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HomeMy Public PortalAbout5701 ROSEMEAD BLVD_Electrical__ WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) LI I hereby 76A663 APPLICATION FOR ELECTRICAL PERMIT 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. (� y/ 1KPO Cy NOJJ�v� Company •�+���• 1 v AJL FOR APPLICANT TO FILL IN ADDRESS ��D //• Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY ❑` 1 &2-Family,Sq.Ft. _ $ $ Certified copy is filed with the county build section NEAREST c)ep� Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR COMPENSATION INSURANCE Outlets:Rec._Light Sw. FIRM NAME ,2 First 20 �� MAIL (This section need not be completed If the work Involved by the Total No. y/ Additional �3 ADDRESS permit Is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY Tel.No. is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,.you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. IT provisions of the Labor Code,you must forthwith comply with such PPLICANT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR % ADDRESS�`p' 1 S�G, S I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. �"' � CITY Tel.N _ (commencing with Section 7000)of Division 3 of the Business and V%6J � 1 7�3 Professions Code,and my license is in full force and effect. Over 10 to 50 Incl /� } LICENSE OR �J//'l Class 1 0 a 5 �/�6 Over 50 to 100 Incl. REG.NUMBER (i tOIO Over 100 DISTRICT NO. PR SED BY V License Number Lic.Class �0 nFINAL l bergs �r[c�c¢f{�c- / 17 Services,Swbd.,,MCC$.�Pder d�.ag rds "g Contract a 0-399 A oder O V bO DATE O ❑ I am exempt under Sec. 400-1000 Amp.Under 600 V FINAL _ VALIDATION LU Over 1000 Amp.or Over 600 V B.&P.C.for this reason BRANCH CIRCUIT FEES BY Z Date: 15A,or 20A,120V,Lighting or Recept. _ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ Al Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 2 i SINGLE FAMILY Temp.Power Pole&Appurtenances ,s• HOME OWNER-BUILDER DECLARATION tiCCT o4 ith Ci B h One ne rancCircuit I hereby affirm that I am exempt from the Contractor's License Law Sign w •t-�t, r��, for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 330,' aftre�.: Code): Z ITEM 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) TOTAL AL J-1.70n22 and Professions Code). CHECK 1-113.24CONSTRUCTION LENDING AGENCY CHANGE e0fl 1 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 13000-00131 11/13/9 Lender's Name PERMIT ISSUING FEE 6486 1 €M11 1:: Lender's Address TOTAL FEE Q, I certify that 1 have read this application and under penalty of purjury state that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize entatives oft ' to enter upon the above-mentioned property r inspe tion Pur ose ] ` SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNA URE OF PERMITTEE DATE -WORKER'S COMPENSATION DECLARATION 20.0019 DPW(12.91) 76A683 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certiflcate of consent to self Insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILD G AND SAFETY DIV. copy thereof 38 0 Lab.C.) Policy No. 2- Company�( 1 ' Fa N I, FOR APPLICANT TO FILL IN JOB S j ❑ ADDRESS 1 Certified copy is hereby furnished. New Residential Bldgs.8 Pools NO. EACH FEE LOCALITY Certified copy is filed with the unty ing i pe tion 1 &2-Family,Sq.Ft. _ $ $ £� ST department. ` Multi-family Sq.Ft. CRossbT. ' Date j©Z.�' Applicant Residential Swimming Pools ASSESSOR MAP BOOK' PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' NER Outlets:Pec._Light Sw. FIRM NAME COMPENSATION INSURANCE � a (This section need not be completed If the work Involved by the First 20 MAIL Tota!No. Additional ADDRESS ! �' fern-S L'>2' permit is for one hundred dollars($100)or less.) d I certify that in the performance of the work for which this permit CITYIL l� r Tel.No. Z $f1 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 i CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER-APPLIANCES NOT OVER 3 HP. provisions of,the Labor Code, ou must forthwith comply with such PERMIT I P Y. P Y APPLICANT provisions or this permit.shall be deemed revoked.. Power Apparatus&Large Appliances LICENSED CONTRACTORS DECLARATION - Size&Type HP,KW,KVA,or KVAR ADDRESS14 A 4- 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 �, Camel.No. S—�•Cja f Professions Code,and my license is in full force and effect. Over 10 to 50 Incl, ZaAR Over 50 to 100 Ind. RCENSE OR •EG.NUMBER d2 S ClassC_ 3— IL (�r'1 a License Number 4 n 0�5 Lic.Class G'�� Over 100 DISTRICT NO. ' PROCESS U Services,Swbd.,MCC&Panelboards S,08 L I`-0 F� CQ , t Z I � 0-399 Amp.Under 600 V DATE 0 Contractor Date ❑ 400-'1000 Amp.Under 600 V ~ I am exempt under Sec. I?— -A 11 VALIDATION V Over 1000 Amp.or Over 600 V FINAL B.&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 F141'Or More Branch Circuits Exemption for Reg.Maim.Elect. 15A,20A,208V To 277V Lighting Br.'Circults 2 SINGLE FAMILY Temp.Power Pole&Appurtenances a HOME OWNER-BUILDER DECLARATIONACCT-'s I hereby affirm that I am exempt from the Contractor'sSign.with One Branch Circuit' . License Law � —, 59.55 a7 0�� for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits 3307 Code): •1 F1 1, ITEMS I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors o � Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) TOTAL and Professions Code). CHECK 59.55 CONSTRUCTION LENDING AGENCY CHANGE D] 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 0000-0001 10/29/9 Lender's Name PERMIT ISSUING FEE p 6243 1 Aid 8■e 53 Lender's Address TOTAL'FEE y. I certify that I have re thl IicatI, and under penalty of purjury state that the above informal' QQpQQp is cor t. I agree to comply with all County a State laulatingectrical wiring,and hereby authorize ,ordinances ntative f this C un to enter upon the above-mentioned property pe. n oses. SEE.REVERSE FOR EXPLANATORY LANGUAGE 4.4 ORE OF PE EE- DATE ' ' I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0304040033 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: BUILDINGLEGAL ID: FEE! Pllff- ON FILE 5701 ROSEMEAD BL} ,FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA ASS55SORNUMBER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 Al PERMIT ISSUANCE FEE 0.00 THOMAS PAGE: GRID: 'LOCALITY: TEMPLE CITY K1 SIGNS, OUTLINE LGT 4.00 SIG 0.00 TENANT: TOTAL FEES 0.00 ISSUED ON: PRESSED LA B : EXPIRES 06/03/03 JK 11/30/03 OWNER: TEL. NO: FINAL DATE FI ALY• CODE: CALAC INVESTMENT - G�_.3 ,,p3 3709 CONVOY ST #300 SAN DIEGO, CA9211137 DESCRIPTION OF WORK NEW SIGNS 2 TEMPLE CITY MARKETPLACE: 2 DOUBLE-SIDED MONUMENT SIGNS 8 2 DOUBLE SIDED PYLON SIGNS W/ CLOCK ON TOP L. FOR.SIGHT•CREATIONS (714) 537-8175- 985 E GREEN SPECIAL CONDITIONS: PASADENA 91101 CONTRACTOR: TE 0: APPROVALS DATE INSPECTOR SIGNATURE C AND C SIGNS (714) 537-8175- 11622 ANABEL AVE. LIC. NO TEMPORARY POWER POLE GARDEN GROVE, CA 92643 541345 C45 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH-WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITYOM REPORT ID: DPR265 ROUTE TO: BS0508 i COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0401290035 BUILDING AND SAFETY / LAND DEVELOPMENT ; TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDINGADDRESS: ON FILE 5701 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA ASSESSOR INFORMATIO NUMBER: I NEAREST CROSS STREET: LAS TUNAS 5397-012-043 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY E1 TEMP SERV POWER POLE 1.00 TMP 43.65 TENANT: TOTAL FEES 71.40 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: APPLEBEE'S 01/29/04 VG 07/27/04 OWNER: TEL. N0: FI AL DATE FI Y: CODE: 3709C INVESTMENT SAN DIEGO, CA9211137 D SCRIPT ON OF OR TEMPORARY POWER POLE APPLICANT: TEL. NO: NATIONAL CONSTRUCTION RENTALS (818) 822-3258- SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE NATIONAL CONSTRUCTION RENTALS (818) 822-3258- 10403 GLENOAKS BLVD LIC. NO TEMPORARY POWER POLE PACOIMA CA 91331 D31 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GRO ND CHARLES RAMM ASSOCIATES (949) 362-1986- 27111 ALISO CREEK RD #195 LIC. NO: ROUGH CONDUIT ALISO VIEJO, CA 10352 ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N QTY COMPANY NOTIFIEDCg * ADDITIONAL DATA ON FILE REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0312220030 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: EGAL ID: FEES PAID BUILDING DD ESS: ON FILE 5701 ROSEMEAD SL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY K1 SIGNS, OUTLINE LGT 2.00 SIG 77.70 TENANT: TOTAL FEES 105.45 ISSUED ON: PROCESSED Y: PLAN BY: EXPIR 5 0 : APPLEBEE'S 12/22/03 VG 06/19/04 OWNER: TEL. NO: FINA E FIN BY: CODE: CALAC INVESTMENT - z 3709 7 SAN DIEGO, CA9211137 DE.SCWIPTION OF WORK ELECTRICAL FOR SIGNS APPLICANT: TEL. NO: SUPERIOR ELECTRIC ADVERTISING (562) 495-3808- 1700 W ANAHEIM ST SPECIAL CONDITIONS: LONG BEACH CA CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SUPERIOR ELECTRIC ADVERTISING (800) 995-9099- 1700 W ANAHEIN STREET LIC. NO TEMPORARY POWER POLE LONG BEACH, CA. 271598 C45 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N TILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 quq 7yc5- oa 6 a, COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0402060007 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUIL G ADDRESS: ON FILE 5701 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA ASSESSOR INFORMATION UMBER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 AW PC CITY $109.35 MIN 0.00 2,196.81 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY Al PERMIT ISSUANCE FEE 27.75 TENANT: F1 120V, 15/20A BR CKTS 160.00 BR 2,153.85 ISSUED ON: PROCESSED BY: PLAN B XPIRES ON: APPLEBEE'S G1 OUTLETS-LGT,SW,RECP 62.00 OUT 95.70 04/01/04 VG 09/28/04 G2 LIGHTING FIXTURES 98.00 LGT 144.30 OWNER: TEL. NO: IA N-RES EX FANS LT 3HP 5.00 EX 76.50 FINAL DATE FINA BY: CODE: CALAC INVESTMENT - JB AC UNITS +3-10HP 3.00 AC 58.95 3709 JF REFRIG CBNT +3-10HP 2.00 REF 39.30 7 SAN DIEGO, CA9211137 JG COOKING EQIP +3-10HP 5.00 C00 98.25 DESCHIPTI OF WORK JX MOTORS, LT 3 HP 7.00 MOT 107.10 ELECTRICAL ON T.I. FOR RESTAURANT JY MOTORS, 5HP 1.00 MOT 19.65 APPLICANT: TEL. NO: K1 SIGNS, OUTLINE LGT 3.00 SIG 116.55 CHARLES RAMM - LD 400 AMP PANELS, MCC 3.00 PAN 228.15 TOTAL FEES 5,362.86 SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE CLARK CONTRACTORS, INC. (949) 581-6577- 19651 DESCARTES LIC. NO TEMPORARY POWER POLE FOOTHILL RANCH, CA 92610 570943 B UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND CHARLES RAMM ASSOCIATES (949) 362-1986- 27111 ALISO CREEK RD #195 LIC. NO: ROUGH CONDUIT ALISO VIEJO, CA 10352 ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY OTI IE REPORT ID: DPR265 ROUTE TO: SS0508