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Home My Public Portal About6123 RENO AVE_Electrical__ WORKER'S COMPENSATION DECLARATION 9 DPW(12-91) 7SA663 APPLICATION FOR ELECTRICAL PERMIT 76A68 • I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy th@reof(Sec.3800 Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB �•y3 ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY $ $Ft S -Family, q. . _ Certified copy is filed with the county building Inspection 1&2 NEAREST department. Multi-family Sq.Ft. CROSS 3T. � v �/yV — t+ Date Applicant Residential Swimming Pools MAP BOOK �p�� PAGE 40"--2-1 PARCEL/ CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Ree. Light-f=Sw. FFII^P.M NAME RE COMPENSATION INSURANCE ,I'm ��11 First MAIL (This section.need not be completed if the work Involved by the Total No.�.1� Additional ADDRESS permit Is for one hundred dollars(8100)or less.) p�g I certify that in the performance of the work for which this permit CITY �,.� Ly`IZ T.I.No. 4, -1 is issued, Ijshall not employ any person in any manner so as to PLAN CHECK t J_/ J become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT Nt_t Total No. Additional d ADDRESS �y� 12.6r,rp /4-_/1—P Date Applicant ` �f NOTICE TO APPLICANT: If, after making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP. CITY L rj(J� Tel.No.III r Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. PERMIT provisions of the Labor Code, you must forthwith comply with such Power Apparatus&Large Appliances APPLICANT V f,21 provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS �iy P_2-0 /jA.11— I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. CITY ( It Tel No. �j (commencing with Section 7000)of Division 3 of the Business and d Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR >_11L 50 to 100 Incl. REG.NUMBER Class. d Over 100 DISTRICT NO. P C SED BY V License Number Lic.Class Services,Swbd.,MCC&Panelboards . I/ cc Contractor Date 0-399 Amp.Under 600 V DATE 0 400-1000 Amp.Under 600 V Y. VALIDATION W I am exempt under Sec. Over 1000 Amp.or Over 600 V FINAL B.&P.C.for this reason BRANCH CIRCUIT FEES BY C0 Date: 15A,or 20A,120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ Al Or More Branch Circuits +3 Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances ACCT.s HOME OWNER-BUILDER DECLARATION with One Branch Circuit "0yy 01 I hereby affirm that I am exemptSign w 3 from the Contractor's License Law 7r 50 for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits ITEMS Code '�j I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL 94.05 is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). CHECK 94.05 CONSTRUCTION LENDING AGENCY GNAKEE Al I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE Ql]�L1-4IO1r' 39 Lender's Name ?j,3',3,I 1 Ai t 9:IDs' PERMIT ISSUING FEE • Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the 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 above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE sIGNAT RE OF PERMITTEE V DATE WORKERS'COMPENSATION DECLARATION 78-888 tD/et APPLICATION FOR ELECTRICAL PERMIT �A hereby'affirm CE-806G that 1-haves certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, er p certified col)y thereof(Sec.3600.Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company FOR APPLICANT TO FILL IN JOB 7 r� ❑ EACHNO. FEE ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools _ El Certified $ LOCALITY Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. — department. Multi-family Sq.Ft. NEAREST Residential Swimming Pools CROSS ST Date Applicant OWNER OR „ n- FIRM NAME (;�/th 1`'��f CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL Outlets:Rec Light- Sw. COMPENSATION INSURANCE 7 ADDRESSCfn This section need not be completed if the work involved b the First 20 ( p y Total No. Additional CITY` �/T Gr r Tel.No. �� permit is for one hundred dollars($100)or less.) I cern that in the performance of the work for which this permit PLAN CHECK p p APPLICANT 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 Additional Total No. CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT rr,, NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. provisions of the Labor Code,you must forthwith comply with such Oven -.,I— Dryer_ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top FAU W.H. CITY ` J�� LICENSED CONTRACTORS DECLARATION Hood Fan ->- Other— Gr�� Tel.No. I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. LICESE OR REG.NUMBBER Cis (commencing with Section 7000)of Division 3 of the Business and REG.NU Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. PROCED Size&Type HP,KW,KVA,or KVAR 5 0 License Number Lic.Class Up to 1 Incl. FINAL 0 Over 1 to 10 Incl. DATE `/ ��`q� VALIDATION d' Contractor Date Over 10 to 50 Incl. / NAL ❑ I am exempt under Sec. Over 50 to 100 Inc. FINAL W B.&P.C.for this reason Over 100 U) Se es,Swbd.,MCC&Panelboards ® Z Date: �/ 0-200 Amp.Under 600 V 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 1 hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits • for the following reason(Section 7031.5,Business and Professions At•C °a L CacJe): Misc.Conduits&Conductors 13L7 113.2c. 1,as owner of the property,will do the work and the structure t is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ ® 1 ITENS and Professions Code). TOTAL 1-13- 80 CONSTRUCTION LENDING AGENCY ,- I hereby affirm that there is a construction lending agency for the i.XEC r Ii35 '01 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) CHANGE .00 Civ.C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE 0:100-7001 x/.''•.1/911 Lender's Address r °r p 1 certify that I have read this application and state that the above TOTAL FEE 3 CK7 I Afl 9-2v r 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 purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sigbbtur4Wof Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PER 'IZ DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL--5087-40.160003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAIDM S• TR: 5904 LT: 47 6123 RENO AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: EMP--i:A-911801 ASSESSOR0 R: NEAREST CROSS STREET: LONGDEN 5384-002-021 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY H5 RES WASH MACH LT 3HP 1.00 WAS 10.80 TENANT: TOTAL FEES 38.55 ISSUED 0 PROCESSED BY: P ES N: 10/16/97 UT 10/16/98 OWNER: TEL. NO: FINAL DATE FINAL BY. CODE: YIN KUN HUNG;LI JUAN GUAN (626) 285-5669- �_� 6123 RENO AV TEMP 917801533 DESCRIPTION OF WORK ELECTRICAL IN GARAGE FOR LAUNDRY FACILITY APPLICANT: . SAME AS OWNER SPECIAL CONDIT ONS: CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO T-EMPORARYPOWER POLE R UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: L. 0: f FER GROUND LIC. NO: ROUGH CONDUIT ROUGH R G MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY 0 IF E REPORT ID: DPR265 ROUTE TO: BS0508