HomeMy Public PortalAbout9524 LIVE OAK AVE_Electrical__ WORKERS' COMPENSATION DECLARATION 10/81 APPLICATION FOR ELECTRICAL PERMIT
` I hereby afft{m CE-806 that I have a certificate of consent to self CE-806G
insure, ,or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a terrified copy the Qf (Sec. 3800, Lal. �/
Policy No.�Company J V/�6 FOR APPLICANT TO FILL IN JOB
EACH NO. FEE ADDRESS
Certified copy is hereby furnished. I New Residential Bldgs. Pool
F1 8 2-Family, S Ft. $ — $ LOCALITY
Certified copy is filed with the county buildin in pec- y. q
tion epartment. Multi-family Sq. Ft. NEAREST
CROSS ST.
�.j• 2 Residential Swimming Pools OWNER OR
Date Applicant FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL O
Outlets: Rec Light Sw.
COMPENSATION INSURANCE First 20 ADDRESS
.(This section need not be completed if the work involved by Total No. Additional CITY L A Tel. No.
th �N
e permit is for one hundred dollars ($100)or less.) PLAN CHECK
1 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
Total No. Additional
CITY Tel. No.
Date Applicant Fixed Appliances Not Over I HP PERMIT r
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT s( �®
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 fit
with comply with such provisions or this permit shall be Top _ FAU —W.H: —
deemed revoked. Hood _ Fan _Other_ CITY44 2 Tel. No.
07
LICENSED CONTRACTORS DECLARATION LICENSE OR
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 DISTRICT NO. PROCESS 0r.'
and Professions Code,and my license is in full force and effect. Power Apparatus & Large Appliances _ Q _ 0
Size&Type HP, KW, KVA, or KVARV
License Number / ����jj6.00 Lic. Class Up to 1 Incl. FINAL f=
Contractor, (��/ML.Date '��' �' Over 1 to 10 Incl. DATE �1 7�2 J VALIDATION
F-1
Over 10 to 50 Incl. FINAL _ W
I am exempt under Sec. Over 50 to 100 Inc. BY 0
B.&P.C, for this reason Over 100 Z
Date: Services, Swbd., MCC & Panelboards ►
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 Sin with One Branch Circuit „
I hereby affirm that I am exempt from the Contractor's License g1_
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits
-.
Professions 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 Other (See Complete Fee Schedule)_
7044, Business and Professions Code). - 'AL .,h o„
.�'
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for �.;;::t,1 ;-• �,
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 ;_,,.,• ___ F jf'•'/
PERMIT ISSUING FEE w
Lender's Addressfl.i
.�.
I certify that I have read this application and state that the TOTAL FEE D'�•7
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
the above-mentione pro ty f Inspection urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
3 -
Signature of Permittee Date
.t COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1103210023
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
IBK: 248 PG: 37 PC: 2 9524 LIVE OAK AV
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917802513 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS'STREET: CLOVERLY
18566-006-028 IS3 ADDTNL ELECT PLAN CK 1.00 HOU 109.40 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl
1A1 PERMIT ISSUANCE FEE 27.80
(TENANT: IP3 INVRTR RES PV110KW 27.90 JISSUED ON: PROCESSED BY: PLAN BY:
1 1 TOTAL FEES 165.10 111/13/12 SR
DOWNER: TEL. NO: IFINAL DATE FI Y: CODE:
ICHANG, JOSHUA (626) 376-5599-
19518 LIVE OAK AV 1 1 1
ITEMP 917802513 DESCRIPTION OF WORK 1
1 1 ISOLAR INSTALLATION FLUSH W/ROOF 1
APPLICANT: TEL. NO:
ICHANG, JOSHUA (626) 457-1374-
1412 WEST VALLEY BLVD ISPECIAL CONDITIONS:
ISAN GABRIEL CA 91776
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CONTRACTOR: TEL. NO: IAPFROVALS DATE INSPECTOR SIGNATURE
JUS TOPCO ENERGY INC (977) 528-6726- 1 1 1
14441 BALDWIN'AVE A LIC. NO 1 ITEMPORARY POWER POLE I I 1
JEL MONTE CA 91731 956994 1
I 1 JUNDERGROUND CONDUIT I 1 1
(ARCHITECT OR ENGINEER: TEL. NO: IUFER GROUND
JJWDA ARCHITECTS -
1529 E. VALLEY BLVD. LIC. NO: IROUGH CONDUIT
ISAN GABRIEL, CA 91776 NONE
1 IROUGH WIRING 1
1 IMAIN WATER LINE I 1 1
1 IPLASTIC YIN METAL YIN I 1 1
UTILITY COMPANY NOTIFIED1
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I IREPORT ID: DPR265 ROUTE TO: DS0508 1 1
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