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Home My Public Portal About9588 LOWER AZUSA RD_Electrical__ WORKERS COMPENSATION DECLARATION CE 806 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure CE so6G or a certificate of Workers Compensation Insurance or a certified COUNTY OF LQ$ ANGELES BUILDING AND SAFETY copy Ahereo�f�(Sac 3800 Laab�C) Policy No C"�A�'Cpm a 4 ")a 'vs o. FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished EACH NO FEE ADDRESS �5�� >��s�� New Residential Bldgs &Pools LOCALITY ❑ 1 & 2 Family Sq Ft $ _ $ �I Certified copy is filed with the county building ins ion NEAREST departm t Multi family Sq Ft (4 �✓"� l V Residential Swimming Pools CROSS ST Date Applicant OWNER OR G�� Q 2 FlRM NAME CERTIFICATE OF EXEMPTION FR M W ERS Outlets Rec�Light 3 SW MAIL COMPENSATION INSU NCE ADDRESS '� Q (This section need not be completed If the work Involved by the Fist 20 n- Total No Additional CITY C..FT Tel No permit Is for one hundred dollars($100)or less) _ I certify that in the performance of the work for which this it APPLICANT CHECKPLAN • �• ��j Is issued I shall not employ any person in any manner a to become subjeO to the Workers Compensatio Laws Lighting Fixtures First 20 ADDRESS Additional y� Date 1005-1 Applicant � Total No CITY Q ��Tel N QJ�+ %{p NOTICE O AP CANT If after king t is ificate of Fixed Appliances Not Over 1 HP PERMIT Exemption you should become subject the ers (Compensation Range_ Heater___,_ DW APPLICANT G- provisions of the Labor Code you st fort ith comply with such Oven Dryer_ W M ADDRESS provisions or this permit shall be deemed revoked Top FAU _ WH _ LICENSED CONTRACTORS DECLARATION Hood Fan _ Other_ CITY 6–e 1770/Y/iF �''FTel No I hereby affirm that I am licensed under provisions of Chapter 9LICENSE ORg' rtl °s Class (commenting with Section 7000)of Division 3 of the Business and Disp — Room Air Cond REG NUMBER Professions Code and my license is in full force and effect DISTRICT NO SED BY Power Apparatus&Large Appliances Size&Type HP KW KVA or KVAR 9 License Number Lie Class " '� Up to Incl FINAL Over to 10 InclDAA VALIDATION Contractor Date '�" 1 ❑ Over 10 to 50 InFINAL I am exempt under Sec Over 50 to 100 Inc BY 1TEr,S W B&P C for this reason Over 100 Services Swbd MCC&Panelboards _ Date 0 200 Amp Under 600 V CItCll.,�. .•-s=• ' Signature 201 1000 Amp Under 600 V Over 1000 Amp or Over 600 V ,VANGE ❑ Exemption for Reg Maint Elect SINGLE HOME OWNER BUILDER B FAMILY DECLARATION Temp Power rt&Appurtenances Sign with One Branchh Circuit I hereby affirm that I am exempt from the Contractors License Law °c for the following reason(Section 70315 Business and Professions Additional Sign Branch Circuits 13014 A0 � Z■ f Code) ❑ I as owner of the property will do the work and the structure Misc Conduits&Conductors Is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) 11110.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 3 Lenders 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 20 and State laws regulating Electrical wiring and hereby authorize representatives of this Coun enter upon the ab a mentioned property for Inspection o s r SEE REVERSE FOR EXPLANATORY LANGUAGE c 819dure m e (Date �7/ d / S .rWfirm th COMPENSATION DECcafe of TIONcorse 76AW DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I hcv�a certificate of consent to self insure, or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS or a certified copy thereof (Sec 3800 Lab C ) Policy No Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE ADDRESS 9588 LOWER AZUSA RD. ❑Certified copy is filed with the county building inspec 1 &2 Family Sq Ft $ — $ LOCALITY TEMPLE CITE tion department Multifamily Sq Ft — NEAREST Residential Swimming Pools CROSS ST RO Date Applicant OWNER OR T� �+ p �+pMr FIRM NAMET.C.'`.S. BASEIULLL TFt> CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec Light Sw_ MARESS 01 E. LEMONIL COMPENSATION INSURANCE First 20 ADDAV. (This section need not be completed if the work Involved by Total No Additional CITY T I 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 permit is issued 1 shall not employ any person in any manner so as to become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS Date IF-1 7 -90Applicant DALES ELECTRIC Total No Additional CITY Tel No NOTICE TO APPLICANT If after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption you should become subject to the Workers Range— Heater—D W _ APPLICATION I= DALES ELECTRIC Compensation provisions of the Labor Code you must forth Oven — Dryer —W M — ADDRESS 672 ARDILLA ST. with comply with such provisions or this permit shall be Top — FAU —W H — deemed revoked Hood — Fan —Other_ CITY LA PUENTE CA•Tel e,67-8627 LICENSED CONTRACTORS DECLARATION LICENSE OR �7 Disp _ Room Air Cond _ REG NUMBER 2/621 8 Class C-1 0 I hereby affirm that I am licensed under provisions bf Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO PROCE BY >_ and Professions Code and my license is in full force and effect 11 27621 8 Ci-10 Size&Type HP KW KVA or KVAR ,5. Q License Number Lic Class Up to 1 Incl FINAL DALES ELECTRIC1+-17-90 Over 1 to 10 Incl DATE �(o "Q� VALIDATION Contractor ate O ❑ Over 10 to 50 Incl FINAL F- I I am exempt under Sec Over 50 to 100 Inc BY W B&P C for this reason Over 100 1Z i"Date Services Swbd MCC&Ponelboards , Z 0 200 Amp Under 600 V Signature 201 1000 Amp Under 600 V ❑ Over 1000 Amp or Over 600 V Exemption for Reg Maint Eject SINGLE FAMILY Temp Power Pole&Appurtenances HOME OWNER BUILDER DECLARATION 2 1 hereby affirm that I am exempt from the Contractor s License Sign with One Branch Circuit a Law for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits ACCTAr Professions Code) ,5-07 18.0{3 F-1I as owner of the property will do the work and the Misc Conduits&Conductors 1 ITEMS structure is not intended or offered for sale(Section 7044 Other(See Complete Fee Schedule)_ Business and Professions Code) TOTAL 113, .00 CONSTRUCTION LENDING AGENCY TEMPQRABI Cf A A �NEC11i iVe { 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) CHANGE .00 (Sec 3097 Civ C ) PLAN CHECKING FEE Lender s Name PERMIT ISSUING FEE 0000-0001 5I23/90 Lender s Address 0866 1 AM 8:37 1 certify that I have read this application and state that the TOTAL FEE above information is correct I agree to comply with all County 16 oyl ordinances and State jaws regulating Electrical wiring and ' hereby authorize representatives of this County to enter upon th"a �ti�prop y for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE JA 4-17-90 Signature of Permittee Date ®s DEC TION kyOrm that Ihave COMPENSATION cafe of corse 20-0019 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT O I ir�ereby affirm that I have a certificate of consent to self �� insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS or a certified copy thereof(Sec 3800 Lab C ) Policy No Company FOR APPLICANT TO FILL IN JOB ADDRESS 9588 LOWER AZUSA RD. Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ❑Certified copy is filed with the county building inspec 1 &2 Family Sq Ft $ — $ LOCALITY TMPLE CITY tion department Multifamily Sq Ft — NEAREST p D Residential Swimming Pools CROSS ST ROSEMF�AvC� Tr rn�+A�� Date Applicant FOWNER OR IRM NAME TCHS BASEBALL 1iYe M CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec Light Sw_ MAIL COMPENSATION INSURANCE ADDRESS 9501 E• LEMON AV• (This section need not be completed if the work involved by First 20 CITY I No the permit is for one hundred dollars($100)or less) Total No Additional TEMPLE CITY Cog _155-.3691 PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS Date 5-8- 91 Applicant DALES ELECTRIC Total No Additional CITY Tel No NOTICE TO APPLICANT If after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT APPLICATION DALES ELECTRIC Exemption you should become subject to the Workers Range— Heater—D W ` Compensation provisions of the Labor Code you must forth Oven — Dryer —W M — ADDRESS9923 E.LIVE OAK with comply with such provisions or this permit shall be Top _ FAU _ _ deemed revoked Hood — Fan —Other— CITY�i PIZ CITY CA%l N0287-862 LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp — Room Air Cond — REG NUMBER 276218 Class C-10 (commencing with Sectiori 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO P ESSED BY >_ and Professions Code and my license is in full force and effect Size&TypeHP KW KVA orKVAR 27621$ C-1O �iO 1 y O License Number Lic Class U FINAL Over 1 to 10 Incl VALIDATION DALES ELECTRIC, _$_ 1 up to 1 Incl DATE ��--�� Er Contractor to 0 ❑ Over 10 to 50 Incl FINAL I— I am exempt under Sec Over 50 to 100 Inc BY W B&P C for this reason Over 100 r t1 4 4ate Services Swbd MCC& Panelboords ► Z 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 SINGLE FAMILY Tem Power Pole 8 HOME OWNER BUILDER DECLARATION P Appurtenances I hereby affirm that I am exempt from the Contractor s License Sign with One Branch Circuit Law for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits Professions Code) 3� ? :.y. Cll ❑ I as owner of the property will do the work and the Misc Conduits&Conductors 1 structure is not intended or offered for sale(Section 7Q44 Other(See Complete Fee Scheduled , A Business and Professions Code) TOTAL 23®00 ERIko CONSTRUCTION LENDING AGENCY CHECK 2Ze0 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) (Sec 3097 Civ C ) PLAN CHECKING FEE Lender s Name U030-0001 5/30/91 PERMIT ISSUING FEE �3 Lender s Address TOTAL FEE dp 720 1 10 i I certify that I have read this application and state that the 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 t abov ent� Medrorty for in pection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 5-8-91_ Sigrtature&Viii,Fnittre I Date ®s WORKERS COMPENSATION DECLARATION CE-CE-BO63 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self 6G insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES �, BUILDING AND SAFETY or a certified copy thereof (�ec� 00 Lab GG 2v c(/1— lC/ 7i e Policy NoCompany FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE 9588 Lower A9,.i3.qq R0,qd Certified copy is filed with the county building inspec 1 &2 Family Sq Ft $ _ $ LOCALITYTem le Ci-ty, Call tion d part ent Multifamily Sq Ft NEAREST CROSSST Temple City Blvd. Residential Swimming PoolsOWNER OR Date Applicant FIRM NAMED E . Parra RTIF ATE OF EXEMPTI N FROM WORKERS Outlets Rec Light Sw_ MAIL COMPENSATION INSURANCE First 20 ADDRESS 10127 Townemay Drive (This section need not be completed If the work Involved by Total No Additional CITY E Monte, Tel No _ 314- the permit Is for one hundred dollars($100)or less) PLAN CHECK I certify that in the performance of the work for which this APPLICANTArthur Kajiwar;;; 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 Date Applicant CITY SO El Monte Tel No _NOTICE TO APPLICANT If after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT APPLICANT Arthur Ka 1 ara 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 2205 T roy Avenue with comply with such provisions or this permit shall be Top _ FAU —W H — deemed revoked - Hood _ Fan _Other_ CITY E Monte Tel No _ LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Cond REG NUMBER Z Class (;—l� (commencing with Section 7000) of Division 3 of the Business DISTRICT NO PR:Z:d-�Z and Professions Code and my license is in full force and effect Power Apparatu & Large Appliances >- Size&Type joKW KVA or KVAR si96 License Number Lic Class G—� D 0 Up to 1 Incl D FINAL V Contractor Date 0 Over 1 to 10 Incl DATE l �- VALIDATION 89 ❑ Over 10 to 50 Incl FINAL / I am exempt under Sec Over 50 to 100 Inc BY W Over 100 IL B&P C for this reason N Date Services Swbd MCC& Ponelboards ► ? 0 200 Amp Under 600 V Signature 201 1000 Amp Under 600 V ❑ Exemption for Reg Maint Elect �[oS� Over 1000 Amp or Over 600 V 7 SINGLE FAMILY Temp Power Pole&Appurtenances HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit 1 hereby affirm that I am exempt from the Contractor s license Additional Sign Branch Circuits f 8 6 9 3 A Law for the following reason (Section 7031 5 Business and Professions Code) 19 • • • • • 2 ❑ I as owner of the property will do the work and the Misc Conduits&Conductors • . structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ ► 6650 7044 Business and Professions Code) ® � 0 6 6 5 0 FI CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 1230-82 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 S PERMIT ISSUING FEE Lender s Address I certify that I have read this application and state that the TOTAL FEE G G's-0 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 opbpowyn2ritioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o e Dat