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HomeMy Public PortalAbout9443 LAS TUNAS DR_Electrical__ 4- 'WORKERS'.COMPENSATION DECLARATION„ - 76-663 10/81 APPLICATION /TION F®p ELECTRICAL PERMIT Ther y{'affirm that I have a certificate of consent to self insure, CE-806G �- F@ i�9 Bl �./ Pl \./P� !V9 or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof-(Sec. 3800,Lab. C.) Policy No. _� � Company 'r " FOR APPLICANT FILL-IN' JOB - - .Certified copy is hereby.furnished EACH' NO. FEE ADDRESS - New Residential Bldgs.&.Pools , LOCALITY''' �e Certified copy.is filed'with the county building mspechon 1 & 2-Family,Sq.Ft. $ $ cm .� de' toren - - Multi-family Sq.Ft. NEAREST :t ` ` ' Residential Swimming Pools CROSS ST. �',, _ OWNER OR .� ,Date Applicant /'//'� , "�, �, �' `',. `+,,,, FIRM NAME CERTIFICATE'OF,EXEMPTIO ROM ORKERS' Outlets:Reck Light —� Sw-_a �/ ~ MAIL COMPENSATION INSURANCE - ADDRESS��'yD lve First 20f _ (This section need not be completed if'the work involved by the CITY /� Tel.No.✓ permit Is for one hundred dollars ($100)or less.) Total No. Additional I certify that in the performanceof the'work for which-this permit / PLAN CHECK' is issued, I shall not employ any,person. in any manner so-as to APPLICANT.. become subject to the Workers';COmpensa' n Laws. Lighting Fixtures First 20 ADDRESS Additional Total No CITY Tel.No. Date �d Applicant �� Fixed Appliances Not Over 1 HP PERMIT �+ NOTICE TO APPLICANT: -If, after making, this Certificate of Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _. APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven Dryer _ W.M.! ADDRESS A,1/7 Qa`/e— provisions or this permit shall be deemed revoked.- Top — FAU W.H. CITY �� Tel.No.a6,9/3 LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ I hereby,affirm that,I am licensed under provisions of.,Chapter 9 Dis Room Air Cond. LICENSE OR (commencing with Section 7000) of Divisiori 3 of the Business and P REG.NUMBER 7 Gass Q Professions Code,and my license'is in.full force and effect. DISTRICT NO. - P C ED BY Power Apparatus&Large Appliances ��[[�, •�g'> /� Size& Type HP,KW,KVA,or KVAR cense Number I 1717 Lia Classy�® LiUp to 1 Incl. �a® V FINAL // V �°/� `�^ Over.1 to 10 Incl. DATE yy VALIDATION 0 Contractor (G©,iG.l.46 Date 6 Z� Over 10 to 50 Incl. FI v �:_- I am exempt under Seca Over-50 to 100 Inc. LV 100 0- B.&P,C. for this reason Over U) Services,Swbd.,MCC&'Panelboards Z Date: 0- 200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V Over 1000 Amp.or Over 600 V g Exemption for Reg.Maint . }} Elecf. 'T a SINGLE FAMILY Temp.Power Pole&.Appurtenances. 010 ° -56500 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 230.-88 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business,and Professions Additional Sign Branch Circuits Code): ❑ Misc.Conduits&Conductors I,as owner.of the property,will do the work and the.structure is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule_),, 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(Sec.3097, PERMIT FEE (Sub-Total) 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 above TOTAL FEE 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 the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE - W D X� Sig re of Per ttee ate ,76A663 10/81, �g �'A�VORKERS' COMPENSATION DECLARATIONe T wo 1 C ® p ®�►{� I hereby affirm that"I have a certificate of consent to self insure; CE-806G APPLICATION ION FOR n'EI�GC'a'TRI,A�' PE,f MIT or.a certificate of'.Workers'`Compensdion Insurance;or certified ,,COUNTY OF'LOS ANGELES BUILDING AND SAFETY copy thereof,(Sec.3800,Lab.--QT Policy,No panyZci. �i�/,D - . FOR APPLICANT TO FILL IN • JOB ❑ NO Certified copy,:is hereby:furmshed New Residential Bldgs.& Pools EE EACH . .F }� LOCALITY , 3 r Certified .copy.is,fiied.-with''the county pudding msp`ection 1 &•2-Family,Sq.Ft. -departments_: Multi family Sq Ft. -NEARESSTa,. r•. Swimming Fools CROSS _ Residential Swi Date 2. p Applicant _ ., ..'.. OWNER OR''NAME10 < ,- ,r CERTIFIGATE,OF EXEMPTION FROM. MO KERS',,. MAIL Outlets'Rec Light Sw — COMP,ENSATION INSURANCE. y CADDRESS not b&.com leted if the•work,involved b the First 20 P y .`CITY Tel No. per- section need undred''dollars($160)_or.less) Total No.' Additional .. ? !L Y• .p J. permit PLAN CHECK. C. ermit is for one h "I certify*that in the performance thework.for which this ermit ;` r v ;is issued; I'shallnot,employ any person in-any manner so as to' become subject tothe Workers'Compensation taws ,' Lighting Fixtures first 20 - ADDRESS. maw Additional - Totah No: e C1TY a` Tel.No. u bl Date H Applicant Fixe_d Appliances.Not Over 1 HP PERMIT NOTICE TO APPLICANT -If, after making this Certificate'--'of =`Exemption,you should become subject.fo the Workers'Compensation,:, ;, Range_`-Heater_ D.W. . .,... •s •,.. APPLICANT provisions-of the Labor Code,:you must•fortl with comply,with such, Oven'_ Dryer'— W:M•_ ADDRESS provisions,or this,permit shall,be deemed revoked. v. Top- FAU W.H. qITY_ LICENSED'CONTRACTORS DECLARATION„ _;Other_ ' - Hood• Fan'. , I.hereb affirm that•I•am.Iicensed under provisions'of Chapter.9" -hereby.affirm . . .�, LICENSE OR' Tel d ' No., (commencing with Section 7000) of Division 3 of tne•Bu`siness and; UMBER C - Z Class e-44 Professions Code;and my Ileense•is 191iull,force''and effect: powDelr Apparatus& Large Ap DISTRICT NO. C SED BY - .. 9 pliances c Size'& Type HP,KW,KVA,or KVAR U -lass Up to i"Incl.. . FIN License Number Lic C Contractor`C�1 Date Y Over 1 to 10.Incl A f VALIDATION y && (/ DATE. �. J Over 10 to 50 Incl 0 " I a FINAL U • m exempt under Seo. Over,50 to 100 Inc. BY' ` LIJ B.&P:C.for, his reason Over 100 N` - MCC&Panelboa _ Date' Z ervices,':Swbd, boards 0-200 Amp.Under 600 V S Signature 201- 1000 Amp.Under.600 V �• ,- ... 4 39 A Over'1000 Amp..or Over 600 V Exemption for Reg. Maint Elect._` - - r # o 0-0 0 0,2 SINGLE FAMILY Temp:Power Pole& Appurteo;ronances [J , HOME OWNER-BUILDER'DECLARATION : Sign with One Branch,Circuit' 23,10,".8,8' I hereby affirm that I am exempt from, tlie Contractors License.Law ' . =for the following reason(Section 7,031:5, Business and Professions Addihonal_,Sign Branch Circuits._ Code) : ... I;as ownerof`theproperty;will•do the work and'the structure: uits& Conductors., ; s.not.intended or•offered fo'r sale (Section.7044,-Business:,.- Oth CSee,Complete Fee Schedule) : Other(See and Professions Code). CONSTRUCTION LENDING'AGENCY f hereby affirm that'there is a construction lending agency for the', performance of.-the work for which this permit is issued(Sec 3097;- PERMIT-FEE - - (Sub-Total) Civ..C,).. •, .- , - PLAN`CHECKING`FEE _ tenders Name PERMIT ISSUING FEE Lenders Address -• ' -- e I certify that I have ead this application and state that the above TOTAL FEE, ` ;information:is,correct. agree to comply with'all County,ordinances and,State` I g.Electrical'wiring, and hereby authorize: representati s unty to•,enter upon the'above-mentioned property for aes SEE REVERSE FOR EXPLANATORY•,LANG UAGE. -Sig re f t Date i ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0008070020 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 8526 LT: 1 BL: .001 9443 LAS TUNAS DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802100 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: OAK AVAE. 8587-008-018 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY K1 SIGNS, OUTLINE LGT 1.00 SIG 38.85 TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: DOMINO'S PIZZA 08/07/00 UT 02/04/01 OWNER: TEL. NO: F1 AL TE FINAL BY: CODE: TEMPLE CITY PROPERTIES 533 14TH ST SANM 904022927 DE CRIP ION OF WORK ELECTRICAL FOR WALL SIGN APPLICANT: TEL. NO: DIVERSIFIED SIGNS & GRAPHICS (714) 744-2845- 5602 E. LA PALMA SPECIAL CONDITIONS: ANAHEIM, CA CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE DIVERSIFIED SIGNS AND GRAPHICS (714) 701-1330- 5602 E. LA PALMA AVE LIC. NO TEMPORARY POWER POLE ANAHEIM CA 92807 737055/C45 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: / UFER GROUND LIC. N0: r 1111111 ROUGH CONDUIT IL ROUGH WIRING F n D ��� W�0 - n�7 MAIN WATER LINE U IIJU`(]ILJI((� PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED O O 0 1i 0 :led 0 REPORT ID: DPR265 ROUTE TO: BS0508 0 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 EELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9610010008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 8526 LT: 1 BL: .001 k 443_1L 0 2_LAS TUNAS DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA .91780210 ASSESSOR INFORMATION NUMBER: NEAREST CROSS-STREET: OAK 8587-008-018 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596-' GRID: J3 • LOCALITY: TEMPLE CITY K1 SIGNS, OUTLINE LGT 1.00 SIG 38.85 TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES 0 HOME BOX VIDEO 10/01/96 TC 10/01 OWNER: TEL. NO: FINAL DATE1 FINAL BY: CODE: TEMPLE CITY PROPERTIES - J� 9 (f 533 14TH ST ` L U SANM 904022927 DESCRIPTION OF WOR WALL SIGN WITH ELECTRICAL APPLICANT: TEL. NO: ITAL SIGNS (818) 444-6027- 2651 N. LEE AVE. #3 SPECIAL CONDITIONS: SO. EL MONTE, CA CONTRACTOR: TEL. N0: =I�.;, APPROVALS DATE INSPECTOR SIGNATURE ITAL SIGNS 2651 N. LEE AVE. #3 LIC. NOTEMPORARY POWER POLE SO. EL MONTE, CA 91733 C45 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. N0: UFER GROUND LIC. N0: - ROUGH CONDUIT , ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILLTY COMPANY NOTIFIED * ADDITIONAL DATA ON FILE i REPORT ID: DPR265 ROUTE TO: BS0508 (I E