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HomeMy Public PortalAbout5839 RENO AVE_Electrical__ ' a WORKERS'COMPENSATION DECLARATION 76A663 10/81 +I,hgfeby affirm that I have a certificate of consent to self insure, CE-806G APPLICATION FOR ELECTRICAL PERMIT }. of a certlicate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY ddpvthei§dof(Sec 3600,Lab.C.) Policy*No.- Company FOR APPLICANT TO FILL IN JOB Iq ( 6746 7 4 2 ❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS% ! � � 14T - Certified Residential Bldgs &Pools $ LOCALITY E] Certifiedcopy is filed with the county building inspection 1 & 2-Family,Sq.Ft. — S department Multi-family Sq.Ft. — NEAREST T. Date Applicant Residential Swimming Pools NE OR �I�N AME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets.Rec Light_k Sw. MAIL / S /� COMPENSATION INSURANCE ADDRESS i �O 1"VQ���-C 1/�f �'r 1/ (This section need not be completed if the work Involved by the (�',` First 20 permit is for one hundred dollars($100)or less.) Total No.�V Additional CITY C� Tel.Ntoz 1 certify that in the performance of the work for which this permit PLAN CHECK APPLICANT is issued, I shall not employ any person in any manner so as to become subject to the Workers mpensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional 77 J .- CITY Tel.No. Date ` Appli n Fixed Appliances Not Over 1 HP NOTICE TO APPLIC NT If. after making this Certificate of PER L-1 ati L,4_1 Exemption,you should tiecome subject to the Workers'Compensation Range Heater_ D.W. _ APPLICANT provisions of the Labor Code,you must forthwith comply with such Oven Dryer_ W.M._ ADDRESS provisions or this permit shall be deemed revoked Top FAU _ W.H. _ LICENSED CONTRACTORS DECLARATION Hood Fan _ Other_ /I CITY Tel.No. I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR Disp. ROOm Air Cond. REG NUMBER Class. (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect Power Apparatus&Large Appliances DISTRICT NO/ PROCESSE e� Size&Type HP,KW,KVA,or KVAR License Number Lic.Class Up to 1 Incl. FINAL �/ Q Over 1 to 10 Incl. DATE 1ALID�ATION Contractor Date❑ Over 10 to 50 Incl. V FINAL 1 am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C.for this reason Over 100 N Services,Swbd.,MCC&Panelboards 7- Date: 0-200 Amp.Under 600 V r' Signature 201 - 1000 Amp.Under 600 V ❑ Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit g, I hereby affirm that I am exempt from the Contractor's License Lawceb for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuitsq Coda). e7o;t�� �✓iloel�! j / I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors g g EM is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ® © � and Professions Code) TOTAL i� CONSTRUCTION LENDING AGENCY CFEM 93211 I hereby affirm that there is a construction lending agency for theG'' performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) yJi`iJ1 s0 Civ.C.). PLAN CHECKING FEE Lender's Name �� 7'19/89 Lender's Address PERMIT ISSUING FEE Jt7 44,c,757 1 A-1, 10:52 1 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 for inspection purpose6%'L"" � ti _ , _ ` SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o Permittee f Date • r COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0104030063 BUILDING AND SAFETY / LANO, DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL D: FEES PAID BUILDING ADDRESS: TR: 3623 LT: 107, 5839 RENO AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801828 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: HERMOSA DR. 5387-010-018 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY C2 SPAS, HOT TUBS, OTHR 1.00 SPA 54.45 TENANT: G1 OUTLETS-LGT,SW,RECP 40.00 OUT 66.00 ISSUED ON: PROCESSED : PLN BY: EXPIRES ON: G2 LIGHTING FIXTURES 42.00 LGT 68.70 04/03/01 UT 09/30/01 H1 RES ELEC OVEN LT 3HP 1.00 OVE 10.95 OWNER: TEL. NO: H2 RES GRBG DISP LT 3HP 1.00 DIS 10.95 FINAL DATE FINAL BY: CODE: TAM, SHUI KI (310) 823-9231- H3 RES DISHWASHR LT 3HP 1.00 DIS 10.95 13603 MARINA POINTE H4 RES RANGE NDS LT 3HP 1.00 H00 10.95 MARINA DEL REY 90292 H5 RES WASH MACH LT 3HP 1.00 WAS 10.95 D_gSC IP Tqp OF�hOR H9 RES APPL LT 3HP 1.00 RES 10.95 REPLACE AND ADD NEW SWITCHES/RECEPTICLES AND LIGHT FIXTURES APPLICANT: TEL. N0: TOTAL FEES 282.60 REPLACE KITCHEN APPLIANCES; INSTALL WHIRLPOOL SAME AS OWNER - _ SPECIAL CONDITIONS: LE CONTRACTOR: TEL. N0: /�Cj � �~ G°/lL,+��� APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - er ��p LIC. NO , '?� �,4TEMPORARYPOWER POLE UNDERGROUND CONDUIT V _ ARCHITECT OR ENGINEER: TEL. N0: ;��' j r`-� !+-� . �, ER GROUND CHEN, DAN (626) 674-3893 r T i I I �� ` 20548 VEJAR LIC. NO• ROUGH CONDUIT WALNUT, CA 91789 C47140 ROUGH WIRING r -`—, I�'� I' `1 (r , i--j f. , 9 MAIN WATER LINE PLASTIC Y/N METAL Y/N ?—\---_ __ —+'--- - _-_--_- —_--� T ITY COMPANY NOTIF15D - \ - -- ; t- 11 171 REPORT ID: DPR265 ROUTE TO: SS0508