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Home My Public Portal About9861 LOWER AZUSA RD_Electrical__ C_ WORKERS'COMPENSATION DECLARATION 76A663 tOiBt APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-80613 insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY 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 Certified copy is filed with the county building inspec- 1 &2-Family, Sq Ft $ — 5 LOCALITY tion department Multi-family Sq Ft — NEAREST RCROSS ST RAIL 14 1-1esidential Swimming Pools 12 Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw MAIL COMPENSATION INSURANCE ADDRESS J (This section need not be completed It the work involved by First 20 Total No Additional the permit is for one hundred dollars($100)or less) l CITY Tel No��o CHECK C4 I I cern that in the performance of the work for which this PLAN permit issued,I shlnot employ any person in any manner APPLICANT so as to hecome s ect rhe Workers' pensotion Laws Lighting Fixtures First 20 ADDRESS Total No Additional Date ppl ant CITY el No NOTICE TO APPLICANT If, after making t Certificate of 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 _WH _ deemed WH — deemed revoked Hood _ Fan _Other_ CITY Tel No LICENSED CONTRACTORS DECLARATION LICENSE OR Disp _ Room Air Cond Clow 1 hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO PROCE BY and Professions Code,and my license is in full force and effect �` Size 6 Type HP, KW, KVA, or KVAR �(! License Number Lic ClassFINAL 0' Up to 1 Incl 0 Over 1 to 10 Incl DATE Contractor Date VALIDATION Over 10 to 50 Incl FINA W 1 am exempt under Sec Over 50 to 100 Inc BY N B&P C for this reason Over 100 Z Date Servs es bd, MCC B Ponelboards 0 -200 poll Am Under600V Signature 201 - 1000 Amp Under 600 V Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V • • *25500 SINGLE FAMILY Temp Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 4.24-86 j hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits for the following reason (Section 7031 5, Business and Prof ions Code) 1, as owner of theproperty, Misc Conduits&Conductors or will do the work and the Other See Complete Fee Schedule structure �s not intended or offered for sale (Section ( P )— ► 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) (Sec 3097,Civ C ) PLAN CHECKING FEE Lender's Name „r PERMIT ISSUING FEE (� Lender's Address 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 ordin and State laws regulating Electrical wiring, and her y ou onze repres tat�ves of this County to enter upon tis abov mentioned p party for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Si ature of er a to COUNTY MP OF LOS ANGELES TELS CITY i{ 0508 ELECTRICAL PERMIT T DEPAR OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0510100001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID FEES PAID BUILDING ADDRESS ON FILE 9861 LOWER AZUSA RD FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803924 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET 8589-020-036 Al PERMIT ISSUANCE FSE 27 75 THOMAS PAGE 597 GRID SS LOCALITY TEMPLE CITY, C GI OUTLETS-LGT,SW,RECP 35 00 OUT 59 25 TENANT G2 LIGHTING FIXTURES 30 00 LGT 52 50 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON HA FAU LESS 3HP 1 00 FAU 10 95 10/10/05 JK 04/08/06 H1 RES ELEC OVEN LT 3HP 1 00 OVE 10 95 OWNER TEL NO H2 RES GRBG DISP LT 3HP 1 00 DIS 10 95 FINAL DATE FINAL By CODE_ GONZAL88„ ALFREDO (310) 261-9157- H3 RES DISHWASHR LT 3HP 1 00 DIS 10 95 3472 YORSHIRE RD H4 RES RANGE EDS LT 3HP 1 00 BOO 10 95 L� PASADENA, CA 91107 HS RES WASH MACH LT 3HP 1 00 WAS 10 95 DESCRIPTION OF WORK H7 RES EXHAUST PANS 1 00 EX 10 95 ELECTRICAL FOR INTERIOR REMODEL AND UPGRADE SERVICE TO JB AC UNITS +3-IOHP 1 00 AC 19 65 200 AMP APPLICANT TEL NO LB 200 AMP PANELS, MCC 1 00 PAN 38 85 SAME AS OWNER - TOTAL BEES 274 65 SPECIAL CONDITIONS CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC NO TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER TEL NO UPER GROUND LIC NO ROUGH CONDUIT -y�- ROIIGH WIRING MAIN WATER LINE `i�'L/j_ PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED REPORT ID DPR265 ROUTE TO BSOSOS