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Home My Public Portal About9042 LONGDEN AVE_Electrical__ WORK DEC TION 76A663 TION 1 hereby offiirm th'tCI h PEe aAcerrtificcate of consent to self CE 806G 10/81 n Pnn C n MN FOR ELECT��/,1 L PERM PT insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES h� 15 h�BUILDING AND USC'/A�FETY or a certified copy thereof (Sec 3800, Lab C ) Policy No Company FOR APPLICANT TO FILL IN JOB ADDRESS �✓ ElCertifiedcopy is hereby furnished New Residential Bldgs & Pools EACH NO FEE _ ❑ 1 & 2-Family, S Ft $ _ $ LOCALITY 7-p2, al C ,,r Certified copy is filed with the county building inspec- y 9 tion department Multi-family Sci FT 'NEARESTCROSS ST fIZZ-7 r Residential Swimming Pools OWNER OR `��n ) Date Applicant FIRM NAME 1 �f1 CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw_ MAIL COMPENSATION INSURANCE ADDRESS First 20 (This section need not be completed if the work involved by Total No m Additional CITY ,, L 71 Tel No. —J q 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 therWorkers'Compensation Laws Lighting Fixtures First 20 ADDRESS CITY Tel No Additional � S Applicant/Jd /S �% Total No Date Fixed Appliances Not Over 1 HP PERMIT NOTIC TO PLICANT If, after making this Certificate of APPLICAN9"C — 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 — ADDRESSOk with comply with such provisions or this permit shall be Top — FAU —W H — CITYTel No q deemed revoked Hood _ Fan _Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp — Room Air Canal LICENSE NUMBER Class (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO PROCESS BY >_ and Professions Code,and my license is in full force and effect O O Size &Type HP, KW, Incl or KVAR Ej ` u License Number Lic Class � Up To 1 Incl FINAL / Over 1 to 10 Incl DATE —' VALIDATION 0 Con tractoQA/2f!/y ��FG/-Date FINAL V Over 10 To 50 Incl ❑ I am exempt under Sec Over 50 to 100Inc BY w v d H B&P C for this reason Over-100 D Date Services, Swbd , MCC 8 Panelboards 0 -200,Amp Under 600 V SignatureT+/ � - /� 201 - 1000'Amp Under 600 V ❑ 0 I,�^^^ Over 1000 Amp or Over 600 V !/ Exemption for Reg Moint 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 o Q 72,9 A Professions Code) ❑ 1, as owner of the property, will do the work and the Misc Conduits&Conductors f! o o o 0 o 2 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ D /�� 7044, Business and Professions Code) J✓',o 3 1,5 0 - CONSTRUCTION LENDING AGENCY o o 0 3 1,5 0 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) 0 3 2 5-83 (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 I agree to comply with all County ~ ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon 1 the above-mentioned property for inspection purposes SEE REVERSE-FOR EXPLANATORY LANGUAGE _y9 nature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0209110019 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 5904 LT: 173 UN: .002 9042 LONGDEN AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801509 ASSESSORN NEAREST CROSS STREET: ROSEMEAD 5384-005-015 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY F1 120V, 15/20A BR CKTS 10.00 BR 172.50 TENANT: G1 OUTLETS-LGT,SW,RECP 40.00 OUT 66.00 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES . G2 LIGHTING FIXTURES 20.00 LGT 39.00 09/11/02 JK 03/10/03 H2 RES GRBG DISP LT 3HP 1.00 DIS 10.95 NER: TEL. NO: H3 RES DISHWASHR LT 3HP 1.00 DIS 10.95 FINAL DATE FINAL Y: CODE: TOM HWANG (909) 985-9542- H4 RES RANGE HDS LT 3HP 1.00 HOO 10.95 2105 N 2ND AVE H7 RES EXHAUST FANS 1.00 EX 10.95 UPLAND 91784 TOTAL FEES 349.05 DESCRIPTION ELECTRICAL FOR ADDITION APPLICANT: TOM HWANG (929) 985-9542- 2105 N 2ND AVE SPECIAL CONDITIONS: UPLAND 91784 --�_ CONTRACTOR: TEL. NO: �� ''� Q��, �_ ��e,� o,n��; APPROVALS DATE INSPEdTORS NATURE CENTRAL AIR SYSTEM (909) 985-9542- ,�� ✓ 2105 N 2ND LIC. NO / / �, �� RARY POWER POLE �� UPLAND, CA 91784 445225 A[- UNDERGROUND CONDUIT TRURMET-OR NG L. N i r �" (—� - FGROUND LIC. NO: , -� ; �,�11 ROUGH CONDUIT � ROUGH WIRING Z MAIN WATER LINE PLASTIC Y/N METAL Y/N - - - - - UTILITY comVA—NT-N-o7rFrff �� •� l �' � iii/ �/�/ * ADDITIONAL DATA ON FILE REPORT ID: DPR265 ROUTE TO: SS0508