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Home My Public Portal About9001 LAS TUNAS DR_Electrical__ WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICA 'ION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self Insure, 76A663 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES .-? DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab. C) qqC Policy No. Company FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished New Residential Bldgs &Pools NO.1 EACH FEE LOCALITY /n ❑ 1 &2-Family,Sq. Ft _ $ $ � G ' Certified copy is filed with the county building Inspection NEAREST department. Multi-family Sq.Ft. CROSS ST Sal Residential Swimming Pools ASSESSOR Date Applicant MAP BOOK PAGE �^' PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec -Light Sw FIRMOWNER NAME j�H Js /' � i COMPENSATION INSURANCE First 20p MAIL (This section need not be completed if the work Involved by the Total No. Additional ADDRESS permit is for one hundred dollars($100)or less.) I certify that In the performance of,the work for which this permit CITY` j Tel.NoICYv � is issued, I shall not employ any person In any manner so as to PLAN CHECK 444``` become subject to the Workers' Compensation Laws: Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT. If, after making this Certificate of CITY Tel No Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP PERMIT provisions of the Labor Code, you must forthwith comply with such Power Apparatus&Large Appliances APPLICANT provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that,l am licensed under provisions of Chapter 9 Over 3 to 10 Incl (commencing with Section 7000) of Division 3 of the Business and CITY Tel No Professions Code, and my license Is in full force and effect Over 10 to 50 Incl. LICENSE OR >_Over 50 to 100 Incl. REG NUMBER Class d Over 100 DISTRICT NO R SSED BY O License Number Lic.Class V Services,Swbd.,MCC&Panelboards D� IZ 0-399 Amp.Under 600 V FINE 0 Contractor Date ❑ I am exempt under Sec. 400-1000 Amp.Under 600 V VALIDATION W Over 1000 Amp or Over 600 V FINAL Q. B.&P.0 for this reason BRANCH CIRCUIT FEES BY f/1 Date 15A,or 20A,120V,Lighting or Recept. ' Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint.Elect 15A,20A,208V To 277V Lighting Br.Circuits .� SINGLE FAMILY Temp Power Pole&Appurtenancesy��+ JL HOME OWNER-BUILDER DECLARATION ACCT Q I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit 4 l for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 3303 48n0 Code): 1 ITEMS ❑ 1,as owner of the property,will do the work and the structure Misc.Conduits&Conductors is not intended or offered for sale (Section 7044, Business Other See Complete Fee Schedule) , TOTAL 4IEP, ®6L0 and Professions Code). CASH 48.60 CONSTRUCTION LENDING AGENCY CHANGE .00 I hereby affirm that there Is a construction lending agency for the performance of the.work for which this permit is issued (Sec 3097, PERMIT FEE (Sub-Total) Civ. C.) PLAN CHECKING FEE 0000-0001 6/24/96 Lender's Name �-t 70.55 1 AM 8°33 PERMIT ISSUING FEE o� (, Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the above information Is correct. I agree to comply with all County Lam'I s 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 OF Pt#7RTEFDATE WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) JF. P61-CATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self Insure, 76A663 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof.(Sec 3800 Lab. C.)• Policy NO Company FOR APPLICANT TO FILL IN JOB ADDRESS S Certified copy Is hereby furnished New Residential Bidgs.&Pools NO. EACH FEE LOCALITY ❑ — $ $ UTY Certified co is filed with the count building inspection 1 &2-Family,Sq.Ft PY• Y 9 P — NEAREST A N A • department. Multi-family Sq Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS', Outlets Rec Light SW OWNER OR COMPENSATION INSURANCE g FIRM NAME (VH -T or GaLU ••�• •• First 20 MAIL (� pp.�`� (This sectlon'need'not be completed If the work involved by the Total No Additional ADDRESS CJ (y EDW GE oll permit Is for brie hiun&ed dollars($100)or-less.) I certify that In the performance df•the work for which this permit CITY P 01_11/ Tel No. Is issued, I shall not employ any person in any manner so as t0 PLAN CHECK become subject to.the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No Additional ADDRESS Date Applicant' RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT If, after making this Certificate of CITY Tel'No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP rovisions of the Labor Code, you must forthwith comply with such PERMIT P• Y p Y Power Apparatus&Large Appliances APPLICANT provisl'ons or thl's permit shall be deemed'revoked. LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS_ I hereby affirm that I am`licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY Tel.No Professions Code,and my license Is In full force and effect Over 10 to 50 Incl. } LICENSE - Cl Over 50 t0 100 Incl REG NUMBER O Over 100 DISTRICT NO P SSED BY License Number Lic Class /� y Services,Swbd.,MCC&Panelboards !/p Q Contractor Date 0-399 Amp.Under 600 V DATE O ❑ I am exempt under Sec 400-1000 Amp Under 600 V — 0 j L11 Over 1000 Amp or Over 600 V FINAL VALIDATION 11 -B&P.C.for this reason BRANCH CIRCUIT FEES BY Cf) Date• 15A,or 20A,120V,Lighting or Recept Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Cucuits Exemption for Reg.Maint Elect. 15-A,20A,208V To 277V Lighting Br.Circwts ��i i t- SINGLE FAMILY Temp.Power Pole&Appurtenances MJf 1rpi E%7 .4E-5 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 hereby affirm that I am exempt from the Contractor',s License Law s it,l t;i for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuit Code) �s h ❑ Misc.Conduits&Conductors I,as owner of the property,well do the work and the structure is not Intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) 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 (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) PLAN CHECKING FEE Lender's Name �� 5 • PERMIT ISSUING FEE - Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the 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 SIGNAlbRE OF PERMITTEE DATE WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) 76A663 APPLICATION FOR ELECTRICAL PERMIT �J I hereby affirm that I have a certificate of consent to self in-!ire, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS efl. ®IJFDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C.) e Policy No. Company 1 FOR APPLICANT TO FILL IN JOB 'V Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE $ $ LOCALITY 'IgA ❑ • Certified copy is filed with the county building Inspection• 1 &2-Family,Sq.Ft. /� , department Multi-family Sq.Ft. CROSS ST. !Q Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWNER OR ))� COMPENSATION INSURANCE- FIRM NAME s B 0/-11-1 b First 20 MAIL (This section need not be completed If the work involved by the Total No. Additional ADDRESS permit is for one hundred dollars($100)or less.) I certify that In the performance of the work for which this permit CITY /� Tel No [ly Is issued, I shall not employ any person In any manner so as t0 PLAN CHECK become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No Additional ADDRESS Date ApplicantRESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If,, after making this Certificate of CITY Tel No Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl (commencing with Section 7000) of Division 3 of the Business and CITY Tel No Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR Class Over 50 t0 100 Incl. REG NUMBER a License Number Llc Class Over 100 DISTRICT NO. PROCE99EID BY 0 Services,Swbd.,MCC&Panelboards K6 Contractor Date 0-399 Amp.Under 600 V FINAL DATE O 400-1000 Amp.Under 600 V a ~ ❑ I am exempt under Sec. �. - J VALIDATION V Over 1000 Amp or Over 600 V, FINAL q W B.&P.0 for this reason BRANCH CIRCUIT FEES BYIt R r Date: 15A,or 20A, 120V� ,Lighting or Recept. 64A, _ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits - 41 Or More Branch Circuits ❑ Exemption for Reg Maint.Elect 15A,20A,208V To 277V Lighting Br Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances - HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code). I, as owner of the property,will do the work and the structure Mlsc Conduits&Conductors is not Intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). CONSTRUCTION LENDING AGENCY cj I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE Lender's Name / PERMIT ISSUING FEE s Lender's Address / I certify that I have read this application and under penalty of purjury state TOTAL FEE that the above information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize representative thIS Co y t enter upon the above-mentioned property for Ins i urpo SEE REVERSE %FOR EXPLANATAORY LAN AGE 4A SIG ATU OF PERMITTEE DOE ////�`%'!r'/ !/ CMT"/(J[—LC•�ifC /l COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9701270003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: S PAID BUILDINGADDRESS: TR: 11213 LT: 4 9001 LAS TUNAS DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801835 INFORMATIONASSESSOR NEAREST CROSS STREET: ROSEMEAD 5387-013-015 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 7.00 OUT 13.65 TOTAL FEES 41.40 ED 0 : PLA . FAMILY�BARBER SHOP 01/27/97 TC 01/27/98 OWNER: TEL. 0: FINAL DATE I FINAL BY: CO EDWARDS JAMES JR;BERNICE E - `•- Z''`-a 300 NEWPORT CENTER D DN=ION OF WORK' t- ELECTRICAL FOR BARBER SHOP - 7 OUTLETS LOFTI ELECTRIC (818) 795-6099- ��O S CIAL CONDITIONS: I CONTRACTOR: N0: - � 0 /.::�" / \ ° OVALS DATE INSPECTOR SIGNATURE LOFTI ELECTRIC (818) 795-6099- �� / 1 3.- . 2275 E. HUNTINGTON DR. #224 LIC. NO � �� i SAN MARINO, CA 91108 350918 C10 'UNDERGROUND L ERGROU D IT ARCHITECT OR ENGINEER: TEL. NO: 'c" LIC. N0: �II�� ?j �,I CM _-_ SkROUGH CONDUIT ROUGH WIRING / MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY PA REPORT ID: DP R265 ROUTE TO: BS0508 • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELEGTRICAL,PERMIT DEPARTMENT OF -PUBLIC WORKS 9071 LAS TUNAS - EL 0508 97061.10008 _ BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE•CITY CA PHONE: (818) 285-0488 EXT: LEGALG-.D TR: 11213 LT; 4 .(9001.LAS TUNAS.DR. FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP`CA 917801835 ASSESSOR I] 95R: NEAREST CROSS STREET: ROSEMEAD 5387-013-015 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY E3 TEMP XMAS TREE, ADDT 1.00 TEM 21.30 TOTAL FEES 49.05 OC E . KNIGHTS OF COLUMBUS- 06/11/97 TC - 06/11/98 OWNER: TEL. NO: F I NAL DATE FINAL BY: ODE: • EDWARDS JAMES JR;BERNiCE E 300 NEWPORT CENTER.D f METTPTION FIREWORKS STAND-NO% OUTSIDE LIGHT NG SELF-CONTAINED APPLICANT: TEL. O: SAME AS OWNER - SPECIAL CONDITIONS: & LES C CONTRACTOR: T 0: O� APPROVALS DAT INSPECTOR RE SAME AS OWNER - LIC. NO � �j _ TEMPYRARY POWER POLE URWROUND CONDUIT ARCHITECT OR ENGINEER: TEL. .NO: 14 UFER GROUND LIC. NO: ,[ --- ROUGH CONDUI ROUGH WIRINGMAIN__l �� V V�� PLASTICTY/NLINE METAL Y/N 0 oUTILITY COMPANY NOTIFIED 0 ra REPORT ID: DPR265 ROUTE TO: BS0508