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HomeMy Public PortalAbout9424 LAS TUNAS DR_Electrical__ 76A663-CED06.7.66 APPLICATION -FOR ELECTRIC PERMIT BUILDING AND SAFETY DIVISION Department of County Engineer BUILDING d County of Los Angeles ADDRESS 7�Z� —/rl.>' 7`r� 11 JOHN A. LAMBIE. COUNTY ENGINEER -�'' / L CASSATT D. GRIFFIN.SUPT OF BUILDING LOCALITY / ° � [�:/V NEAREST FOR APPLICANT TO FILL IN CROSS ST. PERMIT.FEES J NUMBER - - OWNER LIGHT OUTLETS - MAIL ADDRESS �7� Lam✓ ���� �� RECEPTACLESr.�- - WALL SWITCHES - FEE CITY7eg 4 '�' � TEL.,NO. TOTAL OUTLETS @ 5¢ $ ELECTRICIAN EC. RANGES 25 ADDRESS ELEC. HEATERS 25 CITY W" TEL.NO. ` KW.EA STATE LICENSE NO. u' FIXTURES 5 MOTORS DISTRICT NO. ROUP /ZONE I READY FOR INSPECTION NUMBER HORSEPOWER - FEE- I /—'-Z I NEW MVD. HP OVER INC. EACH X12 LESS $ .25 INSPECTION.RECORD 1/Z - 2 .50 2 5 1.00 5 15 •1.50 15 50 2.50 - 50 200 5..00 MISC. NO. SIGNS NO. TRANS. - -NO.-SIGNS- NO. LAMPS ' FOR EACH PERMIT: - WIRING PERMIT - $1.00 -- FIXTURE PERMIT $1..00 - - SUPPLEMENTARY .50 APPROVALS' TOTAL FEE $ DATE INSPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT I .HAVE READ' THIS AP LIGATION CONDUIT AND,STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY - WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. FIXTURES - I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS. REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _ DESCRIBED.RESIDENTII&L PROPERTY. UTILITY CO.NOTIFIED SIGNATURE 4C ."A- OF F -OF PERMITTEE - FINAL v v JOHN A. LAMBIE, VALIDAT;W, ARTHUR C. VEIT. COUNTYENGINEER cK Mo ws H. SUPERVISING ELECTRICAL ENGINEER ` 7BA663-CESOG If-" APPLICATI'ON. FOR-ELECTRIC PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUMDING AND SAFETY DIVISION ADDREss 1OHN A. LAMBIE,Count;Engineer CASSAIf D. GRIMM Supt of uilLOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. ITEM PERNIIT FEES NUMBER EACH FEE OWNER IAC r OUTLETS: $ $ MAIL LIGHTS RECEPT. SW. .10 ADDRESS ' Y� LIGHTING FIXTURES .10 CITY '` TEL.NO. ' ELEC.RANGES CLO.DRYERS - ELECTRICIAN WATER HEATERS .50 ADDRESS4.--v ,•+ ELEC.SPACE HTRS. _ DISHWASHERS I GARBAGE DISPOSERS AUTO.- CITY r TEL.NO. WASHERS STA.COOKING UNITS .25 STATE LICENSE NO. MOTORS: OVER INC. H.P. _ o +/2 .2 5 DISTRICTNO. GRO P ZONE READY FOR INSPECTION — � +/2 — 2 .50 G z — 5 1.00 INSPECTION RECORD 5 — 15 1.50 15 — 50 2.50 50— 200 5.00 SIGNS: NO.TRANS. NO.LAMPS SERVICE C-600V 1.00 SERVICE OVER 600V - 5.00 MISC. WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT• .50' TOTAL FEE $� APPROVALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS. ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENTIAL PROPERTY. SIGNATURE '., { L�,VvvA.�' UTILITY CO.NOTIFIED a OF PERMITTEE "� NO FINAL iY VALIDAT a RTHLJR C.VE T, CK Mo.( SUPERVISING ELECTRICAL ENGINEER.. CK MO' CASH - - - - 9 :2 X16 . . 21 76A888 DB,S SA .5-49 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY. COUNTY OF LOS ANGELES ELECTRIC 1 WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. f � /7 c- -7 /D "7%�f , ELECTRICIAN P _ (( 1 C.t�. h• " _l RECEIVE /BY READY FOR DATE ISSUED ADDRESS ILl /1J o�t_�--- -�_•�.t_-9 {/y FIRST INSPECTION CITY 1.-•��✓ CS• TEL. NO. COUNTY LICENSE NO. g- 'a' Y EXPIRES BUILDING ' PERMIT FEES ADDRESS I G) FEE NUMBER I OUTLETS EACH LOCALITY - LIGHTS Sc I$ Gr v` +yryryj) � NEAREST -rqC 4/ RECEPTACLES 5 r CROSS ST. mac. I FIXTURES 5 C2r7 OWNER ale'--'C '•-�. L�4..LG� rL-•real k� O� WALL SWITCHES 5 rY� MAIL 4� 'ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 CITY TEL. NO. MISC. I 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS NUMBER OF CIRCUITS INSTALLED: APPLICATION AND STATE THAT THE ABOVE IS CORRECT LIGHTS 7S RECEPTACLES LI AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING. NUMBER HORSEPOWERI CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER NEW MVD. HP OVER INC. EACH .I OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. '/,a LESS $ .25 1/ 2 .50 SIGNATURE OF PERMITTEE _ 2 5 1.00 5 15 1.50 INSPECTION RECORD 15 50 2.50 50 200 5.0 200 - Soo 10.00 J 500 1000 15.00 Q OVER 1000 20.00 - Z M.G. SET/FREQ. CHANGER-HP - 0 WELDERS: AC-KYA Q GENERATORS - KW ' TRANSFORMERS - KVA TE P. MOTORS 75% OF ORIG.) MOVED MOTORS 750o OF ORIG. MISC. SIGNS TYPE: NO. TRANS. TYPE: NO. LAMPS APPROVALS DATE INSPECTOR'S NAME FOR EACtl PERMIT: CONDUIT WIRING $1.00 FIXT ErS $1.09:.- �y9 Y WIRING SUPP 6MENTARY .50 FIXTURES �^ POWER TOTAL FEE $ ' �(� UTILITY CO. NOTIFIED FINAL 76A663 DBB5A 11-49 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ' COUNTY OF LOS ANGELES ELECTRIC s LECTR WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT N.O. ?- ELECTRICIAN1 ' RE C IVE BY READY FOR DATE ISSUED ADDRESS .S, [Sw,;L.j{�:=t.. F� � 99 FIRST INSPECTION �]p- CITY TEL. NO, F� 7r���® COUNTY LICENSE NO. lee 7� EXPIRES BUILDING / ♦�+/� q� —jAlg • ADDRESS � 4f P` aFo 3 PERMIT FEES µd To c P.IR'# NUMBER OUTLETS EACH FEE LOCALITY LIGHT Sc B NEAREST S CROSS ST. ® RECEPTACLES 5 FIXTUREB 5 .OWNER WALL SWITCHES 5 MAIL �f ELEC. RANGES 25 ADDRESS - ELEC. HEATERS 25 CITY TEL. NO. MISC. 11 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS NUMBER OF CIRCUITS INSTALLED: TOTA, APPLICATION AND STATE THAT THE ABOVE IS CORRECT LIGHTS RECEPTACLES AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING. - NUMBER HORSEPOWERFEE I CERTIFY THAT I POSSESS THE ABOVE VALID LOS NEw Mvo. HP OVER INC. EACH ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL 1C3JWNE;ROF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. V2 6 LEGS fl] .25I/ 2 .5O SIGNATURE OF 2 5 1.00PERMITTEEGec „ 5 is 1.50 INSPECTION RECORD is so 2.50 s0 2013 s.oD 200' SOO 10.00 500 1000 15.00 J OVER ICO❑ 20.00 M.G. SET/FREQ. CHANGER-HP j9 WELDERS:AC-KVA ! 'S'�"r isyV e��1✓/yG27/,C(![jl° �_ �y� GENERATORS - KW ' ►J�l2. "/� lo' /c• d✓/�_.LJ O TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORIG.) MOVED MOTORS (75% OF ORIG.) MISC. SIGNS TYPE: NO.TRANB. TYPE: NO. LAMPS ' APPROVALS FOR EACH PERMIT: DATE INSPECTOR'S NAME WIRING $1.00 o CONDUIT FIXTURES $1.00 O WIRING SUPPLEMENTARY .50 FIXTURES ro hbLn POWER n TOTAL FEE $ Q® UTILITY CO.NOTIFIED y FINAL !�i^j_1-(j� e r• DB D•A 10-41 ESM - APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFLTY T (`� COUNTY OF LOS ANGELES ELECTRIC WM. J. FOX CHIEF ENGINEER = DISTRICT NO. GROUP ZONE PERMIT NO. . Q NAME1 -72011 f ADDRESS -1 ( o� U CITY Z/ TEL.NO.�qt 1 �E" RECEIVED BY READY FOR DATE ISSUED J COUNTY /�J - �J�l�� a' FIRST INSPECTION W CERT.NO. 6 / EXPIRES �j APPLICANT FILL IN HEAVILY OUTLINED PORTION_ ONLY jB DESCRIPTIO_ N OF WORD ADDRESS Z NUMBER OF OUTLETS ON CIRCUITS LOCALITY *LOCATION BY ROOMS / - NEAREST LIGHT OUTLETS lsw.I UGS I FIX'T CROSS ST. CIRCUIT A B C D E I F G H I m (SAME Z MAIL ADDRESS CITY TEL.NO. I AM THE. LEGAL POSSESSOR OF THE ABOVE LOS ANG_ELE$ .COUNTY CERT1 1 TE PFqUALIFICATION.. ELECTRICIAN. I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE OWNER. CORRECTIONS4 Z . . � q sGl — d Z t� • O TOTAL NO. OF OUTLETS ffi APPROVALS NO. OF FIXTURES ffi DATE INSPECTOR'S NAME .NO. OF MOTORS H.P. ffi CONDUIT NO. OF SIGNS TRANS. ffi WIRING NO. OF RANGES OR HEATERS ffi FIXTURES F MISCELLANEOUS " ffi �yJn POWER PERMIT FEE ffi W�?_ UTILITY CO.NOTIFIED A k 1\/ TOTAL FEE FINAL DBS SA 25M SETS•1-40' _ ( Al P $CA►R7ION FOR PEMM DEPARTMENT' OF BUHDM AND SAFYff "EILECTRE9T n�a Al 1V 1�L7YL I COIJNW OF.LOS LIi NGIMI'S J. EQ& H Z DISTRICT NO., GROUP ZONE /PERMIT NO. a NAME . / ~ fid,+ T ' 2 1 ADDRESS i 4Z/,o G Z� �✓.�s r�2 2' RECEIV a BYf READY FOR DATE ISSUEDI CITY � }'J�.�1 J TEL.NO. FIRST INSPECTION J- COUWTY / ul C1 RT.NO. I'Ale, EXPIRES 7e 1p1� APMCANT I LL IN HEAVILY O I•rED PORTION ONLY . IDES�SQ.H.i.E a Itl. N Off''WOR —ADDRESS ��i�l L� �� L1��S A NUMBER OF OUTLETS ON CSRCUITS LOCALITY LOCATION BY ROOMS NEAREST ' WISHT OU l8w.IPLUC38 ImiT C ST. CIRCUPT A-1111 C I D I E F IG I H 0: NAME /YI MAIL ADDRESS O CITY TEL.NO. 1 AM THE LZGAL POSSESSOR OF THE ABOVE LOS'. ANGELES COUNTY CERTIF�OF QUALIFICATI IIL ELECTRICIAN. 1 AFC THE LEGAL.OWNER OF THE PROPERTY DESCRIBED ABOYE m OWNER. J Q Z_ CORREMONS - � r TOTAL P.O. OF OUTLETS $ APPROVALS NO. OF FDCTURMS $ DATE INSPECTOR'S NACRE NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS - TRANS. $ WIRING 1 ( \ NO. OF RANGES OR HEATERS $ FIXTURES MISCEL LANKgUZ $ POWER PE_RFIIT FEE $ UTILITYCO.NOTIFIED TOTAL F v FINAL :eAB89-CE808 10-60 APPLICATION FOR ELECTR.ICA�PERMIT COUNTY OF LOS ANGELES DEPARMENT OF COUNTY-ENGINEER FB �N . �o BUILDING AND SAFETY DIVISION - / �C T / ,,y ,1 JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM.A.JENSEN,SUPT OF-BUILDING FOR APPLICANT TO FILL.IN cRoss ST. (� PERMIT FEES OWNER r I T E M NUMBER EACH FEE MAIL OUTLETS: ADDRESS $ $ LIGHTS RECEPT. SW. .10 O CITY TEL. NO. LIGHTING FIXTURES .10 ZG ELEC. RANGES CLO. DRYERS ELECTRICIAN ' ✓ ✓ ` i 'WATER' HEATERS - .SO ADDRESS ELEC.SPACE HTRS. DISHWASHERS - - CITY T L NO. GARBAGE DISPOSERS AUTO,- STATE _ J /, WASHERS STA.COOKING UNITS .25- LICENSE NO.., -J �..— e iJ MOTORS: OVER INC. H.P.. - DISTRIIC� NO:, I GROUP 7QN I PR ESSED'BY 0 '/225 (� 2 .50 B0 INSPECTION RECORD 2— 5 .� a. 1.00 t GO _/Dax00 O 1.50 _. lj�y r_ L ¢O�/ V 15— 5019 2.50 Q 0 50— 200 5.00 I W _ 3 NO TRANS. // SIGNS:. NO.LAMPS ".Z!/fpf ®-tY SERVICE 0-600V 1.00 - SERVICE OVER 600V 5.00 MISC. - WIRING PERMIT 1.00 p FIXTURE PERMIT 1.00 OD SUPPLEMENTARY PERMIT 0 TOTAL''FEE l ./.: $ yo I HEREBY ACKNOWLEDGE THAT '1 HAVE READ,.THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ,CONDUIT WITH ALL COUNTY 'ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. - WIRING - + IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR L.CENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES - CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENT( L PROPERTY. POWER SIGNATURE' UTILITY CO.NOTIFIED OF PERMITTEE FINAL (DATION ARTHUR C. VEIT 4 cK Mo casx SUPERVISING ELECTRICAL ENGINEER 1,' 1 `7.54 AUG ;= 1 2D 6 .4D e COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT _ DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0104120011 BUILDING AND SAFETY•/ LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 6561 LT: 741 9424 LAS TUNAS DR E FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802135 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: TEMPLE CITY BLVD.•, 8587-006-013 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY G2 LIGHTING FIXTURES 2.00 LGT 3.90 TENANT: TOTAL FEES 31.65 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 04/12/01 UT 10/09/01 OWNER: TEL. NO: FIN DATE FINAL BY: CODE: LAU HUNG B;KAM C (626) 285-1457- 5337 FRATUS DR TEMP 917803119 DESMIPTIGN OF WORK REPLACE 2 EA. FLORESCEN IGHT F URES APPLICANT: TEL. NO: PYROTECH RESTORATION INC. (323) 888-6995-21 7250 BANDINI BL.#207 SPECIAL CONDITIONS: COMMERCE CA 90040 CONTRACTOR: TEL. N0: i �''J.; _ APPROVALS DATE INSPECTOR SIGNATURE PYROTECH RESTORATION (323) 888-6995- 7250 BANDINI BOULEVARD #207 LIC. NO \ TEMPORARY POWER POLE COMMERCE CA 90040 6941718 UNDERGROUND CONDUIT q J ARCHITECT OR ENGINEER: TEL. N0: UFER GROUND LIC. N0:' JI r ._-a i - �, ROUGH CONDUIT l ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N i UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1307030043 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91'780 PHONE: (626) 285-0488 EXT: (LEGAL ID: - FEES PAID BUILDING ADDRESS: ITR: 6561 LT: 741 - 9424 LAS TUNAS DR E I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917802135 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18587-006-013 1A1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY CAI I IK1 SIGNS, OUTLINE LGT 1.00 SIG 38.90 1 1 (TENANT: I TOTAL FEES 66.70 11SSUED ON: PROCESSED BY: PLAN BY: 1 ISONIC TRAVEL & TOUR 1 107/03/13 SR I I I I (OWNER: TEL. NO: I IFINAL DATE FINAL BY: CODE: 1 ISONIC TRAVEL & TOUR (626) 320-2296- 1 1 19424 LAS TUNAS DR 1 1 ��'7't� 1 ITEMP 917803119 1DE CRIPTION OF WORK ICHANNEL LETTER SIGN WITH L.E.D. I I I I 1APPLICANT: TEL. NO: I 1 IYEUNG, CHAN (626), 373-6688- 1 1424 S SAN GABRIEL BL ISPECIAL CONDITIONS: ISAN GABRIEL CA 91776 I 1 (CONTRACTOR: TEL. NO: 1APPROVALS DATE INSPECTOR SIGNATURE (SUCCESS SIGN GROUP (626) 373-6688- 1 1 1424 S. SAN GABRIEL LIC. NO (TEMPORARY POWER POLE I I ISAN GABRIEL, CA 91776 896068 1 1 1 I 1 1 1UNDERGROUND CONDUIT 1 ( 1 I I I I I I 1ARCHITECT OR ENGINEER: TEL. NO: IUFER GROUND I I 1 LIC. NO: I IROUGH CONDUIT 1 1 1 I I I I I I 1 1 (ROUGH WIRING I I 1 IMAIN WATER LINE -1 1 IPLASTIC YIN METAL YIN 1 1 I I I I I I 1 (UTILITY COMPANY NOTIFIEDI 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 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 IREPORT ID: DPR265 ROUTE TO: BS0508 1 1 1 I I I I _ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT . DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1304080006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID I BUILDING ADDRESS: i ITR: 6561 - LT: 741 1 9424 LAS TUNAS DR E I . I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917802135 1 (ASSESSOR INFORMATION NUMBER: - 1 NEAREST CROSS STREET: 18587-006-013 - IA1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY CAI I IG1 OUTLETS-LGT,SW,RECP 31.00 OUT 53.80 I (TENANT: IG2 LIGHTING FIXTURES 18.00 LGT 36.00 (ISSUED ON: PROCESSED BY: PLAN BY: 1 ISONIC TRAVEL & TOURTOTAL FEES 117.60 104/08/13 SR I I I I I (OWNER: TEL. NO: I IF AL T FINAL BY: - CODE:_ - 1 ISONIC TRAVEL & TOUR 19424 LAS TUNAS DR 1 161 1 ITEMP 917803119 1 IDESCRI TION OF WORK 1 I 1OUTLETS, RECEPT, SWITCHS AND LIGHT FIXTURES 1 I I I I (APPLICANT: TEL. NO: I I I ISHIH, STEVEN (626) 451-0763- I I 19147 OLEMA STREET I ISPECIAL CONDITIONS: ITEMPLE CITY CA 91780 - I I I I I I I I ICONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1 .ISHIH MANAGEMENT INC (626) 45170763- 19147 OLEMA AVENUE LIC. NO 1 - ITEMPORARY POWER POLE I _ I I ITEMPLE CITY CA 91780 8644811 I I I I _ I IUNDERGROUNDCONDUIT I I I I I I I I 1ARCHITECT OR ENGINEER: TEL. NO: I _ IUFER GROUND I I I I I I I I I 1 LIC. NO: I IROUGH CONDUIT 1 I IROUGH WIRING - IMAIN WATER LINE I I I LPLASTIC YIN METAL YIN I I I I I I I I 1UTILITY COMPANY NOTIFIEDI 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 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 WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, HEATING- - VENTILATING - AIR CONDITIONING or a ce tified copy there f (Sec. 3800, Lab.-C.) 76A364C - ��Cs ,!& �A CE-818(REV. 10/81) CeOurroil o. T Company /7 rtifiedd copy.is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING ""/ �A tion epartment. (PRINT OR TYPE ONLY) ADDRESS ZA a G(mlogs Date Applicant �OIL LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CER IFICATE OF EXEMPTION FROM-WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. ABSORPTION UNIT, BTU DISTRICT NO. PROCESSED BY (This section need not be completed if the work involved 6y , the permit is for one hundred dollars ($100)or less.) AIR HANDLING UNIT,CFM I certify that in the performance of the work for which this � ll„// /*. .permit is issued,I shall not employ any person in any manner U ' �+— so as to become subject to the Workers'�Cornpensation Laws; BOILER;BT `� � �" APPROVALS DATE I ECTOR'S SIGN TURE Date Applicant COMPRESSOR, BTU ROUGH NOTICE TO APPLICANT: If, after making thin Certificate'of VENTILATION SYSTEM FINAL. Exemption, you should become subject to the Workers' _ Compensation provisions of the,Labor Code, you must forth- EVAPORATIVE COOLER. VALIDATI with comply with, such provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED—UNIT— `(commencing USPENDED UNIT`(commencing with Section 7000).of Division 3 of the Business WALL .and Professions Code,and my license is in full force and effect. y License Number 3COMS-70 Lic:Class V ��Date � OC Contractor O ❑ U I am exempt.under Sec. d Plcn check fee B.&P.C. for this reason' .01 Date: PERMIT ISSUING FEE $ � Z - — TOTAL FEE f Signature OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT d I hereby affirm that I am exempt from the Contractor's License 'T , Law for the following reason (Section 7031:5, Business and NAME Professions Code): _ ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and , ?° _ the structure is not.intended or offered for sale(Section CITY TEL. NO, r —��+ij 0o�'i 7044, Business and Professions Code). y OWNER Nae , GtJ �. 1 1TENS' ❑ I, as owner of the property, am exclusively contracting MAIL- _ with.licensed contractors'to construct the project (Sec- ADDRESS s I l� 10 tion 7044, Business and Professions Code). CHECK` 4 CONSTRUCTION LENDING AGENCY .CIT.Y .'TEL. NO 4_( _11.50 I hereby affirm that there is a construction lending agency for CHA - I j(� the performance of the work for which this permit is issued CONTRACTOR © ��Cor — , (Sec. 3097, Civ. C.). , ADDRESS � dv/�!'t�0�/ll L �iIt till —�11 4.); y Lender's Name Lender's Address CITY L of Zvdg�e ��I EL. �iQ _._ 0480 i A; 8: l I certifythat I have read this application and state that the STATE LIC. t Yi pp LICENSE NO. �a D CLASS above information is correct. I agree to comply with all County ordinancesand State laws relating 10 building construction, and hereby authorize representatives of this County to,enter upon above- entioned roperty for inspection purposes: SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent .D e