HomeMy Public PortalAbout9515 PENTLAND ST_Electrical__ WORKERS'COhtPEN5AT10N DECLARATION 7663
CE 866G (2 QO) APPLICATION FOR ELECTRICAL PERMIT
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1 hereby affirm that 1 hooe a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure ova certif¢nte of Workers'Compensation Insurance,or
a certified copy thereof(Sec 3800 Lab C)
FOR APPLICANT TO FILL IN JOB
Policy No Company EACH NO FEE ADDRESS .J M' IiKM
New Residential Bldgs &Pools
Certified copy is hereby furnished 1 &2 Femdy,Sq Ft $ — $ LOCALITY7/-Z
Certified cop} is filed with the county building inspection Multi family Sq Ft �L L
CROSS ST
department ' Residential Swimming Pools OWNER OR •AL2 n ,
FIRM NAME
Date Applicant Outlets ReE/_1_ight_lf__ Svv /S MAIL �—
r Fust 20 ADDRESS /��/ /
CERTIFICATE OF EXEMPTION FROM WORKERS - Total No —3-3AdditionalCITY C I Tel Noa,?& /'Y }
COMPENSATION INSURANCE / PLAN CHECK tl
(Thu section need not be completed if the work involved Lightmg Fixture First 20 ADDRESS APPLICANT U
by the permit u for one hundred dollars (5100) or less) Additional
Total No p
1 certify that in the performance of the work for which this Fixed Appli noes Not Over 1 HP CITY Tel No F
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 APPLICANT p,
Oven _ Dryer_W M ADDRESS Z
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Date , pp Hood
Top FAU•_WH CIT,V 7eI No '
Hood _ Fen —Other—
NOTICE TO APPLICANT If after making this Certificate of Dup _ Room Air Cond_ _ LICENSE OR.
Exemption you should become subject to the Workers REG NUMBER Clens
Compensation provisions of the Labor Code, you must forth Power Apparatus& Large Appliances DISTRICT NO PROC ED BY
with comply with such provisions or this permit shall be Size&Type HP KW, KVA or KVA '��
deemed revoked
_ Up to 1 Incl FINAL
Over 1 t 10 Incl DATE
LICENSED CONTRACTORS DECLARATION VALIDATION
Over 10 to 50 Incl
1 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 BusiOver 100 BY '
ness and Professions Code and my license is in full force and
effect , Services '
License Number Lm Class 0 200 Amp Under 600 V ,
201 1000 Amp Under 600 V
Contractor Date Over 1000 Amp or Over 600 V
HOME OWNER BUILDER DECLARATION Temp Power Pole&Appurtenances
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1 hereby affirm with One Branch Circuit
m that I em exempt from the Contractors Additional Sign Branch Circuits '
License Law for the following reason (Section 7031 5 Busi . -9 0 $14-8 A
nese and Professions Code)
' Misc Conduits&Conductors # • • • .,• 2 i
El I, as owner of the property will do the work and the' Other (See Complete Fee Schedule)— _ j j
structure is not intended or offered for sale (Seltlon 2 e - 3700
' 7044 Business and Professions Code) i
CONSTRUCTION LENDING AGENCY jie e • 3 7 0.0=, ,
I hereby affirm that there is a construction lending agency y i
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 Fee) t
Lender s Address PERMIT ISSUING FEE
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I certify that 1 have read this application and state that [tic TOTAL FEE
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
e above mentioned property for inspection purposes
/} • SEL REVERSE FOR EXPLANATORY LANGUAGE
Signature of Pe-rittee Dat. e 0 /
COUNTY OF LOS ANGELES TEMPLE CITY N 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1007060032
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
I LEGAL IO FEES PAID BUILDING ADDRESS
ITR 14572 LT 31 9515 PENTLAND ST
I IFEE DESCRIPTION QUANTITY DOM i AMOUNT TEMP CA 917803845
IASSESSOR INFORMATION NUMBER NEAREST CROSS STREET 1
18590-007-020 Al PERMIT ISSUANCE FEE 29 80 THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY Cl
I G1 OUTLETS-IGT SW RECP-+ 1 00 OUT 1 90
(TENANT TOTAL FEES 29 70 ISSUED ON PROCESSED BY PLAN BY 1
I 0]/06/10 SR
TOWNER TEL NO FINAL DATE FINAL Y CODE
1BATEMAN ROBERT (626) 286-4795- I� n
19515 PENTLAND ST �I-Z��l.V V
TEMP 917803845 (DESCRIPTION OF WORK
(REPLACE (1) GFIC OUTLET IN THE KITCHEN
APPLICANT TEL NO
ADVANCED HANDYMAN (909) 596-6868- I I
1]90 N WHITE AVE I SPECIAI, CONDITIONS
LA VERNE, CA 91750
CONTRACTOR TEL NO JAPPROVAIZ DATE INSPECTOR SIGNATURE
ADVANCED HANDYMAN (909) 596-6868-i1 1
1790 N WHITE AVE LIC NO TEMPORARY POWER POLE
LA VERNE CA 91750 690496 B f
I UNDERGROUND CONDUIT
I
1ARCHITECT OR ENGINEER TEL NO � 1 UFER GROUND 1
LIC NO I TROUGH CONDUIT f
_ IROUGH WIRING
MAIN NATER LINE
PLASTIC YIN METAL YIN
1/ UTILITY COMPANY NOTIFIED
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(REPORT ID OPR265 ROUT£ TO BS0508 I I
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