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Home My Public Portal About10409 MILOANN ST_Electrical__ WORKER'S COMPENSATION DECLARATION 7Bp863 DPW(72-91) APPLICATION FOR ELECTRICAL PERMIT I I�ereby affirm that,l have a certificate of consent to self insure, 1. 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 I FOR APPLICANT TO FILL IN JOB . O ADDRESS i ,/L•�[,ds. Certified copy is hereby furnished. New Residential Bldgs.&Pools NO.I EACH FEE LOCALITY ❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. — $ $ department.. Multi-family Sq.Ft. CROSS ST: Date Applicant Residential Swimming Pools ASSESSOR Q a MAP BOOK G`j�� PAGE PARCEL O-7 CERTIFICATE OF EXEMPTION FROM WORKERS' ut ets:Rec. SW.� 1 OwNENAME S Q��l7 �, C�� COMPENSATION INSURANCE p � ��// First 20 MAIL /�q ` L 0,A M Y (This section need not be completed 0 the work Involved by the Total No._�L�_ Additional ADDRESS', v l YC" o permit Is for one hundred dollars($100)or less.) I certify that in the performance of the work for which'this permit G CITY' ) i::f PLe I Tel.No. _ (r &y3 Is Issued, I shall not employ any person in any mariner so as to / 7� PLAN CHECK become subject to the Workers'Compensation Laws. Lighting FixturesFirst 20 APPLICANT. Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. 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 0�A/ �O provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT /v LICENSED CONTRACTORS DECLARATION Size&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. Over 50 t0 100 Incl. N REGNUMCIS' BER Il Over 100 DISTRICT NO. SEED BY 0 License Number Lie.Class C Services',Swbd.,MCC&Panelboards Contractor Date 0-399 Amp.Under 600 V DATE ❑ I am exempt under Sec. 400-1000,Amp..Under 600 V. VALIDATION W Over 1000 Amp.or Over 600 V FINAL it B.&P.C.for this reason BRANCH CIRCUIT FEES BY CO Z Date: 15A,or 20A,120V,Lighting or Recept. _ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits F141 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILYsj Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm that I am'exempt from the Contractor's License Law Sign with One Branch Circuit tr1 .1 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits ; ifry �Code): ,�,3�;. e I I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors A °k EMS 7T is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule)' , T 0 E A 69 .75 and Professions Code). jr. IX 69.75[y 7 vi?I� 6 o f 5 CONSTRUCTION LENDING AGENCY `H.. 5 r I hereby affirm that there is a construction lending agency for the r ti .00 performance of the work for which this permit Is issued(Sec. 3097, PERMIT FEE (Sub-Total) Ila-fQ Civ.C:) 0000—'0001 6 5/$5 PLAN CHECKING FEE Lender's Name ' PERMIT ISSUING FEE 1;� S 0721 1 AM10e09 Lender's Address g I certify that I have read this application and under penalty of purjury state TOTAL FEE that the above information is correct. I.agree to comply,with all County ordinances and State laws regulating Electrical wiring,and hereby authorize represen 'ves of this County to enter upon the above-mentioned property f�Inspon purpose SEE REVERSE FOR EXPLANATORY LANGUAGE c F MITTE DATE ' �'� W�ORKERS'COMPENSATION DECLARATION 20.0019 DPW 3/87 I Flllife.41 8ffirm'4h,v_X h ve a certificate of consent to self *� APPLICATION FOR EL CTRIiCAL PERMIT' O insure, or a certificate o orkers'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 ;' j JOB ❑Certified copy is hereby furnished. New Residential Bldgs. &.Pools EACH NO. FEE ADDRESS O ❑Certified copy is filed with the'county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST Residential Swimming Pools CROSS ST. Date Applicant—.. OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION'FROM WORKERS' MAIL Outlets: Rec Light Sw._ �A ' COMPENSATION INSURANCE - r V ADDRESS D (This section need not be completed If the work involved by First 20 CITY Tel. No. the permit is for one hundred dollars($100)or less.) Total No. Additional T PLAN.CHECK i -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 Additional Date 1,-2.72 --j-1-Applicant C r/ Total No. CITY Tel. No. e MID/ —,r 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 —WM. — deeined revoked. Hood Fan_ —Other— CITY Tel. No.y T `ZTG 2 LICENSED CONTRACTORS DECLARATION Dis LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 p Room Air Cond. — REG.NUMBER Class. (commencing.with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. P SSED BY >_ and Professions'Code,and my license is in full force and effect, d Size&Type HP, KW, KVA, or KVAR �� 0 License Number ¢WIn 3 L'ic. Class C�� Up to 1 Incl, FINAL J V Contractor . LAC/3s.�.0 Date �Z Over 1 to 10 Incl. j DATE 7- 7- 71 VALIDATION �O ❑ Over 10 to.50 Incl. F- FINAL I am exempt under Sec. Over 50 to 100 Inc. BY U LU B.&P.C. for;this reason. Over 100 Servic ords Z Date: s 0- 00 Amo.�Under� / — Signature 201 - T000 Amp. Under 600 V ❑ Exemption for Reg. Mainz. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY HOMEOWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances J. Sign with One Branch Circuit s, r I hereby affirm that i am exempt from the Concense Additional Sign Branch Circuits Law for the following reason (Section 7031:5, Business and 9 Professions Code): � I;; 510 11 ❑ I; as owner of theproperty, will do the work and the Misc. Conduits&Conductors j ` structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)_ 50 _ _ Business and Professions Code). j s CI 11'11-. .50 CONSTRUCTION LENDING AGENCY I CHECK 50.50. Thereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 11' (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name - : j ! .1-4Lj!+f Gr.t t!7. PERMIT ISSUING FEE Lender's Address 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 thea e-mentioned prop. rty for inspection purposes. 1. SEE REVERSE FOR EXPLANATORY LANGUAGE Si a itfff W Date ®s y COUNTY OF IAS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0810010012 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: ITR: 14053 LT: 26 I 10409 MILOANN ST IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917803472 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: HALIFAX [ 18585-019-039 1A1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, Cl IG1 OUTLETS-LGT,SW,RECP 6.00 OUT 11.70 I I TENANT: I TOTAL FEES 39.45 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: [ 110/01/08 SR 03/30/09 I (OWNER: TEL. NO: I IF T FI BY: CODE: 1 IFLORES, LAURA (626) 235-4722- 1 110409 MILOANN ST 1 r. I ITEMP 917803472 I IDES ION OF WORK 1 I I JADD 6 OUTLETS (APPLICANT: TEL. NO: 1 ISAME AS OWNER - 1 I ISPECIAL CONDITIONS: 1 I I I I ICONTRACTOR: TEL. NO: I [APPROVALS DATE INSPECTOR SIGNATURE 1 ISAMB AS OWNER LIC. NO i (TEMPORARY POWER POLE I I I [UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: - i 1UFER GROUND I I I LIC. NO: I IROUGH CONDUIT TROUGH WIRING I [ IMAIN WATER LINE I I IPLASTIC YIN METAL YIN I [ [ UTILITY COMPANY NOTIFIED( I I IE 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 [ IREPORT ID: DPR265 ROUTE TO: BS0508 [ I I I I I I I I I / COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT ` DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0404230002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL D: FEES PAID BUILD10409ING MILOANNEST: TR: 14053 LT: 26 FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803472 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: HALIFAX 8585-019-039 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 8.00 OUT 15.60 TENANT: G2 LIGHTING FIXTURES 1.00 LGT 1.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIR ON: TOTAL FEES 45.30 04/23/04 VG 10/20/04 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: FLORES/MA, ALBERT/LAURA (626) 625-2855- VV �✓ 10409 M I LOANN ST 1-1v,v TEMP 917803472 DESCRIPTION OF WORK ELECTRICAL FOR NEW FAMILY ROOM & DECK APPLICANT: TEL. NO: FLORES (626) 625-2855- SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE FLORES, ALBERT (626) 625-2855- 10409 MILOANN ST. LIC. NO TEMP6RARY POWER POLE TEMPLE CITY, CA 91780 NONE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. O: LIFER GROUND TRINIDAD, LYDIA - 15811 MARY ST. LIC. NO: ROUGH CONDUIT IRAN NUYS, CA 91406 NONE ROUG11 WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMP Y NO IFIED REPORT ID: DPR265 ROUTE TO: BS0508