HomeMy Public PortalAbout6327 LIVIA AVE_Electrical__ affirm h COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT
I }�er2Sby affirm that 'I have a certificate of consent to self CE-806G
insure, ora certificate of'Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a ct,rtif'ed cooX thereof (Sec. 3800, Lab. C.)
Policy N af_0 Company lffT�� FOR APPLICANT TO FILL 1N JOB
❑ Certified co is hereby furnished. ADDRESS 7 L'
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PY Y New Residential Bldgs. & Pools EACH NO. FEE �
1 8 2-Family, 5 Ft. $ — $ LOCALITY �� l_e Cl
Certified copy is filed with the county building inspec- Y- q —
tion department. Multi-family Sq. Ft. NEAREST
r `. Residential Swimming Pools OWNER CROSS T. I�✓p
Da r Applicant ,,rr 'FIRM
CERTIFICATE OF EXEMPTION FROM WOR RS' Outlets: Recr6 Light7_ `�SwMAIL
COMPENSATION INSURANCE ADDRESS t0 J •
This section need not be completed if the work involved b First 20 )
( P y Total No _ Additional CITY 1,0 "�— Tel. No.OIF7��q
the permit is for one hundred dollars ($100)or less.)
I certifythat in the performance of the work for which this PLAN CHECK
P APPLICANT
permit 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 ADDRESS
Total No. "/� Additional
CITY Tel. No.
Date Applicant
Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT SL 7
Exemption, you should become subject to the Workers' Range_ Heater_D.W. !
or
Compensation provisions of the LabCode, 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_ CITY a Tel. No. � 5rq4
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG. NUMBER 7 y Class.
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCES D
and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances
Size 8 Type HP, KW, KVA, or ICVAR'
License Number Lic. Class Up to 1 Incl. FINAL
�� 6 Over 1 to 10 Incl. DATE ✓ j VALID ION
Controcto Date Over 10 to 50 Incl.
FINAL
ElW'
I am exempt under Sec. Over 50 to 100 Inc. BY /
B.&P.C. for this reason Over 100 Z
Services, Swbd., MCC & Panelboards
Date: 0 -200 Amp. Under 600 V L
Signature 201 - 1000 Amp. Under 600 V
❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY Temp. Power Pole & Appurtenances �1
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
1 hereby affirm that I am exempt from the Contractor's License n Branch Circuits
Law for the following reason (Section 7031.5, Business and Additions!Sig
Professions Code):
I, as owner of the property, will do the work and the Misc. Conduits&Conductors
EJ
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_
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 issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name
it 0 PERMIT ISSUING FEE
Lender's Address
1 certify that I have read this 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 ouImenned
presentatives of this County to enter upon
Z
bove pro erty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signa e of Perm' e 2
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1103280021
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 12115 LT: 5 6327 LIVIA AV
1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917801328
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LONGDEN I
15382-021-037 IA1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl
IG1 OUTLETS-LGT,SW,RECP 4.00 OUT 7.80
(TENANT: IG2 LIGHTING FIXTURES 2.00 LGT 3.90 JISSUED ON: PROCESSED BY: PLAN BY: 1
1 I TOTAL FEES 39.50 03/28/11 SR 1
OWNER: TEL. NO: I IFINAL DATE FIN Y: CODE:
ILO, MARIA Y (469) 274-2645- 1 1
16327 LIVIA AV 1 -1
ITEMP 917801328 (DESCRIPTION O WORK
(ELECTRICAL FOR NEW STORAGE
1APPLICANT: TEL. NO:
ILO, MARIA (469) 274-2645- 1
16327 LIVIA AVE. ISPECIAL CONDITIONS: 1
ITEMPLE CITY CA 91780 1 1 1
(CONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1
IQI ZHANG (626) 253-0188- 1 1 1
13380 BENT TWIG LANE LIC. NO 1 ITEMPORARY POWER POLE I I I
(DIAMOND BAR, CA 91765 910660 I 1 1 I 1
1I 1UNDERGROUND CONDUIT 1 1
(ARCHITECT OR ENGINEER: TEL. NO: 1 1UFER GROUND I I I
1 LIC. NO: 1 IROUGH CONDUIT 1 1
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1 IROUGH WIRING I
1 1 IMAIN WATER LINE �) e 1 1
PLASTIC Y/N METAL Y/N
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1 1UTILITY COMPANY NOTIFIEDI I I
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1 (REPORT ID: DPR265 ROUTE TO: BS0508 I 1 1 1
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