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Home My Public Portal About9919 OLIVE ST_Electrical__ WORKER'S COMPENSATION DECLARATION E76AG63 DPW(12.91) APPLICATION FOR ELECTRICAL PERMIT „!.Cereby t{ffirm that I have a certificate of consent So self insure, 5r a as of Worker's Compensation'f)Isurance,or a certified COUNTY OF LOS ANGELES' DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy fbereof(Sec.3800.Lab.C.) /J Policy No. .Company - FOR APPLICANT TO FILL IN JOB ADDRESS %1 9 r✓c.v Certified copy is hereby furnished. New Residential Bldgs..&Poo sG6 NO. EACH FEE LOCALITY ❑ 1&2-Family,Sq.Ft. O� _ $ ' Certified copy is filed with the county building inspection NEAREST department. Multi-family Sq.Ft. - CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR �/ PAGE(/,�r�/q PARC /A • y ` MAP BOOK a CERTIFICATE OF EXEMPTION FROM WORKERS' ec.—Light SW. OWNER OR Outlets:R COMPENSATION INSURANCE FIRM NAME j/1Q First 20 MAIL (This section need not be completed if the work Involved by the Total No. Additional ADDRESS permit Is Is for one hundred,dollars($100)or less.) ,c—._. I certify that In'the performance of the work for which this permit CITY C TBI.No. Z._ is Issued, I shall not employ any person in.any manner so as to PLAN CHECK become subject to the.Workers'Compen o L Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Dam t Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, aft r making this erti.ficate 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 PERMIT Power Apparatus&Large Appliances APPLICANT provisions or-this permit shall be deemed revoked. ' LICENSED CONTRACTORS.DECLARATION Size&Type HP,,KW,KVA,or KVAR ADDRESS 9949 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 Over 10 to 50 Incl. 09 .� Inl Tel.No. jk��- 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. -0 PR BY Q License Number Lic.Class (� Services,Swbd„MCC&Panelboards 0-399 Amp.Under 600 V DATE 0 Contractor Date❑ VALIDATION V ®— I am exempt under Sec. Over 400-11000 Amp.Under 800 V 000 Amp.or Over 600 V FINAL W B.&P.C,for this reasonCL BRANCH CIRCUIT FEES BY U) Date: 15A,or'20A,120V,Lighting or Recept. Z 1 To 10 Branch Circuits Ir Signature 11 To 40 Branch Circuits 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 2 SINGLE FAMILY Temp.Power Pole&Appurtenances d t1+,r4T a V HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law 330,, + ,06 for the following reason.(Section 7031.5, Business and Professions Additional Sign Branch Circuits code): 1 ITEMS ❑ 1,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL 382.06 is not intended or offered for.sale(Section 704'4, Business Other(See Complete Fee Schedule) and Professions Code). , CHECK 3082.06 CONSTRUCTION LENDING AGENCY CHANGE °00 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 0000-0001 6/11/96 /� Lender's Name 6822 1 AM 8 48 PERMIT ISSUING FEE pc. Lender's AddressTOTALFEE I certify that I have read this application and under penalty of purjury stats . c9Q (v that.the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize repro natives his Co ty to enter upon the above-mentioned property Dr' e os SEE REVERSE FOR.EXPLANATORY LANGUAGE IGNA R PER E DATE WORKER S'COMPENSATIOIVDECLARATION 76A663' a. APPLICATION FOR ELECTRICAL' PERMIT' I hereby affirm that I have a certificCE-8016G (2.80)ate aft Ponsent to self COUNTY OF LOS ANGELES 7— BUILDING AND SAFETY insure,or a certificate of Workers'Compensation Insurance,or o a certified copy thereof(Sec.3800,Lab.C.) FOR APPLICANT TO FILL IN JOB A y Policy No. Company New Residential'Bldgs.&Pools EACH NO. FEE ADDRESS Certified copy is hereby furnished. 1.&2-Family,Sq.Ft. $ -- $ LOCAL•ITyr ❑ Multi-family Sq. Ft. NEAREST Certified copy is filed with the county building inspection. CROSS ST department. Residential Swimming Pools OWNER T ' Date Applicant P�• I FIRM'NAME Aag+� Outlets: Req �Light _Sw.�• 0 �p 10 ADDRESS ?/--,* L/�( J `�"� First 2 ' CERTIFICATE OF EXEMPTION FROM WORKERS' o.eL1 O .3 COMPENSATION INSURANCE Total N Additional CITY Tel No. } PLAN-CHECK CL (This section need not be completed if the work involved S g ob APPLICANT 0 Lighting Fixtures First 20 J by :the•permit is for one hundred dollars ($100) or less.) ADDRESS Total No.(_ Additional O .I certify that in the performance of the work for which this Fixed Appliances Not Over 7 HP CITY Tei No. H permit is issued, I shall not employ any person in any manner PERMIT W so as to become subject to the Workers'Compensation Laws. Range—Heater D.W._ APPLICAN Oven _ Dryer_W.M._ ADDRESS to Date Applicantlez Top _ FAU _W.H. CITY Tel No • Hood _ Fan _Other_ NOTICE TO APPLICANT-4f,after making this Certificate of Disp. _Room Air Cond. LICENSE OR Exemption, .you should become subject to. the Workers' REG.NUMBER Class ekl Compensation provisions of the Labor Code,you must forth- Power Apparatus&Large Appliances DISTRICT NO. PROCE SED BY with comply with such provisions or this permit shall be Size&Type HP,KW,KVA,or KVAR deemed revoked. i 0e V Up-to 1 Incl. FINAL Over 1 to 10 Inc[. DATE , LICENSED CONTRACTORS DECLARATION Over VALIDATION 10 to 50 Incl. r l I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000 of Division 3 of the Busi- BY I �� ( 8 ) Over 100 - ness and Professions.Code,and my license is in full force and effect. I Services 0-200 Amp.Under 600 V License Number Lic.Class-� �� 201-1000 Amp.Under 600 V e-7 t Contractos�i7 - �PG?Q(LDate T Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits 0 4,6 2 A ness and Professions Code):' Mi ' sc.Conduits&Conductors "# 0 0 0•o 0.2 ❑ I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— structure is not intended or offered for sale (Section 2 o o 3640 7044,Business and Professions Code): o o'0 3'�4 0 czi CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is0 70 1 —8'1 issued(Sec.3097,Civ.C.). PERMIT FEE (Sub-Total) (5 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE I certify that I have read this application and state that .the TOTAL FEE IZA3 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 Bove-men Toned property for;n,.,,,mon purposes: SEE'REVERSE FOR EXPLANATORY LANGUAGIf ignature of Permittee Date ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1202080022 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 9919 OLIVE ST (FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:] TEMP CA 917803239 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: CAMBURY 18588-019-012 IA1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl I IFl 120V, 15/20A BR CKTS 2.00 BR 34.60 TENANT: I TOTAL FEES 62.40 ISSUED ON: PROCESSED BY: PLAN BY: 102/08/12 SR OWNER: TEL NO: (FINAL DATEFI BY: CODE: INEWMAN ROBERT E;RENEE M (626) 285-2602- I I 9919 OLIVE ST TEMP 917803239 IDESCRIPTION-OF WORK ELECTRICAL FOR DETACHED GARAGE APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - ILIC. NO I ITEMPORARY POWER POLE I I (UNDERGROUND CONDUIT (ARCHITECT OR ENGINEER: TEL. NO: - I IUFER GROUND I I LIC. NO: I (ROUGH CONDIIIT I�I 1 IROUGH WIRING I I IMAIN WATER LINE IPLASTIC YIN METAL YIN (UTILITY COMPANY NOTIFIED( 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 I I I I I I I I I I I I I I I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 I I I I I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1202080021 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 9919 OLIVE ST (FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917803239 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: CAMBURY 18588-019-012 IA1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl I IG1 OUTLETS-LGT,SW,RECP 1.00 OUT 1.90 I TENANT: IG2 LIGHTING FIXTURES 2.00 LGT 3.90 ISSUED ON: PROCESSED BY: PLAN BY: I i TOTAL FEES 33.60 102/08/12 SR OWNER: TEL. NO: IF NAL T Fr BY: CODE: INEWMAN ROBERT E;RENEE M (626) 285-2602- I \� A 19919 OLIVE ST r, TEMP 917803239 IDESCRIPTION OF WORK ELECTRICAL FOR PATIO COVERk ]APPLICANT: TEL. NO: [SAME AS OWNER - SPECIAL CONDITIONS: !� I CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO i TEMPORARY POWER POLE I UNDERGROUND CONDUIT I (ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND LIC. NO: I TROUGH CONDUIT I I I I i (ROUGH WIRING I I I MAIN WATER LINE IPLASTIC Y/N METAL Y/N (UTILITY COMPANY NOTIFIED( 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 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 IREPORT ID: DPR265 ROUTE TO: BS0508 I I I I I I