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Home My Public Portal About5435 PARMERTON AVE_Electrical__ n. WORKERS COMPENSATION DECLARATION pWt9aPW 3,87 APPLICATION FOVELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self •�� mvfe or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS of o cerop ih of (Sec 3EI00 La C ) Policy Nao Company , FOR APPLICANT TO FILL IN JOB 1-1 ❑Certified copy is hereby furnish New Residential Bldgs 8 Pools EACH NO FEE ADDRESS ertrfied opy is filed with th ounry wldin =spec 1 8 2 Family, Sq Ft b = $ LOCALITY tion e t Multi family Sq Ft NEAREST 2/11 }� Residential Swimming Pools r CROSS ST Date AppL ca nt OWNER I RM NAME CERTIFI TE OF EXEMOR V PTI FROM ORKE utlets Rec. ht �Sw-J--- MAIL COMPENSATION INSURANCE 1 ADDRESS First 20 (This sectipermit I "oil not bo completed lla IF the work a wd by Total No Additional CITY Tel No the pumit IF for one hundred dollar ($If10)or I�iF ) I certify that in .he performance of the work for which this APPLICANTHE permiPLAN CHECK t is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws Lighting Rx tures First 20 ADDRESS Total No Additional Data Applicant - _ CIN 3el No NOTICE TO APPLICANT If after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT < Exemption you should become subject to the Workers Range— Heater— W _ APPLICATION Compensanon provisions of the Labor Code, you must forth- Oven Dryer —W M _ ADDRESS with comply d such provisions or this permit shall be Top — FAU —W H — �� deemed revoked CIN Tel No LICENSED CONTRACTORS DECLARATION Hood — Fon —Other— Room Air Cond LI � H I hereby affirm that I am hcensed'undar provisions of Chapter 9 REGEG NUMBER BER / Class (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO PROCESS D BY and Professions Code/a�nd my lice is in full force and effect YP O' /l'1'1,z1,.7 Size &Type HP, KW KVA or KVAR si b License Number `—T�1 F Lic ClassU Up to 1 Incl FINAL /Q Over 1 to 10 Incl '-� �� Contracto t DATE y gTION 0 ❑ Over 10 to 50 Incl 4FINAL f— I am exeffter Sec' Over 50 to 100 Inc By C) W B &P C fora 'this reason Over 100 i O_ Date Services Swbd MCC & Ponelboards z Z - 0 200 Amp Under Epp V Signature 201 1000 Amp Under 600 V ;E08 ,15,11 ❑ Os er 1000 Amp or Over 600 V ` Exemption for Reg Maint Elect # 2 SINGLE FAMILY / Temp Power Pale 8 Appurtenances HOME OWNER-BUILDER DECLARATIONI • •I1 5 Qi0 I hereby affirm that I am exempt from the Contractor s License Sign with One Branch Circuit Law for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits • • •.1 5, Q 05 Professions Code) ❑ I osowner of the property, Misc Conduits 8 Conductors ao5t88 ;I p p will o the work and the Other See Com structure not intended or offered for sole(Section 7044 ( Complete Fee Schedule)— and , Business and Professions Code) ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is o construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub Total) .(Sec 3097, Gv C ) tt PLAN CHECKING FEE Lender s Name , PERMIT ISSUING FEE Lender s Address TOTAL FEE J b I certify that I have read this application and state that the above information is correct I agree to comply with all County ordinances and State jaws regulating Electrical wiring and L hereby out nze representatives of this County to ente{uPPPggqn , the abov ntioned pro arty forF:�Me, � • T SEE REVERSE FOR EXPLANATORY LANGUAGE 5 � N Signature of Permittee f WORKERS COMPENSATION DECLARATION CE-806G (2 BO) APPLICATION FOR 'ELECTRICAL. PERMIT E-806G I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES /) BUILDING AND SAFETY insure; or a certificate of Workers'Compensation Insurance,or /B r a certified copy thereof(Sec 3800 Lab C) FOR APPLICANT TO FILL IN JOB Policy No Comen New Residential Bldgs & Pools L 1,0r ' Compan EACH NO FEE ADDRESS t: Tj 9 , n21_4ea_TZ1J Y Certified copy is hereby furnished 1 & 2 Fam ly,Sq Ft S $ LOCALITY ❑ Multi family Sq Ft — NE Certified copy is filed with the county budding inspectioni CROSS ST IuiP� 2 department Residential Swimming Pools OWNER OR FIRM NAME DN. /•t%�N�i" Date Applicant Outlets Ree_Light_ Sw ADDA RESS .1 0,rrl 4VZf C.J First 20 CERTIFICATE OF EXEMPTION FROM WORKERS Total No Additional CITU ` y 'Tel No S 1✓30'B `I COMPENSATION INSURANCE e i PLAN CHECK d p APPLICANT e t7 (This section need not be completed if the work involved Lighting Fixtures First 20 U by the permit us for one hundred dollars ($100) or less) ADDRESS AddCC Total No Additional O I certify that in the performance of the work for which this CITY Tel No H a Fixed Appliances Not Over 1 HP U permit u issued 1 shall not employ any person in any manner PERMIT LU S6 as to become sublet[ to the Workers.Compensation Laws Range_ Heater_Ow APPLICANT AM is. Oven _ Dryer_W M _ ADDRESS to Z Date - Applicant Top _ FAU _W H _ — ' Hood _ Fan —Other— CITY Tel No NOTICE TO APPLICANT if after making this Certificate of Disp _ Room Air Cond_ a LICENSE OR Exemption you should become subject to the Workers REG NUMBER Class Compensation provisions of the Labor Code you must forth Power Apparatus& Large Appliances DISTRICT NO P ESS BV with comply with such provisions or this permit shell be deemed revoked wiSize&Type HP KW KVA or KVA deed Up to 1 Incl • Over 1 to 10 Incl FINAL t DATE LICENSED CONTRACTORS DECLARATION, Over 10 to 50 Incl VALIDATION I hereby affirm that i am licensed under provisions of Chapter Over 50 to_100 Inc FINAL BY 9 (commencing with Section d my is nseDivision 3 ll the Busi Over 100 ness and Professions Code and my license is in full force and effect Services L cense Number Lie Class 02 Amp Under 600 V CJ ' 201 1000 Amp Under,600 V ' Contractor. Date Over 1000 Amp or Over 600,V - HOMEOWNER BUILDER DECLARATION Temp Power Pole&Appurtenances �9'31j7 2 4 A 1 hereby affirm that 1 am exempt from the Contractors Sign with One Branch Circuit s , " _ 'O • •s License Law for the following reason (Section 7031 5 Busi Additional Sign Branch Circurt3 # e,! 2 ness and Professions Code) i _ 2•eae 2 3.5 0 Mrsc Conduits& Conductoh I as owner of the property will do the work and the Other (See Complete Fee Schedulel— 'e e�e 2 5 O rtructure is not intended or offered for sale (Section , _ a 7044 Business and'Professions Code) •' IO Q.2 , 8 2 i CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency `for the performance of the work for which this permit is PERMIT FEE (Sub Total) issued (Sec 3097 Civ C) Lender's Name PLAN CHECKING FEE (One Fourth Permit Feel Lender s Address PERMIT ISSUING FEE r - _ I certify that I have read this application and state that the TOTAL FEE above information is correct I agree to comply with all County , ordinances and State laws regulating Electrical wiring and J hereby authorize representatives of this County to enter upon the a ment ed pro rty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE S nature of Permittee Date + , COUNTY OF LOS ANGELES TEMPLE CITY 9 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SL 0508 0609260011 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 ERT LEGAL ID FEES PAID BUILDING ADDRESS TR 13613 LT 69 15433 PARMERTON AV FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803506 ASSESSOR INFORMATION HUMBER NEAREST CROSS STREET DASHES 8573-005-030 Al PERMIT ISSUANCE FEE 27 75 THOMAS-PAGE 597 GRID C3 LOCALITY TEMPLE CITY C G1 OUTLETS-LGT SW,RECP 26 00 OUT 47 10 TENANT G2 LIGHTING FIXTURES 11 00 LOT 21 45 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON H] RES EXHAUST PANS 1 00 ER 10 95 09/26/06 JK 03/25/07 TOTAL FEES 107 25 OWNER TEL NO FINAL D;KrE FINAL BY CODE LAOMAY JUNE ROMERO RITA LAGNAY BOND (626) 443-5520- 5433 PARKERTOW AV THIP 917803506 M ES IPTIO WORK EL CTRIW FOR MASTER RETREAT APPLICANT TEL NO JUNE LAGMAY (626) 443-5520- 5433 PARNERTON AVE SPECIAL CONDITIONS TEMPLE CITY CA 91780 CONTRACTOR TEL NO - APPROVALS DATE INSPECTOR SIGNATURE P S CONSTRUCTION (626) 442-2764- 5415 PERSIMMON AVE LIC NO TEMPORARY POWER POLE TEMPLE CITY CA 91780 431044 B UNDERGROUND CONDUIT ARCHITECT OR ENGINEER TEL NO UPER GROUND FRANK SACCOMAN (626) 358-3360- 408 HEATHER HEIGHTS COURT LIC NO ROUGH CONDUIT MONROVIA CA 91016 NONE ROUGH WIRING MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED REPORT ID DPR265 ROUTE TO BS0500 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0306030014 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID --- BUILDING ADDRESS TR 13613 LT 69 5433 PARMERTON AV FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803506 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET DAINES 8573-005-030 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID C3 LOCALITY TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 2 00 OUT 3 90 TENANT G2 LIGHTING FIXTURES 1 00 LGT 1 95 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON HA FAU LESS 3HP 1 00 FAU 10 95 06/03/03 JK 11/30/03 JB AC UNITS +3-10HP 1 00 AC 19 65 OWNER TOTAL FEES 64 20 FINAL DATE FINAL BY CODE ROMERO,RITA - 5433 PARMERTON AV TEMPLE CITY 91780 UnTTMIUN INSTALL NEW CENTRAL HTG 8 AC SYSTEM APPLICANT TEL NO AMERICAN HEATING 8 A/C (626) 285-8206- 5308 NOEL DRIVE SPECIAL CONDITIONS TEMPLE CITY 91780CONTRACTOR LL NOIAPPROV- IL` I C AMERICAN HEATING AND AIR (626) 285-8206- A SIGNATURE 5308 NOEL DR LIC NOKy TEMPORARY POWER POLETEMPLE CITY, CA 91780 664929 C20 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER TEL NO Y114 IFtiUFER GROUND LIC NO� ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N i l i i REPORT ID DPR265 ROUTE TO BS0508 r