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Home My Public Portal About9083 OLIVE ST_Electrical__ 'WORKERS'COMPENSATION DECLARATION 78-883 10/81 .0.0 r c , ti. CE-BOBG APPLICATION FOR ELECTRICAL PERMIT . I hereby affirm,That,I have a certific3tR,of congent to self insure, n 'uf or oertifica)e'bf V%brkers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY ecopy thereof-.`{Sec:3800,Lab:C.) Policy No. e -d FOR APPLICANT TO FILL IN' JOB Company (�(� O 1 V& �. . ❑ Certified copy'is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADORES 6v L. ❑ 1 &2-Family,Sq.Ft.4 $ _ $ LOCALITY Certified copy is filed with the county building inspection NEAREST I department. Multi-family Sq.Ft. Residential Swimming Pools CROSS ST. Rana Date Applicant OWNER ORIto '!� . Q ,r- FIRM NAME v CERTIFICATE,OF EXEMPTION FROM WORKERS' Outlets:Rao Light v'Sw.� MAIL COMPENSATION INSURANCE D ADDRE 0. 3 pL k V (This section need not be completed if the work Involved.by the First 20 permit is for one hundred dollars($100)or less.) Total No. Additional CIT Tel.No: `1 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 APPLICANT become subject to the.Workers'Compensation Laws. Lighting,Fixtures, First 20 ADDRESS Total No.. P) -Additional' CITY• Tel.No. Date. Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT:if, after making this Certificate of PERMIT 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_/V W.M.✓ ADDRESS provisions or this permit shall be deemed revoked. Top _ FAU WH. LICENSED CONTRACTORS DECLARATION Hood _ Fan ._ Other CITY Tel-No. I hereby'affirm that,l am licensed. under provisions of Chapter 9 LICENSE OR (commencing with Section 7000)of Division 3 of the Business and Disp. Room Air Cond. REG:NUMBER Class. Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NJ y+�� P ES ED BY U Size&Type HP,KW,KVA,or KVAR r O License Number Lic.Class Up to 1 Incl. FINAL Q Over 1 to 10 Incl. DATEALIDATION` . Contractor Date Over 10 to 50 Incl. 6 61" FINAL ❑ I am exempt under Sec. Over 50 to ADO Inc. BY LL1 B.&P.C,for this.reason Over 1.00 N Seryl d.,MCC&Panelboards ONO. Z. Date: 0 200 mp.Under'600 V 1OO.q Signature 20 00 Amp.:Under 600 V `• Over 1000 Amp.or Over 600 V ❑ Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances 2 HOME OWNER-BUILDER.DECLARATION Sign with One Branch Circuit i I hereby affirm that I am exempt from the.Contractor's 'License Law Sign Branch C1�cuits ACCT.A for the following reason(Section 7031:5,Business and.Professions Additional • Code): 3307 64123.00 r; Misc.Conduits&Conductors i I,as owner of,the property;will do the work and the stSueture Other(See+Complete Fee Schedule) _ ' I ITEMS is not intended or offered for sale.(Section 7044, Business and Professions Code). , TOTAL 68 o 00 CONSTRUCTION LENDING AGENCY :HECK 68.611 1 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) CHANGE • o 00, Civ.C..). ' PLAN CHECKING FEE Lender's Name0000-0001 11/2?1880 PERMIT ISSUING FEE 1,05.0 7121 1• AM 1010151 , ' Lender's Address y1, ' I certify that I have read this..application and state that'the. above TOTAL FEE v information is correct.I agree to comply with all County ordinances and State Is gulatin Electr' . wiring, and hereby authorize , representati' of this un to upon the above-mentioned propert p ti purp SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12.91) APPLICATION FOR ELECTRICAL PERMIT I fiereby affirm that"! pave a certificate of consent to self Insure, 76A669 or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY•DIV. copy thereof0ec.3800 Lab:.C.) Policy No. Company. FOR APPLICANT TO FILL IN JOB t ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY 'Y �. ~ ❑ 1 &2-Family,Sq.Ft. _ $ $ Certified copy is filed with the county building inspection NEAREST department. Multi-family Sq.Ft. CROSS ST. SvZ�TigevlQ— Date Applicant Residential Swimming Pools MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light. Sw. wNER ORpiii COMPENSATION INSURANCE FIRM NAME First 20 phis section need not be completed If the work Involved by the MAIL g� (-vk` ermit Is for one hundred dollars($100)or less.), Total No. Additioonal ADDREss I certify that in.the performance of the Work for which this permit CI tw\>P, Mt Tel.N.2810, 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 zcdezoit — I RESID NTIAL 681COEIS VOETZOVEHP. NOTICE TO. APPLICANT: If, after making this Certificate of /� CITY TeLNo. - 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 or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT 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 8 of the Business and CITY Tel.No. Professions-Code,and my license Is in full force and effect. Over 10 to 50 Incl. �. LICENSE OR Class: Over 50 to 100 Incl. REG.NUMBER O Over 100 DISSRICT NO. P EBBED BY License Number Lic._Class V Services,Swbd.i,MCC&Panelboards ✓'AO Contractor Date. 0-399 Amp.Under 600 V DATE V ❑ I am exempt under Sec. 400-1000 Amp.Upder 600 V I +-Q VALIDATION Over 1000 Amp.or Over 600 V FINAL d B.&P.C.for this reasonBY C0 BRANCH CIRCUIT FEES Date: 15A,or 20A,120V,Lighting or RecepL 1 To 10 Branch Circuits. Signature 11 To 40 Branch Circuits 41.6r More Branch CircuitsEl = Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances i3 r'f HOME OWNER-BUILDER DECLARATION I`'' I hereby affirm that I am exempt from the Contractor's License Law Sign With One Branch Circuit , t: for the following reason.(Section 7031.5, Business and Professions Additional Sign Brarici,01rcuits+ "= r 'sem°?' Code): ; f EEM Ei'1 t. I,as owner of.the property,will do the Work and the structure Misc.Conduits&Conductors is not intended oroffered for sale(Section 7044, Business Other(See Complete Fee Schedule) (i}(;ail_ 6 o 75 and Professions Code). CHECK 3L.75 CONSTRUCTION LENDING AGENCY CHANGE 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) f Civ.C. PLAN CHECKING FEE 1000'0-01101 r2 1.71117-151 Lender's Name PERMIT ISSUING FEE 3056 1 AMID 14 Lender's Address I certify that I have read this'application and under penalty of purju y 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 enterupon the above-mentioned property �.NAT_ SEE REVERSE FOR EXPLANATORY LANGUAGE F PERMITTEE ZD. E _ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0607180003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 11218 LT: 19 BL: D 9083 OLIVE ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803024 ASSESSOR INFORMATION NUMBER: NBAR EST CROSS STREET: ROSEMEAD 5388-005-020 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: 84 LOCALITY: TEMPLE CITY, C G1 OUTLETS-LGT,SW,RECP 17.00 OUT 33.15 TENANT: G2 LIGHTING FIXTURES 8.00 LGT 15.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 81 RES ELEC OVEN IT 38P 1.00 OVE 10.95 07/18/06 JX 01/14/07 82 RES GREG DISP IT 3HP 1.00 DIS 10.95 OWNER: TEL. NO: 84 RES RANGE BUS IT 38P 1.00 800 10.95 FINAL DJ►TSFI Y: CODE: BRUGGER MARK B;LIA F (626) 287-5580- TOTAL FEES 109.35 9083 OLIVE ST TEMP 917803024 DESCRIPTION OF WORK ELECTRICAL FOR KITCHEN REMODEL APPLICANT: TEL. NO: L AND W KITCHENS & BATHS (626) 287-1131- 8812 LAS TUNAS DR. SPECIAL CONDITIONS: SAN GABRIEL CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE L AND W KITCHEN AND BATHS (626) 287-1131- 8812 LAS TUNAS DR. LIC. NO TEMPORARY POWER POLE SAN GABRIEL, CA 91776 205344B UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: LIFER GROUND LIC. NO: ROUGH CONDUIT AOO ` ROUGH WIRING ( 9 MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508