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Home My Public Portal About5731 ROSEMEAD BLVD_Electrical__ WORKER'S COMPENSATION DECLARATION 20.0019 DPW 9/gS 76A663 APPLICATION FOR ELECTRICAL PERMIT !lIJJJ I hefeby 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. Company FOR APPLICANT TO FILL IN JOB , ADDRESS [jCertified copy Is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE LOCALITY ❑ 1&2-Family,Sq.Ft. $ — $ Certified copy is filed with the county building inspection NEAREST department. Multi-family Sq.Ft. CROSS ST. Residential Swimming Pools ASSESSOR.. Date Applicant MAP BOOK PAGE IPARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWNER OR. COMPENSATION INSURANCE FIRM NAME (This section need not be completed if the work involved by t First 20 MAIL permit is for one hundred dollars($100)or less.) I No. Additional ADDRESS I certify that in the performancof th r or which t it CITY T.I. is issued, I shall not employ Ben rson in ny ma er s to PLAN CHECK become sub' ct to Worker ' ampensatio w ting Fixtures First ZO APPLICANT J Total No. Additional ADDRESS Date Applicant 15 OR 20A,120V BRANCH CIRCUITS NOT EYPPLICA T: If, a making this Certifica a CITY Tel.No. Ex ptioshould become subjIct to the Workers'Compensation 1 TO 10 INCLUSIVE EACH provisione Labor Code,you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMIT APPLICANT provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH LICENSED CONTRACTORS DECLARATION ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH (commencing with Section 7000)of Division 3 of the Business and I CITY Tel.No. V Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR Power Apparatus 8 Large Appliances REO.NUMBER class. Q Size&Type HP,KW,KVA,Or KVAR DISTRICT NO. POC SED BY Q License Number Lic.Class v�� ! p V Up to 3 Incl. ,�d �?Lz.�T e� W Contractor Over 3 to 10 Incl. FINAL Date d El f7: � Over 10 to 50 Incl. DATE` � I am exe t under Sec." Over 50 to 100 Incl. VALIDATION FINAL p B.&P.C.for this.reason Over 100 BY Services,Swbd.,MCC&Panelboards /Y Date: 0-200 Amp.Under 600 V Signature 201-1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit1. �)oa I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits -+-� 59.55 Code): 3307 ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors 1 ITEMS is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) TOTAL a and Professions Code). CHECK 5Qe55 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the CHANGE .00 performance of the work for which this permit Is issued(Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) Lender's Name PLAN CHECKING FEE 0000-0001 $11ti$� PERMIT ISSUING FEE 4972 1 AM 9'14 Lender's Address I certify that I have read this c and state at a above TOTAL FEE informs correct. I e ply with all unty rdinances an tate I s regul g r' al wiring, a her y authorize presentat' s of Cc y t enter up the a ve-me tioned property f tion p p as. SEE REVERSE FOR EXPLANATORY LANGUAGE I UR OF APPLICANT -AGENTTE t {� I htreby affirM that I WORKER!ha OMa Qert�if gate Doff co s6 tl to self insufe,- 20-0018 DPW(12=91)76A663 APPLICATION FOR ELECTRICAL PERMIT u or a certificate of Worker's Compensation Insurance, or a certifled COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec'38002Lab.C.) Pol•cy No 22 +4 + ! Company• - '�" ~r , FOR APPLICANT TO FILL IN JOB �`- Mot.-I ADDRESS y 3 Q( ot. Certified copy is hereby furnished. ��-�./ New Residential Bldgs.&Pools NO.. EACH FEE LOCALITY Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. NEAREST department. V Multi-family Sq.Ft. CROSS ST. PLP'i wp 7 Date. ^a Applicant VN�r Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE-OF EXEMPTION FROM WORKERS' Outlets:Rec. Light--L Sw.0 OWNER OR FIRM NAME COMPENSATION INSURANCE Id�fl Q I First 20 � MAIL (This section need not be completed If the work Involved by the �'� ADDRESS permit Is for one hundred dollars($100)or less.) I Total No. Additional I certify that in the performance of the work for which this per it CITY Tel.No. is Issued, I shall not employ any person in any manner so a to PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT �A �t�(►f I. Total No. Additional DateApplicant I, RESIDENTIAL APPLIANCES NOT OVER 3 HP. ADDRESS - �T�J ' NOTICE TO APPLICANT: If, after making this Certificate of CITYTel.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 p y Power Apparatus&Large Appliances APPLICANT S A provisions.or this permit shall be deemed revoked: ; LICENSED CONTRACTORS DECLARATION i 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. CITY Tel.No. (commencing with Section 7000)of Division 3 of,the Business and ® 1� Over 10 to 50 Incl. Professions Code,and my license.is in full force and effect. LICENSE OR ` a� 7 Class. Over 50 to 100 Incl. REG.NUMBER G X a Z O Over 100 DISTRICT NO. P OC SSED BY V License Number, 4mr 3 Lic.Class F Q Services,Swbd.,MCC&Panelboards �O l/d / Contractor N� Date a 0-399 Amp.Under 600 V FAQ 0 0 ✓�' I am exempt under Sec. ( 400-1000 Amp.Under 600 V �� •�' VALIDATION LLI V Over 1000 Amp.or Over•600 V FINAL D. B.&P.C.for this reason BY Z BRANCH CIRCUIT FEES Date: 15A,or 20A,120V,Lighting or Recept. _ ( 1 To 10 Branch Circuits Signature I 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 Temp.Power Pole&Appurtenances HOME OWNER-BUILDER.DECLARATION ACCT a va' I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit c for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits �}�� 83.95 Cade): 1 ITEMS 0 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 83 o 95 and Professions Code). CASH 83.95 .lN CONSTRUCTION LENDING AGENCY CHANGE o00 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) C10Of) PLAN CHECKING FEE I 0000'40.01 7!23/96 Lender's Name PERMIT ISSUING FEE7598 1 AM 9:04 a 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 ajids,t la egulating Electrical wiring,and hereby authorize represen ves of thi C unty to enter upon the above-mentioned property for inspe ionpurpose SEE REVERSE FOR EXPLANATORY LANGUAGE "2 SIONATURE'OF PER KT - DATE WORKER'S COMPENSATION DECLARATION 20.0019.DPW'(12-91) 1 I heroby affirm that I have a.certificate of consent to self'Insure, 76A883 APPLICATION FOR ELECTRICAL PERMIT �f or'a certificate of worker's Compensation Insurance, ora certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. 'copy therepf.(Sec.3800 Lab.C Pcficy N� pany / FOR APPLICANT TO FILL IN I ADDRES J E] Certified copy is New Residential Bldgs.&Pools hereby furnished. NO: EACH FEE I LOCALITY Mdft_A/Jn az 1 &2-Family,Sq.Ft. _ $ $ AEW d with the county wilding ins ion NEAREST Multi-family Sq.Ft. CROSS ST. Residential Swimming Pools I ASSESSOR Date Applicant MAP BOOK PAGE PARCEL- CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. FIRM NAME Light OWNER OR COMPENSATION INSURANCE - SW. i First 20 MAIL (This section need not be completed if the work Involved by the Total-No. Additional ADDRES permit is for one.hundred dollars($100)or leas.) I certify that in the performance of the work for which this permit CITYgAt4wQ 1 1 I.No. Is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compensati n Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date - Appli RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICAN after making this Certificate of CITY Tel.No. Exemption,you should be me subject-to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code,you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. 1 Power Apparatus&Large Appliances I APPLICANT LICENSED CONTRACTORS DECLARATIONSize&Type HP,KW,KVA,or KVAR ADDRESS I herebyA I � / �7 affirm that I am licensed under provisions of Chapter 9 . (commencing with Section 7000)of Division 3 of the Business and Over 3 to 10 Incl. CITY TeI.:No. Over 10 to 50 Incl. Professions Code,and my license is in full force and effect. LICENSE OR ' Over 50 t0'100'Incl. REG..NUMBER CI s. ♦✓ d Af 92 Over 100 DISTRICT NO. C ED BY V License Number .1c.Class C p Services,Swbd.,MCC&Panelboards 0 399 Am Under 600 V I FINAL O Contractor, Date p' DATE F 400-1000 Amp.Under 600 V 22D� ❑ I am exempt under Sec. ✓J(). VALIDATION V Over 1000 Amp.or Over 600 V I FINAL Id B•&PCC.for this.reason BRANCH CIRCUIT FEES I BY (n e: 15A,or 20A,12oV,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ aint. 41 Or More Branch Circuits 2 Exemption for Reg MElect. 15A,20A,208V To 277V Lighting Br.CircuitsA►�1 T'Z. SINGLE FAMILY HOME OWNER-BUILDER DECLARATION 3303 Temp.Power Pole&Appurtenances 441f u0 1 hereby affirm that I am exempt from the Contractor's License Law Sign.with One Branch Circuit for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 1 ITEMS Code): TOTAL 66.05 ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&'Conductors CHECK is.not Intended or offered for sale(Section 7044, Business Other(See.Complete Fee Schedule) and Professions Code). poll. CHANGE .00 CONSTRUCTION LENDING A ENCY I hereby affirm that there is a constrSplifn lending agency for the performance of the work for which permit is issued(Sec. 3097, PERMIT FEE (Sub-Total) 0000-W01 715/96 Civ.C.) PLAN CHECKING FEE 7458 1 PM 5:44 ' Lender's Name .. PERMIT ISSUING FEE 0: Lender's Address D TOTAL FEE I-certify that I 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 representatigs of this County to enter upon the above-mentioned property for inspe n purp SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF P,PMTTEE , COUNTY OF LOS ANGELES TEMPLE CITY 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0408160034 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL FEES PAID - BUILDIIiG ADDRESS: ON FILE 5731 ROSEMEAD SL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA ASSESSOR NFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, C K1 SIGNS, OUTLINE LGT 1.00 SIG 38.85 TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED : PLAN BY: EX RES ON: TIM WANG 08/16/04 JK 02/12/05 OWNER: TEL. FL�1TF FI1 BY: COLE: CALAC INVESTMENT (858) 565-5-8333- ((''�/�41P��`��-- 3709 SAN DIEGO, CA9211137 DESCRIPTION OF WORI ELECTRICAL FOR SIGN APPLICANT: TEL. NO: XU (626) 444-8181- _ 2812 PECK RD SPECIAL CONDITIONS: EL MONTE, CA 91731 CONTRACTOR: TEL IdO: PPROVALS DATE INSPECTOR SIGNATURE SUCCESS SIGN (626) 444-8181- 2812 PECK ROAD LIC. NO TEM?ORARY POWER POLE SUITE# A 739177C45 EL MONTE CA 91721 UNDERGROUND CONDUIT ARCHITECT OV ENG REER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDU.1 - — +— ROUGH WIRING MAI— N WATER LIWE PLASTIC Y/H METAL Y/N UTIL�CO COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9608090015 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA DUPLICATE PHONE: (818) 285-0488 EXT: EGAL ID: FEES PAID BU DING ADDRESS: ON FILE 5731 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 A1'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 ISSUED ON: PROCESSED BY: PLA BY: EXPIRES ON: LANICO TV & APPLIANCE 08/09/96 TC 08/09/97 OWNER: TEL. NO: FINAL DATE //FINAL BY: CODE: CALAC INVESTMENT - '2O 9c{� /(ff,;A�1� DESCRIPTIO OF-WORKV ADDITIONAL SIGN CABINET FOR EXISTING POLE SIGN 2lX10l APPLICAN L. NO: SIGN ART CO (818) 287-2512- . SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: v"Ji a APPROVALS DATE INSPECTOR SIGNATURE HSIEH, EDDY (818) 287-2812- 425 S CALIFORNIA LIC. NO TEMPORARY POWER POLE SAN GABRIEL,CA 491427/C45 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TE 0: - -1 ,`fti FER GROUND LIC. NO: I y -�1 ROUGH CONDUIT ROUGH WIRING i p U BB U C . A R K MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED �cl rv�� REPORT ID: DPR265 ROUTE TO: BS0508