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Home My Public Portal About5505 ROSEMEAD BLVD_Electrical__ WORKER I h ve a certificate of consent to 2DOGIe DRV oz a+) APPLICATION FOR ELECTRICAL PERMIT 70-MI I hereby affirm Inel I have a cerldmate of consent to Bell mauve or a Certificate of Worker a Compensation Insurance or a certified COUNTY OF LOS T\NGELLS DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV cagX t al or(Sec 3800 Lab C) p,{�o/I!!/No4A " ^OCemp FOR APPLICANT TO FILL al 26W AJ Certified copy isherebyfurnished New Residential Shape a Poole NO EACH FEE I� — 3 $ LOCALITY C Luul CMdrod wpy u bled with the county building mspectron 1 a 2 Family SF FI department MUIplarNy Sq FI — CROSS I, R059 aT Data T-r-S 3 AppYcan Residential Swimming PooW ASSESSOR NAP BOON PAGE PARCEL CERTIFICATE OF EXEMPTION FR M WORKERS Outlets ReC _Light_Sw � C• �0 rj tr- COMPENSATION INSURANCE (This action need not be completed If the work Involved by the First 20 MAIL. permit Is for one hundred dollars(8100)or less) Total No Additional ADDRESS / I certify that in the performance of the work for which this permit CITY wry IYP TO W7/0 6f.1-7 i* issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws Ug"Fixtures First 20 PSC v Total No Adyuorial C-4 ormuctria rJ Data ApWicara ADDRESS S LAiIZ4 �i.14.� I NOTICE TO APPLICANT II after making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP CITYW CrurN,A To 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 pronsions or this permit Mall be deemed revoked Power Apparatus S Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Sure a Type HP KW KVA or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 8 Over 3 to 10 Ind(commencing with Section 7000)of Division 3 of the Business and CITY TO No Profeasiorm Code and my license is in full force and affect Over 10 to SO Ind } LICENSE OR Class d Over 100 Ind REO NUMBER l.irniss � Number � 1)b l/ CA t0 L. Clore Over 100 DISTRICT NO CED BY V Services Swod MCC S Panelboardecc cc Cantrector�ll l euCTRUclIuJ Date —g 3 FruL 0 389 Amp Under 000 V DATE ❑ I em exempt under fisc 400 1000 Amp Under 800 V VALIDATION W Over IODO Amp or Over B00 V RNAL i Q. B aP C for this reason BY BRANCH CIRCUIT FEES Z Date 10A or ting 20A 12DV fighor Recept Signature I To 10 Branch Cirauita 11 To 40 Branch Cacub 41 Or More Brenta Circuits Exemption for Reg Maint Elect ISA,20A.208V To ZM Br Orate 2 BINDLE FAMILY Temp Fowvr Pole 0 Appurtenances ACCT.i HOME OWNER BUILDER DECLARATION Sign with Oris Branch Circuit hereby affirm that I am exempt from the Contractor a Ucense Lew far the following reason (Section 7031 S Busmen and Professions A lddonal Sign Brants Circuits 3307 97.65 Cads) ❑ Mist Conduits 0 Conductors i ITEMS 1 m Owner of the property will do the work and the WUMure is not intended or offered for sale (Section 7044 Business Omer(See Complete Fee Schedule)- pop. CHECK 97 _ 65 and Profession*Code) CHECK 97.65 CONSTRUCTIONLENDING AGENCY I hereby affirm that there is a construction lending agency for the .UV performance of the work for which this ermit is issued(Sec 3087 PERMIT FEE (Sub-Tot" Or C) (/�, Lander a Name ` 0 MNAU LI1Kt PLAN CHECKING FEE 4/ 5/93 ---A1g PERMIT ISSUING FEE 9040 1 AN 8:1v LaMar s Address c�h�7TYLy� 1"nay,that I have read this apPlicalmn and under penalty of pur)ury state TOTAL FEE ' Met the above mformatim to correct I Spree to compy,with N County ordinances aM State Laws regulating Elecmcal wring andherebyauthon:e repreainfetives of this County to enter upon the above m tionsd property mpedion o e SEE REVERSE FOR EXPLANATORY LANGUAGE e101ullPl aFP TEE OATS WORKER I have PENSAnoNDEconsenoN 2041O19oPW(12 01) APPLICATION FOR ELECTRICAL PERMIT TD*D1 I hereby affirm that I have a certificate of consent to Bell Insure or a certificate of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV �Clyo'p'y,T1h(�e.Ore�of(�S�a�C�38/00�Lab eC) 'P ywN033T17 Smps FOR APPLICANT TO FlLL IN SOB O ❑ Certified copy 4 hereby furnished New Resldentral Bldgs a Pod° NO EACH FEE J ® 1 6 2 Family Sci Fl — S S LOCALITY Cerbiktl copy 4 ldetl cots Use cDIi^b budduy Irtspeclgn T NEAREST department Cyt`/1 ^ Mulfl-femay Sp Ft CR039 aT Date 4�1, 4Z Appuceru 1 A Y GAI.6T'RtyCT101J Reatlerlael��6��ln((mming POda y,�pE BOOK PA PARca Ov$ CERTIFICATE OF EXEMPTION FROM WORKERS Outlets RePL htl�fSw OWNER OR COMPENSATION INSURANCE RRY NAME (ThFirst 20 permtadbn need not be completed H file work Involved by its Tow No 7i/ �It� D A=DDRESS permit 4 for one hundred dollars(6100)or Uu) J–� I certify that in the performance of the work for which this perms C Tor Ni is issued I shall not employ any persoo in any manner so as to become sublets to the Workers Compensation Laws Lighting Fixtures`,/ First 20 PPLANCCHECK Total No SiG Additional o20 ADDRESS Deo ApplicantADDRESS APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT a alter making this Certificate of No .' Exemption you should become yousubjecit to the Workers Compensationwithsch OTHER APPLIANCES NOT OVER; HP provisions of the Labor Code you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked Poser Apperalem 8 Large Appllencea G�� APPLICANT LICENSED CONTRACTORS DECLARATION Soo 6 Type HP KW INA or KVAR ADDRESS I hereby affirm that I em licensed under provisions of Chapter 9 Over 3 to 10 incl (commencing with Section 7000)of Division 3 of the Business and OfTY TO No Professions Code and my license n In lull force and effect Over 10 to so ind LICENSE } Over 50 W 1O0Incl RM NIIµUMBER74J`4 a. O License Number ./–��r(�� ,.��i�– Lie Class Over 100 DISTRICT NO PROCESSED BY U Services Swbd MCC a Panalboards <! d� cc cit tr,tmT�iC+2'� iq ✓A1LOfYEo„e 0 309 Amp Under 600 V �O a 0 E] I em exempt under Sec DATE 400 1000 Amp Under BOO V y0 7-2 VALIDATION w Over loco Amp or Over 600 V FINAL d B AP C la tMs reesM BRANCH CIRCUIT FEES BY N Data 1&A or 20A 120V Lighting or Recept Z 1 To 10 Branch Cutups SignatureI I To 40 Branch Circuits ❑ 41 Or More Branch Circuits, im Exemption for Reg MaEked 15k M 206V To ZM Br Crams 23 SINGLE FAMILY Temp Power Pole a Appunanau Cor A HOME OWNER BUILDER DECLARATION Syn cots One Branch Cucun BO ACCT. me c I hereby affirm that I am exempt from the Contractor a Lwenss Law t 1029.91 for the following reason (Section 7031 5 Business and Professions Additional Syn Branch Grcu14 Code) 2 ❑ I as comer of the property well do the work and the st ucture Miac Conduits a Conductors ACCT.&T Is not intended or offered for sale (Section 7044 Business ( Complete Fee Sched�) S v and Professions Coate) L /O O poo. 3307 1497.0[1 CONSTRUCTKXfLENDING AGENCY 2 ITEM5 I hereby affirm that there is a construction lending agency for the 14 � performance of the work for which this permit is issued (See 3097 PERMIT FEE (Sub-Total) TOTAL 2526.9`•' Civ C) OMPLUNrtw1,1,,.'�PCW IL PLAN CHECKING FEE (.�C( 2�J26.95 Lander•Name J Lender a AddressTI't1 w W r" PERMIT ISSUING FEE CHANISE 'GO ty that I certiI have read this uti appbon and under penalty of pur{ury ewe TOTAL FEE that the above information a connect I agree to comply with all County 0000-0001 4/13/93 ordutsrlroa and State have regulating EWMCIIl Wiring and hereby euthoriu representatives of thus County,to enter upon the ehoveananaaned properly 9190 1 AN 10:39 13� SEE REVERSE FOR EXPLANATORY LANGUAGE TE TUBE e1tTEE WORKER sCOMPENSATION ateofconsAnoN 72DODIS&AM aw(12a1) APPLICATION FOR ELECTRICAL PERMIT 7d1Ba7 I hereby affirm that 1 neve a certificate of consent to sell Insure a a certificate of Worker•Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 3800 Lab C) pnllcy NO Company, � -�`_ POR APPLK:AKT TO FM1L IN AOp1E Cemhed Copy u hereby furnished New Residential Bldgs 8 Pods NO EACH FEE 1 ❑ 1&2 Family Sq Ft — S 7 _ LOCALITY ...+i n department Copy u pled with the county balding Inspectionry = / Mdtflamdy Sq FI "cRosa gToll Date Applxam S/ �-�S. Residential Swimming PadaASSESgpR WP BOOK PAGa PNICEL CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec _Light—Sw Fiftm IOOn COMPENSATN INSURANCE RRu (This"often need not be completed If the work Involved by the First 20 NAR �-x.--� permit Is for one hundred dollars(s100)or lass) Total No Additional ADDRESS" riS- Sf -0-It(I/ B/y,e I certify that 1n the performance of the work for which this permit CITY -f el Tel No I$ Issued 1 shell not employ any person in any manner so as to become subject to e Workers Compensation Laws Ughhng Futures First 20 AP R�TEC1( M Total No Addlhorial ADDRF Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT It after making this Certificate of CITYIb 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 suchc provisions or this permit shall be deemed revoked Power Apparatus A Large Appliances A➢PLIGNT LICENSED CONTRACTORS DECLARATION Size a Type HP KW KVA or KVAR ADDRESS 1 hereby affirm that I em licensed under provision. of Chapter B Over 3 to 101rnd (commendng with Section 7000)of Division 3 of the Business and CITY TM w d� Professions Code and my[icon"is In full force and elect Over 10 to 501nc1 Over 50 to 100 Ira REO 2 Z a License Number' 9e'i-zZ S LM Claes '� Over 100 p19TRICT NO r O PROCESSED BY O q services Swbd MCC a Panelboerds n�O O (cc Camactor45-5'• f' //-st/� Date(� 3-/ 0 389 Amp Under SW VUnderSDOV �� O 400 1001)❑ 1 am exempt under Sec Over 1000 Amp or Over 800 V ` Z - VALIDATION W Amp F IAL B aP C for this reasonBRANCH CIRCUIT FEES eY N Data 15A.or 20A 120V Lighting or RwW Z 1 To 10 Branch Circuits Sfpne[ure 11 To M Brunch Circuits 41 IJExemptionfor Reg Miami mi Elect ISA 20A 20 To 277VOr More B Ga� HOME OWNER BUILDER SINGLE ILY DECLARATION Temp Power Pole Appurtenances ACCT.i I hereby affirm that I em exempt from the Contractor•License Law Sign with One Branch Cucun 7'7n7 c for the following reason (Section 7031 5 Business and Prof9"mns AddNonal Sign Branch Cucate 3303 109.65 Code) 1 ITEMS ❑ I as owner of the property will do the work and the structure iConduits&Conductor is not intended or offered for sale(Section 7044 Buainees Other(Sae Complete Fee Schedule)_ poli. TOTAL 109. 65 and Professions Code) a CHECK, 109.65 CONSTRUCTION LENDING AGENCY �yiLy= .00I hereby affirm that there to a construction lending agency for the 4fltvnzC Wormaece of the work for which this permit is issued(Sec 3087 PERMIT FEE (Sub-Total) Civ C) / r rPLAN CHECKING FEE 0 " 01 6� 3/93 LerxW '5z C--.,,-`� 0 71 PERMIT ISSUING FEE �j 00$7 1 A11 957 Lender a Actr 3 3 3 c1 BG2 CaCL/t+�,( I artery that I have reed thio ncauon and uMm penalty of purlury state TOTAL FEE O GS that the above mbrmauon N correct I agree to txenpty with all County ordmances and Stats lows reguWmg Electrical wuing and hereby authorize representatives of this County to emu upon the rwhonsid property DaDo>•s SEE REVERSE FOR EXPLANATORY LANGUAGE n z�' G