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Home My Public Portal About6214 LOMA AVE_Electrical__ WORKERS'COMPENSATION DECLARATION, 76A663 10/81 I hereby affirm that I have a certificate of consent to self CE-806G`' insure, or a certificate ofWorkers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or✓a�cer�tified copy there &c?8NPb C P❑o1q, IVo Comparyf�D FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS LOCALITY �rl Certified copy is filed with the county building mspe - 1 &2-Family, Sq Ft $ — $tion department .Multi-family Sq Ft — NEAREST CROSS ST lr✓ Residential Swimming Pools OWNER OR Date _ Applicant - FIRM NAME -'5' CERTIFICATE OF EXEMPTION FROM WORKERS' le- MAIL Outlets Rec,�Light Sw COMPENSATION INSURANCE ,7 1 ADDRES50,;t �/ LO Yrl,� (This section need not be completed If the work involved by First 20 CIT / the permit is for one hundred dollars ($100)or less.) Total No Additional y! I No I certify that in the performance of the work for which this PLAN CHECK permit is issued, I shall not employ any person in any manner / �J PPLICANT so as to become subject to the Workers'Compensation Laws Lighting Fixtures First 20 / ADDRESS Total No Additional CITY Tel No Date Applicant NOTICE TO APPLICANT If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT `� L Exemption, you should become subject to the Workers' Range Heater_D W APPLICANTiv 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 CITY ��1� Tel No-3-1) LICENSED CONTRACTORS DECLARATION Hood _ Fan Other_ / Disp _ Room Air Cond LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9" REG NUMBER yd Z�33 Class (commencing with Section 7000) of Division 3 of the Business DISTRICT N PROCESSED BY and Professions Code,and my license is-in full force and effect Power Apparatus 8 Large Appliances Q� y. Size &Type HP, KW, KVA, or KVAR ® O CL License Number��?�—Lic Class Up to 1 Incl FINAL V /fes/-/�L� v �— Over 1 to 10 Incl DATE VALIDATION 09 Contractor-, ' zl ��Date Over 10 to 50 Incl O FINAL ~ ❑ I am exempt under Sec Over 50 to 100 Inc, BY, uVi B&P C for this reason Over 100 y Date Services, Swbd , MCC& PanelboW4s D ' / ? Z 0 -200 Amp Under 600 V j f Signature 201 - 1000 Amp Under 600 V ❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V 3 1 6 8.A SINGLE FAMILY Temp Power Pole &Appurtenances. # 04 60 0 io 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 2.0 0'(�Q 2 5 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 o o o 6 Q 2 5:5 Professions Code) 0.8 0 2-8 4 ❑ r Misc Conduits&Conductors 1, as owner'of the property, will do the work and the structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ D 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 - PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE above information is correct 1 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 prooerty for inspection purposes • SEE REVERSE FOR EXPLANATORY LANGUAGE - 8- z-/gl / gnature of Permit a Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1304250039 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT ILEGAL ID FEES PAID BUILDING ADDRESS ITR 5904 LT: 267 I 6214 LOMA AV I IFEE DESCRIPTION QUANTITY- UOM- AMOUNP:I TEMP CA 917801634 I (ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET I 15384-012-013 1P2 PC RES PV,10KW 153 90 I THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY, Cl Al PERMIT ISSUANCE FEE 27 80 I 1 ITENANT IP3 INVRTR RES PV<10KW 27 90 (ISSUED ON PROCESSED BY: PLAN BY 1 I TOTAL FEES 209 60 105/22/13 SR 1 I 1 I JOWNER TEL NO I FINAL--PATF FINAL Y CODE 1WONG, ALAN (626) 863-7784- 16214 LOMA AV 1 I 1 ITEMP 917801634 I ID SCRIPTION"OF WORK 1 IRES ROOF MOUNT 20 PANELS 1 INVERTER FOR PHOTO VOLTAIC 1 I 11NSTALL (APPLICANT TEL NO I _ (SMITH, LOGAN (909) 973-0226- 1 1 I 11755 B IOWA AVE 1 ISPECIAL CONDITIONS IRIVERSIDE CA 92507 1 I I I (CONTRACTOR TEL NO 1 1APPROVALS DATE INSPECTOR SIGNATURE 1 ISOLARCITY CORPORATION (650) 638-1028- 1 13055 CLEARVIEW WAY LIC NO 1 1 ISAN MATEO CA 94402 888104 I (TEMPORARY POWER POLE 1 1 1 I I (UNDERGROUND CONDUIT 1 1 1 ARCHITECT OR ENGINEER TEL NO i IUFER GROUND LIC NO IROUGH CONDUIT ;7,3q- 1 (ROUGH WIRING 1 1 I IMAIN WATER LINE I 1 I I 1 IPLASTIC YIN METAL YIN 1 1 1UTILITY COMPANY NOTIFIE I q 1 1 1 I I I I I I I I I I 1 I I I I I I 1 I I I I I I I I I I 1 1 I I I I 1 I I I I I 1 I I I I I 1 IREPORT ID DPR265 ROUTE TO BS0508 1 I I I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1108120002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID I FEES PAID BUILDING ADDRESS ITR 5904 LT 267 1 6214 LOMA AV IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917801634 ASSESSOR INFORMATION NUMBER _1 NEAREST CROSS STREET 15384-012-013 1A1 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY, Cl ILB 200 AMP PANELS, MCC 1 00 PAN 38 80 1 ITENANT I TOTAL FEES 66 60 (ISSUED ON PROCESSED BY PLAN BY I 108/12/11 SR I (OWNER TEL NO 1 IFINAL DATE FIN Y CODE 1 IWONG, ALAN 16214 LOMA AV 1 ITEMP 917801634 1 ID CRIPTION OF WORK I IRELOCATE 200 AMP ELECTRICAL PANEL I (APPLICANT TEL NO IKWOK, TERENCE (323) 697-2120- I 1 1760 E GARVEY AVE 1 ISPECIAL CONDITIONS I IMONTEREY PARK 91755 ICONTRACTOR TEL. NO 1 1APPROVALS DATE INSPECTOR SIGNATURE I IBEN KWOK CONSTRUCTION CO (626) 922-6181- 1 1720 HILL PLACE #3 LIC NO ITEMPORARY POWER POLE ILOS ANGELES, CA 90012 591589 B I I (UNDERGROUND CONDUIT (ARCHITECT OR ENGINEER TEL NO I IUFER GROUND 'I I IKWOK, TERENCE (323) 697-2120- I 1 i(J� COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1108100035 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID FEES PAID BUILDING ADDRESS ITR 5904 LT 267 6214 LOMA AV IFEE DESCRIPTION QUANTITY UOM AMOUNT I TEMP CA 917801634 (ASSESSOR INFORMATION NUMBER I - I NEAREST CROSS STREET 15384-012-013 1A1 PERMIT ISSUANCE FEE 27 80 I THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY, Cl I IG1 OUTLETS-LGT,SW,RECP 11 00 OUT 21 40 I (TENANT. 1G2 LIGHTING FIXTURES 13 00 LGT 25 20 (ISSUED ON PROCESSED BY PLAN BY IH5 RES WASH MACH LT 3HP 1 00 WAS 10 90 108/10/11 SR I 1H7 RES EXHAUST FANS 1 00 EX 10 90 1 (OWNER TEL NO 1H9 RES APPL LT 3HP 1 00 RES 10 90 1FI AL DATE FIN BY CODE 1 IWONG, ALAN - I TOTAL FEES 107 10 1 1 16214 LOMA AV I I ITEMP 917801634 1 ID RI ION OF WORK 1 1 (ELECTRICAL FOR ADDITION 1 1APPLICANT TEL NO 1 1 1 1KWOK, TERENCE (323) 697-2120- 1 1 1760 E GARVEY AVE 1 ISPECIAL CONDITIONS IMONTEREY PARK 91755 1 1 ICONTRACTOR TEL NO 1 1APPROVALS DATE INSPECTOR SIGNATURE I IBEN KWOK CONSTRUCTION CO (626) 922-6181- I 11 1720 HILL PLACE #3 LIC NO 1 ITEMPORARY POWER POLE ILOS ANGELES, CA 90012 591589 B II 1 I I (UNDERGROUND CONDUIT (ARCHITECT OR ENGINEER TEL NO I IUFER GROUND I IKWOK, TERENCE (323) 697-2120- 1 1 1260 E GARVEY AVE LIC NO 1 IROUGH CONDUIT IMONTEREY PARK, CA 91755 C24796 1 I 1 1 IROUGH WIRING 1 IMAIN WATER LINE 1 1 1 IPLASTIC Y/N METAL Y/N 1 1 1 1 , 1UTILITY COMPANY NOTIFIED( 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 I I I I I I I I I I I I I I I I I I I I I IREPORT ID DPR265 ROUTE TO SS0508 1 I I