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HomeMy Public PortalAbout9075 LAS TUNAS DR_Building__ 76A638A CE 0803 3-68 APPLICATION FOR BUILDING ERMIT LJ COUNTY OF,LOS ANGELES BUILDING DEPARTMENT OVI COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W. JENKINS, SUP T OF BUILDING CROSS ST. U 1- 7 DISTRICT GR UP TYPE P B FED OR APPLICANT TO FILL IN Q coNsr. Print ort e only) y- O STATISTICAL LAS FICATION SEWER MAP � 1 + CLASS NO. DWELL,UNITS' BK G 37' BLOCK USE ZONE M �/)-O NO C/ IJ / SPECIAL NO.OF BLDGS. CONDITIONS LOT NOW ON LOT BLDG. BLDG.SETBACK FROM TEL. FRONTPROP LINEOF (STREET) S NO. TYPEOFEXISTING SETBACK HIGHWAY + YARD = TOTAL Cyd �� HIGHWAY WIDTH FROMC.L 77 l OZ7 + �- CITY BL FROM ARCHITECT OR TEL. SI PROP.LINEOF (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD - = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. TEL. CONTRACT O (� NO. Q + - d ADDRES ^ NO L CORNER CUTOFF YES ❑ NO ❑ U CITY c Ass 4- S� SEE REVERSE SIDE FOR SPECIAL APPROVALS /bESCRIPTf0N OF WORK U W O_ N Z NEW ADD ALTER REPAIR DEMOLISH SQ FT. NO. OF NO. OF SIZE STORIES FAMILIES USE OF STRUCTURE T SIGNATURE OF APPLICANT VALUATION $ I APPROVALS DATE INSPECTOR'S SIGNATURE P.0 PMT. FOFORMS UNDATI MATERIAALS FEE $ ON FEE $ v v FRAME: FIRE STOPS, ' 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE- LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION, I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- TI ON OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. LATH, INT. ING TO WORKMEN'S COMPENSATION INSURANCE LATH, EXT. SIGNATURE OF �l / HOUSE NUMBER COR- PERMITTEE I RECT'AND POSTEDle ADDRESS FINAL a PLAN CHECK VALIDATION CK Mo CASH JOHN F. LEWIS' PRINCIP LST CK RIAtoENGINEER PERMIT VALIDATION I'A f,_.c 7 6 91Z NOV 18 1 D 9.0 0- TEMPLE C�T�� IGA638A CE#80L 1-61 APPLICATION FOR BUILDING PERM[ COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS toe BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST -WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST DISTIL Np_ UP TYPE P SSED BY FOR APPLICANT TO FILL IN " CO/ TYPE ADDREIN L� T0 N A STATISTICAL CLASSIFICATION SEWER MAP. y07lil CLASS NO DWELL UNITS LOT NO. BLOCK WATER NOT REQUIRED RECEIVED. CERTIFICATE TRACT !/ MAP HIGHWAY STATE MAJOR ECOND, LOCAL NO OF BLDGS. NO (CIRCLE) SIZE OF LOT NOW ON LOT USE ZONE SPECIAL USE F 1 CONDITIONS EXI ING BLDG PA)A17 rQ IZ / OWNER'n/NKX'Y'S PAiAir vTdmwo. BUILDING EXIST SETBACK YARD HWY TREET AME WIDTH ADDRESS %07i- -LAS UAI 5 FRONT ARCHITECT OR TEL 'P L ENGINEER NO SIDE P L. ADDRESSTEL.�I r INSPECTION RECORD Q CONTRACTOR A -W' Q m�,EsO N NO. �0?i O3 V ADDRESS ,2F49 ROWCNA AVE, ./1• 99 O DESCRIPTION OF WORK W CL NEW ADD ALTER REPAIR DEMOLISH N SQ FT. NO OF NO OF Z SIZE STORIES FAMILIES ' USE OF ' STRUCTURE /NS'TA41-AFr/O 0 I— 000 4SAL. 14/7. SrORASPI A Th1N SIGNATURE OF APPLICANT VALUATION$ ,¢�Q, d APPROVALS DATE INSPECTOR'S SIGNATURE P C. PMT FOUNDATION: LOCATION FEE $ 400-10, FORMS,FORMS,MATERIALS FRAME FIRE STOPS, IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT THE ABOVE IS CORRECT'AND "AGREE TO COMPLY FURNACE LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION ( CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH, INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. ING TO WORKMEN'S COMPENSATION INSURANCE LATH,EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE- RECT AND POSTED ADDRESS' FINAL CLYDE N DIRLAM,/PRINCIPAL STRUCTURAL ENG PERMIT CHECK VALIDATION CK. M.O. CASH PERT VALIDATION cK. m.o. CABH r, .� o 4 4- 6 4 'o OCT 3 0 1 D 3 .0 0 WORKERS'COMPENSATION DECLARATION hereby affirm that I havecertificate of consent to self APPLICATION FOR BUILDING PERMIT LI Is �- insure; br a certificate of Workers' Compensation Compensation Insurance, or a certified copy thereof2pany—. c-3 ab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy NW 7t S'wp V� BUILDING Certified copy is hereby furnished' FOR APPLICANT TO FILL IN ADDRESS• 971 A , 14lii 771 Al" Certified copy is filed with the unt ding inspec- A BUILDING �y tion department I` ADDRESS - O 7, s—/ZI&F LOCALITY NEAREST Date `�� �6 Applican-V CITY G� ZIP CROSS ST CERTIFICATE OF EXEMPTION F RKERS' NO OF BLDOT ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL ,(This section need not be completed if the permit is for one USE ZONE MAP �t hundred dollars ($100)or less ) TRACT BLOCK L NO n NO (J meq– l/.,. SPECIAL y I certifythat the performance of the work for which this WIN R" t NO �� CONDITIONS a. P DISTRIC GROUP TYPE FIRE PROC D BY O permit is issued, I shall not emplo ony pers any ma er �� '� CONST ZONE V ADDRESS j� /Pfo/fl} so as to b come subject to the W er o p n ion a s S` r r � TY Dote Applican AIRCHITECT OR TY ZIP TEL STATISTICAL CLASSIFICATION APT CO 0 NOT I TO APPLICANT If, after making is Certificate of ENGINEER NO CLASS NO DWELL UNITS W Exemption, you should become subject to the Workers' 0. Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP N with comply with such provisions or this permit shall be TEL Z deemed revoked. CONTRACTOR OL NO BK PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO VALUATION O (commencing with Section 7000)of Division 3 of the Business and LICj�rn Professions Code, and'my license is in full force and effect CITY CLASS $ �s SQ FT NO OF NO OF CHECK License Number Lic Class f` SIZE STORIES FAMILIES_ ',ONE �(/ 3 GvAfhS NEW - $ Contractor Date DESCRIPTION OF WORK D 2 8 O1,7 A I am exempt under Sec T7 C!�/� AD ALTER E] FINAL !� # a o .o • a l B.BP.C. for this reason REPAIR DATE I • • 3.7,5 0 USE OF FIN Date DEMOL ,❑ EXISTING BLDG L Signature APPLICANT L N L BY • . 0 37.509 OWNER-BUILDER DECLARATION O &2 9-8 5 I hereby affirm that I am exempt from the Contractor's License ADDRESS ©/� 1 Law for the following reason (Section 7031 5, Business and Professions Code)- BUILDING 1, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code) MOVING TEL 1, as owner of the property, am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec- ADDRESS ;@283,0A tion 7044, Business and Professions Code) REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LIN WIDTH Poo. # • e o • • 1 hereby affirm that there is a construction lending agency for FRONT • - 40.50 the performance of the work for,which this permit is issued P L (Sec. 3097, Civ C ) SIDE • • - 4Q5,05 FD PL Lender's Name 0 9,0 3-8 5 PC Fee$ ✓�/^�/`' Lender's Address Permit Fee _ I certify that I have read this application and state that the Issuance Fee 0 J v abov4nT is correct I agree to comply with all County Investigation ee ordmtate jaws relating to building construction, Total Feed and nze representatives of this County to enter uponve-mentionepproperty for inspection purposes r�„ •J SEE REVERSE FOR EXPLANATORY LANGUAGE•icant or Agent Dat ®t COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0809150041 PHONE (626) 285-0488 EXT ILEGAL ID- INUMBER OF SIGNS 1 1 BUILDING ADDRESS. ITR 5905 LT: 37 BL 001 ISIGN DESCRIPTION 1 SET CHANNEL LETTERS I 9075 LAS TUNAS DR I I I TEMP CA 917801901 (ASSESSOR INFORMATION NUMBERI I NEAREST CROSS STREET I 15387-015-006 1 1 THOMAS PAGE 596 GRID H3 LOCALITY TEMPLE CITY, Cl ITENANT (EXIST BLDG USE (ISSUED ON PROCESSED BY EXPIRES ON IGATOWAY CENTER IEXIST OCC GRP 109/15/08 SR 03/14/09 I OWNER TEL NO IBLDGS NOW ON LOT VALUATION IFINAL DATBY CODE 1 1KELVIN WONG (626) 215-0232- 1 2,460 1 EXPIRS 9075 LAS TUNAS DR ITEMP 917801901 I FEES PAID IDESCRIPTION OF WORK 1 I 11 SET CHANNEL LETTERS I IFEE DESCRIPTION QUANTITY DOM AMOUNT (APPLICANT TEL NO- I ISIGNS EXPRESS (626) 443-3333- IAA BLDG PERMIT ISSUANCE 27.75 I 11438 SANTA ANITA AVE IAX BUILDING REVIEW FEE 54 70 ISPECIAL CONDITIONS- I IS. EL MONTE 91333 ID2 PERMIT W/O EN-HC 2460 00 VAL 99.00 I I 1 1 TOTAL FEES 181 4.5 1 I (CONTRACTOR TEL NO (APPROVALS DATE INSPECTOR SIGNATURE 1 ISIGNS EXPRESS MANUFACTURING COMPANY (626) 443-3333- 1 1 11438 SANTA ANITA AVE LIC NO I ILOCATION AND SETBACKS I 1 1 ISOUTH EL MONTE CA 91733 552097C-45 I I 1 I ISOILS'ENGINEER APPROVAL I 1 1 (ARCHITECT OR ENGINEER: TEL. NO: 1 (FOUNDATION/TRENCH FORMS I I LIC NO 1 ISUPPORT STRUCTURE 1 I I I I I I I I I IMAP NO: SEWER MAP BOOK. PAGE: FIRE ZONE CMP I I 1 1 I I 001 I INO. OF FAMILIES DWELLING UNITS- APT/GOND STAT CLASS. I 1 1 1 1 NO 20 I I 1 SCHOOL WITHIN HAZARDOUS 1 1 1 1 (AIR QUALITY- 1000 FEET MATERIALS 1 1 1 1 1 1 NO NO NO 1 I 1 I 1 1 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 1 IMPORT ID: DPR261 ROUTE TO BS0508 1 1 1 I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 SL 0508 0309020035 PHONE: (626) 285-0488 EXT: CONST TR: 5905 LT: 37 BL: .001 SQ. FT STORIES TYPE OCCUP GROUP 9075 LAS TUNAS DR STRUCTURE: 2000 1 VN B TEMP CA 917801901 ASSESSOR 1AFOUPITION N NEAREST CROSS STREET: SULTANA 5387-015-006 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG 0ISSUED 0 CSS RSO . NEWLAND REALTY EXIST OCC GRP: B 11/04/03 VG 10/29/04 OWNER: TEL. NO: BLDG NOW ON LOT: ALUATION: WJ2,�2- 73 E FINAL C E.IRISH WILLIAM (626) 451-1696-PGR 30000 ✓9622 LEROY ST ' ARCADIA 91007 FEES PAID 5TESCRIPTION'OF T.I.FOR REAL ESTATE OFFICE PAND BATHRMS,CONSTRUCT OFFICES) FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: WONG SIU Y (626) 292-1122- AA BLDG PERMIT ISSUANCE 27.75 9075 LAS TUNAS DR AE STRONG MOTION OTHER 30000.00 VAL 6.30 SPECIAL CONDITIONS: TEMPLE CITY 91780 Al PLANCHECK W/EN-HC 30000.00 VAL 524.61 A2 PERMIT W/ENERGY-HC 30000.00 VAL 617.21 CONTRACTOR: TOTAL FEES 1,175.87 TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE PETRA CONSTRUCTION MANAGEMENT (626) 233-8148- 2410 W ALHAMBRA RD LIC. NO LOCATION ALHAMBRA, CA 91801 761300-8 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TE FOUNDATION/TRENCH LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING AP 0: SEWER MAP BOOK: PAGE: FIRE ZONE: P: UNDERFLOOR INSULATION 3 04 NO. OF SHEATHING. F IL G U /CO AT C NO 22 ROOF SHEATHING SCHOOL WITHIN HAZARDOUSSHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION / 7 FIRE SP LER HANGERS1 INSULATION/W5ATH5R STRIP INTERIOR LATH/DRYWALLo EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENING T AR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN BU'-LDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0312160040 PHONE: (626) 285-0488 EXT: TZTGAL iADDRESS: i�TR: 5905 LT: 37 BL: .001 SIGN DESCRIPTION: "NEWLAND REALTY" t 9075 LAS TUNAS DR TEMP CA SS( INFORMATION NUMBER: I NEAREST CROSSISOTREET: SULTANA 5387-015-006 j THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY T A EXIST N: PROCESSED BY: EXPIRES INEWLAND REALTY EXIST OCC GRP: 12/18/03 JK 12/12/04 OWNER: TEL. N0: BLDGS. NOW ON LO VALUATION: FINAL D TEEXPEtY CODE: WONG HERMAN - 1,500 9075 LAS TUNAS DRIVETEMPLE CITY 91780 S PA D SSC DESCRIPTION--UF-WORK ONE SET INDIVIDUALLY ILLUMINATED CHANNEL LETTER WALL SIGN FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: "NEWLAND REALTY" APPLICANT: T SUCCESS SIGN PRINTING INC (626) 448-1166- AA BLDG PERMIT ISSUANCE 27.75 9621 VELLEY BLVD AC STRONG MOTION RESID 1500.00 VAL 0.50 SPECIAL CONDITIONS: tL MONTE 91731 D1 PLANCHECK W/O EN-HC 1500.00 VAL 82.11 D2 PERMIT W/0 EN-HC 1500.00 VAL 82.20 TOTAL FEES 192.56 CONTRACTOR: EL. NO: APPROVALS DATE INSPECTOR SIGNATURE SUCCESS SIGN PRINTING (626) 444-8181- 9621 VALLEY BL LIC. NO LOCATION E BACKS SUITE # A 8/0614360 EL MONTE CA 91731 SOILS ENGINEER APPROVAL RCHIT Ci OR G EL. N RMS LIC. NO: SUPPORT STRUCTURE MAP NO: SEWER MAP BOOK: PAGE: FIRE CMP: 00 N0. OFt AMI E LING NITS: : STAT C SS: NO 20 SCHOOLHA7ARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO * ADDITIONAL DATA ON FILE REPORT ID: DPR261 ROUTE TO: SS0508 i6A663-CE806 468 APPLICATION FOR ELECTRICAL PERMIT • COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING c BUILDING AND SAFETY DIVISION ADDRESS 13 JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST NO EACH FEE y $ $ OWNER RECEPT _ MAIL LIGHT TOTAL FIRST 20 20 ADDRESS Gi C SWITCH_ OVER 20 10 CITY TEL. NO. l PLAN CHE LIGHTING 1 TOTAL FIRST 20 20 APPLICAN FIXTURES Jj OVER 20 10 ADDRESS RANGE—DRYER—WTR HTR.— CITY TEL NO STA COOK_DISP _F.A U — CONTRACTOR SPACE HTR AIR COND. ADDRESS CLOTHES WASH —DISHWASH._ CITY EL. NO. U FAN—OTHER 1 00 LICENSE NO CLASS. S MOTORS,TRANSFORMERS RATING IND HEATERS, ETC HP. KW KVA I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING 0 - 1 1 00 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1 - 10 3 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO 10 - SO 5 00 RESIDE IN, THE ABOVE OESCRIP.ED RESIDENTIAL PROPERTY 50 - 100 1000 SIGNATURE ©� U OF PERMITTEE 100 - 500 1S 00 J� DI S��j21CT N GRQUP ZONE P o TUBE, A �ADDITIONAL GN AND NE CIRCUIT 3 00 V`= aj CY U W MARQUEE CIRCUITS 1 00 NOTES: � Z SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00 SERVICE OVER 600 VOLTS OR 200 AMP 5 00 TEMP SERVICE, POLE, &APPURTENANCES 3 00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING PERMIT FEE (SUB TOTAL) FIXTURES PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED PERMIT ISSUING FEE 2 00 UTILITY CO NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1 00 ]FINAL TOTAL FEE JOSEPH C. ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATIONCK M O CASH , 2 7 0-%-o' N&J 18 2 a 5.Q 0,y EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE �(� - • C - 76A66C-CE$X806 5-61 APPLICATION FOR EL CTRICAL P IT COUNTY OF LOS /ANGELES DEPARMENT OF COUNTY ENGINEER BUILDING`^;' BUILDING AND SAFETY DIVISION ADDRESS D JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A JENSEN,SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST PERMIT FEES OWNER 1 T E M NUMBER EACH FEE MAIL OUTLETS. $ $ ADDRESS LIGHTS RECEPT. SW. .10 CITY TEL. NO. LIGHTING FIXTURES 10 ELEC. RANGES CLO DRYERS ELECTRICIAN 1 WATER HEATERS .50 ADDRESS 3I-fL ELEC SPACE HTRS DISHWASHERSol CITY TEL NO. .X GARBAGE DISPOSERS AUTO.- STATE WASHERS STA COOKING UNITS •2$ 1 LICENSE NO. � 73 O MOTORS. OVER INC HP DIST T O G O P Z NE P ESSED B .25 4 vz— 2 50 INSPECTION RECORD 2— 5 1.00 t 5— 15150 u 15— 50 2.50 O 50— 20o 500 1- W SIGNS NO TRANS A NO LAMPS H Z SERVICE 0.600V 1.00 SERVICE OVER 600V 500 M ISC WIRING PERMIT 1 00 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT 50 i TOTAL FEE $ s°`D 1 NDHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'SSIGNATURE- AISTATE THAT THE ABOVE,IS CORRECT AND AGREE TO COMPLY J I WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT ELECTRICAL WIRING WIRING �' I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR _ LICENSED AS REQUIRED BY,LOS ANGELES COUNTY AND STATE OF FIXTURES ' CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDTL PROPE POWER SIGNATURE UTILITY CO NOTIFIED rl OF PERMITTEE FINAL l I b/9,•i�' LIDATION ARTHUR`C. VEIT' ^MO CASH SUPERVISING ELECTRICAL ENGINEER U'_.i 3 4 201 JU;J 4 2 D 2.5 0 rl WORKERS'COMPENSATIONDECLARATION CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT J 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 �21eft' cQ a of(Sec.3800,Lab C) � JFOR APPLICANT TO FILL IN JOB Policy No Company On$.the. a New Residential Bldgs &Pools EACH NO. FEE ADDRESS 9075 Las Tunas Certified copy is hereby furnished 1 &2-Family,Sq. Ft $ — $ LOCALITY temple Cit ® Multi-family Sq Ft — NEAREST Certified copy is filed with the county building inspection CROSS ST Sultana Residential Swimming Pools department OWNER OR 6-81 FIRM NAME Date 4 Applicant Edwards Electric ,Outlets Rec_Light_ Sw MAIL First 20 ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional CITY Tel No' COMPENSATION INSURANCE PLAN CHECK CL APPLICANT (This section need not be completed if the work involved U by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First ADDRESS Total No Additional O P I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HCITY Tel No permit is issued, I shall not employ any person in any manner I PERMIT W so as to become subject to the Workers' Compensation Laws Range_ Heater_D.W. _ APPLICANT CL W Oven _ Dryer_W M ADDRESSto Date Applicant Top _ FAU _W.H 2515 Z Hood _ Fan _Other_ CITY Tel No _ 5096 NOTICE TO APPLICANT• If, after making this Certificate of Disp _ Room Air Cond.— LICENSE OR C-Z 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 PROCESSED BY with comply with such provisions or this permit shall be deemed revoked Size&Type HP,KW, KVA,or KVAR Up to 1 Incl FINAL ' Over 1 to 10 Incl � DATE LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl VALIDATION I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc FINAL BY 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 ness and Professions Code, and my license is to full force and effect Services License Number 257191 Lic Class C-10 0-200 Amp. Under 600 V 201 Edwards ElectrD3tq July 1982 Over 000 Amp Under r 6 0 V Contractor a Over 1000 Amp or Over 6000 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances 47 3 R I 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 '#'o 0 0 o o2 ness and Professions Code) � - Misc Conduits&Conductors 0 0 0 0 0_o o I, 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 4:� 4-8.1 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 PERMIT FEE (Sub-Total) issued (Sec 3097,Civ C) 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 NO 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 4-6-81 Signature of Permittee Date r