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Home My Public Portal About6059 OAK AVE_Electrical__ ON I Aereby aff mOtthat I WORKER'S certificate of consen ON self insure, BABB3 DPW(12.9t) 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. Ila b u 981 Company FOR APPLICANT TO FILL IN JOB ADDRESS a Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. $ EACH $ FEE LOCALITY ❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. _ NEAREST department. }� Multi-family Sq.Ft. CROSS ST. b Date (Z-��3 Applicant �" L` �� Residential Swimming Pools MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Light_J,Sw.� OWNER OR COMPENSATION INSURANCE O!/ FIRM NAME (This section need not be completed If the work Involved by the First 20 ADDRESS permit Is for one hundred dollars($100)or less.) Total No. Additional 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 comply with such PERAPPLICANT IT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances S LICENSED CONTRACTORS DECLARATION Size&Type HP,KW, /A/[g�r,�KVAR ADDRESS 6� 1 hereby affirm that I am licensed under provisions of Chapter 9 erdto TO Incl. Alp (commencing with Section 7000)of Division 3 of the Business and CITY C-0-rutoL pf� Tel.No. Professions Code,and my license is in full force and effect. I Over 10 to 50 Incl. �--P�g Over 50 to 100 Incl. REG.NUMBER 6(sl q C/ Class. LICENSE OR J C° } a License Number5:"% } f Lia Class a Over 100 DISTRICT NO. P SED BY 0 �`✓ C�- V Services,Swbd.,MCC&Panelboards w Contractor &Ay r Date 1.113 0-399 Amp.Under 600 V DATE FINAL 400-1000 Amp.Under 600 V /J 1" ❑ I am exempt under Sec. -(, VALIDATION V Over 1000 Amp.or Over 600 VW B.&P.C.for this reason BY AL d BRANCH CIRCUIT FEES � Date: 15A,or 20A,120V,Lighting or Recept. Z_ 1 To 10 Branch Circuits 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 I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits W._�._; •:�._I.. 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) ' i ;liji sir and Professions Code). { r r• 5e CONSTRUCTION LENDING AGENCY I. hereby affirm that there is a construction lending agency for the :' t�u�• •-� performance of the work for which this permit is issued(Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) ' PLAN CHECKING FEE �j)ii�•_.I_ (�;s )i u•`y. Lender's Name PERMIT ISSUING FEE i `4? ° AM 10 o 01 i� 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 i 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 Q' �� ( r3 SIGNATURE OF PERMITTEEDATEF WORKERS'COMPENSAT;ON,DEC(�ARATION C-80B 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certlflbate of consent to self LQsure, . E-aot1G or a certificate of Workers' Compensation Insurance, or a certified I COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3600,Lab.C.) q `fl Policy No. Company FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. EACH NO. FEEADDRESS f i New Residential Bldgs.&Pools ❑ Certified copy is filed with the county building inspection I 1 &2-Family,Sq.Ft. $ _ $ LOCALITY department. Multi-family Sq.Ft. NEAREST Residential Swimming Pools CROSS ST. 1OWNER OR Date Applicant FIRM NAME r CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec-Light _Sw.- IMAIL COMPENSATION INSURANCE First 20 ADDRESS C� (This section need not be completed if the work involved by the Total No. Additional CITY/� eL N permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit PLAN CHECK Is issued, I shall not employ any person in any manner so as to I APPLICANT become subject to the Workers'Compensation Laws. I Lighting Fixtures First 20 ADDRESS Total No. Additional CITY el.No. Date Applicant i 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 (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER Class. Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO Q PPP CE E Y Size&Type HP,KW,KVA,or KVAR 1 lU� Q License Number Lic.Class Up to 1 Incl. FINAL V Over 1 to 10 Incl. DATE Contractor Date Over 10 to 50 Incl. /v �n VALIDATION F- ❑ FINAL I am exempt under Sec. Over 50 to 100iInc. BY W Over 100 �, 0- BAP.C.for this reason � rServi wbd.,MCC& an s/ Z Date: 0-200 Amp.Under Signature 2 - Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole& Appurtenances I HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit a I hereby affirm that I am exempt from the Contractor's License Lawes- "'Q for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits �, 'j Code): S�,i f f J 10 . E] Misc.Conduits&Conductors i 1 I,as owner of the property,will do the work and the structure I!a.!, is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ® T) e and Professions Code). 00 CONSTRUCTION LENDING AGENCY r_HEf_K v�et�ill I hereby affirm that there is a construction lending agency for the C1�.r7� Performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) Civ.C.). PLAN CHECKING FEE -«-- Lender's Name °jl;l,lj—I;i�l � PERMIT ISSUING FEE '►-0t; f }t; {o i' Lender's Address I 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 !ring, and hereby authorize repres ntatives of th' County to r upon the above-mentioned pro y for ingpecti ses. SEE REVERSE FOR EXPLANATORY LANGUAGE na ure of er i d Date I COUNTY OF IAS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF'PUBLIC WORKS 9701 LAS TUNAS EL 0508 1209190051 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 i PHONE: (626) 285-0488 EXT: LEGAL ID: f FEES PAID BUILDING ADDRESS: ITR: 6561 LT: 335 I 6059 OAK AV I I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917802030 1 (ASSESSOR INFORMATION NUMBER: �1 I NEAREST CROSS STREET: 7.80 15385-005-001 Al PERMIT ISSUANCE FEE 2THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, C G1 OUTLETS-LGT,SW,RECP 1.00 OUT 2.00 I I TENANT: I TOTAL FEES 29.80 (ISSUED ON: PROCESSED BY: PLAN BY: I 109/19/12 SR I II I i (OWNER: TEL. NO: 1 IFINAL DATE FI L BY: CODE: 1 ICSEHY LOUIS J;CSEHY LOUIS L (626) 286-6113- iI 111 O 1 6059 OAK AV TEMP 917802030 I DESCRIPTION OF WORK I IADD GFI (APPLICANT: TEL. NO: I I I IBENYESHAY, BINYAMIN (310) 628-8221- I I I 16670 RESEDA BLVD. I ISPECIAL CONDITIONS: 1 IRESEDA, CA 91335 I (CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I INOFAR CONSTRUCTION (818) 205-9363- I 1 I 16670 RESEDA BLVD LIC. NO I ITEMPORARY POWER POLE I I I [RESEDA CA 91335 830716-B * I I I I I I I (UNDERGROUND CONDUIT 1ARCHITECT OR ENGINEER: TEL. NO: I UFER GROUND I I 1 LIC. NO: I IROUGH CONDUIT 1 I I (ROUGH WIRING I I I I I I I I IMAIN WATER LINE 1 I I PLASTIC Y/N METAL Y/N I I I I I I � I UTILITY COMPANY NOTIFIED( I I I I I I I I I I I I 1 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* ADDITIONAL DATA ON FILE I 1 I 1 (REPORT ID: DPR265 ROUTE TO: BS0508 I I I I