HomeMy Public PortalAbout5911 RENO AVE_Electrical__ NORKERS'COMPENSATION DECLARATION 10/81 gel
CE-8066 APPLICATION FOR ELECTRICAL PERMIT
t• Ihem y affirm that I have a certificate of consent to self CE-806
Y insure,Apr a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a ceifieddcooppyy thereof(Sec. 3800, Lob. C.)
Policy No&�.5M 7rc ompany OA FOR APPLICANT TO FILL IN JOB
EACH ADDRESS �� d
Certified copy is hereby furnished. New Residential Bldgs. &Pools NO. FEE
LOCALITY
Certified copy is filed with the co ty building inspec- 1 &2-Family, Sq. Ft. $ — $ 7
tion dep rtment. Multi-family Sq. Ft. — NEAREST
f/ Residential Swimming Pools CROSS ST.
Date �'" Applicant OWNER OR
FIRM NAME
CE TIFICATE OF'EXEMPTI FROMtORKERS' MAIL
Outlets: Rec Light Sw._ /
COMPENSATION INSURAN / ADDRESS
tThis section need not be completed if the work involved b First 20
he permit is for one hundred dollars($100)or less.) Y Total No. Additional CITY Tel. No.
that in the performance of the work for which this PLAN CHECK
I certify P APPLICANT
permit is issued,I shall not employ any person in any manner
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Total No. Additional
Date- Applicant CITY Tel. No.
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. — APPLICAN Kms%
Compensation provisions of the Labor Code, you must forth- Oven —Dryer _W.M.— ADDRESS
with comply with such provisions or this permit shall be Top — FAU —W.H. — fjJ�j�
deemed revoked. CITY a Iv�i Tel. No�
LICENSED CONTRACTORS DECLARATION Hood _ Fan —Other_
Di p. — Room Air Cond. LICENSE OR Class.
I hereby affirm that I am licensed under provisions of Chapter 9 l° REG. NUMBER
(commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PRO ED BY
and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances C
�p ,/� Size Type HP, KW, KVA, or KVAR 7
License'Numberl� `TJ / �Lic. Class ��� Up to 1 Incl. SooFINAL _ — �— kp
Over 1 to 10 Incl. DATE° Q VALID TION
09
Contract6;5&424g, Date Over 10 to 50 Incl. FIN V
❑ I am exempt under Sec. Over 50 to 100 Inc. B d
Over 100
BAP.C. for this reason H
Services, Swbd., MCC&Ponelboards
Date: 0 -200 Amp. Under 600 V W_
Signature 201 - 1000 Amp. Under 600 V 161.7 A
❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V # o o o 0 0 2
SINGLE FAMILY Temp. Power Pole&Appurtenances ( 0 - 2(100
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit =
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits o�o o 2 Q 0 0 ti
Law for the following reason (Section 7031.5, Business and Q 4—$6
Professions Code):
❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ ,
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
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 V
Lender's Address
I certify that I have read this application and state that the TOTAL FEE 0 r
above information is correct. I agree to comply with all County
orddauth
State laws regulating Electrical wiring, and
here representatives of this County to enter upon
theioned property for inspection pu po s.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Simi f re—e ate
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0903230017
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: 1
ITR: 5904 IT: 0 BL: .001 I 1 5911 RENO AV 1
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801529 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1
15384-018-026 1A1 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl
IG1 OUTLETS-LGT,SW,RECP 10.00 OUT 19.50 1
TENANT: 1H3 RES DISHWASHR LT 3HP 1.00 DIS 10.95 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1
I JH4 RES RANGE HDS LT 3HP 1.00 HOO 10.95 103/23/09 SR 09/19/09
I 1 TOTAL FEES 69.15 11
(OWNER: TEL. NO: I IFZ DAT FINAL BY: CODE: 1
1ZHANG, XUAN (626) 757-6685- I ]
15911 RENO AV I ]
tp
ITEMP 917801529 1 IDESCRI TIO OF WORK I1
I I ]KITCHEN AND BATHROOM REMODELING ]
(APPLICANT: TEL. NO: 1
1J. P. CONSTRUCTION CO. (626) 572-9181- I I
12714 STINGLE AVE. 1 ISPECIAL CONDITIONS:
IROSEMEAD, CA 91770 I
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE ]
1J. P. CONSTRUCTION CO. (626) 572-9181- 1 1 ]
12714 STINGLE AVENUE LIC. NO I ITEMPORARY POWER POLE I
IROSEMEAD CA 91007 642751 B I I I I I
I I (UNDERGROUND CONDUIT I I I
1ARCHITECT OR ENGINEER: TEL. NO: - 1 1UFER GROUND I I I
1 LIC. NO: 1 1ROUGH CONDUIT 1 1 I
I I I ROUGH WIRING
I 1 MAIN WATER LINE L
1 1 1PLASTIC YIN METAL YIN ] I I
I (UTILITY COMPANY NOTIFIED] I I
I I I I I I
I I I I 1 1
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I IREPORT ID: DPR265 ROUTE TO: BS0508 I I I I
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