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Home My Public Portal About9945 LOWER AZUSA RD_Electrical__ .VrVORKERs'COMPENSATION DECLARATION 766,Mvorwa,s7 APPLICATION FOR ELECTRICAL PERMIT s 2 h�efN.Pffign that I have a certificate of consent to self a-smG 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 NoF Company FOR APPLICANT TO FILL IN rD ye z ❑Certified copy is hereby furnished //{� l New Residential Bldgs &Pools EACH NO FEE ADDRESS e I'M Certified copy is filed with the county building inspec- 1 8 2-Family, Sci Ft $ = S LOCALITY WJ4 tion depor met Multi-faily Sci Ft NEAREST AA +{/ Residential Swimming Pools Date � mCROSS ST Applicant OWNER /,�.WR � /� FIRM NAME t�"/�' CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw_ DRESS lO ZO E• COMPENSATION INSURANCE First 20 (This section need not be completed If the work involved by Total No Additional CITY-'"A,/ Tel No the permit is for one hundred dollars($100)or less.) PIAN CHECK .L• �AR,�OL1/ LSA . all 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 9/70Fi • �A�/v� Additional Total No CINTel No Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If, after making this Certificate of APPLICATION 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 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 LICENSE OR /J�� I hereby affirm that I am licensed under provisions of Chapter Disp — Room Air Cond — REG NUMBER L Class 10 (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO PROCE 0 BY d and Professions Code,and my license is in full force and effect Size&Type HP, KW, KVA, or KVAR t O License Number fy�O� Lic Class A-/ Up to 1 Incl FINAL U Contractory�' ' -��y+� /� Over 1 to 10 Incl DAA �� LIDATION cc ❑ Over 10 to 50 Incl FINAL U I am exempt under Sec Over 50 to 100 Inc BY W B&P C for this reason Over 100 0- Services, Swbd, MCC&Ponelboards , &0 8 Q 7 A Z Date z 0-200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V # • • • • • 2 ❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V go � 2550 SINGLE FAMILY Temp Power Pole&Appurtenances • • •2 5 5 0 HOME OWNER-BUILDER DECLARATION 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 CO3-88 Professions Code) ❑ I, as owner of the property, will do the work and the Misc Conduits&Conductors structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)— Business chedule)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 PERMIT ISSUING FEE Lender's Address - S I certify that I have read this application and state that the TOTAL FEE above information is correct I agree to comply with oil County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purpose) SEE REVERSE FOR EXPLANATORY LANGUAGE lcs �r l4 3 de I ®•DaeC:A� A.• C/ lwf' Ty KERS'COMPENSATION DECLARf�TION saaoiv DPW 3ie7 //1 7/3'dlk •�I.hei 3firm khat I have a cert icate bf consent to self a-e06G APPLICATION FOR ELECTRICAL PERMIT • i4Zre, ;a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certif(4opy th reo c 3800, Lab,C ) Poli y No` m pany ��f p'a V FOR APPLICANT TO Fill IN JOB y �Sertified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE ADDRESS �� 1 ❑Certified copy is filed with the county building inspec- 1 &2-Family, Sq Ft $ — $ LOCALITY tion department �� Multi-family Sq Ft — NEAREST f'y.7-6 "� Residential Swimming Pools CROSS ST Date Applicant OWNER O / FIRM NAME B&P k. � RO CERTIFICATE OF EXEMPTIO M WORKERS' Otlets Rec IL_Llight�v Sw MAIL Outlets COMPENSATION INSURANCE ADDRESS First (This section need not be completed if the work Involved by Total No/2 Additional CITY Tel 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, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws Lighting Fixtures First 20 1K ADDRESS Total No Date Applicant Additional No CITY Tel Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If, after making this Certificate of APPLICATION 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 with comply with such provisions or this permit shall be Top — FAU —W H deemed revoked Hood — Fan —Other_ CIN V V I K Tel No _y LICENSED CONTRACTORS DECLARATION Disp _ Room Air Cond _ NSE OR fn LICE7 Class p (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO PROCESSE Y and Professions Code,and my license is in full force and effect Y >_IZ CD Size 8 Type HP, KW, KVA, or KVAR v C O License Number I-c Class_L_ Up to 1 Incl FINAL U Contractorate �� - - Over 1 to 10 Inc[ DATE VAL TION Er ❑ Over 10 to 50 InFINAL O 1 am exempt u der Sec Over 50 to 100 Inc BY U W B&P C for this reason Over 100 0. Date Ole Services, Swbd , MCC 8 Ponelboords , Z 0-200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V S/d0 Del fKA ❑ Exemption fOver 1000 Amp or Over 600 V ffreg Maim Elect SINGLE FAMILY Temp Power Pole 8 Appurtenances 0 9 9.9 A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # • • • • • 2 I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuit Circuits Law for the following reason (Section 7031 5, Business and 9 Professions Code) ( • 1 6a 0 0 ❑ 1, as owner of the property, will do the work and the Misc Conduits&Conductors • • 16 a 006 structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)— Business and Professions Code) , ( 0,266-88 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 PERMIT ISSUING FEE Lender's Address 0 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 jaws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon thea ve-mentioned pro rty for inspection purp ses SEE REVERSE FOR EXPLANATORY LANGUAGE (� Zoo Sig tura Permittee to ®s WORKER'S COMPENSATION DECLARATION 7&AM3 DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT IJ 78A883 I hereby affirm.that I have a certificate of consent to self Insure, or a clfrtifrcate of WoLker's CorRpensation Insurance,or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sac 3800 Lab C) Policy NO Company FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy Is hereby furnished New Residential Bldgs &Pools NO EACH FEE $ $ LOCALITY ❑ Certified copy is filed with the county budding inspection 1&2-Family,Sq FtEAREST department Multl4amdy Sq Ft NST Date Applicant Residential Swimming Pools ASSESSOR AWP BOOK I PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec 11 Light Sw Fl MENR EE �u COMPENSATION INSURANCE MAIL (This section need not be completed If the work Involved by the First 20 permit Is for one hundred dollars($100)or less) Total No w Additional ADDRESS I certify that in the performance of the work for which this permit CITY Tel No is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'CompenWWft Lighting Fixtures First 20 APPLICANT Date Appl �G � Total No AdditionalADDRESS icant Laws NOTICE-TO APLICANT If, aft a RESIDENTIAL APPLIANCES NOT OVER 3 HP Certificate of CITY Tel Z Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Sae&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl (commencing with Section 7000)of Division 3 of the Business and CITY Tel No Professions Code,and my license Is In full force and effect Over 10 to 50 Incl NSE ORt - 1 Over 50 to 100 Incl REG NUMBER L I claw Q. License Number Lc Class Over 100 DISTRICT NO p P LJ ;S SED BY Services,Swbd,MCC&Panelboards ��v G :/ �Lsfit� cc Contractor `—�—fig Date 0-399 Amp Under 800 V DATE AL O ❑ I am exempt under Sec 400 1000 Amp Under 800 V VALIDATION U Over 1000 Amp or Over 800 V FINAL W B&P C for this reasonBRANCH CIRCUIT FEES BY W Date 15A,or 20A,120V,Lighting or Recept Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Giraffe ❑ ore Branch Exemption for Reg Maint Elect 15A,20A,2DBV To 277V41 Li Mhtmg Br Circuitsu its SINGLE FAMILY Temp Power Pole&Appurtenances 2 HOME OWNER-BUILDER DECLARATION ACC CT,T epc� 1 hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit 330,E 65.85for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits Code) ❑ I,as owner of thero Misc Conduits&Conductors 1 ITEIS p party,will do the work and the structure Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) , TOTAL. 65. 85 and Professions Code) CEC K 65.85 CONSTRUCTION LENDING AGENCY CHANGE e00 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 0000-0001 5/22/95 Lender's Name PERMIT ISSUING FEE p 5 0527 1 Air $%21 Lender's Address / I certify that I have read this application and under penalty of purjury state TOTAL FEE �f that the above information is correct I agree to comply with all County ordfnanand State laws r ul ing Electrical winng,and hereby authorize repr nt my to enter upon the above-mentioned property I nspect ^p rposes SEE REVERSE FOR EXPLANATORY LANGUAGE axaNA DATE COUNTY OF LOS ANGELES TEMPLE CITY 9 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0108140019 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING BK: 17 PG: 52 PC: 1 19945 LOWER AZUSA:RD FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TES CA 917804041 ASSESIM INFORMATION NUMBER: NEAREST CROSS STREET: BALDWIN 8589-025-045 AW PC CITY $109.35 MIN 0.00 359.94 THOMAS PAGE: 597 GRID: B5 LOCALITY: TEMPLE CITY Al PERMIT ISSUANCE FEE 27.75 TENANT: G1 OUTLETS-LGT,SW RECP 150.00 OUT 214.50 . TEMPLE CITY ARTIFICAL KIDNEY CENTER G2 LIGHTING FIXTUkES 75.00 LGT 113.25 03/21/02 JK 09/17/02 . IA N-RES EX FANS LT 3HP 2.00 EX 30.60 OWN81: TEL. NO: JS AC UNITS +3-10HP 2.00 AC 39.30 . AMMAD, BASHIR - LN OTHER PNL 0-399 AMPS 3.00 PAN 116.55 0 'Z� . 717 W. FOOTHILL BLV TOTAL FEES 901.89 MONROVIA CA 91016 VESMIPTION OF T.I., PLUGS, SWITCHES, LIGHT FIXTURES, EQUIPMENT HOOK-UP APPLICANT: TEL. NO: HVAC, EXHAUST FANS 83 SUB PANELS:200, 225, 100 AMP PANEL GOLDEN CONTRUCTION (714) 549-9309- P.O. BOX 1872 _ SPECIAL CONDITIONS: CAOSTA MESA CA 92628 CONTRACTOR: TEL. NO: APPRMLS DAY15 INSPECTOR SIOUNUFF-_ GOLDEN CONSTRUCTION (714) 549-9309- P. 0. BOX 1872 LIC. NO T8U;0RARY POWER POLE COSTA MESA, CA 603827 B UNDERGROUND CONDUIT ARCHITECT TEL. NIJ: UFER GROUND KINCANNON ARCHITECH (714) 730-5995- 13691 REDHILL AVENUE LIC. N0: ROUGH CONDUIT TUSTIN CA 92680 C10523 ROUGH WIRING RUW'WM LINE PLASTIC Y/N METAL Y/N i REPORT ID: OPR265 ROUE TO: BS0508