The URL can be used to link to this page

Home My Public Portal About5451 PARMERTON AVE_Electrical__ WORKERS COMPENSATION DECLARATION 76A663BD6 ID,B, APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to "if CE��' �l insure or a certificate of Workers Compensation Insurance, COUNTY OF LOS ANGELES T e BUILDING AND SAFETY or a certified copy thereof (Sec 3800 Lob C') Policy No 6 6 Y3c.mpnv _ FOR APPLICANT TO FILL IN JOB ADDRESS,5_Z/3—/ K/y C—tl� ��'� Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE ❑ 1 8 2-Family Ft f — $ LOCALITY C Certified copy a filed with the county building mspeo- Y 59 NEAREST tion deportment Multifamily Sq Ft CROSS ST 0 Residential Swimming Pools OWNER OR Data Applicant FIRM NAME A/ t 6.71-1 CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec 21-bg1ti MAIL n +- COMPENSATION INSURANCE First 20 O ADDRESS (Thu sectipermit i need not be red leteddolga If the work less )Involved by Total No-�� Additional CITY � C Tel No the parmu L for on•hundred dollen ($100)or leu ) certify that in the performance of the work for this APPLICANT PIAN CHECK nl 0 �- k N� Do permit is issued I shall not employ any person in anyy ma manner � so as to become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS K 2 2 54, L 7, v1 Total No Additional CIN C Tel No "2 g,5—y 7 7 Date T If, aft Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If, after making this Certificate of Exemption you should become subject to the Workers Range_ Heater_D W APPLICANT nJ 0 Zet L LL LTG DQ Compensation provisions of the Labor Code you must forth Oven _ Dryer — W M _ ADDRESS ,2 1 2 with comply with` such provisions or this permit shall be Top FAU —W H r deemed revoked CITY - C - Tel No L` O-S�7 7 LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ ? 00 Ihereby affirm that am licensed _ Room Air Cond LICENSE OR Classcensed under provisions of Chapter 9 REG NUMBER J 'T (commencing with Section 7000) of Division 3 of the Business Paver Apparatus 8 Large Appliances DISTRICT NO PROC SED BY and Professions Code and my license is in full force nd effect rO 0 Size 8 Type HP KW KVA, or KVAR License Num �6�'7 Lic Class Up to 1 Incl FINAL triosV Over 1 to 10 Ind DATE ofn Contracto Date VALIDATION 0 - Over 10 to 50 Ind FINAL ❑ I am exempt under Sec Over 50 to 100 Inc BY B 8P C for this reason Over 100 Z Dote Services Swbd MCC 8 Panelboards pool0 200 Amp Under 600 V Signature 201 1000 Amp Under 600V ❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V SINGLE FAMILY Temp Power Pole 8 Appurtenances _ HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit hereby affirm that j exempt from the Contractors ss and Additional Sign Branch Circuits 9 2 0 a � A Law for the followingg r reason (Section 7031 5 Business and Professions Code) I #'a ° ° ° ° 2 ❑ I as owner of the properly will do the work and the Muc Conduits 8 Conductors r structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , 2'. .17100 7044 Business and Professions Code) s CONSTRUCTION LENDING AGENCY :° ° ° 7 1'0 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub Total) ' (Sec 3097 Civ C ) PLAN CHECKING FEE _ Lender s Name PERMIT ISSUING FEE Lender s Address - I certify that I have read this application and state that the _ TOTAL FEE / p0 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 ab ve mentioned property f r inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 5-18-�r3 Stgnature of Perfnittee Date I COUNTY OF IAS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0506 1103100016 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT ,LEGAL ID FEES PAID BUILDING ADDRESS ITR 13613 LT 72 5451 PARMERTON AV FEE DESCRIPTION QUANTITY DOM AMOUNT TEMP CA 919803506 1 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET 18573-005-033 1A1 PERMIT ISSUANCE FEE 29 60 I THOMAS PAGE 597 GRID C3 LOCALITY TEMPLE CITY Cl ITENANT ,G1 OUTLETS-LAT SW RECP 50 00 OUT 79 30 1 TG2 LIGHTING FIXTURES 5 00 IAT 9 70 1SSOED ON PROCESSED BY PLAN BY TOTAL FEES 116 80 103/10/11 SR _TOWNER TEL-NO FINAL DATE FINAL BY CODE TCLEMAN JOHN DONNA (626) 443-8633- I^� 15451 PARMERTON AV -1 / �I TEMP 917803506 D S III ION OF WORK IRE-FIRE EXISTING HOME 1APPLICANT TEL NO COLEMAN ELECTRIC (626) 665-9017- 15042 CALMVIEW AVE 1SPECIAL CONDITIONS 1 BALDWIN PARK 91706 l�wi`rt CONTRACTOR TEL NO I FOVATSVALS DATE INSPECTOR SIGNATURE TCOLEMAN ELECTRIC (626) 665-9017- 15042 CALMVIEW AVE LIC NO TEMPORARY POWER POLE BALDWIN PARK CA 91706 819050 C10 _ ,UNDERGROUND CONDUIT 1ARCHITECT OR ENGINEER TEL NO i IUFEP GROUND LIC NO ROUGH CONDUIT TROUGH WIRING I MAIN WATER LINE TPLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED I I I 1 I I I I I I L 1 I I I I I I I I I I I I I I I I I 1 I I I IREFORT ID pPA265 ROUTE TO 850508 1 I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS £L 0508 1102220004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID FEES PAID BUILDING ADDRESS ITR 13613 LT 72 5451 PARMERTON AV J (FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803506 (ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET J 18573-005-033 JAI PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 597 GRID C3 LOCALITY TEMPLE CITY Cl IHA FAU LESS 3HP 2 00 FAO 21 80 J (TENANT IJB AC UNITS +3-10HP 2 00 AC 39 40 ISSUED ON —PROCESSED-BY _PLAN_EY IM 200 AMP PANELS MCC 1 00 PAN 38 80 102/22/11 SR TOTAL FEES 127 80 1 IOWNER TEL NO IFINAL DATE FiuuABY CODE N JOHN DONNA X626) 443-Bfi 33- 15451 J5951 PARMERTON AV (ICC TEMP 917803506 JDESCRIPTION OF WORK 200 AMP MAIN ELECT SERVICE (2) 240 VOLT A/C CIRCUITS 1 1 (2) 120 VOLT F A U CIRCUITS JAPPLICANT TEL NO 1 COLEMAN ELECTRIC (626) 665-9017- 15042 CALMVIEW AVE J CIAL CONDITIONS J BALDWIN PARK 91706 ///tom 1 (CONTRACTOR 1 `CI_I / I wJT � TEL NO JAPPRCVALS DATE INS PE TOR SIGNATURE I (COLEMAN ELECTRIC (626) 665-9017- I 1 I 15042 CALMVIEW AVE LIC NO J ITEMPJRARY POWER POLE IJ JBALDWIN PARK CA 91706 819050 C10 (UNDERGROUND CONDUIT JARCHITECT OR ENGINEER TEL NO JUFER GROUND LIC NO ROUCH CONDUI ROUGH WIRING (MAIN WATER LINE IPLASTIC YIN METAL YIN I I UTILITY COMPANY NOTI FIE 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 (REPORT ID DPR265 ROUTE TO BSO508 I I I I I I I I I I