HomeMy Public PortalAbout9213 LEMON AVE_Electrical__ i
WORKER'S COMPENSATION DECLARATION 20-0019 DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT
1 hereby aF-Vrm 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.
COW th�reof'(Sec.9800 Lab. C) _ /�Q �/
Policy NaJOB
Companyy. FOR APPLICANT TO FILL IN ADDRESS
�p❑(( Certified copy is hereby furnished; New Residential Bldgs.&Pools —EACH•- NO FEE LOCALITY '[ f
ISL Certified coPy�is filed with the County building inspection 1 &2-Family,Sq.Ft. $ — $
department ,-�•/�;�, ,t, Multi-family Sq..Ft. CROSS ST
Date hcant_ �7�~/Ci'�'L G`� G Residential Swimming Pools ASSESSOR
AAP - MAP BOOKPAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR
COMPENSATION INSURANCE Outlets Rec. Light Sw. - FIRM NAME-
t MAIL
(This sectlon•need,not be completed If the work Involved by the First 20 f
permit Is fo�'one hundred'dollars(5100)or less.) Total No / Additional --- ADDRESS q
I certify that'in the performance of thehwork for which this permit CITY �%lzj��'Q! Tel No yc)LL_/Lt
Is issued, I shall not employ any person In any manner so as to ;'
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT CHECKLAN '
o{• Total No. Additional
.- - -ADDRESS
Date " Applicant'
NOTICE TO APPLICANT:, Iff:after making this-Certificate of 15 OR-20A,120V-BRANCH CIRCUITS - CITY Tel No.
Exemption,you.should-become,subject to,the Workers',•Compensation 1 TO 10 INCLUSIVE EACH •
provisions of the Labor,Code, you must forthwith,,comply,with:such 11 TO 40 INCLUSIVE EACH -- - -- _ PERMIT-- _
provisions or this permit shall be deemed revoked. APPLICANT
.. •• 41 OR MORE BRANCH CIRCUITS EACH
LICENSED CONTRACTORS DECLARATION -.. - ADDRESS. d
I hereby affirm that I am licensed under prrovisions of Chap15 OR 20A,208V TO 277V LIGHTING EACH ter 9 - - Q
(commencing with_Section 7000) of Division 3 of the Business and _ -• _ CITY D��� Tel No U
Professions Code, and my license is in full force and effect RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR
r^� /�fir, Power Apparatus&Large Appliances REG NUMBER t�J L�-b CIS
License Number < ��� Lic.Class `� — w Size&Type HP,KW,KVA,or KVAR DISTRICT NO PROC D BY O
•.p a.1' j�G,
/n►_ + '- r Up'to'3 Incl:' . - �. CJ V - W
Contractor 1 Y 'lO fyV r% Date - Over 3 to 10 I ncl FINAL d
DATE Z
❑ - - - -- - �-Over 10 to 50 Incl. _' - � 8•_- y A ,`
I am exempt under Sec. Over 50 to 100 Incl. Q _ _ y VALIDATION
100 FINAL
- --
B.&P.C.for this reason Over - BY
Services,Swbd,MCC&Panelboards
Date - _ -7 05 - - -
c•.. 0-200 Amp Under,600 V
Signature __201 -1000 Amp:.Under 600 V-
EJ _ _-__• „-,�+ Over 1000 Amp or Over 600 V
Exemptionfor Reg.Maint Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION -- —--- - - - - -
I herebyaffirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit t s
P _•t•I ,e
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits
Code): -
�;
El 1, &Conductors
I C -- - i
I,as owner of the property,will do the work and the structure I TENS,
Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule)
and Professions Code). I_iI i H� •- ,®
CONSTRUCTION LENDING AGENCY _ _ •- _- - _ ;_: E :p vl a}( `
I hereby affirm that there is a construction lending agency for the Lt 0113.;
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE Sub-Totaltr3 'I�I-
Ci�.C>
._ _..( ).. . _40 les -
-� PLAN CHECKING FEE
Lender's Name 00110-000
PERMIT ISSUING FEE / q
Lender's Address
I certify that I have read this application and state that the above TOTAL FEE
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
pror9ffyNr Inspection urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF APPLICANT OR AGENT DATE '
` COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0209050013
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: S PAID BUILDING
ON FILE 9213 LEMON-AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801327
ASSESSORNOR-EFF NEAREST CROSS STREET: OAK_
5382-015-029 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J1 LOCALITY: TEMPLE CITY
G1 OUTLETS-LGT,SW,RECP 47.00 OUT 75.45
TENANT: G2 LIGHTING FIXTURES 15.00 LGT 29.25 ISSUED ON: PROCESSED ON:
H4 RES RANGE HDS LT 3HP 1.00 HOD 10.95 09/05/02 JK 03/04/03
H5 RES WASH MACH LT 3HP 1.00 WAS 10.95
OWNER: TEL. NO: LB 200 AMP PANELS, MCC 1.00 PAN 38.85 FINAL DATE FINAL BY: CODE:
WONG - TOTAL FEES 193.20
3749 COGSWELL RD y
EL MONTE 9 D1732 SCRTP'TION OF R
ELECTRICAL FOR ADDITION/REMODEL
APPLICANT:
SUNG-LAM CHAN (626) 926-9840-
120 W CAMINO REAL AV SPECIAL DITIONS:
ARCADIA 91007
=\
CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE
INf BUILDERS (626) 574-0138-
120 W CAMINO REAL LIC. NO �� .i'� ': �� 0
ARCADIA CA 91007 490547BHIC XA
UNDERGROUND CO DUIT
ARCHITECTGIN E : L. N0: /// - ; UFER GROUND
LIC. NO - - -,:� � � ROUGH CONDUIT
lROUGH
WIRING
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
ED
- - - -- -- ---- -- -- ---- -/ UTILITY COMPANY N
OTIFI
REPORT ID: DPR265 ROUTE TO: BS0508