HomeMy Public PortalAbout4700 C MILLER DR_Electrical__ WORKERS'COMPENSATION DECLARATION 1' 6A6679DPw3/87 APPLICATION FOR ELECTRICAL PERMIT '
..�1 herebyyaffirm that I Have a certificate of consent to self CE406G
1%ure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF'PUBLIC WORKS
or a certified opy thereof(Sec. 3800, b. C.)I e '
Policy No. Company V �f FOR APPLICANT TO FILL IN G JOB ///�n
V
tified copy is hereby furnished. �� New Residential Bldgs. &Pools EACH NO. j FEE ADDRESS V fJ �f✓
$ LOCALITY __LL
tified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft.
NEAREST ,P
tion�dyepa/rtment. Multi-family Sq. Ft. CROSS ST. L q
/.Z�V, 9� LA4Residential Swimming Pools OWNER OR
Date Applicant I FIRM NAME 4 le► v e~
CERTIFICATE OF EXEMPTION FROM WORKERS' I; Outlets: Rec Light Sw._ I AMAIL
DDRESS S� '� i
COMPENSATION INSURANCE First 20
(This section need not be completed if the work Involved by CITY Tel. ol` t
The permit is for one hundred dollars(;100)or less.) Total No. Additional �•E h.�d�!' °I - L .�
I certify that in .the performance of the work for which This PLAN CHECK
LICANT
permit is issued,.I shale not employ anyperson in any manner Li htin Fixtures First 20 ADDRESS
so as to become subject to the Workers'•Compensation Laws. g g
Additional l
Date Applicant. Total No. CITY Tel.'No.
NOTICE TO APPLICANT: If, after makingthis Certificate of Fixed Appliances Not Over 1 HP PERMIT '>
APPLICATION ,e ✓'V s �jLC (n („
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.— I ADDRESS J(.,, /'A-04
with .comply.with-such provisions or this permit shall be —
deemed revoked. Top FAU —W.H. —Hood — Fan —Other— I, CITY &,,X _T.I. No. f0 14
•LICENSED CONTRACTORS DECLARATION �, LICENSE OR
Disp. _ Room Air Cond. — REG.NUMBER G� -C Class
I hereby affirm that I am licensed under provisions.of Cliapter,9 l
fdo
(commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances 1, DISTRICT NO. PR9GESSED BY a
and Professions Code,and my license is in full force an effect. O
• •� �j�.7 �,_,J� Size&Type HP, KW, KVA, or.KVAR U
License Numb -! Lic. rimss ( Up to 1 Incl. FINAL
Zell- Over 1 to 10 Ind. DATE ZL,L�`/� VALIDATION 0
Contracto Over 10 to 50 Incl. 0 00 FINAL lV I U
❑ I am exempt under Sec. Over 50 to 100.lnc. BY W
B.&P.C.for this reason Over 1.00
Date:
Services, Swbd., MCC&Panelboards 1 ,
r I/17Z
0-200 Amp. Under 600 V ,
Signature r'. 201 :1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect.
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances I
I hereby affirm that I am exempt from the-Contractor's License Sign with One Branch Circuit ACCT.-Ir
Law for the following reason (Section'7031.5, Business and Additional Sign Branch Circuits ! 341� 7 �iw,0
Professions Code):
+ t J
Ell,. as owner of the property,. will do the work and the Misc. Conduits&Conductors 1 ITEMS
structure is not intended or off..eted for sale(Section 7044, Other(See Complete Fee Schedule)_ , TOTAL 53..00
Business and Professions Code).
CONSTRUCTION LENDING AGENCY CHECK 53.OLD
I hereby affirm that there is a construction lending agency fqr I CHANGE 01)
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) O d °
(Sec. 3097, Civ. C.). ,
PLAN CHECKING FEE
Lender's Name 0000--ODLI I 1?/12/°?I
i' PERMIT ISSUING FEE �3
44=01 1 Ai`l1U.1c
Lender's Address TOTAL FEE 00
I certify that I have 'read this application and state that the
above information is•correct. I agree to comply with all County I
ordinances and State laws regulating Electrical wiring, and
,hereby authorize representatives of this County to enter upon
theabove-mentioned p ertylpr inspection purposes.
�y SEE REVERSEFPR EXPLANATORY LANGUAGE
®'
ature of Permitte ate
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1407090053
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
1BK: 260 PG: 68 PC: 4700 MILLER DR C-3
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917803752
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LOWER AZUSA ROAD I
18592-003-052 1A PC CITY $109.35 MIN 0.00 164.10 I THOMAS PAGE: 596 GRID: JS LOCALITY: TEMPLE CITY 1
I 1A1 PERMIT ISSUANCE FEE 27.80 1 I
TENANT: G2 LIGHTING FIXTURES 2.00 LGT 4.00 11SSUED ON: PROCESSED BY: PLAN BY:
IH1 RES ELEC OVEN IT 3HP 1.00 OVE 11.00 110/01/14 SR I
I 11B N-RES WTR HTR IT 3HP 1.00 Wm 15.30 1 1
(OWNER: TEL. NO: 1JE WATER HEATER +3-10HP 1.00 WTR 19.70 IFINAL DATE FINAL Y: CODE: 1
YANG, LEE (626) 278-9230- 1 TOTAL FEES 241.90 1 /r
1135 E LIVE OAK AVE 1 `l
1ARCADLA CA 93.006 1 ]DESCRIPTION OF WORK
ITENANT IMPROVEMENT - ELECTRICAL
1APPLICANT: TEL. NO: I
IZHANG BING, DRP INC. (626) 570-9978- 1
I
1119 S ATLANTIC BLVD 1 ISPECIAL CONDITIONS: I
(MONTEREY PARK 91754
I I 1
CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE
J Y CONSTRUCTION GROUP INC. (626) 332-6789- 1 1 I
11214 E EDNA PLACE LIC. NO (TEMPORARY POWER POLE
1COVINA CA 91724 963661 I I I
1 i (UNDERGROUND CONDUIT
1ARCHITECT OR ENGINEER: TEL. NO: JUFER GROUND
I I
I - I
I I
LIC. NO: i (ROUGH CONDUIT I I I
(ROUGH WIRING tn
I IMAIN WATER LINE I I I
IPLASTIC Y/N METAL Y/N I I
1 i JUTILITY COMPANY NOTIFI8D1 I
I I 1 I I I
I I I I I I
I 1 I I 1 1
I I I I I I
I
I I I I I
I IREPORT ID: DPR265 ROUTE TO: BS0508 I I I I
I I I I I I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 CTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS - EL 05 A060D27
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (818) 285-0488 EXT:
LEGA ID: FEES PAD VBUI --- DR S''-'j
BK: 260 PG: 68 PC: MILL�DR-C-Z-
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: CA 917803752
ASSESSOR INFOR14ATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA ROAD
8592-003-052 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY
F1 120V, 15/20A BR CKTS 3.00 BR 51.75
�
TEN J5 OTHER PWR APP LT 3HP 5.00 PWR 76.50 ISSUED 0PROCESSED B AN BY: EXPIRES ON:
J.B.E. PASTRY TOTAL FEES 156.00 10/06/98 UT 10/06/ 9
OWNER: TEL. 0: FINAL DATE .. FINAL BY: ODE:
OWEN BROS ENTERPRISES (818) 443-0078-
4265 BALDWIN AV
ELMT 917311101 DSC
ELECTRICAL FOR TENANT IMPROV-E-gMT
APPLICANT: TEL. O:
THOMAS PAUL ROBERTS GEN. CONT. (310) 358-6549-
- _-- - SPECIAL CONDITIONS:
CONTRACTOR: TEL. N0: `%'•'Rji`' �" APPROVA S DATE INSPECTOR SIGNATUR
THOMAS PAUL ROBERTS GEN. CONT. (310) 358-6549-
171 PIER AVE. #233 LIC. NO f ; y � '� TEMPORARY POWER POLE
SANTA MONICA, CA 90405 717848 B
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. 0: IUFER GROUND
LIC. NO:� -Ji ,� --I i i j i - -;'� ROUGH CONDUIT
ROUGH WIRING
ji
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPAffY NOTIFTED
REPORT ID: DPR265 ROUTE TO: SS0508