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Home My Public Portal About5745 RIO HONDO AVE_Electrical__ WORKER S'COMPENSATION DECLARATION i CE-B06G (2.80) APPLICATION FOR ELECTRICAL PERMIT ., 'CE-806 *4hereby affirm that I have a certificate of consent to self COUNTY OF BUILDING AND SAFETY insure,or a certificate of Workers'Com ensation Insurance,or V a�cerrti e, copy thereof Secc_.3800, C.) V �— /�A d�PN6. FOR APPLICANT TO FILL IN JOB ADDRESS �O / s'`�� New Residential Bldgs.&Pools EACH NO. FEE ❑ Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY I` Multi-family Sq. Ft. CROSS ST rtified Idelveow part en Py filed with the c only buildin�nspection Residential Swimming Pools OWNER OR iv Dateb 2 A licant FIRM NAME Cif pp Outlets: Rec.—Light Sw. MAIL r' First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CIT GTel N..;1616'17 €j& COMPENSATION INSURANCE } PLAN CHEC a (This section need not be completed if the work involved APPLICANT U by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS Additional Total No. CITY Tel No. 0 I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP permit is issued, I shall not employ any person in any manner PERMIT so as to become subject to the Workers'Compensation Laws. Range_Heater D.W._ APPLICANT Oven _ Dryer_W.M._ ADDRESS Date Applicant Top _ FAU _W.H.._ �� Z J Hood Fan _Other_ CITY Tel No. NOTICE TO APPLICANT: If, after making this Certificate of Dis —Room Air Cond. LICE SE O F 7� Exemption, you should become subject to the Workers' p REG.NUMBER Q Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCESselb BY with comply with such provisions or this permit shall be deemed revoked. Size&Type HP,KW,KVA,or KVAR Up to 1 Incl. Over 1 to 10 Incl. FINAL DATE !� LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. VALIDATION I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FI AL Br , 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 '>�(} ness and Professions.Code, and my license is in full force and effect. Service&— Licens baric.Class Under 600 V g 201-1000 Amp.Under 600 V j Contract ate (J Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances , 1 A I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit D061 Sign Branch Circuits License Law for the following reason (Section 7031.5, Busi- { 0 0 0 a ness and Professions Code): Misc.Conduits&Conductors 2 , o 1 9. 50 ❑ I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— structure is not intended or offered for sale (Section o o. u 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY (1 ?L( I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE issued(Sec.3097,Civ.C.). (Sub Total) Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE 7 I certify that I have read this application and state that the TOTAL FEE / above information is correct.I agree to comply with all County ordinances and State laws regulating Electrical wiring, and eby authorize representatives only to enter upon thea mentioned prop rty f ins a on SEE'REVERSE FOR EXPLANATORY LANGUAGE Z rignature of Permittee Date RKER'S COMPENSATION DEConsenttN �} ;a�o6oe�DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT 11 �thaC I have a certificate of consent to self insure, �(Worker's Compensation Insurance,or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.. 3800 Lab.C�-/.) L R.�[Tlpany C FOR APPLICANT TO FILL IN ADDRESS y s ereby furnished. '7 s� New Residential Bldgs.&Pools NO. $EACH $ FEE LOCALITY Certified copy Is filed with the county building Inspection 1 &2-Family,Sq.Ft. NEAREST dep In o� � Multi-family Sq.Ft. CROSS ST. Date Applicant�GpJ Residential Swimming Pools MAP BOOK PAGE PARCEL®� CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec.�Light.,� FIRM NAME Sw. OWNER " COMPENSATION INSURANCE p��d0 //�s{ First 20 MAIL � (This section need not be completed If the work Involved by the Total Nol! Additional ADDRESS 5-1 j; . permit is for one hundred dollars($100)or less.) t I certify that in the performance of the work for which this permit CITY � .� Tel.No. 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.NoAdditional ADDRESS data l\ Annl,d21n1\ f..rlfilla•O RESIDENTIAL APPLIANCES NOT OVER 3.HP. � NOTICE TO APPLIC , after making thls'(,eTficate of CITY Tel,No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. IT provisions of the Labor Code,you must forthwith comply with such ppp�jryT !• provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances 0 i1: C 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 4,x0Tel.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 !69622M Class' /� d Over 100 DISTRICT NO. O EBBED BY V License Number Lic.Class Services,Swbd.,MCC&Panelboards 2 yL�f IAI UO0-399 Amp.Under 600 V FINAL Q Contractor p ate, 400-10.OQ Amp.Under 600 VDATE 2 3--� ~ I am exempt under Sec. VALIDATION F1 W Over 1000 Amp.or Over 600'V FINAL ' B:&P.C.for this reasonBRANCH CIRCUIT FEES BY (a Date: 15A,or 20A,120V,Lighting or Recept. I Z_ Signature d 1 To 16 Branch Circuits 11 To 40 Branch Circuits ,3 F141 Or More Branch Circuits 2 Exemption for Reg.Maint.Elect. 16A,.20A,208V To 277V Lighting Br.Circuits ACCT o v SINGLE FAMILY Temp.Power Pole&Appurtenances - HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 330,E 59030 1 hereby affirm that I am.exempt from the Contractor's License Law for the following reason (Section 7031.5,.Business and Professions Additional Sign Branch.Circuits 1 ITEMS Code): 4 ak ❑ I,as owner of the property,.will do the work and the structure Misc.Conduits&Conductors 4h51h1l1tt��,,'�l Is not Intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). ' CHANGE .00 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(Sec. 3097, PERMIT FEE (Sub-Total) � 0000-0001 3/21/96 Civ.C.) 54.3E 1 Aid 92510 PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address Q 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 SIGNATURE OF PERMITTEE DATE TION WORKERS t I have a certificate of corse 7MM3 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT Q I hereby affirm that I have a certificate of consent to self I CE-806G insure, or a certificate of.Workers'gompensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof(Ser. 3800, Lab. C.) Policy No. "Company. FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESSEl- \'O Certified co is filed with the count buildinginspec- 1 &2-Family,S Ft. $ — $ LOCALITY Py y p y� . NEAREST tion.department. � � Multi-family Sq. Ft. 'CROSS S7. Date Applicant Residential Swimming Pools OWNER OR IRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' I Q MAIL COMPENSATION INSURANCE Outlets: Rec Light Sw. ADDRESS ��. (This section need not be completed If the Work Involved by first tCITY Tel. No. the permit is for one hundred dollars($100)or less.) Total No. Additional 'PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued,'I skull not employ any person in any manner so as to become subject to the Workers'Compensation.Laws. Lighting Fixtures First 20 ,ADDRESS Additional Date Applicant` Total No. — CITY Tel. No. NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION 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. — deemed revoked: Hood — Fan —Other— CITY Tel: No. LICENSED CONTRACTORS DECLARATION ,LICENSE OR Disp. — Room Air Cond. — Class. I.hereby affirm that I am licensed under provisions of Chapter 9 REG.NUMBER (commencing with Section 7000.)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. POC ED BY >_ and Professions Code,and my license Is in full force and effect. p d Size&Type HP, KW, KVA, or KVAR License Number Lic.Class Up to 1 Incl. FINAL Contractor Date Er Over 1 to.10 Incl. DATE _Z VALIDATION , Q Over 10 to 50 Incl. FINAL t– U I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C. for.this reason Over 100 a- Z Services, Swbd., MCC&Panelboards Z Date. 0-200 Amp. Under 600 Voil.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 a E L Sign with One Branch Circuit I,hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits 7 �; Professions Code): _ 2-1-as owner of the property, will do'the.work and the Misc. Conduits 9,Conductors l (f i=� structure is not intended or offered for sale(Section 7044, + Other(See Complete Fee Schedule)_ ® TOTAL Z�6 -874 Business and Professions Code). CONSTRUCTION LENDING AGENCY CHECK "i='`'-rt I hereby affirm that there is a construction lending agency for ;; AN the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. Q.). PLAN CHECKING FEE Lender's Name // (313013-131301 H'r c"1111"51 PERMIT ISSUING FEE (O 0 Lender's Address '11 ' t MI i.2°Ll' I certify that I have read this application and state that the I TOTAL FEE 6 above information is-correct. I agree to comply with all County 1 ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon 1 the by ed ro my for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE %1 i . Signature of Perm.l tee I Dat ®' i ~ T' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0904280015 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 6561 LT: 1 UN: .005 1 5745 RIO HONDO AV IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:I TEMP CA 917802433 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: WORKMAN I 8587-003-007 IA1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl I IRA FAD LESS 3HP 1.00 FAD 10.95 I 1 (TENANT: JB AC UNITS +3-10HP 1.00 AC 19.65 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 58.35 04/28/09 SR 10/25/09 (OWNER: TEL. NO: I IFfNAI D FIft BY: CODE: I 1ALMOITE VIOLETA (626) 291-2449- I I 1 5745 RIO HONDO AV I I 1 ITEMP 917802433 I IDMCR±PTICIN OF WORK V1 I I IELECTRICAL FOR HVAC SYSTEM (APPLICANT: TEL. NO: I I 1 IRONS HEATING AND AIR CONDITIONING (626) 674-1650- I I 1 1367 N. JENITER AVE. I ISPEC_IAL CONDITIONS: COVINA, CA 91724 ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE IRON'S HEATING AND A/C INC. (626) 674-1650- 1 1 1367 N. JENITER AVENUE LIC. NO I ITEMPORARY POWER POLE I I [COVINA, CA 91724 910446 C20 I 1- 1-1 I 1UNDERGROUND CONDUIT I I 1 (ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND I I I I - I I I I I LIC. 140: I 1ROUGH CONDUIT 1 I (ROUGH WIRING 1 1 1 [MAIN WATER LINE 1 1 1 1 1 [PLASTIC Y/N METAL Y/N 1 1 1 1 I UTILITY COMPANY NOTIFIEDI I 1 I I I I I I I 1 I I I I I I I I I I 1 I I 1 [ 1 IREPORT ID: DPR265 ROUTE TO: BS0508 I I I 1 I I I I I I