abovefnerWoned action purposes. �f (^� SEE'REVERSE FOR EXPLANATORY LANGUAGE `\/0ofermittee Date WORKERS'COh1PENSATION DECLARATION 76-663 6 63 (2601 APPLICATION FOR ELECTRICAL PERMIT 7B 1 hereby affirm that I have a certificate of consent to self COUNTY OFLOS ANGELES AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) FOR APPLICANT TO FILL IN ,IpB Policy No. Company New Residential Bldgs.&Pools EACH NO. FEE ADDRE El Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — S LOCALITY ❑ — �. Certified copy is filed with the county building inspection Multi-family Sq. Ft. NEARESTCROSS ST department. I Residential Swimming Pools OWNER OR FIRM NAME Date Applicant Outlets: Rec.ILight�5w. - MAIL First 20 �(J ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY - rTel No. COMPENSATION INSURANCE PLAN CHECK CL (This section need not be completed if the work involved - APPLICANT O by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS Total No. Additional O 1 certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. permit is issued, 1 shall not employ any person in any manner PERMIT so as to become subject to the Workers' Compensation Laws. Range_ Heater—D.W. _ APPLICANT e, W W IL Oven _ Dryer_W.M. ADDRESS N Z DateApplicant Top _ FAU _W.H. Hood _ fan _Other_ CITU el No. NOTICE TO APPLICANT: If, after making this Certificate of 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. PROCES D BY with comply with such provisions or this permit shall be deemed revoked. - Size&Type HP, KW, KVA,or KVAR Up to 1 Incl. _01— FINAL Over 1 to 10 Incl. DATE LICENSED CONTRACTORS DECLARATION —� ��_�� VALIDATION Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 1 _ VI/ 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 BY ness and Professions Code, and my license is in full force and effect. Services License Number Lie.Class 0-200 Amp. Under 600 V 201-1000 Amp. Under 600 V Contractor Date Over 1000 Amp.or Over 600 V. HOME OWNER-BUILDER DECLARATION Temp.Power Pole& Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License w for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits tress a Professions Code): z 5 0 b 5 A Misc.Conduits&Conductors 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 # o o'o a o '� 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 2 0 0 (1.50 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub-Total) a to o (� rj 0 issued(Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Feel D 5 0 -1 —81 Lender's Address PER ISSUING FEE z I certify that I have read this application and state that the TOTAL FEE above information is correct. 1 agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon th o -mentioned property for inspection purposes. / SEE'REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee a Date - COUNTY OF LOS ANGELES TEMPLE CITY k 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0910200022 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID BUILDING ADDRESS: BK: 147 652 PG: PC: 1 9903 LA ROSA DR I IEEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 91780 1ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 1 18589-007-027 1A1 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl ILB 200 AMP PANELS, MCC 1.00 PAN 38.85 I 1 (TENANT: I TOTAL FEES 66.60 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I 110/20/09 SR 10/20/10 1 I 1OWNER: TEL. N0: 1 ;FINAL PATE FI L BY: CODE: I 1ELLIS, ARTHUR (626) 285-9028- 19903 LA ROSA DR. ITEMPLE CITY, CA I ID SCRIPTION'OF WORK 1 1 1 (UPGRADE MAIN PANEL FOR 200 AMP I 1APPLICANT: TEL. NO: 1KALIF (SIB) 674-0800- I I I 15813 BERTRAND AVE. I ISPECIAL CONDITIONS: I IENCINO, CA 91316 1 ; I I I I I 1CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IA AND E ELECTRIC (818) 674-6700- 1 1 15801 WILLIS AV LIC. NO ; ;TEMPORARY POWER POLE I I VAN NUYS CA 91411 910675 1 I I 1UNDERGROUND CONDUIT I I I I I ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: I IROUGH CONDUIT !I I I I I I I TROUGH WIRING (MAIN WATER LINE ;PLASTIC YIN METAL YIN 1UTILITY COMPANY NOTIFIED(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 I I I I I I I I I I I I I I I I I I I I I I f I I I I I I I (REPORT ID: DPA265 ROUTE T0: BS 0508 I I I I I I I • COUNTY OF LOS ANGELES TEMPLE CITY N 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0805120022 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: FEES PAID BUILDING ADDRESS: ISK: 147 652 PG: PC: 9903 LA ROSA DR I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: I TEMP CA 91780 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1 18589-007-027 IA1 PERMIT ISSUANCE FEE 27.75 1 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl I IG1 OUTLETS-LGT,SW,RECP 10.00 OUT 19.50 I I I TENANT: IG2 LIGHTING FIXTURES 5.00 LGT 9.75 11SSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I IH2 RES GREG DISP LT 3HP 1.00 DIS 10.95 105/12/08 SR 11/08/08 1 IH3 RES DISHWASHR LT 3HP 1.00 DIS 10.95 1 J OWNER: TEL. NO: IH4 RES RANGE NDS LT 3HP 1.00 HOD 10.95 IFINAL DATE FINAL BY: CODE: 1ELLIS, ARTHUR (626) 285-9028- 1 TOTAL FEES 89.85 19903 LA ROSA DR. 1 ITEMPLE CITY, CA 1 IDESCRIPTION OF WORK I 1 1 (ELECTRICAL FOR KITCHEN REMODEL 1APPLICANT: TEL. NO: 1 I I ITIMNA POLGAR (818) 266-8978- 113564 RYE ST. #6 SPECIAL CONDITIONS: SHERMAN OAKS 91423 1 I (CONTRACTOR: TEL. N0: 1 (APPROVALS DATE INSPECTOR SIGNATURE I IREMODELING CALIFORNIA, INC. (310) 733-4232- 1 1 13611 MOTOR AVE #100 LIC. NO (TEMPORARY POWER POLE I I I 1LOS ANGELES, CA 90034 881905 B I IUNDERGROUND CONDUIT I (ARCHITECT OR ENGINEER: TEL. N0: 1 1UFER GAOUNTI I I I I I I 1 LIC. NO: 1 1ROUGH CONDUIT I I I IROUGH WIRING MAIN WATER LINE PLASTIC YIN METAL YIN 1 I I I I I IDTILITY COMPANY NOTIFIED( 1 1 I I I�Q�1I2� re 11 FSG a �a UP* 11eg1 tv a4k I I I I 12 I I I I I I I EXPIREDav�o I I I I (REPORT ID: DPR265 ROUTE TO: BS0508 I I I I I I