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Home My Public Portal About6207 MUSCATEL AVE_Electrical__ WORKER'S COMPENSATION DECLARATION 20.0019 DPW(12.91) APPLICATION FOR ELECTRICAL PERMIT ' I hereby affirrti that I have a certificate of consent to self Insure, 76A883 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy tbekof(Sec.3800 Lab.C:) Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS 19 A C4 Z Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE $ $ LOCALITY C' ❑ Certified co is filed with the count building inspection 1 &2-Family,Sq.Ft. department. y g p Multi-family Sq.Ft. ORoss ST. Date Applicant. Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWNER OR COMPENSATION INSURANCE FIRM NAME D First 20 MAIL (This section need not be completed If the work Involved by the Total No. Additional ADDRESS yQ �I L( re— permit Is for one hundred dollars($100)or less.) p I certify that in the performance of the work for which this permit CITY / C� ^� Tel.No.2 _ / YS is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 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.t'o the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code,you must forthwith comply with such PERMIT ��,. G p p y Power Apparatus&Large Appliances APPLICANT .moi( 2 c provisions or this permit shall be deemed revoked. 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..4,14 2'O Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. Over 50 t0 100 Incl. LICENSE B Class REG.NUMBER {�.�/Q t1 Over 100 DISTRICT NO. PROCESS O License Number Lic.Class 06 U Services,Swbd.,MCC&Panelboards a IY Contractor Date 0-399 Amp.Under 600 V DATE FINAL IV. T 'O F1 I am exempt under Sec. 400-1000 Amp.Under 600 V Z� — VALIDATION W Over 1000 Amp.or Over 600 V FINAL (Z B.&P.C.for this reasonBY / CO BRANCH CIRCUIT FEES Date: 15A,or 20AA,,120V,Lighting or Recept. 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits F-141 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,20 VV To 277V Lighting Br.Circuits r SINGLE FAMILY 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 for the followingSection 7031.5, Business and Professions Additional Sign Branch Circuits s=('1: C-O `•i1 Code): reason ( 9 I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors ° ITC'`r`' is not'intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) I N :_e� �40 and Professions Code). CONSTRUCTION LENDING AGENCYElI r'14 I hereby affirm that there is a construction lending agency for the performance of.the work for which this permit is issued(Sec:3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE 0000""t�3I..j 1 Y Lender's Name .� PERMIT ISSUING FEE V ,i'r' I AMr 1`2 r s!. Lender's Address TOTAL FEE I certify that I have read this application and under penalty of purjury statey 111d that the 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 Coen r Upon the above:mentioned property for in ction p poses. SEE REVERSE FOR EXPLANATORY LANGUAGE A-91 SIG RE OF PERM EE DATE WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, 76A663 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 ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY $Ft Sq. . — $ Certified copy is filed with the county building inspection 1 &2-Family, _ NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWN NAME COMPENSATION INSURANCE FIRM First 20 MAIL (This section need not be completed if the work involved by the Total No. Additional ADDRESS permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY Tel.No. is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers' Compensation Laws. Lighting Fixtures First 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 com I with such PERMIT p p y provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS 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 TelNo. IZ Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. C LICENSE Cl Over 50 t0 100 Incl. REG.NUMBER ass.ER (. License Number Lia Class Over 100 DISTRICT NO. PROCESSED BY LL Services,Swbd.,MCC&Panelboards LL 0-399 Amp.Under 600 V FINAL > Contractor Date DATE ❑ 400-1000 Amp. Under 600 V I am exempt under Sec. VALIDATION Q Over 1000 Amp.or Over 600 V FINAL i7 B.&P.C.for this reasonBY C BRANCH CIRCUIT FEES a Date: 15A,or 20A,120V,Lighting or Recept. 1 To 10 Branch Circuits LL Signature 11 To 40 Branch Circuits ~ ❑ 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 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 Law for the following reason (Section 7031.5, 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). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address 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 representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF PERMITTEE DATE W10PKER'S COMPENSATION DECLARATION 20-0019 DPW(12.91) I hereby affiriffthat I have a•certificath of consent to,self insure, APPLICATION FOR ELECTRICAL PERMIT or a ce�ificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS. BUILDING AND SAFETY DIV. copy tgereof(Sec.3800 Lab.C.) / I Policy No. Company FOR APPLICANT'TO FILL IN JOB D 'ADDRESS eL Certified copy Is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY ❑ Certified copy is filed with the count building inspection 1&2-Family,Sq.Ft. $ . $ NEAREST department. Multi-family Sq.Ft: CROSS ST. Date Applicant 'Ar �� Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL. CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWNER FIRM NAOR ME M COMPENSATION INSURANCE First 20 _ - MAIL (This section need not be completed If the work Involved by the Total No. Additional ADDRESS permit is for one hundred dollars($100)or less.) I certify that iri the performance of the work for which this permit CITYel.No is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPUCANT Total No. ' Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.Nd. 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 provisions dr this permit shall be deemed revoked. Power Apparatus&.Large Appliances APPUCAN LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS. O . 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. slid CITY Tel.NolpZ �•�.]1l Professions Code,and my license Is in full force and effect. Over 10 to 50 Incl. LICE EOR Clasa4e--490 b d ry Over 50 to 100 Incl. REG.NUMBER License Number �'- .S r Lia Clash�I -C 36`� Over 100 DISTRICT NO. p ESSED BY U ervices bd., & anelb�oa�rdd . Od dontractor �� Date 610e mp. de fiOD V — FINAL TQ ❑ under Sec. 400-1000 Amp.Under 600 V & 0 I am xempt Over 1000 Amp.or Over 600 V FINAL VALIDATION W B.&P.C.for this.reason BRANCH CIRCUIT FEES BY Date: 15A,or 20A,120V,Lighting or Recept. 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits 41 Or More Branch Circuits El Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Be.Circuits. 2 SINGLE FAMILY Temp.Power Pole.&Appurtenances ^q HOME OWNER-BUILDER DECLARATION P'CCE IF I hereby affirm that I am exempt fSign with.One Branch Circuit. rom the Contractor's License Law � for the following reason (Section 7031: -��.7 .•I;M1.) 5, Business and Professions Additional Sign Branch Circuits ,.ra �` Code): 1 ITEMS ❑ I,as owner of thepro ert ,will do the work and the structure Misc.Conduits&Conductors is not intended oroffered for sale(Section 7044, Business Other(See Complete Fee Schedule) TOTAL 63- 45 and Professions Code). , (,HECK 63.45 CONSTRUCTION LENDING AGENCY k' I.;` I hereby affirm that there is a construction lending agency for the t`i l'�3t` performance of the work for which this permit is Issued (Sec.3097, PERMIT FEE (Sub-Total) Civ.C.) Pr PLAN CHECKING FEE )� v#,-I'itl]!' � •`` Lender's Name. PERMIT ISSUING FEE 775 i j Pr{12:` �� a Lender's Address TOTAL FEE I certify that I have read this application and under penalty of purjury state . that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize representatives of is Coujo to enter upon the above-mentioned property for inspection p oses. SEE REVERSE FOR EXPLANATORY LANGUAGE 04 SIGNATURE OF PER E D T , COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0909090022 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID BUILDING ADDRESS: JTR: 5903 LT: 58 UN: .002 1 6207 MUSCATEL AV N I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( SGAB CA 917752626 ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: LONGDEN 15386-009-061 [Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl JF2 208, 277V LGT BR CKT 2.00 BR 54.60 ITENANT: IG1 OUTLETS-LGT,SW,RECP 80.00 OUT 120.00 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1 JG2 LIGHTING FIXTURES 60.00 LGT 93.00 109/09/09 SR 09/09/10 1 JHA FAU LESS 3HP 1.00 FAD 10.95 1 1 DOWNER: TEL. NO: JH1 RES ELEC OVEN LT 3HP 1.00 OVE 10.95 JF NAL DATE FIN BY. CODE: ISLOAN, WILLIAM/INGRID (626) 282-5562- JH2 RES GREG DISP LT 3HP 1.00 DIS 10.95 1 1 I721 W. SAN MARINO AV JH3 RES DISHWASHR IT 3HP 1.00 DIS 10.95 ALHAMBRA, CA 91801 JH4 RES RANGE HDS IT 3HP 1.00 HOO 10.95 D-MCRIPTION OF WORK JHS RES WASH MACH LT 3HP 1.00 WAS 10.95 JELECTRICAL FOR ADDITION, R ODEL, HVAC SYSTEM AND UPGRADE JJB AC UNITS +3-10HP 1.00 AC 19.65 ISERVICE PANEL TO 200 AMP 1 [APPLICANT: TEL. NO: ILB 200 AMP PANELS, MCC 1.00 PAN 38.85 [ ICOOLMAN (626) 285-0835- I TOTAL FEES 419.55 J 1 15075 SERENO DRIVE I ISPECIAL CONDITIONS: 1 ITEMPLE CITY CA 91780 ICONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE 1 ISC ENTERPRISES (626) 292-2265- 1 1 1 11201 ELM AVENUE LIC. NO 1 ITEMPORARY POWER POLE [ 1 [ ISAN GABRIEL, CA 91775 815046 B I I I [ 1 J I JUNDERGROUND CONDIfT I I I (ARCHITECT OR ENGINEER: TEL. NO: 1 JUFER GROUND I I I LIC. NO: 1 IROUGH CONDUIT [ 1 1 D IROUGH WIRING 1 [MAIN WATER LINE J 1 IPLASTIC Y/N METAL Y/N I [ 1 [ (UTILITY COMPANY NOTIFIEa{ r L. [ I I I 1 I I I [ I [ I I I [ I I ] [ I [ I I ]REPORT ID: DPR265 ROUTE TO: BS0508 ] 1 I [ 1 ] ] D J I a Ni ( fh I Df .•A t'•N, 22" DEPARTMENT OF BUILDING' AND SAFET� APPLICATION FOR PKtIbSIT COUNTY of Los ANGELES ;A ELECTRIC. . L i OF—IN—.TrALLATION I .DISTRICT No. ,GROUP TYPE PSIIMITNo.•�. WIRING rlrTufn P�feRVlee ' G aANae NfATty p I p rIROT tnir®C_f'11�1 {. Rath:vaA av DATdS tpDUgDr•. f10N■ I RtreC[LLAN[OUf •• r• r ? 3 +: OU. 's- NAM[ r I JOG //�� U ADORlSS . V' /' x•10• ic•�� Al LOGALITV} pl,.J.;.. C• ,� o k� 0.7• P TttL Norte CROSS ST• _ s STAT[ CO LICrN.R Ne REG. No. ' d\7 1• ` •'F D:SCRII'TION OF WORK �.3 -sf MAIL.! 1 l ° "UNDER Or OUTLETS ON CIRCUITS ADOREtlf 8 LOCATION fV ROOMS pL.i(. J' GfTT'•. TEL MO. LIONT OUTLETS ■W. rLuaf na. CORRECTIONS CIRCUIT\ I A a C D [ I F. A HI (i „r a K �1 `••'rte T � LIVING ROOM _ ' • - S" DINING ROOM I e11rfT.RM. ..pQr�4•r:• w� T. OATH [NT. MALL HALL No. FRONT PORCH fes$ .•i- �• OUTSIDE KITCHEN •y` • SERV. !'CM. I ' ,., ,} C • Son".No. / s ... a •�. rt'- cLrmrr IJ I boll". Ne. If / eLofl-T r -APPROYALs e A Ya• waw w :;I CONDUIT •r •i••.• 3�. 7•'- • WIRING. �. i.•; �.'• 4:4.`� TOTAL !lTtlRlS '1 .� _ No. Or OUTLETS S •1 1 A POWER .• ,� -•.�. .1. ~+ iy• NO. OI rIXTUR[f 07' S •i•� tITILIT'V CO.NOTtrIID q . ' NO. Or MOTORS. H.la. • PI AL R ti; t NO. W iICN1TawN1. 1 AM THE LLGAL"Ulm&.T'HNA •. s COVNTT R[OISITRATIam HU307 «t ' NO.'Or RA!{O[S C!t H[AT[RO •'^• S't.• •i. _ •r•� I !'S •" - ?" X MIfICRtANFOUR .....,.��, ' :'.I: `.. - .,, •.?. ..: SL[{.71MCW.r "n ' AM+fHN LEGAL .' " •g�. �' ft PERUIT'rre pWHolOr771N'rROrNRTYp>I liter(. s TO*AL^•rll - -S c:' •'h` "'�r,'f s.y:t r-,,;,; _ .. ' _�.. ' "� . ...••rsTC7:.r•.•.t..p-...,•..'. ••.a.•.t^owR[R.'. y,......`: r•�..rr:� (.�•• •bj .n.!"k f.w•i:•y.• •.�••7.~ax.;.rsr Riw,'k.•. •1:•i a'•