HomeMy Public PortalAbout9551 LOWER AZUSA RD_Electrical__ ' WORKERS'COMPENSATION DECLARATION CE 863 10/81 APPLICATION FOR ELECTRICAL PERMIT
I herleby aff� that I have a certificate of consent to self CE 8o6G
insure or c rtificdte of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY
' or a certifi copy thereof (Sec 3800 Lab C )
Policy No Company FOR APPLICANT TO FILL IN JOB 4"g
J /f[1 �� G�,g�
Certified co is hereby furnished EACH NO FEE ADDRESS /� 1��7
PY Y New Residential Bldgs 8 Pool
1 8 2-Family S Ft 1— E _ a LOCALITY
Certified copy is filed with the county building inspec- Y q
tion department Multi-family Sq Ft NEAREST ^-��
Residential Swimming Pools CROSS S7 L/'
Date Applicant OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec�Light73Sw 3 MAIL / P G q
COMPENSATION INSURANCE I First 20 ADDRESS C (s.
(This section need not be completed if the work Involved by Total No Additional CITY ,_ fe,'70:1Tel 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 f�
permit is issued, I shall not employ any person in any manner
so as to become subject to the Worker ' mpens ti Laws Lighting Fixtures First 20 ADDRESS Gt 1
Total No Additional
Dote Applican CITY Tel No
NOTICE TO APPLICANT If, after making is 6;Aiate Fixed Appliances Not Over 1 HP PERMIT
Exemption you should become subject 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 Tel No
LICENSED CONTRACTORS DECLARATION D�sp — Room Air Cond LICENSE OR Class
I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER >„
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO PR OC BY (-
and Professions Code and my license is in full force and effect Power Apparatus 8 Large Appliances p/ U
Size 8 Type HP, KW, KVA, or KVAR ( tJ/�
License Number Lic Class Up to 1 Incl FINAL ILI
Over 1 to 10 Incl DATEVA ATION O
Contractor Date W
Over 10 to 50 Incl FINA
I am exempt under Sec Over 50 to 100 Inc BY �-
B 8P C for this reason Over 100 Z
Date Services, Swbd , MCC& Ponelboards
0 -200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V
Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V P-3 2 1.8
SINGLE FAMILY Temp Power Pole&Appurtenances # • • • • •
HOME OWNER-BUILDER DECLARATION ( • • 2 OO
Sign with One Branch Circuit • • •
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits "
13
Law for the following reason (Section 7031 5 Business and ' 0,1 8 8 5
Professions Code)
I as owner of the property, will do the work and the Misc Conduits 8 Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ,
7044 Business 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 PERMIT FEE (Sub-Total) OL If
(Sec 3097, Civ C )
PLAN CHECKING FEE
Lender's Name �D
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
the ab e-mention roperty for inspection purpoe4eses SEE REVERSE FOR EXPLANATORY LANGUAGE
�r—/o--
Signature mit Date
COUNTY OF LOS ANGELES TEMPO` CITY # 0508 ELECTRICAL-PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS t-EL-0508_9705270012
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE- (818) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
TR 5342 LT 3 9557 LOWER AZUSAIRD
FEE DESCRIPTION QUANTITY• UOM: AMOUNT. TEMP CA 917804223
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET:
8590-017-004 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY
LA 100 AMP PANELS, MCC 1.00 PAN 38 85
TOTAL FEES 66 60 .
05/27/97 TC 05/27/98
OWNER- A ATE FINAL BY CODE.
YOUNG DAVID;SUSIE (818) 797-1530-
2260 WOODLYN RD 5-Z&-Ol'1 N3aAA
PASO 911043337
NEW 100 AMP ELECTRICAL SERVICE UPGRAGE
APPLICANT: TEL NO:
HUANG'S CONSTRUCTION CO. (818) 309-1181-
SPECIAL CONDITIONS
� ;LES,
CO �� APPROVALS DATE INSPECTOR SrG-gA-T-UR-E
HUANG'S CONSTRUCTION CO (818) 309-1181- \UUUv�
5029 TEMPLE CITY BLVD LIC NO TEMPORARY POWER POLE
TEMPLE CITY CA 91780 639226 B
' O UNDERGROUND
ARCHITECT OR ENGINEER. TEL. NO UFER CROUND
LIC. NO. I DROUGH CONDUIT
ROUGH WIRING
MAIN WATER LINE
U Lo L C V/V 0'ro-- I1 � PLASTIC Y/N METAL Y/N
O 0
%v O 0
O ❑
n
REPORT 1D: DPR265 ROUTE TO: BS0508