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HomeMy Public PortalAbout5721 ROSEMEAD BLVD_Electrical__ WORKERS'COMPENSATION DECLARATION 20.OD19DPW 3/878���` Tl®®® ®� e�®`��� RMIT n I Thereby affirm that I have a certificate of consent to self 7 Ar APPLICATION j insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS �J / rJJ//a Certified copy thereof (Ser-3800, La C.) �' , {�PlSG7y(@o O a Gdr�pany , FOR APPLICANT TO FILL IN JOB i! ❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS FJ 7�rJ A �' LOCALITY ❑Certified copy is filed with the county bzbtx ec- 1 8 2-Family, Sq. Ft.— El t. $ '— $ i tion department. 1 Multi-family Sq. Ft. NEAREST J• �?j Residential Swimming Pools OWNERCROSS ORDate ADpIicon T. +a FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec T--Light 4a Sw._� ADDRESS COMPENSATION INSURANCE ADD First 20 ' �I (This section need not be completed If the work involved by Total No.—LLL Additional CITY Tel. No. the permit is for one hundred dollars($100)or loss.) 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 Lighting Fixtures First 20 �'7g ADDRESS so as to become subject to the Workers'Compensation Laws. Additional X1.3 Total No. 4' ' CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP - NOTICE TO APPLICANT: If, after making this Certificate of PERMIT �+ Exemption, you should become subject to the Workers' Range— HeaterD.W. APPLICATION — — �s13-/• �• �/ /-/ Compensation provisions of the Labor Code, you must forth- Oven — Dryer �W.M. ADDRESS with comply with such provisions or this permit shall be Top FAU -4L W.H. ,- deemed revoked. Hood Fan Other— 3CITY , Tel. No. �c •- LICENSED CONTRACTORS DECLARATION r�J� •7 Disp. � Room Air Cond. �- v �" LICE SE OR •� y� Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER 67 .. (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROB/ d and Professions Code,and my license is in full force and effect. Size&Type HP, KW, KVA, or KVAR •�/V O License Number, -�22V_gE Lic. Class if V© '.,—� ,Up to 1 Incl. 3 Ale FINAL { ��•... � ' — ?2 Over 1 to 10 Incl. DATE f O-43 VALIDATIOIN cc ControctoygLelikS i/'"Zi-ate I'—ZZ-"!`' -t Over 10 to 50 Incl. -9"41, FINAL U ❑ I am exempt under Sec. Over 50 to 100 Inc. BY W B.BP.C. for this reason Over 100 .7 _J a- Services, Swbd., MCC&Panelboards ' Z Date: 0-200 Amp. Under 600 V •�_ PC), I G r^ Signature 20 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits ti.•i ea Professions Code): -, E] tet: I, as owner of the property, will do the work and the Misc. Conduits&Conductors �+ 11r !o.''r structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— �(i ITEMS Business and Professions Code). Dr/1 ! F _ I CONSTRUCTION LENDING AGENCY � �yo.-r r. I hereby affirm that there is a construction lending agency for 'H_E_ , 75r. 4 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 0•60 27 s:H �+((3E I LY1 (Sec. 3097, Civ. C.). ��.. PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE R — eJ:IJLI-�Ip�t1 ;/ I;r` Lender's Address 7 I certify that I have read this application and state that the TOTAL FEE _ - �5L� 1 till! X. above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize rep nt ives of this County to enter upon / thenabo B-alention pr a ty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ate Signature of Permittee WORKER'S COMPENSATION DECLARATION 7SA0663 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT -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.3.8800 7¢Lab.C.) Company `'�'i'vFOR APPLICANT TO FILL IN JOB ADDRESS , osG-ice I'� ❑ Certified copy is hereby furnishe �_�— New Residential Bldgs.&Pools NO. EACH FEE LOCALITY _ Certified copy is filed with the coun ing inspectio --"% 1 &2-Family'Sq.Ft. $ $ NEAREST s department. �J Multi-family Sq.Ft. CROSS ST. S Date J ppllcant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTIO OM RKERS' Outlets:Rec._Light Sw. OWNER OR FIPMv COMPENSATION I MAIL First 20 MAIL RANCE NAME (This section need not be completed If the work involved by the Total No. Additional ADDRESS -,?,;)L/ ge ew permit is for one hundred dollars($100)or less.) certify that in the performance of the work for which this permit CITY e— 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 tDA-eV' C��l ^F O 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 APPLICANT ` provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. /r (commencing with Section 7000) of Division 3 of the Business and CITYGv�`M it7 Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR /� �s Over 50 to 100 Incl. REG.NUMBER ij� b Class.C� a /O C� G_ Over 100 DISTRICT NO. PROCESSED BY U License Number ��L/�///► Lic.Class L' `"� ' �y/ J Services,Swbd.,MCC&Panelboards contractor ® Date S 0-399 Amp.Under 600 V DANE ❑ 627 400-1000 Amp.Under 600 V VALIDATION V 1 am exempt under Sec. Over 1000 Amp.or Over 600 V FINAL UJ B.&P.C.for this reasonBRANCH CIRCUIT FEES By co Date: 15A,or 20A,120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits To Exemption for Reg.Maint.Elect. 15A,20A,208V 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances AL HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit a -t• U ,ry I hereby affirm that I am exempt from the Contractor's License Law C7!�•�ov for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): 3337 94.35 ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors i 1�1= ti is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). TOIAL 94. 35I 4o35 CONSTRUCTION LENDING AGENCY NECK ���°3`�r 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 66 76 1 AN 8:5i Lender's Address TOTAL FEE certify that I have read this application and under penalty of purlury state that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize represent f this County to enter upon the above-mentioned property for insp tion rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE -�SfGNA FN.TT DATE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1002090002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: ON FILE I I 5721 ROSEMEAD BL IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 91780 1ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LAS TUNAS 15397-012-043 IA1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, Cl IF1 120V, 15/20A BR CKTS 2.00 BR 34.50 I I ITENANT: IG1 OUTLETS-LGT,SW,RECP 8.00 OUT 15.60 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1 IYOSHINOYA TEMPLE CITY STORE IG2 LIGHTING FIXTURES 47.00 LGT 75.45 102/09/10 SR 02/09/11 1 I IIA N-RES EX FANS LT 3HP 2.00 EX 30.60 1 (OWNER: TEL. N0: IJB AC UNITS +3-10HP 2.00 AC 39.30 IFI D FINAL BY: CODE: IYOSHINOYA AMERICA, INC. (310) 527-6060- IJF REFRIG CBNT +3-10HP 3.00 REF 58.95 1 �N � � I 1991 W. KNOX ST. IJG COOKING EQIP +3-10HP 2.00 COO 39.30 1 ITORRANCE CA 90502 1JQ TRANSFORMERS 37.5KVA 1.00 XFM 46.05 ID SCRIPTION OF WORK 1 IJR TRANSFORMERS, 45 KVA 1.00 XFM 46.05 IT.I. ELECTRICAL I ILA 100 AMP PANELS, MCC 1.00 PAN 38.85 I I 1APPLICANT: TEL. NO: ILB 200 AMP PANELS, MCC 1.00 PAN 38.85 I I IMIZUNO (213) 487-9964- 1 TOTAL FEES 491.25 I I 12917 TEMPLE ST. 1 ISPECIAL CONDITIONS: (LOS ANGELES CA 90026 I I I I ICONTRACTOR: TEL. NO: 1 APPROVALS DATE INSPECTOR SIGNATURE 1 ISHIN SHIN CONSTRUCTION CORP. (626) 279-7991- 1 1 I 19324 E GARVEY AVE #J LIC. NO 1 ITEMPORARY POWER POLE I II 1EL MONTE CA 91733 858568B I I I I I I I (UNDERGROUND CONDUIT I I I 1ARCHITECT OR ENGINEER: TEL. NO: 1 IUFER GROUND I I I (ATELIER-U (213) 487-9964- I 1 I I I 12917 TEMPLE STREET LIC. NO: 1 IROUGH CONDUIT I LOS ANGELES, CA 90026 NONE I (ROUGH WIRING Alv II I (MAIN WATER LINE 1 I I 1 (PLASTIC YIN METAL YIN 1 I I I (UTILITY COMPANY NOTIFIEDI I I I I I I I 1 I I I I I I I I I I I I I I I I I I I I I I 1 REPORT ID: DPR265 ROUTE TO: BS0508 I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0611170032 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EBT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 5721 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, C G1 OUTLETS-LGT,SW,RECP 2.00 OUT 3.90 TENANT: TOTAL FEES 31.65 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: YOSHINOYA WEST INC. 11/1/06 JK 05/16/07 I OWNER: TEL. NO: FIN L DATE FINAL BY: CODE: CALAC INVESTMENT - �e�� 3709 SAN DIEGO, CA9211137 DESCRIPTION OF WORK REPLACE SELF SERVING SODA FOUNTAIN 120 V RECEPT RELOCATE & ICE MACHINE APPLICANT: TEL. NO: PARK (818) 640-4789- 1732 1/2 SAN JOSE ST SPECIAL CONDITIONS: GRANADA HILLS 91344 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE J.H. ELECTRIC & CONSTRUCTION, CO. (818) 640-4789- 1732 1/2 SAN JOSE ST. LIC. NO TEMPORARY POWER POLE GRANADA HILLS, CA 91344 484367 CIO UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: LIFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508