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HomeMy Public PortalAbout5318 ROSEMEAD BLVD_Electrical__ WORKERS' COMPENSATION DECLARATION 76A663 DPw3,67 APPLICATION FOR ELECTRICAL PERMIT O I hereby affirm that I have a certificate of consent•to self CE-806G or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified co thereof (Sec. 3800, lab. C.) Policy No. Company £ FOR APPLICANT TO FILL IN JOB A/I I� Certi 'ed opy is h eby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS L ��( Certified copy is filed with the county building 'nspec- 1 & 2-Family, Sq. Ft. $ _ $ LOCALITY tion dep tmenI. L Multi-family Sq. Ft. CROSS NEARESTT. Date ` Applicant �• Residential Swimming Pools OWNER ORf vHq FIRM NAME CERTIFICAT OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL 2 I COMPENSATION INSURANCE First 20 ADDRESS (This section need not be'completed if the work involved by Total No. Additional CITY 4 U Tel. No. the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit 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 G �� Additional Total No. CITY �� 41, Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION Exemption, you should become subject to the Workers' Range— Heater—D.W. — Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS with comply with such.provisions or this permit shall be Tap — FAU —W.H. — deemed revoked. Hood — Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR -7 / Disp. — Room Air Cond. — L� Class. 1 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. PR C�EESSED BY d and Professions Code and m license is in full force a effect. Z� Size &Type HP, KW, KVA, or KVAR 0 O 0 License Number Lic. Class 0. Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE60 // Q VALIDATION 0 Contractor Date Over 10 to 50 Incl. l( GG FINAL U I a exempt under Sec. Over 50 to 100 Inc. BY _ W B.&P.C. for this reason Over 100 LU Services, Swbd., MCC& Panelboards Z Date: 0-200 Amp. Under 600 V Signature U 201 - 1000 Amp. Under 600 V 11f VVW Over 1000 Amp. or Over 600 V s Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp' Appurtenances CiPower Pole & HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit �_ I hereby affirm that I am exempt from the Contractor's License - .��aE j)„i Law for the following reason (Section 7031.5, Business and Additional Sign Branch-�rcuits -��_( Professions Code): i� € 1, as owner of the ro ert will do the work and the Misc. Conduits&Conductors --c P p' y Other See Complete Fee Schedule) 1'-1 l�- structure is not intended or offered for sale(Section 7044, ( Pr1-a; Business and Professions Code). f:;�-(t.;.: CONSTRUCTION LENDING AGENCY -.HP -- t" I hereby affirm that there is a construction lending agency for t14;1` the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). {-lel fl PLAN CHECKING FEE : -• - Lender's Name c!_. I Ari 9 a j_l7 PERMIT ISSUING FEE //�J = Lender's Address 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 law regulating Electrical wiring, and hereby authorize represe tatives of this County to enter upon the bove-m ni'oned pr perty far inspection pos s. (L/O SEE REVERSE FOR EXPLANATORY LANGUAGE signf6tune'IjWrmittee Datei ©s 1 ,> T ,per 1 �/� L ;WJRKERS COMPENSATION DECLARATION 76-806 10/81 APPLICATION FOR ELECTRICAL_ `PERMIT affirVi that I haveJ4 certificate of consent to self insure, CE-806G APPLICATION fl ELECTRICAL 1� or if c2te ofV Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY 4; 'copy thereof(Sec.3$00,Lab. C.) rr Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS S N �,QSFA✓l�'�} .�lY ❑ Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ❑ 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY /✓L �£, G� CA Certified copy is filed with the county building inspection department... Multi-family Sq.Ft. NEAREST N© &, CROSS ST.'• Residential Swimming Poolstt f 5 D n Date Applicant ''cc Q'� �' .4 FIRM NAME ..�£. o N O Cv vs CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:RecS��Light 4W_ Sw. 'vv * `.' MAIL COMPENSATION INSURANCE KID �� ADDRESS- 13 9s`/ cIDA viN 1LAn+d This section need not be completed if the work involved by the First 20 ( P Total No.S Additional �� 'CITY R.Q./ OS Tel p, permit is,for one hundred dollars($100)or less.) PLAN CHECK I certify that in the performance of the work r which this permit APPLICANT is,issued, I shall not employ any person a m anebecome subject to the W rkers'Comp do LLighting Fixtures First 20 ADDRESS Total No. /yo^ Additional CITY Tel.No. Date pplica Fixed Appliances Not Over 1 HP PERMIT NOTI TO APPLICANT: If, ter making this Certificate of `APPLICANT 1% 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 6T// S4-4+1- ST provisions or this permit shall.be deemed revoked. Top. FAU W.H. — .LICENSED CONTRACTORS DECLARATION Hood Fan Other_ CITY + P4Ri Tel No 9'I9 — I hereby,affirm that I am licensed under provisions of'Chapter 9 Disp. Room Air Cond. yZ vC� LICENSE-45R ., 7 I C_ .� (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 NO. PROCESSED BY d 7 4 O p Size& Type HP,KW,t<VA,or KVAR '�l License Number a._ 7 / ( C--fo 1 Lic.Class Up to 1 Incl FINAL U �. / 1 q G Over 1 to 10 Incl: DATE U V I 5 A W Contractor S Atxx ACC—fAl6 Date to 'z! O Over 10 to 50 Ind. 0 I am exempt under Sec. Over 50 to 100 Inc. BY AL�'; #'0 o.0 0 0 2 W B.&P.C.for this reason Over 100 / �`� ,0 71 6.5 0 CL / / Services,Swbd.,MCC& Panelboards ' Da 0- 200 Amp.Under 600 V 110. 0c 0 7.1 65 Q czi 1K Signatur 201 - 1000 Amp.Under-600 V Over 1000 Amp.or Over 600 V- 2 9—88 Exemption for Reg.Maint.Elect. SINGLE'FAMILY Temp.Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 703 1.5,Business and Professions- Additional Sign Branch Circuits Code): ❑ I,as owner of the property,wilPdo the work and.'the structure Misc.Conduits.&Conductors is not intended or offered for sale (Section 704, Business Other(See Complete Fee Schedule) , and Professions Code). 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) Civ.C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the above TOTAL FEE li information is correct. I agree to comply with all County ordinances and State Jfws regulating Electrical wiring, and hereby authorize reWw nty to enter upon the above-mentioned poses. ^' SEE REVERSE FOR EXPLANATORY LANGUAGE SI nature of Permittee Xe `+�/ COMPENSATION DECLARATION C -663 ,D/a, APPLICATION FOR ELECTRICAL PERMIT lt' _ 'y mfir n a-I hail'.r-certificate of consent to self insure, CE-806G or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Se(!"3800,Lab. C.) r Policy No. Company STA/F FUAI FOR APPLICANT TO FILL IN JOB Q //�� �( 'Q— Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRESS S3 /705F// /T L✓n . ❑ 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY 64 �A® G D� Certified copy is filed with the county building inspection department. Multi-family Sq.Ft. NEAREST ✓ G A� J A'� CROSS ST. Date Applicant „ /v Residential Swimming Pools OWNER OR �r If FIRM NAME �/ flff / Nv 0'4151 i CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light Sw. AMAIL DDRESS 53�v O ' COMPENSATION INSURANCE This section need not be com leted if the work involved b the First 20 ( P Y CITY permit is for one hundred dollars ($100) or less.) Total No. Additional ��'r Tel.No. PLAN I certify that in the performance of the work for which this permit A PLICANT CHECK G PIAl0 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 Additional /3°") 1 LJ 0 v/„� L� Total No. CITY 61r� JC'aT 0 �� Tel.No. e Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption,you should become subject to the 1.Workers'Compensation Range_ Heater_ D.W. _ APPLICANT ,/{ 1 v pFovisions 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. CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am licensed 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 Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. f� PROCESSEKBY Size& Type HP,KW,KVA,or KVAR License Number A Lic.Class Up to 1 Incl. FINAL / U e Over 1 to 10 fncl. DATE r� VALID TI N / ContractorCTFA/O�"dP�.e Date %` — Over 10 to 50 Incl. FINA O ❑ I am exempt under Sec. Over 50 to 100 Inc. BY BAP.C. for this reason Over 100 e Services,Swbd.,MCC&Panelboards , N Date: Z 0- 200 Amp.Under 600 � V 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 ;9 3 4,0 A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law #..o o,o' o-o 2 for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): i I o o 25.5 0 ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors o 0 o2 5,5 O.=c> is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) _ and Professions.Code). , 04, 07-88 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) Civ.C.). PLAN CHECKING FEE Lender's Name l ' PERMIT ISSUING FEE l Lender's Address t^,� 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 andate laws regulating Electrical wiring, and hereby authorize repr s ntatives of th' County to enter upon the above-mentioned Aa for inspec purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE of Permittee Date WORKERS'COMPENSATION DECLARATION - 10/81 APPLICATION FOR ELECTRICAL PERMIT CE806 I hereby affirm that I have a certificate of consent to self insure, CE-806G or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec. 3800,Lab.C.) fl Policy No./ ' / of Company D FOR APPLICANT TO FILL IN JOB Certified co is hereby furnished. EACH NO. FEE ADDRESS pY, Y New Residential Bldgs.& Pools ® 1 & 2-Family,Sq.Ft. $ — $ LOCALITY Certified copy is' filed with the :Aout tkg6inspection NEAREST ' department. _ Multi-family Sq.Ft. CROSS ST Q Residential Swimming Pools OWNER OR 'Date Applicant FIRM NAME . CERTIFICATE EXEMPTION FROM ORKERS' MAIL COMPENSATION INSURANCE Outlets:Rec Light Sw. ADDRESS 1 (This section.need not be completed if the work involved,by the First 20, permit is for one hundred dollars($100) or less.) Total No. Additional CITY --� L Tel.No'. I is issued, I shall notemploy any person in any manner so as to certify that in the performance.of the work for which,this permit PLAN CHECK APPLICANT . become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS u Additional Total No. CITY a Tel.,No.uK _ Q Date 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 Nange_ Heater_ D.W. _ fl provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS D provisions,or this permit shall be deemed revoked. Top _ FAU _ W.H. CITY Tel.No. r LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ �� I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR ! (commencing with Section 7000) of Division 3 of,-the Business and Disp. — Room Air Cond. REG:NUMBER tJ Class. C Professions Code,and my license.is in full force and effect. DISTRICT NO. PROCESSEDVYY Power Apparatus& Large Appliances �,� / Size& Type HP,KW,KVA,or KVAR License Number Lic.Class� Up to 1 Incl. FINAL U ContractorDate — Over 1 to 10 Incl. DATE'oo C VALIDATION Over 10 to 50 Incl. FINAL ❑ I am exempt under ec. Over 50 to 100 Inc. gy W B.&P.C.for this reason Over 100 ACC °s NI Services,Swbd.,MCC&Panelboards 3307 301. % Date: 0- 200 Amp.Under 600 V 'A+l I ° Signature 201 - 1000 Amp.Under 600 V I 1TEML E-1Exemption 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. TOTAL 30 m 0 SINGLE FAMILY Temp.Power Pole& Appurtenances (;HECK 30.50 HOME OWNER-BUILDER DECLARATION /Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law CHANGF .010 for the following reason (Section 7031.5, Business and Professions /Additional Sign Branch Circuits OC Code): ❑ �a» I,as owner of the property,will do the work and the structure Misc.Conduits& Conductors 0011130-0001 1/25/89 is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) qi and Professions Code). 11174(-71 IAN 11:50 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) y 0 p a Civ.C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I havI plication and state that the above TOTAL FEEinformation is c rrcomply with all County ordinances and State laws cal wiring, and hereby authorize representatives oenter u' on the above-mentioned property for ins SEE REVERSE FOR EXPLANATORY,LANGUAGE Signat a of Per Date^ ` � COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1303200043 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: I FEES PAID BUILDING ADDRESS: ' ON FILE 5318 ROSEMEAD BL IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB CA 917762211 ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 15388-010-004 1A1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY CAI I IG1 OUTLETS-LGT,SW,RECP 12.00 OUT 24.00 (TENANT: IG2 LIGHTING FIXTURES 8.00 LGT 16.00 JISSUED ON: PROCESSED BY: PLAN BY: TOTAL FEES 67.80 +03/20/13 SR 10WNER: TEL. NO: I�AL TEFIN BY: CODE: ISHU MAI LU (626) 242-3558- / 18238 BEVERLY DR SGAB 917762211 I ID SCRIPTION OF WORK 112 OUTLETS AND 8 LIGHT FIXTURES (APPLICANT: TEL. NO: j YUAN, SAM (909) 980-0358- 17234 RAVENSWOOD PL I (SPECIAL CONDITIONS: (RANCHO CUCAMONGA CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE IFENG CONSTRUCTION CORP (909) 980-0358- 1 I 17234 RAVENSWOOD PLACE LIC. NO I ITEMPORARY POWER POLE IRANCHO CUCAMONGA CA 91701 877951 I 1UNDERGROUND CONDUIT (ARCHITECT OR ENGINEER: TEL. NO: IUFER GROUND I I LIC. NO: I IROUGH CONDUIT 1 1 I I . IROUGH WIRING I I I I I I (MAIN WATER LINE PLASTIC Y/N METAL Y/N I I I I I I I (UTILITY COMPANY NOTIFIEDI 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 t 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 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 I 1 I I I I I I I t I I * ADDITIONAL DATA ON FILE I I I I I I I I I I (REPORT ID: DPR265 ROUTE TO: BS0508