The URL can be used to link to this page

Home My Public Portal About5717 RIO HONDO AVE_Electrical__ WORKERS'COMPENSATION DECLARATION 78-8ioiat CE-808G APPLICATION FOR ELECTRICAL PERMIT ` rhereby affirm that I have a certificate of consent to self insure, o8 or a certificate of Workers; Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY 'qpy thereof(Sec.3800,Lab..C,. p Policy No. C- Company FOR APPLICANT TO FILL IN ADDRESS 14-MPP11 El Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ — $ LOCALITY '�' NEAREST r department: Multi-family Sq.Ft. CROSS ST V�- Date 'Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Red, Li ht Sw. MAIL +� COMPENSATION INSURANCE' g ! O AP l ADDRESS) �� ' (This section need riot be completed if the work Involved by the First 20 permit is for one hundred dollars($100)or less.) Total No. Additional • "' CITY Tel.No.. I certify that in,the.performance of the work for which this permit pppVNT K is issued; I shall not employ any person in any manner so as to f� become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS - U Additional Total No. i, CITY Date Applicant O r' PERMIT NOTICE TO APPLICANT: If, after making this Certificate of' Fixed Appliances Not 1 HP APPLICANT Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. provisions of the Labor Code,you must forthwith.comply with such Oven Dryer_ W.M._ /D ADDRESS provisions or this permit shall be deemed revoked. Top FAU _ W.H. CITY Tel.No; LICENSED CONTRACTORS DECLARATION Hood — Pan _ Other T I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. tJ_' UCENS (commencing with Section 7000)of Division 3 of the Business'and REG.NUMBER Com$ Professions Code,and my license is in full force and effect. DISTRICT NO. PRO SSED BY Power Apparatus&Large Appliances. Size&Type HP,KW,KVA,or KVAR , d0 License Number Lic.Class Up to 1 Incl: FINAL DATE Over ] to 1.O.*Incl. � � ' VALIDATION Contractor Date " -0 Over 10 to 50 Incl. � FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc. BY W B,&P.C.for this reason Over 100 N Services;Swbd.,MCC&Panelboards Date: 0-200 Amp.Under 600 V Signature 201 - 1000 Amp,Under 600 V l J' ❑ Over 1000 Amp,or Over 600 V' Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign.with One Branch Circuit r I.hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits ll F34 .v for the.following reason(Section 7031.5,Business and Professions Code): i�� 17 q1 ifil �� • :3L)J . Wisc.Conduits&Conductors ,I I,as owner of the property,will do the work and the structure• 1 ITEMS is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ ► and Professions Code). TOTAL 47 -00 CONSTRUCTION LENDING AGENCY I CHECK 47.00 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-T )otal .00 Civ.C.). PLAN CHECKING FEE ^ Lender's Name I 0010 I-00101 °i 1/ 7/90 PERMIT ISSUING FEE �+ LO Lender's Address 0 r 8+��.r� 1 �1'E �-"_�: I 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 I and State laws regulating Electrical wiring, and hereby authorize representati of this County to enter upon the bove-mentioned , property.fo ..spec purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE stal ee of Per ittee WORKER'S COMPENSATION DECLARATION 2M663 DPW(12.91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to salt insure, or a certificate of Workers Com(Lensation Insurance,or a certified COUNTY.OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab..Q...) Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS 1 Y�l rl ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY (� Y ❑ Certified co Is filed with the count building Inspection 1&2-Family,Sq.Ft. _ $ $ PY' Y 9 P NEAREST department. Multi-family Sq.Ft. CROSS ST. GA verQ r s l� Date Applicant Residential Swimming Pools ASSESSOR p�J MAP BOOKR�5p�Q,� / �I PAGE PARCEL CERTIFICATE OF'EXEMPTION:FROM WORKERS' Outlets:Rec. Light Sw. OWNER N NAME r r�{�r"Uf J COMPENSATION INSURANCE First 20 This section need not be completed If the work Involved b the MAIL ( P Y . Additional l NADDRESS Total oO Q t permit is for one hundred dollars($100)or less.) To � I certify that in the performance of the work for which this permit CITY gyp(,(, Tel.No. • is issued, I shall not employ-any person in any manner so as to PLAN CHE K become subject to the Workers'Compensation Laws. I Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you shouid become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. rovislons of the Labor Code,you must forthwith comply with such PERMIT P Y P Y APPLICANT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or WAR ADDRESS 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. Professions Code,and my license is-in full force and effect. Over 10 to 50 Incl.. - LICENSE OR >" Over 50 to 100 Incl, REG.NUMBER Class CL O Over 100 DISTRICT NO. PROCE D B U License Number Lic.Class Services,Sww ,MCC&Panelboards 5'.00 Contractor Date v '-399 Amp.Under 600 V DATE O ❑ I am exempt under Sec. 400-1000 Amp.Under 600 V VALIDATION W Over 1000 Amp.or Over 600 V FINAL a B.BP.C.for this reasonBRANCH CIRCUIT FEES BY Z Date: 15A,or 20A,120V,Lighting or Recept. 1 To 10 Branch Circuits Signature _ 11 To 40 Branch Circuits 4- ❑ '41 Or More Branch Circuits _ Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits f SINGLE FAMILY Temp.Power Pole.&Appurtenances ^' HOME OWNER-BUILDER DECLARATION ACCT A; hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit t{ 60.30 for the following reason(Section 7031.5, Business and Professions -Additional Sign Branch Circuits •%+ +� Code): qq ITEMS L 1S �•I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors 0 ®30 is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) TOTAL and Professions Code). , r+�t!t3 60.3D CONSTRUCTION,LENDING AGENCY 1 hereby affirm that:there is CHANGE- performancea construction lending agency for the of the.work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) Civ.C.) — 93 PLAN CHECKING FEE 0000-00011717 Lender's Name -• ?� PERMIT ISSUING FEE 0315 i AM �'47 Lender's Address_ I certify that I have read this application and under penalty of purjurY state TOTAL FEE (00.30-11 that the above information is correct. I agree to comply with all County ordinances and State laws reulating Electrical wiring,and hereby authorize representative f this Cou to enter upon the above-mentioned pr party for lnspectio SEE REVERSE FOR EXPLANATORY LANGUAGE S NATURE F PERMITTEE DATE ' # WORKERS'COMPENSATION DECLARATION CE-806 io/si AppLl'CATION FOR ELECTRICAL PERMIT . I laereb"y affirm that I have a certificate of consent to self insure, CE-76A606 `or a certificafe of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY .copy thereof(Set' 3800 Lab.C.) � cy:go Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. Residential Bld shad. EACH N0. FEE ADDRESS gs.&Pools _ I A� ❑ Certified copy I:, filed with the county building inspection 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY NEAR6Z ST I dep,•irtment Multi-family Sq.Ft. CROSS ST �t VISL Date Applicant Residential Swimming Pools OWNER OR J f)� S FIRM NAME COMPENSATION INSURANCE Outlets:Rec Light 1� w. ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' (This section need not be completed If the work involved by the First 20 CITY Tel.No. �=g permit Is for one hundred dollars($100)or less.) Total No. Additional i I certify that in the performance of the work for which this permit PLANECK 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. Data Applicant Fixed Appliances Not Over 1 HP PERMIT 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 _ Dryer _ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _L CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am I:censcd under provisions of Chapter 9LICENSE OR (commencing with Section 7000)of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Class Professions Codo,and my license is in full force and effect. DISTRICT NO. O SSED BY Power Apparatus&Large Appliances Size&Type HP,KW,KVA,or KVAR , / Q License Number Lic.Class Up to 1 Incl. FINAL (� Over 1 to 10 Incl. D ✓ U VALIDATION Contractor Date Over 10 to 50 Incl. AL V ❑ I am exempt under Sec. Over 50 to 100 Inc. BYvs� W BAP.C.for this reason Over 100 N Services,Swbd,MCC&Panelboards 11110. Z Date: 0-200 Amp.Under 600 V i Signature 201 - 1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V Exemption for Rog.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit prn7 ss I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits ' '°4 _ for the following reason(Section 7031.5,Business and Professions �C-oodde): 2J I,as owner of tho property,will do the work and the structure Misc.Conduits&Conductors I ITEELS is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). E O t`l-ls ;!5-7_-3 o ' CONSTRUCTION LENDING AGENCY 'r.•f'�..•�� +�!°{F. 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 33, 9[ri 1r A:.'/� Lender's Name i „I-• r I r''� ti," PERMIT ISSUING FEE Lender's Address 62-77 d X11 9u1)1 I 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 lays regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned ;,go� perty or in ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE lure of ermitts ate WORKERS'COMPENSATION DECLARATION C-663 ,orfs, APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, CE-Sova ct acertiacate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY �cyopy thereof(Seg.3800.Lab.C.) Policy Nb. Company FOR APPLICANT TO FILL IN JOB p ,r r7 ❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS 1 d ON�v � , Y New Residential Bldgs.&Pools _ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ $ LOCALITY–r. department. Multi-family Sq.Ft. NEAREST I �I G A Residential Swimming Pools CROSS ST. V F Gi Date Applicant OWNER OR FIRM NAME Cr CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec_Light—Sw. MAIL — COMPENSATION INSURANCE ADDRESS t Cl low( P y C. This section need not be completed If the work involved b the First 20 Total No. Additional CITY Tel.No., permit is for one hundred dollars($100)or less.) I certifythat in the performance of the work for which this permit PLAN C ECK 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 Total No. Additional CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT Exemption,you should become 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_. CITY Tel.No. I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. LICENSE OR (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER Class Professions Code,and my license Is in full force and effect. Power Apparatus&Large Appliances DISTRICT PRC SED BY Size&Type HP,KW,KVA,or KVARogpO License Number Lic.Class Up to 1 Incl. FI V Over 1 to 10 Incl. D E VALIDATION Contractor Date Over 1'0 to 50 Incl. V El FINAL I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C.for this reason Over 100 Services,Swbd.,MCC&Panelboards , Z Date: 0-200 Amp.Under 600 V e s Signature 201 - 1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch.Circuit A I hereby affirm that I am exempt from the Contractor's License Law ACCT°0 for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits �5,� Code): 07 32°50 I,.as owner of the property,will do the work and the structure Misc.Conduits&Conductors i ITEMS is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ TOTAL and Professions Code). o � CONSTRUCTION LENDING AGENCY CHECK 32.50 I hereby affirm that there is a construction lending agency for the1 performance of the work for which this.permit is issued(Sec.3097, PERMIT FEE (Sub-Total) CHANGE °00 Civ.C.). ` Lender's Name PLAN CHECKING FEE p - [U�iJ�l14ii11 10f/23/V7 PERMIT ISSUING FEE 6342 Lender's Address 1 AN i0°24 I 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 la reg ting Electrical wiring, and hereby authorize representati oft County to enter upon the above-mentioned property f ' n purposes. ` ,^ SEE REVERSE FOR EXPLANATORY LANGUAGE ignat a of Per ttee l �DJat 4 • � COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT ` DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1212110026 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID BUILDING ADDRESS: [ ITR: 6561 LT: 1 BL: .001 I [ 5717 RIO HONDO AV IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917802433 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18587-003-019 1A1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY Cl IFl 120V, 15/20A BR CKTS 1.00 BR 17.30 [ 1 ITENANT: IG1 OUTLETS-LGT,SW,RECP 12.00 OUT 24.00 ISSUED ON: PROCESSED BY: PLAN BY: I 1G2 LIGHTING FIXTURES 5.00 LGT 10.00 12/11/12 SR I 1 TOTAL FEES 79.10 (OWNER: TEL NO: 1 IF NAL AT FI AL BY: CODE: I (AYE AYE MAW 15717 RIO HONDO AVE I I [ ITEMPLE CITY 91780 I ID SCRIPTION OF WORK I 1 11 BRANCH CIRCUIT, 12 OUTLETS AND 5 LIGHT FIXTURES (APPLICANT: TEL. NO: I I I ISAME AS OWNER [ I ISPECIAL CONDITIONS: I I I I I I ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE [SAME AS OWNER _ 1 I I LIC. NO [ [TEMPORARY POWER POLE 1-1 I I 1 (UNDERGROUND CONDUIT I I I [ARCHITECT OR ENGINEER: TEL. NO: - [ [UFER GROUND I I I LIC. NO: [ IROUGH CONDUIT I I 1 [ TROUGH WIRING I ,I' I MAIN WATER LINE [ [ IPLASTIC YIN METAL YIN I I I [ [ [UTILITY COMPANY NOTIFIED( I I I I I I I I I I I I I I I I I [ I I I I I 1 I I I [ I I I I I I I 1 I I I I I [ IREPORT ID: DPR265 ROUTE TO: BS0508 I I I I I