The URL can be used to link to this page

Home My Public Portal About10404 MILOANN ST_Electrical__ ✓ C' *ORKERS'COMPENSATION DECLARATION .;20-o019DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT O • laheretiy'affirm that I have a certificate of consent to self 7 3 insure; pt: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 ADDRESSA%4%>C:pti+.1%. Certified copy is filed with the county building irispec- 1 &2-Family, Sq. Ft. — $ LOCALITY tion department. `Multi-family Sq. Ft. — NEAREST t L Residential Swimming Pools CROSS ST. bbY Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec .Light SwAW MAIL e COMPENSATION INSURANCE / Q � ADDRESS {�I�VO Atao hK (This section need not be completed If the work Involved.by First 20 CITY Tel. No. Total No. Additional ' z4Lk-(�1� the permit is for one hundred dollars($100)or less.) I 1 PLAN CHECK ,{ I.certify that in the performance.of the work for which this APPLICANT e4 C:ven�cSYUt W-- permit is issued, I shall notemploy any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS 7 p` Additional It Date '2�U-4Z Total No." Tel. No. Applicant 0 Fixed Appliances Not Over 1 HP PERMIT M NOTICE TO APPLICANT: If, after making this Certificate of ,i APPLICATION • Exemption, you should become subject to the Workers' Range.. HeaterD.W. — Compensation provisions of the Labor Code, you must forth- Oven 67 Dryer W.M.— ADDRESS with comply.with. such provisions of this permit shall be Top 7 FAU AW W.H. — deemed revoked. % CITY Tel. Nm LICENSED CONTRACTORS DECLARATION Hood Fan Other— �`� -mr Dis ✓ Room Air Cond. '�� leo LICENSE OR I hereby affirm that 1,am licensed under provisions of Chapter 9 P• REG.NUMBER �•l Class. (commencing with Section-7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY >_ and Professions Code,and my license is in full force and effect. d 2� c Size&Type HP, KW, KVA, or KVAR p 3 License Number, .141 Lic. Glass _Up to 1 Incl. FINAL V Contractor Date 2`111-4L Over 1 to 10.lncl. DATE Z1 �Gl VALIDATION 0 ❑ Over 10 to 50 Incl. 10 7 i- FINAL U I am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this,reason Over 100' d T� L JZ Services, Sw d.. MCC&Panelboards CO Date: L.� C / F , - K 0: 00 A Under 600 V' - Signature � '`t`" 201 - Amp. Under 600 V ❑, Exemption for Reg. Maint. Elect. Over 1'000 Amp. or Over 600 V ' SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances Sign with. Branch Circuit I hereby affirm that I am exempt from the Contractor's License Si g IiF'• r4 Additional Sin Branch Circuits Law for the following reason (Section 7031.5, Business and 9. . . Professions Code)- 1, ode):I, as owner of'the,property, will do the work and the Misc. Conduits&Conductors A ITEMS structure is not.intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)_ Business and Professions Code).. , TOTAL 265.57 CONSTRUCTION LENDING AGENCY : crc� 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) �lfo •.•i .. ,lel{ (Sec. 30$7, Civ. C.). PLAN CHECKING FEE Lender's Name [fEii;t-t,l !'I; °7s'iLIE p•T= PERMIT ISSUING FEE ca Al Lender's Address - - ►,L f• AN a 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 representatives of this County to-enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE a \Signature of Permittee ''Date ®s ss WORKER'S COMPENSATION DECLARATION 20.0019 DPW 9/89 I'hereby affirm that,!,have a certificate of consent to self insure, 76A653 APPLICATION FOR ELECTRICAL PERMIT or'a certificate.of Worker's Compensation Insurance,or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C,) Policy No. . Company FOR APPLICANT TO FILL IN JOB ,^�r `.'l ❑ Certified co is hereby furnished. ADDRESS loq-00. copy New Residential Bldgs.&Pools EACH NO. FEE LOCALITY ❑ Certified copy is f 1 &2-Family,Sq.Ft. $ — $ filed with the county building inspection _ NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant- Residential Swimming Pools ABBE SOR MAP BOOK PAGE PARCEL CERTIFICATE COMP COMPENSATION EXEMPTION INSURANCEVVORKERS' Outlets:Rao._.Light Flys. OWNER NAME SA A� �!_ z 1 FIRM NAME VW� C��d'`rv�e�� (This section need not be completed If the work Involved by the MAIL z Total No. Additional ADDRESS ZV permit Is for one hundred dollars($100)or leas:) 1 S I certify that in the performance of the work for which this permit CITY ,1 Tel.No. Is Issued. I shall not employ any person in any manner so as to PLAN CHECK w become subject to the Workers'Compensation Laws. Lighting Fixtures First 20. APPLICANT C7 v►� Total No. Additional ADDRESS Date Applicant 15 OR 20A,120V BRANCH CIRCUITS ._ NOTICE TO APPLICANT: If, after making this Certificate of CITY �I� Tel:No, 577_AZqck Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code,you must forthwith comply with such 11 TO 40 INCLUSIVE EACH APPLICANT PERMIT provision's or this permit shell be deemed revoked, 41 OR MORE BRANCH CIRCUITS EACH } LICENSED CONTRACTORS DECLARATION ADDRESS d I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH Q (commencing with Section 7000)of Division'8 of the Business and CITY Tel.No. V Professions Code,and my license is In full force and effect. RESIDENTIAL APPLIANCES UP TO 8HP• LICENSE OR Power Apparatus&Largs Appliances REG..NUMBER qI ' License Number !�4s7q l LIC.Class. Size&Type HP,Kw,KVA,or KVAR DISTRICT NO. I/,, �i PROCESSED BY V Up to 9 Incl. �(/O 1% L d Contractor y'"�t Date S?��2 Uj Over 3 to 10 Incl. DIANE C0 ❑ Over 10 to 50 Incl. Z I am exempt under Sec. Over 50 to 100 Incl. �—Z�D v VALIDATION Over 100 FINAL B.&P.C.for this reason Services„Swbd.,MCC,&Panelboards C / /Date: 0-200 Amp.Under 600 V Signature t '` 201-1000 Amp.Under 600 V Over 1000 Amp.or Over 600 V ElExemption for Reg.Maint.Elect. _ SINGLE FAMILYTemp.Power Pole&Appurtenances - HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ” y I hereby affirm,that I am exempt from the Contractor's License Law .? F ,, for the following reason (Section 7081.5, Business and Professions Additional Sign Branch.Circuits ' 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) and Professions Code). , .; T " t� CONSTRUCTION LENDING AGENCY ;�i-; rte j y .'. mF.0 I hereby affirm that there is i construction lending agency for the . performance of the work for which this permit is issued,(Sec.3097,. PERMIT FEE (Sub-Total) Civ.C.) ,-:�jz:,', PLAN CHECKING FEE Lender's Name -r.;%,•. t T.,=, ;z PERMIT ISSUING FEE '"'""''• t' ' -' � �" 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 and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APPLICANT OR AGENT - DATE. ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1305300016 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I ITR: 14053 IT: 2 I 1 10400 MILOANN ST [ IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917803471 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18585-018-002 IA1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY CAI I IG1 OUTLETS-LGT,SW,RECP 2.00 OUT 4.00 I I TENANT: G2 LIGHTING FIXTURES 2.00 LGT 4.00 JISSUED ON: PROCESSED BY: PLAN BY: 1 IH7 RES EXHAUST FANS 1.00 EX 11.00 06/03/13 SR I I I TOTAL FEES 46.80 (OWNER: TEL. NO: i IFI AL DATE FI AL BY: CODE: FERTIG, DAVID 110400 MILOANN ST I 36 I ITEMP 917803471 1 ID$SCkIPTtOfi OF WORK u1 I (BATHROOM REMODEL. LIGHTING FIXTURES AND OUTLETS 1 (APPLICANT: TEL. NO: 1 I IGREEN, EDUARDO 15001 LINCOLN AVE 1 ISPECIAL CONDITIONS: (LOS ANGELES CA 90042 I t I [CONTRACTOR: TEL. NO: 1 1APPROVALS DATE INSPECTOR SIGNATURE I IMR FIX, INC. (800) 995-2107- 1 I I 15681 YORK BLVD LIC. NO 1 ITEMPORARY POWER POLE 1 1#202 932510 B 1 1 ILOS ANGELES, CA 90042 I (UNDERGROUND CONDUIT I I [ IARCHITECT OR ENGINEER: TEL. NO: [ IUFER GROUND I I I _ I I I I LIC. NO: I IROUGH CONDUIT I 1 TROUGH WIRING I [ IMAIN WATER LINE [ IPLASTIC YIN METAL YIN I I I (UTILITY COMPANY NOTIFIED( I I I I [ I [ I I I I I I I I I I I I I I I I I I I [ I I I I I I I I I I I I 1 I I I I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 I [ I I