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Home My Public Portal About9312 OLIVE ST_Electrical__ PEN AT ON N 20-0019 I hereby affi mORn ER`at Ihavelula cert f elate oEconsentllto self insure, M663 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT Or a certificat&of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copAheieof(Sec.•3800 Lab.C.) - POlicy No. Company !' FOR APPLICANT TO FILL IN b 'ASB •�/ . DRESS E 0 Certified copy is hereby.furnished. New Residential Bldgs.&Pools NO.I EACH.. FEE LOCALITY 1&2-Family,Sq.Ft. —Is $ 0 Certified copy is filed with the county building inspection _ NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Light—2—Sw.2 OWNER OR COMPENSATION INSURANCE FIRM NAME / Q • First 20 "� �� MAIL (This section need not''be completed if the.work involved by the � ADDRESS p permit Is.for one hundred dollars.($100)or less.) Total No.t/ Additional certify that in the performance of the work for which this permit F1CITY ,e-,x �►�f 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 RESIDENTIAL 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 p p y Power Apparatus&Large Appliances APPLICANT 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. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. Over 50 to 100 Incl. LICENSE OR Class REG.NUMBER d Over 100 DISTRICT NO. SSED-BY V License Number Lic.Class Services,Swbd.,MCC&Panelboards r� ��+ oe_,_� W '0-399 Amp.Under 600 V FINAL 0 Contractor Date DATE ❑ 400-1000 Amp.Under 600 V I am exempt under Sec. VALIDATION V Over 1000 Amp.or Over 600 V FINAL d B:&P.C.for this reason BRANCH CIRCUIT FEES BY Date: 15A,or 20A,120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits El 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,2DA,20 VV To 277V Lighting Br.Circuits 7 SINGLE FAMILY Temp.Power Pole&Appurtenances �� P s HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that 1.am exempt from the Contractor's License Law s3'7;�'0 for the following.reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): 1 ITEMS I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL .37 o 30 is not Intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). , CHECK 37.30 CONSTRUCTION LENDING AGENCY CHANGE °Cil I hereby affirm that.there.is a construction lendinb agency for the performance of the work for which this permit is issued (Sec.`3097, PERMITTEE (Sub=Total) �d Civ..C.) • PLAN CHECKING FEE -OQOQ-0001 6/10/96 Lender's Name 6796 1 Ali 8°40 PERMIT ISSUING FEE C Lender's Address J 6 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 OFVERMITTEE DATE ON N 20-0019 I hereby affirmORfKaR'haveMa certificate oEconseMlOo.self insure, I7SM63 DPW(12-91) 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.) Poli No. Com an t FOR APPLICANT TO FILL IN JOB ❑cy P Y I. ADDRESS 14•E O 1 i ve Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY Temple City, CA.91]8.0 ❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. _ $ $ 6 NEAREST department. Multi-family Sq.Ft. CROSS sr. H 1 ton I Residential Swimming Pools ASSESSOR Date Applicant MAP BOOK 8590 PAGE 002 IPARCEL OO CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Light. Sw. OWNER OR Olive Trus t COMPENSATION INSURANCE v FIRM First 20 MAIL (This section need not be completed if the work Involved by the Total No. Additional ADDRESS. 1613 Che1$ea ROa.d. 4201 permit is for one hundred dollars($100)or less.) 1 certify that in the performance of the work for which this permit CIN San Marino, Ca Tel.No.2_87_6092 Is Issued, I shall not employ any person in any manner so as to I PLAN CHECK. become subject to the Workers'Compensation Laws. Lighting Fixtures First 20' APPLICANT S arae Total No. Additional ADDRESS Same Date 01.114/9.5 Applicant � RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of ; CITY Sae 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 provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances Same LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS Same I hereby affirm that I am licensed under provisions of C3 to 8 Over o 1..0 Incl. (commencing with Section 7000)of Division 3 of the Business and Over 3 t to 50 Incl. CITY -Same Tel.No. Professions Code,and my license is in full force and effect. LICENSE OR } Over 50 to 100 Incl. REG.NUMBER Class' d. Over 100 DISTRICT NO. ESSED BY V License Number. Lic.Class Services,Swbd.,MCC&Panelboards i. p/• �O 0-.399 Amp.Under 600 V FINAL O Contractor Date, DATE ❑ 400-1000 Amp.Under 600 V o � VALIDATION W I am exempt under Sec. Over 1000 Amp:or Over 600 V FINAL B.&P.C.for this reason BRANCH CIRCUIT FEES BY N ' 'Date: 15A,or 20A,12OV,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,MA,OW To 277V Lighting Br.•Circuits 2 SINGLE FAMILY Temp.Power Pole&Appurtenances 1 b ACCT o 4 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's.License Law 3303 70-10 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): I ITEMS ❑ - I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL 0_ 10 is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) , I'E �/, 700 10 and Professions Code). ;- CHANGE e00 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.) 0000-0001 9I25/95 PLAN.CHECKING FEE �l�i 1 AM10.28 i Lender's Name PERMIT ISSUING FEE �Lender's Address 1 certify that I have read this application and under penalty of purjury state TOTAL FEE ®� 1 that the above information is correct. I agree to comply with.all County I ordinances and State laws regulating Electrical wiring,and hereby authorize jrepresentatives of this County to enter upon the above-mentioned property tfor inspect TMIT�TE SEE REVERSE FOR EXPLANATORY LANGUAGE09/14/95 F E DATE , WORKERS'COMPENSATION DECLARATION 76-663 10/81 APPLICATION FOR ELECTRICAL PERMIT I Ilerebq:affirm that I have:a-certificate of consent to self insure, CE-808G M , ,or a certificate of Workers',Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT T_O FILL IN JOB [� Q Certified copy is hereby furnished. I EACH NO. FEE ADDRESS .9g New Residential Bldgs.&..Po s y�•�� 1 &2-Famil LOCALITY \�^'r•� .Certified copy is filed with the county building inspection Y. q• �� $ $ department: 'Multi-family Sq.Ft.' — NEAREST CROSS ST. tO V Date Applicant Residential Swimming Pools ;, OORM NAME GU �S 9e,��1 o m NT CERTIFICATE OF EXEMPTION FROM.WORKERS' „ t.' MAIL COMPENSATION INSURANCE Outlets:Rec—Light— t'20— ADDRESS (This section need not be completed if the work involved by the First'2 Total No. Additional. CITY Tel.No. permit is for,one.hundred dollars.($100)or less.) PIAN CHECK I certify that in the performance of the work for which this permit r APPLICANT Is issued, I shall not,employ any person in any manner so as to become subject to the Workers'Compen tion Laws. Lighting Fixtures First 20 ADDRESS Additional �+1-2. � Total No. CITY Tel.No. u•Date Applicant Fixed Appliances,Not Over 1 HP- PERMIT NOTICE TO .APPLICANT: If, after ma. g. this Cert'rficate of APPLICANT` q_c Exemption,you should:become subject to the Workers'Compensation Range_ Heater D.W. provisions'of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS J�25 13�71� .J-pt, provisions or this permit shall be deemed revoked.. Top ,_ FAU W.H. _ CITYTel.No.44%k-157 LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ I hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR Disp. —. Room Air•Cond. REG.NUMBER Class (O (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is.In full force.and effect. DISTRICT NO.. . P C SED BY - Power Apparatus�&Large Appliances -o� - Size&Type HP,KW„KVA,or I<VAR . License Number Sims-Tv Lic.Class rs-J Q Up to 1,Incl. FINAL 8 J Over 1 to 10 Incl.' DATEVALIDATION• O' .Comtractor � ` �hDate . Over 10 to 50 Inc[. ' ❑ FINAL it am exempt under Sec. Over 50 to 100 Inc. LLI BYOver 100 4' B.&P.C.for this reason co Services,Swbd.,MCC&Panelboards. Date: 0-200 Amp.Under 600 V c a Signature 201 -'1.000 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 ACCTo v ° 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):-. 3303 402.40 I,as owner of the property,wiMisc.Conduits&Conductors I ITERS • 'll do the work and the structure ' isnot intended or offered for sale (Section:7044; Business Other(See Complete Fee Schedule) and Professions Code). TOTAL . 402.41121.— CHECK 4027.40CONSTRUCTION LENDING AGENCY t I hereby affirm that there is a construction lending agency for theD CHANGE -000 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total) Civ.C.). PLAN CHECKING FEE 0000-0001 12/ 1/95 Lender's Name PERMIT ISSUING FEE Q� 1 3530 `1 ACIIO�I� Lender's Address - 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 wiring, and hereby authorize representatives of this County to enter upon the above-mentioned property r inspectio p SEE REVERSE FAR EXPLANATORY LANGUAGE ' Sigrifiture Te rmitte.e Date