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HomeMy Public PortalAbout5439 ROSEMEAD BLVD_Electrical__ ION WORKER'S I have a certificate of consent to 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT LJ 76A663 I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab. C.) Policy No.147,60V00 0- ompany 45-4 ��� FOR APPLICANT TO FILL IN JOB fJ ❑ ADDRESS ,'� �s�7{yJ�/�-G{� Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE $ $ LOCALITY cT 21, Certified co is,filed with the count building inspection 1 &2-Family,Sq.F[. PY Y 9 P NEAREST department. Multi-family Sq.Ft. CROSS ST. j WL DateApplicant� � Residential Swimming Pools ASSESSOR MAP BOOK PA(E PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWNER OR NAME ^ S COMPENSATION INSURANCE FIRM �.J First 20 MAIL (This section need not completed the work involved by the Total No. Additional ADDRESS 54�� �, L"!j ,� permit is for one hundredd dollars($100)or less.) 1 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 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 should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP. rovisions of the Labor Code, ou must forthwith com I with such PERMIT provisions or this permit shall be deemed revoked. /pI p y P y Power Apparatus&Large Appliances APPLICANT CJee Y' t .A.10 CID LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS 03 , S-l- E! 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 ' M >" � '( Over 50 to 100 Incl. REG.NUMBER A,6-ID Class.c- !i a License Number u V f LIC.Class C-14 + Over 100 DISTRICT NO. PROCESSED BY `T O -Services,Swbd.,MCC&Panelboards 0 Contractor yu��* 15Date r 0-399 Amp.Under 600 V DATE (�. yy-Ql FINAL O ❑ I am exempt under Sec. 400-1000 Amp.Under 600 V �C/,_GLS W Over 1000 Am or Over 600 V VALIDATION P FINAL _ CLB.&P.C.for this reason BRANCH CIRCUIT FEES BY U) Date: 15A,or 20A, 120V,Lighting or Recept. z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits El 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit M for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): ❑ I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors is not intended or offered for sale (Section 7044, 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.) O PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEETTENIy. Lender's Address _ I certify that I have read this application and under penalty of purjury state TOTAL FEE 3 ;ITFAL that the above information is correct. I agree to comply with all County _I F i s1_ ordinances and State laws regulating Electrical wiring,and hereby authorize .r== 3 representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE CHANG fG _ sl SIGNATURE OF PERMITTEE I IIATE 3, �, WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12.91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, 76A663 or a certificate of Worker's Cd',ipensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C Policy NO. Ompany FOR APPLICANT TO FILL IN JOB `' ADDRESS14 ao er fied copy is hereby furnished. N Residential Bldgs.&Pools NO. EACH FEE / $ $ LOCALITY Zf;�Zicant/� h the count buildin ins ction 1&2-Family,Sq.Ft.Y g NEAREST Multi-family Sq.Ft. CROSS ST. Date Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTI ICATE OF EXE N FROM WORKERS' Outlets:Rec.-Lig Sw. OWNER IRM NAME COMPENSATION INSURANCE First 20 MAIL (This section need not be completed if the work involved by the Total No. Additional ADORES permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITYS_ Tel.No. is issued, I shall not employ any person in any manner so as to PLAN c ECK become subject to the Workers'Compensation Laws. 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 CITY47 Tel.No. Exemption,you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT P Y P y provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT p LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS ti 3 ` l 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. Over 50 t0 100 Incl. LICENSE ORREG.NUMBER CI C' CL CL Over 100 DISTRICT NO. P ESSED BY O License Number Lic.Class Services,Swbd.,MCC&Panelboards ��O Contractor Date 0-399 Amp.Under 600 V FINAL Q DATE El 400-1000 Amp.Under 600 V +� I am exempt under Sec. VALIDATION V Over 1000 Amp.or Over 600 V FINAL a B.&P.C.for this reasonBRANCH CIRCUIT FEES BY Date: 15A,or 20A,120V,Lighting or Recept. Z JAV 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Tem Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION P PP it h Circ B with One ne rancu I hereby affirm that I am exempt from the Contractor's License Law Sign / jO ;��n ,�,°•?L� for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits - Code): ❑ I, as owner of the property,will do the work and the structure . Misc.Conduits&Conductors 1_4L4 •a - a✓ P P Y, "i sT ti 3 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) `' ')' 1_ - and Professions Code). , CHECK iLt��c CONSTRUCTION LENDING AGENCY CAN(,— °%i_I 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.) - -r 1/5N PLAN CHECKING FEE "' ' Lender's Name PERMIT ISSUING FEE �y, 'f=' Lender's Address 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 me on the ove-mentioned property for in, cti rpo SEE REVERSE FOR EXPLANATORY LANGUAGE GN RE OF PERMITTEE DATE WORKER'S COMPENSATION DECLARATION 20.0019 DPW(12-91) 76A663 APPLICATION FOR ELECTRICAL PERMIT • I he4eby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof �',,(Se�c13�S8�0[0 Lab. C.) R-t-erttil'ited olicy No. iw-W Compdo"/-� FOR APPLICANT TO FILL IN JOB ri ADDRESS ied copy is hereby furnished. / Residential Bldgs.&Pools NO. EACH FEE $ $ LOCALITY copy•is file with the county building inspection 1&2-Family,Sq.Ft. 1 NEAREST cep rent Multi-family Sq.Ft. CROSS ST. Date Applicant �' Residential Swimming Pools ASSESSOR F '"�• MAP BOOK PAGE PARCEL CERTI KATE OF EXEMPTION FROM WORKERS' f` OWNER OR COMPENSATION INSURANCE Outlets:Rec. Light L Sw // IP,M NAME /�� First 20 /f0 3(0 BTU (This section need not be completed if the work involved by the Total No.L� Additional b�RESs r� permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit h "'' CITY Tel.No. is issued, I shall not employ any person in any manner so as to / © 3� PLAN CHECK become subject to the Workers' Compensation Laws. , Lighting Fixtures —7�1 First 20 APPLICANT Total No. I (•/ Additional ADDRESS Date Applicant :s _ ­m- „, " � RESIDENTIAL APPLIANCES NOT OVER 3 HP` ++`•%`-"^' .� _. v-,+ '-T•. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such YFAMIT ", "� w J j) �` provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances PLICANT�v �(_/( LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS �� _ ,�, I hereby affirm'fhat I am licensed under provisions of Chapter 9 %Zn_ 1 Over 3 to 10 Incl. CITY Tel.No. 1 1, (commencing with Section 7000) of Division 3 of the Business and � J ��48 Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. Over 50 to 100 Ind.Over B (0-7 Class. C' _ .REG.NUMBER a License Number t Lic.Class Over 100 DISTRICT NO. p PR ESSED BY 0 i Services,Swbd.,MCC&Panelboards 0-399 Amp.Under 600 V � o !�.7D FINAL._ 0 Contractor ' Date DATE -. 400-1000 Amp.Under 600 V 9.30 0 0 a 1-0 VALIDATION V ❑ I am exempt under Sec. Over 1000 mp.or Over 600 V FINAL - ^.ss'.._ 1`t _a,s a B.&P.C.for this reason BRANCH CIRCUIT FEES BY Cn Date: 15A,or 20A, 120V,Lighting or Recept. — Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuitsh a ❑ 41 Or More Branch Circuits rl t' v,il._ Exemption for Reg.Maint. Elect. 15A,20A,208V To 277V Lighting Br.Circuits _ SINGLE FAMILY Temp.Power Pole&Appurtenances - s `3 HOME OWNER-BUILDER DECLARATION "t ts� nca J, ' I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit i (.._ ,:: _.,7 :+ :: for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits CHECK ±pC 55 Code): ❑ Q I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors t•HANGt iI(_ is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). CONSTRUCTION LENDING AGENCY .' It I herebyaffirm that there is a construction lendin a enc for the Oji 1 110:.'; 9. 9 Y �� All J. performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) v Civ. C.) PLAN CHECKING FEE 30 Lender's Name PERMIT ISSUING FEE a210 D Lender's Address I certify that I have read this ap lication and under penalty of purjury state TOTAL FEE that the above inform tion ' co rect. I agree to comply with all County ordinances and S I ws egula ng Electrical wiring,and hereby authorize represen es f t i County t enter upon the above- ntione property ctio urp s s 19 SEE REVERSE FOR EXPLANATORY LANGUAGE SI ATURE OF P DAT COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0411090015 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 5431 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB CA 917762212 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BROADWAY 5388-024-041 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY, C K1 SIGNS, OUTLINE LGT 2.00 SIG 77.70 TENANT: TOTAL FEES 105.45 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: PEP BOYS AUTO 11/09/04 JK 05/08/05 OWNER: TEL. N0: F FINAL Y: CODE: OA;MWN ENTERPRISES (626) 457-2945- 1025 FREMONT AV _ ALHM 918031324 DESCRIPTION OF WORK ELECTRICAL FOR NEW SIGNS APPLICANT: TEL. NO: COURTNEY (909) 597-3157- 2328 BROWN DEER SPECIAL CONDITIONS: CHINO HILLS, CA CONTRACTOR: TEL. NO: = APPROVALS DATE INSPECTOR SIGNATURE LOREN ELECTRIC SIGN (562) 946-7545- 321 VAN NORMAN LIC. NO TEMPORARY POWER POLE MONTEBELLO, CA 90640 455415C45 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508