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Home My Public Portal About4817 RIO HONDO AVE_Electrical__ I WORKERS'COMPENSATION DECLARATION =Ak06 10,151APPUCATION FOR ELECTRICAL PERMIT I horoby affirm that I have a certificate of consent to a�:lf Insure, `•E-sesta or certificate of Workers' Compensation Insarunce, or a ccrtifizd COUNTY OF LOS ANG,RES ' BUILDING AND SAFETY copy thereof(Sec 3600,Lab.C.) r Polley No. Company FOR APPLICANT TO FILL IN JO,' /^ ^� U 1�U 1�`^♦DG�v� ❑ ADLPESS / C 1 Certified copy is hereby furnished. New R;;sidcntlal Bldgs.&Pools EACH NO FEE 1 & 2-Family.Sq Ft. $ — $ LOCALITY Certified copy is filed with the county building Inspection NEf Fit St department Multi-family Sq Ft CRI'Ss S1 GG�f"�-� Z�J Date Applicant Rosidontial Swimming Pools OWNER oR .-� ', FIR CERTIFICATE OF EXEMPTION FROM WORKERS ADDRESS P-�� a 1Pf COMPENSATION INSURANCE Outlets Rcc—Light— t 2 — L. � V This section need not be completed if the work Involved b the First 20 7 ct ( p y Total No Additional CITY ,e)� L c J Tel No. �' gS t/3 , permit is for one hundred dollars($100)or loss.) PLAN CFiLCK 1 certify that in the performance of the work for which this permit 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 Total No. Additional CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT- If, after making this Certificate of APPLICANT Exemption,you should become subject to th.Workers'Compensation Range_ Heater DWAPPLIC provisions of the Labor Code,you must fol tn.nth comply with such Oven _ Dryer_ W.M _ ADDRESS provisions or this permit shall be deemed revoked. Top — FAU _ W.H CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Dlsp. — Room Air Cond. LICENSE OR Class. (commencing with Section 7000)of Division 3 of the Business and REG NUMBER Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO _ ! Q ESSED BY Size& Typo HP,KW,KVA,or KVAR 6• �-/� -�� License Number LIc Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE VALIDATION p Contractor Date Over 10 to 50 Incl. F0 1 13FINAL \1 I am exempt under Sec Over 50 to 100 Inc. BY W BAPC for this reason Over 100 1 N ServFos,�yji �C % r07 Date- 0- 00 A Un crlSOSignature 201 - 1000 Amp.Under 6 ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. � SINGLE FAMILY Temp.Power Polo& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with Ono Branch Circuit 4 .� R 1 hereby affirm that I am exempt from the Contractor's License Law .4r-Q- 4r- a o for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits �- CCodde): :a �'.9 �I'711 Misc.Conduits&Conductors 1 4 -� Y� I,as owner of the property,will do the work and the structure Other(See Complete Fee Schedule) is not intended or offered for sale (Section 7044, Business ® E' r-r I�fL .l and Professions Code). , CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the C;ff rl. �� performance of the work for which this permit is issued(Sec.3097, PERMIT FEE -� I} Civ.C.). (Sub-Total) PLAN CHECKING FEE 7/31/9 Lender's Name PERMIT ISSUING FEEJ [1 1615 f nl-; �y + Lender's Address 1 certify that I have read this application and state that the above TOTAL FEE J� 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 inspectio ur qhs. SEE REVERSE FOR EXPLANATORY LANGUAGE reSignature of Permittee Date • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0412080014 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: GA I FEES PAID B ILDI G D SS: TR: 5246 LT: 80 BL: .001 UN: .002 4811 RIO HONDO AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803739 ASSESSOR INFORMATION NU BER: NEAREST CROSS STREET: LOWER AZUSA 8590-029-017 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY, C G1 OUTLETS-LGT,SW,RECP 14.00 OUT 27.30 TENANT: G2 LIGHTING FIXTURES 5.00 LGT 9.75 ISS ED ON: PROLE S BY: P A B E PIKES 0 : H3 RES DISHWASHR LT 3HP 1.00 DIS 10.95 12/08/04 JK 06/06/05 H5 RES WASH MACH LT 3HP 1.00 WAS 10.95 OWNER: TEL. NO: TOTAL FEES 86.70 FINAL DATE FI ALBY: CODE: TSE, DANNIS g 4817 RIO HONDO [ ^z0'-CA TEMPLE CITY CA 91780 DESCRIP ON OF WORK ELECTRICAL FOR REMODEL. APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT-OR ENGINEER: TEL. N0: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING - �p AIN WATER LINE T PLASTIC Y/N METAL Y/N UTILITY COMPANY NOT F REPORT ID: DPR265 ROUTE TO: BS0508