The URL can be used to link to this page

Home My Public Portal About9050 LAS TUNAS DR_Electrical__ WORKERS'COMPENSATION DECLARATION 76A663 ovw9 87 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self '�E"4 insure;-or a,cer4 ficate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS 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 & Pools EACH NO FEE ADDRESS Certified copy is filed with the county building inspec- 1 & 2-Family, Sq Ft $ — $ LOCALIT tion department Multi-family Sq Ft NEAORESTT SS S Residential Swimming Pools _SR OWNER O Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw_ MAIL COMPENSATION INSURANCE First 20 ADDRESS (This section need not be completed if the work involved by Total NoAdditional CITIMT- Tel the permit is for one hundred dollars ($100)or less.) PLAN CHECK I 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 Layvs Lighting Fixtures First 20 ADDRESS ee-k�►c, Additional Total No CITY Tel No Dot Applica r Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If, after making this Certificate of APPLICATION 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— Cl Tel N?&,. 2 LICENSED CONTRACTORS DECLARATION Disp — Room Air Cond — LICENSE ORClass I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER �J (commencing with Section 7000)°of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO PIROCESSED BY >_ and Professions Code,and my license is in full force and effect ` p 13 - 0 Size &Type HP, KW, KVA, or KVAR �O o License Number��Lic Class( -�L Up to 1 Incl FINAL V Contract 1��Date " l� Over 1 to 10 Incl DATE /1_,—27 VALIDATION 0 ❑ Over 10 to 50 Incl FINAL F- I am exempt under Sec Over 50 to 100 IncgY U W B&P C for this reason Over 100 a- Services,Services, Swbd , MCC& Panelboards Z Date 0-200 Amp Under 600 V — Signature �Q�-� 201 - 1000 Amp Under 600 V ❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V SINGLE FAMILY Temp Power Pole&Appurtenances w HOME OWNER-BUILDER DECLARATION - i a I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits 7i45.75 Professions Code) 71 ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors 1 ITEM_ structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— TOTAL 45 - 75 Business•and Professions Code , r CONSTRUCTION LENDING AGENCY � � _ c ' I hereby affirm that there is a construction lending agency for CHANGE .013 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) f (Sec 3097, Civ. C ) PLAN CHECKING FEE [10aI-0j If 1 5/f3;f9. Lender's Name PERMIT ISSUING FEE 97032 1 AN 8.140 Lender's Address ` I certify that I have read this application and state that the TOTAL FEE of above information is correct I agree to comply with all County ordinances and State jaws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the abo -me ned ro erty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee ate a ©s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0110290002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUFLDING ADDRESS: ON FILE 9050 LAS TUNAS DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801834 ASSESSOR INFORMATION NUMBER:, NEAREST CROSS STREET: SULTANA 5387-024-002 Al PERMIT ISSUANCE FEE 0.00 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY F1 120V, 15/20A BR CKTS 2.00 BR 0.00 G1 OUTLETS-LGT,SW,RECP 10.00 OUT 0.00 P . TEMPLE CITY CHAMBER OF COMMERCE G2 LIGHTING FIXTURES 6.00 LGT 0.00 10/29/01 JK 04/27/02 TOTAL FEES 0.00 OWNER: TEL. NO: FINATE FIA B . CITY OF TEMPLE CITY (626) 285-2171- /�� 9701 LAS TUNAS DRIVE TEMP 917801834 ELECTRICAL JAMES LUTZ 10673 ROSEGLEN ST SPECIAL CONDITIONS: TEMPLE CITY iL�'iS CO TRACTO : E NO: APPROVALS®�f1VAPPROVALS DATE INSPECTOR SIGNATURE J. LOUIS ELECTRICAL CONTRACTORS (626) 444-3173- 10673 ROSEGLEN ST. LIC. NO TEMPORARY POWER TEMPLE CITY, CA 759071010 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUNDi LIC. NO!:/// 111111 ROUGH CONDUIT KUTGR I MAI WATER LI PLASTIC Y/N METAL Y/N O K3 wh � F � O B U=Y COMPANY NOT= Ip^' El ❑El �y *3ervice REPORT,- ID: DPR265 ROUTE TO: BS0508