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Home My Public Portal About6243 RENO AVE_Electrical__ WORKER'S COMPENSATION DECLARATION 200019 DPW(12-91)'' APPLICATION FOR ELECTRICAL PERMIT 76A663 I hereby affirm tfyat'l.have a certificate of consent to self insure, or a certificate oi.WorRer's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800'Lab.C.) Policy No. GS company �t �✓'— '+ FOR APPLICANT TO FILL IN JOB C— New Z '( � �1 v C Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY ❑ 1 &2-Family,Sq.Ft. — $ $ Certified copy is filed with the county building inspection NEAREST rC A-) department. Multi-family Sq.Ft. CROSS ST. L Date Applicant/ y f[ -� Residential Swimming Pools ASSESSOR // MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Light Sw. FFIIRM NAME COMPENSATION INSURANCE First 20 MAIL n �1 •y (This section need not be completed the work involved by the Total NoJ� Additional ADDRESS permit is for one hundred dollars($7000 .)or less.) � � I certify that in the performance of the work for which this permit CITY^��PGL C Teir l No.20�L7 vL7 is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional DRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: 14, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the.Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. _ provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT J 6:j� AJ t>G Z LICENSED CONTRACTORS DECLARATION Size&Ty P KW,KVA,or KVAR ADDRESS y V A.;P C — I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000)of Division 3 of the Business and CITY Tel.No.Q/W�60p Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. } LICENSE S / Class F�- ) O Over 50 t0 100 Incl. REG.NUMBB ER N L y / Over 100 DISTRICT NO. PROCES License Number !�f h ! Lie.Class ^ U Services,Swbd.,MCC&Panelboards �a ContractoP�0 l 5 AJ 6.6-' 0-399 Amp.Under 600 V FINAL DATE 0 F-1I am exempt under Sec. 400-1000 Amp.Under 600 V VALIDATION W Over 1000 Amp.or Over 600 V FINAL a B.&P.C.for this reasonBY to BRAN IRCUIT FEES te: 0 20V,Lighting or Recept. Z Rinnan,ra i� � _ OrL_�_. 1 To 10 Branch Circuits 11 To 40 Branch Circuits El Exemption Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&.Appurtenances r1_v a s HOME OWNER-BUILDER DECLARATION with One Branch Circuit n I hereby affirm that I am exempt from the Contractor's License Law Sign . 515 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits L �„ Code): -`s ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors hiL4y Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) �__,.•1: 7 c and Professions Code). :_'ti•?. °••J'- CONSTRUCTION LENDING AGENCY u i t. , t= 1 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 FEEvt y Lender's Name 129 PERMIT ISSUING FEE 2, Ler9ffer's Address TOTAL FEE I certify that I have read this application and under penalty of purJury state that the above Information is correct. I agree to comply with all County _12-9 � ,,,,,� ordinances and State laws regulating Electrical wiring,and hereby authorize .Y representatihiCounty to enter up above-mentioned property for in�?npdt.' SEE REVERSE FOR EXPLANATORY LANGUAGE IGNADATE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1305020015 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 5904 LT: 56 6243 RENO AV I FEE DESCRIPTION: QUANTITY: DOM: AMOUNT:1 TEMP CA 917801535 ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: LONGDEN 15384-001-021 Al PERMIT ISSUANCE FE��- 27.80 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CAI 1 1G1 OUTLETS-LGT,SW,RECP 20.00 OUT 40.00 TENANT: IG2 LIGHTING FIXTURES 7.00 LGT 14.00 ISSUED ON: PROCESSED BY: PLAN BY: 1LB 200 AMP PANELS, MCC 1.00 PAN 38.90 105/02/13 SR I I TOTAL FEES 120.70 1 1 OWNER: TEL. NO: IFIAL TE F BY: CODE: IMEDINA ARM ANDO;MARGARET M (626) 452-1807- I �� 6243 RENO AV I TEMP 917801535 DOMPTIOS OF WORK I i 122OPOUTLETS, 7 LIGHT FIXTURES AND UPGRADE SERVICE PANEL 200 M (APPLICANT: TEL. NO: 1 I ILUDWIG, KIRK W (626) 434-0362- 1 I I 12615 BASHOR ST I ISPECIAL CONDITIONS: 1 DUARTE CA i I 1 II CONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1 ACTIVE CONTRACTORS (626) 434-0362- I 1 1 IPO BOX 692 LIC. NO 1 1TEMPORARY POWER POLE I I I IWILDOMAR CA 92595 932342 1 1 1 1 I 1 JUNDERGROUND CONDUIT (ARCHITECT OR ENGINEER: TEL. NO: - i IUFER GROUND LIC. NO: i IROUGH CONDUIT I 1 1ROUGH WIRING I 1 1 1MAIN WATER LINE I 1 1PLASTIC YIN METAL YIN 1 1 JUTILITY COMPANY NOTIFIED( I I I I I I I I I I I I - •- I 1 I I I I I I I I I I I I I I I I I 1 1REPORT ID: DPR265 ROUTE TO: BS0508 I I I I I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY P # R5D9 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9804140003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGALID: FEES PAID BUILDING ADDRESS: TR: 5904 LT: 56 6243 RENO AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801535 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5384-001-021 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 5.00 OUT 9.75 H7 RES EXHAUST FANS 1.00 EX 10.80 ISSUED 0 PROCESSED PLAN BY: EXPIJtES TOTAL FEES 48.30 04/14/98 UT 04 4/99 . OWNER: TEL. NO: FINAL DATE FINAL BY: y CODE: MEDINA ARMANDO;MARGARET M (626) 285-4867IL - 6243 RENO AVIA q TEMP 917801535 ESC ON OF WORK REWIRE GARAGE (HOUSING REHAB) GFIC'S AND EXHAUST FAN IN BATH APPLICANT: NO: G & S CONSTRUCTION (626) 583-9558- 6770 ANGELINA CT SPECIAL CONDITIONS: CHINO CONTRACTOR: TEL. N0: d ��J +� +�L/� a APPROVALS DATE NSPECTOR SIGNATURE G & S CONSTRUCTION (626) 583-9558- 6`: N. 6770 ANGELINA LIC. NO � ': �? \�� TEMPORARY POWER POLE CHINO, CA 91710 615634 B ` ' + `� '•'t .j--z_ \ ` C, UNDERGROUND CONDUIT ARCHITECT OR NG TEL. N0: - �'+til �r i' �- ; 'I-; + .- \\ �� UFER ROUND LIC. N0: - - I '-� -- - 1 A' ROUGH CONDUIT -- - - — - ROUGH IRI G MAIN WATER LINE :� i,'• PLASTIC Y/N METAL Y/N - UTILI7Y COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1306120004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: ITR: 5904 IT: 56 1 I 6243 RENO AV IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917801535 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LONGDEN 1 15384-001-021 1A1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CAI I 1E1 TEMP SERV POWER POLE 1.00 TMP 43.70 I TENANT: TOTAL FEES 71.50 (ISSUED ON: PROCESSED BY: PLAN BY: 106/12/13 SR 1 (OWNER: TEL. NO: I FIPL DATEFIN CODE: 1 IMEDINA ARMANDO;MARGARET M (626) 452-1807- 1 1 16243 RENO AV 1 ITEMP 917801535 I IMSCRIPTIOkf OF WORK 1 I I ITEMPORARY POWER POLE I 1APPLICANT: TEL. NO: 1 I 1 1HINTON, DAVID (951) 579-8147- 1 I 1 1 ISPECIAL CONDITIONS: I I I I I I I ICONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1 1ACTIVE CONTRACTORS (626) 434-0362- I 1 1 IPO BOX 692 LIC. NO ITEMPORARY POWER POLE I I 1 IWILDOMAR CA 92595 NONE 1 1 1-1 I (UNDERGROUND CONDUIT I 1 1ARCHITECT OR ENGINEER: TEL. NO: I 1UFER GROUND I LIC. NO: I IROUGH CONDUIT 1 I 1 I IROUGH WIRING I IMAIN WATER LINE I I IPLASTIC Y/N METAL YIN I I I 1 I 1UTILITY COMPANY NOTIFIED( I 1 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 I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 I I I I I I