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Home My Public Portal About5555 ROBINHOOD AVE_Electrical__ �90RKER3 coMPENSATION DECLARATION ,o,e, APPLICATION FOR ELECTRICAL PERMIT �i reb�edilrm tfmt I have a certlflcate of conee�rt to self h�ure or a cer-rcate of Workers' Comperbatbn Insurance, or a certtM1ed COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof($&a 3800,Lab.a) Policy N0. Company FOR APPLKANf TO FILL LN JOB gS' O j1 -00 ❑ Certified copy b hereby fumhhed. New Reabandal Bldgs.d Enols EACH NO. FEE ADDRESS ❑ Certified oopy is filed with the county bulldlrlg Irlepectlon 1 & 2-Famrfy,Sq.Ft $ — $ LOCALITY �r�,/p� C/ G•A departrr-tt Multi-famhy Sq.Ft — NEAREST CF10&4 ST. Date AppI k"A Reelderrtfal Swlmming PooleOWNER OR a�� 1 m FFN NA!E peoieUXT ION CERTIFICATE OF EXEMPTFROM WORKERS' atIm.Roo. ught� S. — • COMPENSATION INSURANCE =3S(Thie section Dead not be oompiaUsd tf the work kmohmd by the Flrat 20 patt la for one twndrad dollars($100)or e.) Total No. AddlHonel CITY rmlosj4 .,444 if I comity that In the pertorrrwce of the work for which thio permit PLAN CHECK APPLK'1,NF Is fasued, I shall not employ arty person In ary maruter 8o as to become sub)ed to the Workers'Companaation Laws. Lighting FbAuree Brat 20 ADDRESS Total No. Addkionel CFFY Tel.No. Date r Apot Fixed Appilarc Not Over 1 HP NOTICE TO :. til after maldng thio certificate of Exemption,you should becorne auib)oct to the Workers'Cornpenaation Range— Heater— D.W. — Q provtalona of the Labor Code, you mfthmpl must kxthwcoy with arch Oven — Dryer — W.M.— ADDRESS /61 provisions or this permit shall be deemed,revoked. Top — FAU — W.H. — CFFYTel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan — Other i4h,64— I hereby affirm that I am licensed under provtsione of Chapter 9 Dlap. — Room All CbrrL m � y aura —/Q (comendrp b with Sectlon 7000) of Dfvfan 3 of the Buaineas end Profeaalone Co(*and my Icenee Is In full force and effect Power APAP h Large Appilartcea Dk9TRlCT 40. Pflo(E BY nn 0� Stze&Type HP,KW,K1i4,or KVAR a Lbertae Number ..Lb.Clew Up to 1 Incl. FINAL i Over 1 to 101nol. D• �� Contractor Dote .� —3 Oho Over 10 to 60 Incl. ❑ I am exempt under Sec O W 60 tp 100 Inc. BY f3&P.C.for thle reason Over 100 Services,Swbd,MCC d Panelboerde Date' 0-200 Amp:Under 800 V Siptature 201 - 1000 Amp.Under 600 V 0,.w1000 Amp.or Over 600 V 6 7 7.3 A F-1 Exemptbn for Rep.Mefrrt Elect . SJNGLE FAMILY Temp.Power Pole& Appurteaeraee # 0 0 0 0 0 2 HOME OWNER-BUILDER DECLARATION Sipe wkh One Bi anoh arcutt ° ° 14.2 5 I hereby affttm that I am exempt tram trador the con8 Lloense Law 1 .sly Branch arcvfta for the following reason(Section 7031.6,Buslnese and Pro(esaione Code): ° ° -,1 4 2 5 T5 ❑ 1,as owner of the property,wlII do the work and the atruoture MIsC.Conducts 8 Conductors Is not Intended or offered for a" (Section 7044, Bustnees Other(See Complete Fee Schedule) , y �>e Code). 3 3 1 .. 8 7 aid Profe CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a corntruction lending apency for the pNIormance of the work for which this permit Is leeued(Sea 3097, PERMFF FEE (SUIrTotal) Ctv.C.). PLAN CHECKING FEE Lenders Name PERMFr ISSUING FEE Lenders Address 1 I cwtffy that I have read this application and state that the abo a TOTAL FEE trdonnation is correct I agree to conpiy with all County ordinances and State laws repiletlng Elecr�al wtrtr and hereby authortra repreeental vee of this CaxTty to enter upon the above-mentioned vol—ty for f Purl-e— SEE REVERSE-FOR EXPLANATORY LANGUAGE 1 r �� Siptature of Porn-At e Dtr- COUNTY OF LOS ANGELES TEMPLE CITY f 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0211220025 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91730 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING TR: 1695T LT: 69 5555 ROGINHOOD AV FEE DESCRIPTION: QIYdNTITY: LON: AM"T: TEMP CA.917802719 NEAREST CROSS STREET: DAINEES 3586-DZ2-017 Al PERMIT ISSUANCE FEE ' 27.75" THOMAS PAQE: 597- GRID: 83 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW RECP 20.OQ OUf 39.00 G2 LIGHTING FIXT56ES 4.0Q LGT 7.80 . MESSED BY: P�AM BY: EX IRES ON: H2 RES tRBG DISP LT 3HP 1.00 DIS 10.95 11/26/02JIB 05/25/03 H5 RES WASH MACH LT 3HP 100 WAS 10.95 H7 RES EXHAUST FANS -'-1".00 EX 10.95 Tfl0l—" FINAL JACQUELINE CAI (626) 375-1771- TOTAL FEES 107.4-0 ' /� 5555 ROBINHOgp AV. TEMP 917802719 DESCRIPTION OF WORK- ELECTRICAL FOR REMODEL APPLICANT- TEL. NO: EDWARD MAK (626) 864-0452- 4112 WALNUT GiROVE SPECIAL CONDITIONS: ROSEMNEAD 91770 CQNTRACTOR: TEL: W: APPROVALS DATE INSPECTOR SI WTIJRE EDWARD TING (626) $64,0452- 411L WALNUT GROVE AVE. LIC, NO TEMPORARY POWER POtE ROSEMEAD, CA 91770 774980-B LIC, NO: , f PLASTIC Y/W M AL Y/M UTILITY QWANT-Wn= REPORT ID: DPR265 ROUTE T0: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUiA8 EL 0508 0212200039 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING TR: 16957 LT: 69 5555 ROBINHOOD AV FEE DESCRIPTION: QUANTITY: UOM: AMOUKT: TEMP CA 917$02719 ASSESSOR INFORMATION KMER: NEAREST CROSS STREET: DAILIES 8586-022-017 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B3 LOCALITY: TEMPPLE CITY LA 100 AMP PANELS, MCC 1.00 PAN 38.85 TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES 12/20/02 JK 06/18/03OMER: TEL. NO: FINAL DATE FINAL BY: u-uE . JACQUELINE CAI (626) 375-1771- 2 -3/-0-3 . 5555 ROBIMHOOD AV TEMP 917802719 DESCRIPTION OFWORK RELOCATE ELECTRICAL PANEL APPLICANT: TEL. NO: EDWARD MAK (626) 864-0452- 4112 WALNUT GROVE SPECIAL CONDITIONS: ROSEMEAD 91770 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE MAIC EDWARD TING (626) 864-0452- 411� WALNUT GROVE AVE. LIC. NOTEMPORARY POWER POLE ROSEMEAD, CA 91770 774980-8 ARCHITECT OR ENGINEER: TEL. NiO: LIFER GROUND LIC. Md: JROUGH CONDUIT is PLASTIC YIN METAL Y/N UTILITY COMPANY NUTrFIED REPORT ID: DPR265 ROUTE TO: RS0508