Loading...
HomeMy Public PortalAbout6218 LOMA AVE_Electrical__ WORKERS' COMPENSATION DECLARATION :76A663 DPW 3 87 I heAPPLICATION FOR ELECTRICAL PERMIT ly affirF� that I have a certificate of consent to self Ce 806G insuw.e, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or 9 cerlified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS El Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. NEAREST Residential Swimming Pools CROSS ST. Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' OutSwMAIL Outlets: Rec Light ._ C"J Ll/ COMPENSATION INSURANCE ADDRESS completed if the work involved b First 20 (This section need not be com P Y Total No. Additional CITY Tel. No. 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 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 Additional Date Applicant Total No. CITY Tel. No. NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION 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 Tel. No, 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 Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PR C SED BY >- and Professions Code,and my license is in full force and effect. d Size &Type HP, KW, KVA, or KVAR O License Number Lic. Class Up to 1 Incl. FINAL Contractor Date Over 1 to 10 Incl. DATE VALIDATION 0 ❑ Over 10 to 50 Incl. FINAL I am exempt under Sec. Over 50 to 100 Inc. BY �7 y✓► .__- L B.&P.C. for this reason Over 100 t1 Date: Services, Swbd., MCC& Panelboards Z Z 0-200 Amp. Under 600 V — Signature 201 - 1000 Amp. Under 600 V aExemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit i I ��•_ Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): 20 - 00 a, as owner of the property, will do the work and the Misc. Conduits&Conductors (.HECK(Section 7044, 1r41? l structure is not intended or offered for sale SiOther (See Complete Fee Schedule)— �•�E a,c„«:- Business and Professions Code). '_ Hf'VIE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for ;n the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 01,_ (Sec. 3097, Civ. C.). `sss_ ' fLol; 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. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives o his County to enter upon the abo mentioned pr oy r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ja 'Nenature of Permitt Date ©s WORKERS' COMPENSATION DECLARATIQN 76A663 10/8 APPLICATION FOR ELECTRICAL PERMIT fi CE-8000 I hereby•affirm..that I have a certificate of�conserit`to'se. � 'insure, or a certificate of�Workers' Compensation Insurance, COUNTY OF LOS ANGVLES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT.TO FILL IN JOB m� E� Certified co is hereby furnished. EACH NO. FEE ADDRESS, pC /�/ / PY Y New Residential Bldgs. & Pools ❑ 1 &2-Family, S Ft. $ _ $ LOCALITY Certified copy is filed with the county building inspec- Y• q� tion department. Multi-family Sq. Ft. 'NEAREST CROSS ST. e,-7 Date Applicant Residential Swimming Pools OWNER OR FIRM NAME l CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light . Sw._ MAIL COMPENSATION INSURANCE ADORES AJ 04- This section need not be com leted if the work involved b First 20 ( p Y Total No. Additional CIT Tel. N a/- 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 eany person in any manner so as to become subject to e Wo kers'Com ensatioK Laws. Lighting Fixtures First 20 ADDRESS _ C/4 Total No. Additional Date Applic CITY Tel. No. 4NOTICE TO APPLICANT: If, after making th Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subj to the Workers' Range— Heater_D.W. APPLICANT 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 7e1.,No. LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Di SP' — Room Air Cond. REG. NUMBER Class. (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY and Professions Code,and my license is in full force and effect. Size &Type HP, KW, KVA, or KVARO License Number Lic. Class Up to 1 Incl. FINAL V Over 1 to 10 Incl. ` DATE -/ X VALIDATION Contractor Date Over 10 to 50 Incl. FINAL U ❑ 1 am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100 Date: Services, Swbd., MCC& Ponelboards , 0 - 200 Amp. Under 600 V 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 Circuit 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 Professions Code): 2 5 8.9 A ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors oo 0 0 0 2 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ t 7044, Business and Professions Code). ► 2,-.9 2 5,5 0 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for ° ° ° 2,5:5 0 C the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 07-09—84 (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE, p Lender's Address I 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 ebyauthorize representatives of this County to enter upon the above-mentionedfproperty for inspection pur poses. SEE REVERSE FOR EXPLANATORY LANGUAGE o "Sgn.tPe mittee TION 76A66 WORKERS' CI have certificate f corse CE-8Q6 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-Bc6G � . 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 n Certified co s hereby furnished. EACH NO. FEE ADDRESS PY Y New Residential Bldgs. kP 1 & 2-Famil S Ft.� $ — $ LOCALITY El Certified copy is filed with the county building inspec- Y, q i' tion department. Multi-family Sq. Ft. NEAREST CROSS SL� Date Applicant Residential Swimming Pools OWNER OR 0 yy 'FIRM NAME Q,I'1, CERTIFICATE OF EXEMPTION FROM WORKERS' �/ � 13 MAIL Outlets: Rec Light Sw._ !1 l COMPENSATION INSURANCE � . ADDRESS d. l'V�.�} �UQ.. This section need not be completed if the work involved b � First 20 ( p y Total No. Additional CITY a4qTel. No. KJ7–/7/0 the permit is For one hundred dollars ($100)or less.) I certify e that in the performance of the work for which this PLAN CHECK permit is issued, I shall not employ any person in any manner APPLICANT so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional Applicant CITY Tel. No. Date Fixed Appliances of Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making 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 Class. (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCES ED BY and Professions Code,and my license is in full force and effect. Size &Type HP, KW, KVA, or KVAR' License Number Lic. ClassUp to 1 Incl. FINAL U Over 1 to 10 Incl. DATE VALIDATION C9 Contractor Date Over 10 to 50 Incl. tBlY AL j I am exempt under Sec. Over 50 to.100 Inc. � B.&P.C. for this reason Over 100 Services, Swbd., MCC & Ponelboards Date: 0 -200 Amp. Under 600 V 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 Circuit 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 Professions Code): I, as owner of the property, will do the work and the Misc. Conduits &Conductors f 8 7.5,16 P, structure is not. intended or offered for sale (Section Other (See Complete Fee Schedule)_ o o o o 0 7044, Business and Professions Code). , # , I , ,2 CONSTRUCTION LENDING AGENCY °Eo 4.2125 1 hereby affirm that there is a construction lending agency for ' the performance of the work for which this permit is issued ° °I° 4 2 2 5 v P P PERMIT FEE (Sidi-Total) , (Sec. 3097, Civ. C.). r ' PLAN CHECKING FEE 02. 07-84 Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the I TOTAL FEE above information is correct. I agree to comply with all County 14-5 ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the ove-mentj�aned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Aia,�a d, Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1310230040 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID BUILDING ADDRESS: ITR: 5904 LT: 268 6218 LOMA AV 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801634 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LONGDEN 1 15384-011-001 1A1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CAI I IP2 PC RES PV<10KW 153.90 ITENANT: IP3 INVRTR RES PV<10KW 27.90 JISSUED ON: PROCESSED BY: PLAN BY: I TOTAL FEES 209.60 110/23/13 SR 1 (OWNER: TEL. NO: I (FINAL DATE FIN BX: CODE: 1 ICHIN GENNA (626) 348-3893- / 1 16218 LOMA AV ITEMP 917801634 I Ift-SCRIPTION OF WORK I IROOF MOUNTED PHOTO VOLTAIC 14 MODULES 3:45 KW APPLICANT: TEL. NO: ICHU, JONATHAN (626) 390-5886- 1 1451 W LAMBERT RD I ISPEC7AL CONDITIONS: IBREA CA 92821 I I I I I I I I (CONTRACTOR: TEL. NO: 1APPROVALS DATE INSPECTOR SIGNATURE 1 ISUN BEES GROUPS INC (714) 676-8888- I 1- 1451 W LAMBERT ROAD SUITE 212 LIC. NO I (TEMPORARY POWER POLE IBREA CA 92821 970591 I I I (UNDERGROUND CONDUIT I I I I I I I (ARCHITECT OR ENGINEER: TEL. NO: 1UFER GROUND I (DOUG ENGINEERING (949) 285-5104- 1 1 1102 PINON TREE LANE LIC. NO: I IROUGH CONDUIT I ICOSTA MESA CA 92627 C69163 I f�% I I J (ROUGH WIRING IMAIN WATER LINE IPLASTIC Y/N METAL Y/N 11 1UTILITY COMPANY NOTIFIED( `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 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: BS0508 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 0709210016 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 5904 LT: 268 6218 LOMA AV IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917801634 (ASSESSOR INFORMATION NUMBER: 1 ,,1 NEAREST CROSS STREET: LONGDEN 1 15384-011-001 IA1 PERMIT ISSUANCE FEE 27.75 'I ' THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl I IB2 1 OR 2 FAMILY DWELL 2520.00 SQ 264.60 I I TENANT: ILB 200 AMP PANELS, MCC 1.00 PAN 38.85 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1 TOTAL FEES 331.20 109/21/07 SR 03/19/08 I I I I I 10WNER: TEL. NO: 1 IFI AL DATE FIN Y: CODE: ICHIN GENNA (626) 580-6238- I 1 16218 LOMA AV I I p 1 ITEMP 917801634 1 IDtItRIPTION OF WORK 1 I I IRE-WIRE ENTIRE. HOUSE FOR ADDITION, REMODEL AND UPGRADE 1 1 I ISERVICE PANEL TO 200 AMP 1 1APPLICANT: TEL. NO: I I I ICHIN (626) 580-6238- I 1 1 16218 LOMA AVE. I ISPECIAL CONDITIONS: 1 TEMPLE CITY CA 91780 I 1 (CONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1 (AIR CARE MECHANICAL CO. (626) 442-6792- 1 1 1 18143 CELITO DR LIC. NO I ITEMPORARY POWER POLE I IROSEMEAD CA 91770 516562 C20 *I I I I1 I I 1UNDERGROUND CONDUIT I 1ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND I I 1 ILUK, SAMUEL (626) 858-0438- I 1 1 1 1527 N AZUSA LIC. NO: 1 IROUGH CONDUIT 1 1 INONE 1 I COVI COVINA, CA 91722 1 1 ROUGH WIRING IMAIN WATER LINE 1 1 IPLASTIC YIN METAL YIN I 1 1 I I I 1 (UTILITY COMPANY NOTIFIE 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 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 1* ADDITIONAL DATA ON FILE I 1 1 1 IREPORT ID: DPR265 ROUTE TO: BS0508 1 1 1 1 I I I I I I