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Home My Public Portal About4950 MCCLINTOCK AVE_Electrical__ 1I WORKERS'COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm 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 certified copy thereof(Sec. 3800,-Lob. C.) Policy No. `Company FOR APPLICANT TO FILL IN 'OB �J/� yy Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS � � ./�/e�71�� G��" ❑ 1 &2-Family, S Ft. $ — $• LOCALITY 2- NEAREST . Certified copy is filed with the county building inspec- y+ 9' NEAREST tion department. Multi-family S Ft. • p y 9' CROSS ST. /Pif1'/) Date Applicant Residential Swimming.Pools OWNER OR /� v�' G FIRM NAME ,,/� �s _] CERTIFICATE OF EXEMPTION FROM.WORKERS' � v 'MAIL �O /�/C GI�I N B�K COMPENSATION INSURANCE Outlets: Rec Light Sw._ First 20 (This section need not be completed if the work involved by Total No.el-Cl Additional CITY />`'I `/� ,�� el. N the permit is for one hundred dollars($100)or less.) n_ A w I certify that in the performance of the work for which this PLA �'T �� 04.115 permit is issued,1 shall not employ any person-in ariy manner Al, so as to become.subject to the Workers'Com.pen . ion Laws. Lighting Fixtures. First 20 ADDRESS' 02 AQ 1.4-n./e,,O-SJE- _ Additional' � t, Total No.— CITY / r C Tel. No?r(x,:-?r(.; Date oo pplicant: Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after aking t s Certificate of // APPLICANT Exemption, you should becom .subject to the Workers' Range- . Heater—D.W.. — Compensation provisions of the Labor Code, you must forth- Oven _Dryer -L W.M.— ADDRESS with comply 'with such provisions or this permit shall be Top FAU —W-H. — CITY Tel. No: deemed revoked. Hood. Fan _Other_ LICENSED CONTRACTORS DECLARATION ��.So a LICENSE OR IDis hereby affirm that I am licensed under provisions of Chapter 9 p. Room Air Cond. REG.NUMBER Class.,e- (commencing with Section 7000).of Division 3 of the Business DISTRICT NO. PROCESS BY and Professions Code,and m license.is'in full force and effect. Power Apparatus&Large Appliances r��7 y Size&Type HP, KW, KVA, or KVAR' -� U Q 017(/ / to License Number �� Lic. Class '� Up To 1 Incl. FINAL ' �! li'2 /+2 � S �•_! ,.. Over 29 1. to 10 Incl. DATE ~" LVAUDATION Contractor Date I•• ❑ Over 10 to 50 Incl. FINAL I am exempt under Sec. Over 50 to 100 Inc. BY B.&P:C. for this reason Over 100 ate: Services, Swbd., MCC&Panelboards , 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V IDExemption 1000 Amp. or Over 600 V Exemption for 4eg. Matnt.-Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am.exempt from the Contractor s.License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors Complete See Fee Schedule)— "6 4 A structure Is not intended or offered for sale (Section Other( p 7044, Business and Professions Code). , Do 0 0,0'2 CONSTRUCTION LENDING AGENCY o J ' F I hereby affirm that there is a construction lending agency for 4. the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 1 r ry a (Sec. 3097, Civ. C.). PLAN CHECKING FEE + £ c+ ''j_ ?{ 4 Lender's Name , ;PERMIT ISSUING FEE Lender's Addresst r� 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 re sentatives of this-County to enter upon the e_ i d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE . Sig a rmit ee Date r %1W0RKgRS'COMPENSATIONDECLARATION ;,CE-806 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure,.or a certificate of Workers'Compensation Insurance,or ' s a certified copy thereof(Sec.3800,Lab.C.) FOR APPLICANT FILL IN JOB 5.99 f� ��7^pC� Policy No. Company EACH NO ADDRESS ^f I F New Residential Bldgs.&Pools FEE , ❑ 'Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY Y' a r77 �► C / Multi-family Sq.Ft. — NEAREST E] Certified copy is filed with the county building inspection CROSS ST G I�A Aj b department. Residential Swimming Pools OWNER OR A_- FIRM NAME S ISI /�f� L Date Applicant Outlets: Rec1�+ Light Sw. 1 ADDRESS + First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. 19 Additional CITY j 0/n7 ,1.0 61/r Tel No. COMPENSATION INSURANCE - PLAN CHECK�-�-+ /� a APPLICANT .�✓ /71.`A1e &AIS7—, 0 e (This,section need not be completed if the work involved "Lighting Fixtures First 20U by the permit is for one hundred dollars ($.100) or less.) ADDRESS �,�2 �' /l�, f�%ff'12�!S� Additional _ Total No. CITY .� L �// el No.p? i I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP /� g�~ ^r 0 permit is,issued, I shall not employ any person in an manner PERMIT �- ��y�`/Vis' V so as to become subject to the Workers'Compe n Laws; r Range_Heater D.W.._ APPLICANT ► -Vi Oven _ Dryer_W.M._ ADDRESS %j Date -7 4 f AppH To e2p _ FAU _W.H. der Hood _ Fan —Other=, CITY Tel No. NOTICE TO'APPLICANT: If,7ome .making this Certificate of Disp. _Room Air Cond._ LICENSE OR Exemption, you should besubject to the Workers' REG.NUMBER 07961-V Class Compensation provisions of the Labor Code,you must forth- Power Apparatus&Large Appliances DISTRICT NO. PROCES ED g.Y with comply with such provisions or thispermit. shall be !. Size&Type HP,KW,KVA,or KVAR deemed revoked. 'Up to 1 Incl. l�pQ 1 FINAL Over 1 to 10 Incl. DATE LICENSED CONTRACTORS DECLARATIONVALIDATION Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000)of Division 3 of the Busi: Over 100 BY ness and Professions.Code,,and my.license is in full force and effect. Services6 ' License Number.-.. 7f! Lic.ClassT� 0-200 Amp'.Under 600 V . 2 201-1000 Amp.Under 600 V ,) Contractor ('�7 .Date Over 1000 Amp.or Over 600 V + HOMEOWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances I hereby -affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits + ness and Professions Code): 9 2 1 9.6'A Misc.Conduits&Conductors Ell, asowner of the property, will do the.work and theI Other(See Complete Fee Schedule)— }( 0 0 0 0 0 2 structure is not intended I or offered for sale (Section 7044,Business and Professions Code). L 0 0 2530 CONSTRUCTION LENDING AGENCY i I hereby affirm that there is a construction lending agency + for the performance of the work for which this permit is0 0 0,2 i 3 C E J PERMIT FEE (Sub-Total) A -issued.(Sec.3097,Civ..C.). j 2 O 7_8 1 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address0 + PERMIT ISSUING FEE I certify that I have read this application and state that the I TOTAL FEE 61 above information is correct.I.agree to comply with all.County ordinances and Stat. ws regulating Electrical wiring, and I hereby.authori entatives of this County to enter upon. thea a-m i property for i , ection purposes. I SEE'REVERSE FOR EXPLANATORY LANGUAGE ��r7 el S' atrurA mittee Date ( ''MIORKERS'COMPENSATION DECLARATION i� 20.0019 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT Y hereby a{firm theta I have a certificate of consent to se(f :CE -8060 insure, or-.a certific6te of Workers'Compensation Insurance, COUNTY OF LOS ANGELES ' DEPT. OF PUBLIC WORKS of a certified copy thereof(Sec. 3800, Lab. C.) 1 Policy No. Company FOR APPLICANT TO-FILL IN JOB �s Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE j ADDRESS U Certified co is filed with the count building $ — $ 1 LOCALITY �. copy ' y g inspec- 1 &2-Family, Sq. Ft. tion department. Multi-family Sq. Ft. NEAREST CROSS Residential Swimming Pools OWNERST. OR. Date Applicant FIRM NAME, CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec49. Light MAIL COMPENSATION INSURANCE p ADDRESS C1 First 20 D D ArQ (This section need not be completed'if the work involved by Total No.t`L `! Additional Q CITY Tel. No. the permit Is for one hundred dollars($100)or less.) r 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 Ito Additional Q Total No. .� CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT //�� NOTICE TO APPLICANT: If,.after making this Certificate of APPLICATION 1 CLIr /) L_R. 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 SO. e �f t(/I G with comply with such provisions or this permit shall be Top — FAU i W.H. — �Q, deemed revoked. Hood _ Fan -1—Other— CITY `P Tel. No.5 SE7S 7� LICENSED CONTRACTORS DECLARATION LICENOR I 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 ( g ) Power Apparatus&Large Appliances DISTRICT PROCESSED BY a and Professions Code,and my license is in full force and effect. 0 .I Size&Type HP, KW, KVA, or KVAR � � U License Number Lic. Class Up to 1 Incl. ! FINAL cc Over l,to 10 Inc[. DATE '7,.,2,4 VALIDATION 0 Contractor Date Over. 10 to 50 Incl. U FINAL I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C. for this reason ! Over 100 n.. Services, Swbd., MCC&Ponelboards N i Q Z Date: 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 Sign with.One Branch Circuit .s I hereby affirm that i am exempt from the Contractor's License r.,. Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits , Professions Code): 1 331,17 97.t Misc. Conduits&Conductors i TTENG I, as owner of the property, will do the work and,the Other(See Complete Fee Schedule)_ , ,� Schedule)— structure is not intended or offered for sale(Section 7044, O}AL 9- . 40 Business and Professions Code). CONSTRUCTION LENDING AGENCY i i- Ef-si`�-1' I hereby affirm that there is a construction lending agency for11 I the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) ' ` `t (Sec. 3097, Civ. C.). ,. Lender's Name PLAN CHECKING FEE' 0131313-1 0131 2/191191 PERMIT ISSUING FEE C7 Lender's Address TOTAL FEE I certify that I have read this application and state that the 7 4016 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 bove-menti ed property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ca" ipoC? ®i Signatureof rmittee Date c COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT + DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0812090020 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID BUILDING ADDRESS: ITR: 4902 IT: 50 I 1 4950 MCCLINTOCK AV IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:I TEMP CA 917804103 I (ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: GRAND 18574-023-016 [A1 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY, Cl I IG1 OUTLETS-LGT,SW,RECP 1.00 OUT 1.95 1 ITT: IG2 LIGHTING FIXTURES 3.00 LGT 5.85 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: [ 1 [ TOTAL FEES 35.55 112/11/08 SR 06/09/09 (OWNER: TEL. NO: I (FIN AT FIN Y: CODE: ICAPRA DAVID J;MARY A (626) 279-9171- I 14950 MCCLINTOCK AV ITSMP 917804103 I JOESCRIPTION OF WORK [ 1ELECTRICAL FOR BATHROOM REMODEL [ 1APPLICANT: TEL. NO: I I ITOM (626) 287-0927- I 1 15823 AGNES AVE. i ISPECIAL CONDITIONS: ITEMPLE CITY CA 91780 I I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE [ ITOM O+LEARY CONSTRUCTION (626) 287-0927- I 15823 AGNES AVENUE LIC. NO I ITEMPORARY POWER POLE I I 1TSMPLE CITY, CA 91780 489354 B-1 1 [ I (UNDERGROUND CONDUIT I I I I I I I (ARCHITECT OR ENGINEER: TEL. NO: LIFER GROUND I - I [ LIC. NO: [ IROUGH CONDUIT 1 [ I I [ _[ 1 ROUGH WIRING IMAIN WATER LINE I I I [ IPLASTIC Y/N METAL Y/N I I I 1 [ [UTILITY COMPANY NOTIFIED[ I 1 I I I I [ [ [ I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 1 I I I I I I I I I f COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0110180009 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: S PAIIY-- BUILDING ADDRESS: TR: 4902 LT: 50 4950 MCCLINTOCK AV FEE DESCRIPTION: QUANTITY: LION: AMOUNT: TEMP CA 917804103 ASSESSOR INFORMATION E : NEAREST CROSS STREET: GRAND 8574-023-016 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY F1 12OV, 15/2OA BR CKTS 7.00 BR 120.75 G1 OUTLETS-LGT,SW,RECP 17.00 OUT 33.15 ISSUED 0 0 P ON: G2 LIGHTING FIXTURES 8.00 LGT 15.60 10/18/01 JK 04/16/02. H1 RES ELEC OVEN LT 3HP 1.00 OVE 10.95 OWNER: TEL. 0: H2 RES GRBG DISP LT 3HP 1.00 DIS 10.95 FINAL DATE FIN 8 +' CODE: CAPRA DAVID J;MARY A (626) 279-9171- H3 RES DISHWASHR LT 3HP 1.00 DIS 10.95 4950 MCCLINTOCK AV H4 RES RANGE HDS LT 3HP 1.00 HOO 10.95 i TEMP 917804103 TOTAL FEES 241.05 UES-CUMMON OF KITCHEN REMODEL SAME AS OWNER - SPECIAL COltDjTIONS. CONTRACTOR: TEL. N0: E LE coAPPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO TEMPORARY-POWER POLE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO. /- �» ROUGH CONDUIT !L � ROUGH WIRING � ��- r— r� n n D U' W 0�n 17 AIN WATER LINE � I`J�•�U '+�Vj- \1J ILLLJ^111;]]]I`ji<(� PLASTIC Y/N METAL Y/N s UTILITY COMPANY NOTIFIED Elej c Service Thai { REPORT ID: DPR265 ROUTE TO: BS0508