HomeMy Public PortalAbout5807 MUSCATEL AVE_Electrical__ WORKERS'COMPENSATION DECLARATION CE- O3 1oia1 APPLICATION
l,PPL I,�+d TION FOR la=g E(r t-®IC/�L PERMIT I hereby affirm that I have a certificate of consent to self insure, CE-bosG `y L �sli 1 E V GIA. `>as fl f,1 r G Il�Y� 1
or a certificate of Workers' Compensation Insufance,or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof•(Sec.3$00,Lab.C) "fl
Policy No. Company • FOR APPLICANT TO FILL IN JOB
ADDRESS
[3Certifiedcopy Is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE
❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft $ = $ LOCALITY
department. Multi-family Sq.Ft. NEAREST T n'
I CROSS ST
Date Applicant Residential Swimming Pools OWNER OR `
FIRM NAME
CERTIFICATE
OF EXEMPTION
INSURANCE WORKERS' Outlets:Rec—Light—Sw.— ADDRESS
(This section need not be completed if the work Involved by the Additional
20
permit is for one hundred dollars($100)or less.) Total No. Additional CITY a C+ i Tel.No.
I certify that in the performance of the work for which this permit PLAN CHECK
APPLICANT
is Issued, I shall not employ any person in any manner so as to
oecome subject to the Worker;Compensation Laws. Lighting Fixtures First 20 ADDRESS
Total No. Additional CITY Tel.No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS
provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _ CITY Tel.No.
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR Class.
(commencing with Section 7000)of Division 3 of the Business and REG NUMBER
Professions Code,and my license is In full force and effect. DISTRICT NO. PR E ED
Power Apparatus&Large Appliances Ga;
Size&Type HP,KW,KVA,or KVAR C C
License Number Lic.Class Up to 1 Incl. FINAL V
Over 1 to 10 Incl DAT KALI AT10N IX
Contractor Date Over 10 to 50 Incl.
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&Panelboards rN ®
Date: 0-200 Amp.Under 600 V (� (/
Signature 201 - 1000 Amp.Under 600 V—
❑ i
Exemption for Reg Maint.Elect. Over 1000 Amp or Over 600 V
SINGLE FAMILY Temp Power Pole& Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit a
I hereby affirm that I am exempt from the Contractor's License Law .7
for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits
Code). LI'
❑ 'Misc.Conduits&Conductors T
I,as owner of the property,will do the work and the structure •-
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ ® _
and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the r• iP,k-r-• '.
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total)
Civ.C).
PLAN CHECKING FEE
Lender's Name �l
PERMIT ISSUING FEE v 0
Lender's Address 1 IUD'-`
I certify that I have read this application and state that the above TOTAL FEE r, G
information is correct.I agree to comply with all County ordinances
and State la regulating Electrical wiring, and hereby authorize
represent es this County to e r upon t above-mentioned
propert for i ec�ion purpo SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Dat
(COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1209110047
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 5905 IT: 120 5807 AV
1FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CCA 917801824
(ASSESSOR INFORMATION NUMBER: II NEAREST CROSS STREET: 1
15387-014-017 1A1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID. H3 LOCALITY: TEMPLE CITY, Cl
I _1G1 OUTLETS-LGT,SWyRECP 1.00 OUT 2.00 I I
(TENANT: ] TOTAL FEES 29.80 11SSUED ON: PROCESSED BY: PLAN BY: 1
109/11/12 SR 1
OWNER: TEL. NO: 1FINAL DATE FINAL BY: CODE: 1
ISCOFFINGER JOSEPH W;PATRICIA J (626) 287-4716- 1
15807 MYDA AV
I
1TEMP 917801824 1 1DESCRIPTION OF WORK 1
I I 1REPLACE GFI OUTLET 1
I I I I
1APPLICANT: TEL. NO: 1
IX-TREME BUILDERS (626) 786-2347- 1 I I
12509 EUCLID CRESCENT i 1SPECIAL CONDITIONS:
]UPLAND, CA 91784 I I
I
I I
1CONTRACTOR: TEL. NO: 1 1APPROVALS DATE INSPECTOR SIGNATURE 1
IX-TREME BUILDERS INC. (909) 931-4464- I 1- I
12509 EUCLID CRESCENT EAST LIC. NO 1 1TEMPORARY POWER POLE I I I
1UPLAND, CA 91784 627142B 1 I I I I
I I IUNDERGROUND CONDUIT I I I
]ARCHITECT OR ENGINEER: TEL. NO: - ] ]LIFER GROUND I I I
] LIC. NO: ] ]ROUGH CONDUIT I I I
1 I TROUGH WIRING I I
I I IMAIN WATER LINE
I ] ]PLA£TIC YIN METAL YIN I I I
I ] rED
UTILITY COMPANY NOTIFIED
] ] ]
I I I
]
I 1REPORT ID: DPR265 ROUTE TO: BS0508 I• I I I
I I ] I I ]
Y COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0809040017
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I
ITR: 5905 LT: 120 I [ 5807 MYDA AV 1
I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:[ TEMP CA 917801824
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
15387-014-017 [A1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl
IG1 OUTLETS-LGT,SW,RECP 30.00 OUT 52.50 I I
ITENANT: G2 LIGHTING FIXTURES 4.00 LGT 7.80 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: [
I 1HA FAU LESS 3HP 1.00 FAU 10.95 09/04/08 SR 03/03/09 I
I IH4 RES RANGE HDS IT 3HP 4.00 H00 10.95 1 1
(OWNER: TEL. NO: IJB AC UNITS +3-10HP 1.00 AC 19.65 IF NAL DATE FI AL BY: CODE:
ISCOFFINGER JOSEPH W;PATRICIA J (626) 287-4716- ILB 200 AMP PANELS, MCC 1.00 PAN 38.85 I I
15807 MYDA AV I TOTAL FEES 168.45 I I
ITEMP 917801824 1 I P ON OF WORK I
I I 1NEW ELECTRICAL PANEL TO 200 AMP + RE-WIRE ENTIRE HOUSE 1
(APPLICANT: TEL. NO: I I I
IBETTER CONSTRUCTION & DESIGN INC. (818) 399-1112- I I I
117001 OAK VIEW DR. I ISPECIAL CONDITIONS: 1
[ENCINO, CA 91436 I I I
(CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I
IBETTER CONSTRUCTION AND DESIGN, INC (818) 399-1112- I 1 I
117001 OAK VIEW DR LIC. NO I [TEMPORARY POWER POLE I I I
IENCINO CA 91436 817160 B I I I I I
1 I 1UNDERGROUND CONDUIT I I I
(ARCHITECT OR ENGINEER: TEL. NO: I [LIFER GROUND
1 LIC. NO: I IROUGH CONDUITF
r
ROUGH WIRING I 1 [
I I I I I I
I [ IMAIN WATER LINE
I [ 1PLASTIC YIN METAL YIN [ I [
I I (UTILITY COMPANY NOTIFIE ' ' I [
I 1 I I I I
I I I I I I
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I I I I I I
I I I I I I
I I I I I I
1 I 1 I I I
1 I I 1 I I
I I I I I
[ I I I I I
[ 1REPORT ID: DPR265 ROUTE TO: BS0508 I I I I
I I I I I I