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Home My Public Portal About5727 ROSEMEAD BLVD_Electrical__ ".fav 1f11&KERS'COMPENSATION DECLARATION 76A963 70/91 ��pQ,II��I� //�� w� I� I hereby.aff'irm that I have a certificate of consent to self.insure, i CE-9o9G /■ P IP'LI C/ T,i O N F R L�.CTR I CAL PERMIT " or.a certificate of Workers' Compensation Insurance, or a certified r copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES i BUILDING AND SAFETY .y ' Policy No..- Company FOR APPLICANT TO FILL IN JOB fI�r /� y� Certified copy is hereby furnished. EACH NO. FEE ! ADDRESS `7 /Z 7 r�C��':` �'✓ New Residential Bldgs.&Pools $ _ $ 'I LOCALITY ❑ Certified copy is filed. with the county building inspection 1.&2-Family,Sq.Ft. _ I . NEAREST (,�+ department. Multi-family Sq.Ft: rl /vrl Residential Swimming Pools CROSS ST it Date Applicant . ,•, OWNER OR FIRM NAME Y &�'CO CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL { • Outlets:Rao Light._Sw.— COMPENSATION INSURANCE ADDRESS' j (This section need not be completed If the work involved by the First 20 Total No. Additional CITY Tel.NO. permit is for•one hundred.dollars($100)or less.). ;. PLAN CHECK I certify that in the performance of the work for which this permit APPLICANT I is issued, I shall not .employ any person in any'manner so as to i become su 'ecttpthe Workers'Compen ation Laws. Lighting Fixtures First 20 ADDRESS Additional I, Z Z �(�✓A Total No. CITY Tel.No. Date Applicant 1. Fined Appliances Not Over. I HP PERMIT NOTICE APPLICANT: •If; after making is Cert'rficate'of -� ■J� Tlti�v Range_ Heater D.W. APPLICANT Exemption, should become subject to the Workers'Compensation f*� � provisions of•the.Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS ti�CY , provisions or this.permit shall be,deemed revoked. Top FAU W.H. _ v Z, �i-� CITY SLI'{ ( (, Tel. o. 1(��s/,- 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. I REG.NUMBER UV �r� Cis Professions Code,and my license is in full force and effect,. Power Apparatus&Large Appliances, . � DISTRICT NO.. PROCESSED BY Size&Type HP,KW,KVA,or KVAR I �/'0 0 License Number Lic.Class [ Up to 1 Incl. FINAL ' V Z r Over 1.to 10 Incl. i. DATE ° VALIDATION Contractor- Date ( ( is 0 Over 10 to'50 Incl. ❑ 'I am exempt under Sec. Over 50.ta 100 Inc. �' gY LAla W B.&P. for this 2 son Over 100 d' ! i Services,Swbd.,MCC&Panelboards ® Z Date: ' 2" 0 T 200 Amp..Under.800 V e■� Signature 201 - 1000 Amp.Under 600 V ❑' Over 1000.Amp,or Over 600 V Exemption for Reg.Maint.Elect. I SINGLE FAMILY Temp.Power Pole&Appurtenances I HOME OWNER-BUILDER.DECLARATION Sign with One Branch Circuit I hereby affirm that I am-exempt from the.Contractor's License Law Additional Sign Branch Circuits F,�: ■ ' for the following reason(Section 7031.5,Business and Professions g Code): I' �3=7 "c Misc.Conduits&Conductors El 1,as owner of the property,will-do the work and the structure y zk. r is not intended or offered for sale (Section 7044,'Business I Other(See Complete Fee Schedule) _ ' and Professions Code). i 3 L _ v+I oil. ' � a;'" _75 r� o 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, [PLAN ERMIT FEE (Sub Total) 'Civ.C.). I CHECKING FEE Lender's Name . 1 1.;rr `iERMIT ISSUING FEE Lender's AddressI certify that I have read this application and state that the above IOTAL FEE information is correct.1 agree to comply with all County ordinances ' and State laws regulating Electrical wiring, and hereby authorize i representatives of this County to enter upon the above-mentioned I' property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE F Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 78A683 16681p I.hereby affirm,that I have a certificate of consent to self insure, CE-sow APPLICATION ELECTRICAL PERMIT or a certificate of Workers'Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec,3800,Lab.C.) + Policy No. Company FOR APPLICANT TO FILL IN JOB „ADDRESS ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO.. FEE ❑ ^Certified co 1 &2-Family„Sq.Ft: $ — $ i LOCALITY copy is-filed with the :county building inspection _ department. 'Multi-family Sq.Ft. NEAREST CROSS ST Date Applicant Residential Swimming Pools. } OWNER OR FIRM NAME if I CERTIFICATE'OF EXEMPTION FROM WORKERS' Outlets:Rao—Light_Sw.— MAIL y ' COMPENSATION INSURANCE ADDRESS 0 (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- Tel. . I certify that in the performance of the,. r for hlah this permit PLAN CHECK -61 ,is issued, I s II not employ any person in. any anner to as to I APPLICANT become subj tot .Workers'Compens tin Lighting Fixtures First 20 ADDRESS Additional l Total No. CITY :Date Applicap Fixed Appliances Not Over 1 HP PERMIT NOTICE APP IC: T. if, aft e maklig 't Certifloab of APPLICANT Exemption,you should become subje the.Work :Compen. tion Range.— Heater_ D.W. provisions of the Labor Code,you t forthwith comply with such ;�. Oven _ Dryer_ W.M._ ADDRESS L provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. CITY Tel.No. LICENSED.CONTRACTORS DECLARATION Hood _ Fan _ Other_ Ihereby affirm that I,am licensed under provisions- Disp . ns•of Chapter 9 Room Air Condu. REG.NUMBER ClassCCENs oR + (� • (commencing with Section 7000)of Division 3 of the Business and . Professions Code,and my licen-se is fn full force and effect. Power Apparatus&Large Appliances DISTRICT NO. PRO ED BY c Size&Type HP,KW,KA,or KVAR p License umberosT Lin.Class Up t 8 o 1 Incl. FINAL VA Over 1 to 10 Incl, DATE ,/�� VALIDATION 0 Contrac ate Over 10 to 50 Incl. ( 0 • FINAL C� I s mpt under a Over 50 to 100 Inc. i BY a B.& for this reason ' Over 100 N Services,Swbd.,MCC&Panelboards ® Z Date: 0-200 Amp.Under'800 V Signature ' 201 -1000 Amp.Under 606V ❑ Over 1000 Amp.or Over 800 V 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 i :•�I for the following reason(Section 7031.5,BuAdditional Sign Branch Circuits and Professions ' , • ,. Code): Misc.Conduits&Conductors ❑ I,as owner of the property,will do the work and the structure I '-�+�-t! • °'''- is not intended or offered for sale.(Section 7044, Business Other(See Complete Fee Schedule) _ and Professions Code). pop- CONSTRUCTION'LENDING AGENCY I hereby affirm that there is a construction lending agency for the i;f_.{�Il–y (�a �'�jyi:• performance of the work for which t i ermit is Issued(Sec.3097,, PERMIT FEE (Sub Total) + Civ.C.).- V: Arf PIAN CHECKING FEE I Lenders Name—R PERMIT ISSUING FEE p2 j Lender's Address r I certify that I have read this application and state that the above TOTAL FEE information is correct.I agree to comply with all County ordinances and State laws gulatin Electrical wiring, and hereby authorize representatives this C unty to enter upon.the abo -mentioned p erty ins 4Ddr?Do SEE REVERSE FOR EXPLANATORY LANGUAGE44 U Sig rmiate • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0103150016 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: EGA D: FEES PAID ------WILDING ADDRESS: ON FILE 5727 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 G1 OUTLETS-LGT,SW,RECP 2.00 OUT 3.90 TENANT: IA N-RES EX FANS LT 3HP 2.00 EX 30.60 ISSUED ON: PROCESSED B A BY: EXPIRES ON: TOTAL FEES 62.25 03/15/01 UT 09/11/01 OWNER: TEL. NO: ARIPTIUN L DAT FIN-AL--BY: CODE: CALAC INVESTMENT - 3709 O SAN DIEGO, CA9211137 OF WORK ELEC. FOR EXPANDING 0 IXI TING R NT (STORAGE) AP CANT: T 0: WINSTON CONSTRUCTION - SPECIAL CONDITIONS. CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE WINSTON CONSTRUCTION (909) 483-0707- 2011 GREENWOOD LANE LIC. NO TEMPORARY POWER0 POMONA, CA 91766 576739 B UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: EL. NO: -- UFER GROUND LIC. NO: ' ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N T I r rTTCO PA WY ROTT IF T D REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0101170005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUIL RNG ADDRESS: ON FILE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780 ASSESSOR INFORMATION BER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY K1 SIGNS, OUTLINE LGT 1.00 SIG 38.85 TENANT: TOTAL FEES 66.60 ISSUE ON: PROCESSED Y: PLAN BY: EXPIRES ON: 01/17/01 UT 07/16/01 OWNER: TEL. NO: FINAL DATE FIN Y: CODE: 37709C INVESTMENTco SAN DIEGO, CA9211137 ESCRIPTION OF WOR ELECTRICAL FOR ILLUMINATED SIGN APPLICANT: TEL. 0: HUNG BAD DIEP DBA SPECIAL SIGN - 126 S. SAN GABRIEL SPECIAL CONDITIONS: SAN GABRIEL, CA CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE HUNG SAO DIEP (626) 282-4964- DBA SPECIAL SIGNS LIC. NO TEMPORARY POWER POLE 126 S. SAN GABRIEL BLVD. 783838 C45 SAN GABRIEL CA 91776 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. ND: 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