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Home My Public Portal About5752 LOMA AVE_Electrical__ WORKERS'COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE 806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lob. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB `� Certified co is hereby furnished. EACH NO. FEE ADDRESS d PY Y New Residential Bldgs. & Pools 9 Ft. $ $ LOCALITY — S — Certified copy is filed with the county building inspec- 1 & 2-Family, _ tion department. Multi-family Sq. Ft. NEARESTCROSS ST. Residential Swimming Pools OWNER OR Date Applicant f �j FIRM n CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RJV—Light Sw. / MAIL S�r 7i�oZ // J�YI COMPENSATION INSURANCE First 20Jr fl � ADDRES (This section need not be completed if the work involved by Total No. Additionali.SL CITYT66V7 & X Tel. No��`.,kg5 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 j Q€jo /�!7/�?-��'% permit is issued, I shall not employ any per n in any manne, so as to'become subject to the mpensation Laws. Lighting Fixtures First 20 ADDRESS �a�jCjQ�fj �� G Total No.—_ Additional � �N` J4"_C� C CITY/—' Tel. No.J4"_ T Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, of aking this Certificate of APPLICANT 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— CITY Tel. No. LICENSED CONTRACTORS DECLARATION �� LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. NUMBER � d�� Class.6.6 V. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCES D BY and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances ^� Size&Type HP, KW, KVA, or KVAR' ( / (• O License NumberLic. Class Up to 1 Incl. FINAL vOver 1 to 10 Incl. DATE —g VALIDATION Contractor 2 Date Over 10 to 50 Incl. U aBy I am exempt under Sec. Over 50 to 100 Inc. BY Over 100 B.&P.C. for this reason / Date: Services, Swbd., MCC&Panelboards ► / (/ 0X200 Amp. Under 600 V fF 7 Signature 201 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit3 O A I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Prof scions Code): c o 0 0 2 I, as owner of the property, will do the work and the Misc. Conduits&Conductors L o - 36.25 structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ 7044, Business and Professions Code). , v 3 A i�i U 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) T, (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE L� Lender's Address I certify that I have read this application and state that the TOTAL FEE aA above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authoriz presentatives of this County to enter upon t m oned property fer inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE E �Oy i n ureoT Permittee Date 1� COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0509210002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 5752 LOMA AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802452 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5387-017-018 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, C LA 100 AMP PANELS, MCC 1.00 PAN 38.85 TENANT: I TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 09/21/05 JK 03/20/06 OWNER: TEL. NO: ( F A AT FIN CODE: DELAROSA LAWRENCE F;MARTHA C (626) 285-8852- 5752 LOMA AV TEMP 917802452 D CRI ION OF WORK ELECT CAL SERVICE UPGRADE 100 AMP APPLICANT: TEL. NO: GARCIA (626) 962-4988- 1023 W. LOUISA AVE SPECIAL CONDITIONS: , WEST COVINA CA 91790 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE L & R ELECTRIC CO. (626) 962-4988- 1023 W. LOUISA AVE LIC. NO TEMPORARY POWER POLE WEST COVINA, CA 91790 476575 C10 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 f�lc0�/Cv �2 7