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Home My Public Portal About5739 ROSEMEAD BLVD_Electrical__ WORKER'S COMPENSATION DECLARATION 20.0019 DPW(12.91) 78A683 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I Save 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 AFETY DIV. copy thereof(Sec.3800 Lab.C,) /As P❑011l:y NO. COrtipany FOR APPLICANT TO FILL IN JOB f.� /2C p /�j�� ADDRESS J C/,� % fyy/ Certified co is hereby furnished. NO. EACH FEE C ` PY Y New Residential Bldgs.&Pools _ $ $ LOCALITY � ❑ Certified copy is filed with the county building Inspection 1 &2.-Family,Sq.Ft. _ NEAREST M department. Multi-family Sq.Ft. CROSS ST. Z U/V/vS Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. —Light t_Sw. OWNER OR FIRM NAME Z COMPENSATION INSURANCE First 20 MAIL � i� (This section need not be completed If the work Involved by the Total No. Additional ADDRESS 3 _ s�� w permit Is for one hundred dollars($100)or less.) f I certify that in the performance of the work for which this permit CITY c e T 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. NOTIC 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. provisions of the Labor Code, you must forthwith comply with such P P Y Power Apparatus&Large Appliances APPLICANT ` PERMIT provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESSRAWOU I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl' !V (commencing with Section 7000)of Division 3 of the Business and CITYZ4ft Tel.No. Professions Code.,and my license is in full force and effect. � Over 10 to 50 Incl } Over 50 to 100 Incl: REG.N N8Li 0 ._ 1- Class. T /® IL License Number Over 100 DISTRICT NO. PROCESSED BY V Lic.Class C—� g�dyy� y p ? Services,Swbd.,MCC&/t?��ne bo –' d O �� 7 47" Date ✓ / 0-399 Am ,UISd 60( �� FINAL ATE Contfactor 0 ❑ I am exempt underSec.. 400-1000 Amp.Under 600 V �� –4' VALIDATION W . Over 1000 Amp.or Over 600 V FINAL B.&P.C.for this'reason BRANCH CIRCUIT FEES BY co a Date: 15A,or 20A,120V,Lighting or Recept. p Z_ 1 To 10'Branch Circuits �``°' �O ivo Signatur r 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,2D8V To 277V Lighting Br.Circuits 2 SINGLE FAMILY Temp.Power Pole&Appurtenances s HOME OWNER-BUILDER DECLARATION l�C l4,a I 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 330 232.5C'( Code): ' _ I �'TEM''F ❑ Misc.Conduits&Conductors TU4' �- I,as owner of the property,will do the work and the structure 3 Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) `o and Professions Code). CHECK CONSTRUCTION LENDING AGENCY HE .00 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) 6 Civ.C.) PLAN CHECKING FEE 3/10/93 Lender's Name I PERMIT ISSUING FEE �� 858S i Ate 9:28 Lender'sAddress I certify that I have read this application and under penalty of purjury state NOTAL FEE xzra that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorize representatives of this County to enter upon the above-mentioned property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE TURE OF PERMITTEE DATE WORKER'S COMPENSATION DECLARATION 20.0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, 76A883 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 .7 � Certified copy is hereby furnished. NO. EACH FEE LOCALITY p New Residential Bldgs.&Pools ❑ 1&2-Family,Sq.Ft. _ $ $ NEAREST Certified copy is filed with the county building inspection �rGt department. Multi-family Sq.Ft. CROSS sr. !',S l � J V%P, Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK I PAGE PARCEL 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 the First 20 MAILADDRESS permit is for one hundred dollars(8100)or less.) Total No. Additional 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 4 Vic// , Total No. Additional ADDRESS Date 61 Applicant V 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. provisions of the Labor Code,you must forthwith comply with such APPUCANY G7 provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances Gtr LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS 3 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 L Tel.No.09 Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. Over 50 to 100 Incl. 'REG.NUMBER 4L,3 class. (FS' D. License Number T/ Lic.Class �4 5� Over 100 DISTRICT NO. p PROC SED BY U �/ Services,Swbd.,MCC&Panelboards ��O �y Er Contractor ��f^ �'T�7Date /93. � 0-399 Amp.Under 600 V FINAL DATE ) O F1i 400-1000 Amp.Under 600 V —l VALIDATION W I am exempt under Sec. Over 1000 Amp.or Over 600 V FINAL a B.&P.C,for this reason BRANCH CIRCUIT FEES BY4/y"' Z Date: 15A,or 20A,120V,Lighting or Recept. _ 1 To 10 Branch Circuits Signal (i' e- 11 To 40 Branch Circuits F-141 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,20 VV To 277V Lighting Br.Circuits 7 SINGLE FAMILY Temp.Power Pole&Appurtenances ACCT o 5 HOME OWNER-BUILDER DECLARATION h Circuit 3 Sign with One Branc -�-+ I hereby affirm that I am exempt from the Contractor's License Law 730 77■65 for the following reason(Section 7031.5, Business and Professions. Additional Sign Branch Circuits Code): 1 ITEMS ❑ 1,as owner of the property,will do the work and the structure Misc.Conduits&.Conductors TOTAL 97.65 ®65 is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). I CASH 97.65 CONSTRUCTION LENDING AGENCY �VIC-_ CHANGE .00 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 /18/93 Lender's Name � X6763 1 AM 11:212 PERMIT ISSUING FEE p` Lender's Address TOTAL FEE I certify that I have read this application and under penalty of purjury state • (�J that the above information is correct. I agree to comply with all County 1 ordinances and State laws regulating Electrical wiring,and hereby authorize! representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE i SIGNATURE OF PERMITTEE DATE f COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0805150032 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I 1 ON FILE I 1 5739 ROSEMEAD BL [ IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ TEMP CA 91780 [ (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LAS TUNAS I 15397-012-043 1A1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, Cl IFI 120V, 15/20A BR CKTS 13.00 BR 217.05 1 [ [TENANT: I TOTAL FEES 244.80 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1 [ 105/15/08 SR 11/11/08 [ (OWNER: TEL. NO: I IFI DATE FI BY: CODE: I ICALAC INVESTMENT (858) 565-8333- 1 1 [ 13709 1 1 I ISAN DIEGO, CA9211137 I IDESCRIPTION OF WORK [ I I ITENANT IMPROVEMENT MEDICAL OFFICE I (APPLICANT: TEL. NO: 1 1 I IPHAN (626) 279-7390- 1 1 [ 110838 WEAVER AVE #6 1 ISPECIAL CONDITIONS: IS EL MONTE CA 91733 I I I ICONTRACTOR: TEL. NO: I [APPROVALS DATE INSPECTOR SIGNATURE 1 IKIM WONG PLUMBING, INC. (626) 286-6080- 1 1 [ 11300 E LAS TUNAS DR LIC. NO 1 ITEMPORARY POWER POLE I [ I ISAN GABRIEL CA 91776 752619BC36 I [ [ 1UNDERGROUND CONDUIT [ [ [ARCHITECT OR ENGINEER: TEL. NO: - I 1UFER GROUND 1 1 1 1 LIC. NO: 1 [ROUGH CONDUIT 1 [ ROUGH WIRING 1 1 [ [MAIN WATER LINE I [ [ [ 1 [PLASTIC Y/N METAL Y/N I I I I I [UTILITY COMPANY NOTIFIED[ I [ [ I I I [ I 1 I [ I [ [ I [ I I I [ 1 [ [ I [ 1 [ [ I [ I I 1 [ [ I I [ IREPORT ID: DPR265 ROUTE TO: BS0508 [ [ [ • COUNTY OF IAS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0803310016 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: [LEGAL ID: I FEES PAID I BUILDING ADDRESS: I [ ON FILE [ [ 5739 ROSEMEAD BL [ [ TEMP CA 91780 I [ASSESSOR INFORMATION NUMBER: IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:I NEAREST CROSS STREET: I 15397-012-043 [Al PERMIT ISSUANCE FEE 27.75 [ THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, Cl [K1 SIGNS, OUTLINE LGT 1.00 SIG 38.85 [ TENANT: [ TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: MEDICAL CLINIC [ [03/31/08 SR 09/27/08 [OWNER: TEL. NO: I [FINAL DATEF BY: CODE: ICALAC INVESTMENT / 3709 SAN DIEGO, CA9211137 [ [DESCRIPTION OF WORK 14 [ [ [ (ELECTRICAL FOR ILLUMINATED CHANNEL LETTERS [APPLICANT: TEL. NO: [ [ IJ & H SIGN, INC. (626) 448-1166- [ [ [9441 VALLEY BLVD. I (SPECIAL CONDITIONS: [ROSEMEAD, CA 91770 [CONTRACTOR: TEL. NO: [ [APPROVALS DATE INSPECTOR SIGNATURE [ IJ AND H SIGN, INC. (626) 448-1166- [ I [ 19441 VALLEY BLVD. LIC. NO [ [TEMPORARY POWER POLE I I [ [ROSEMEAD, CA 91770 873439 C45 I I I I [ (UNDERGROUND CONDUIT I I [ARCHITECT OR ENGINEER: TEL. NO: [ [UFER GROUND I [ [ [ LIC. NO: [ [ROUGH CONDUIT I [ (ROUGH WIRING u [ I [MAIN WATER LINE I I [ [ [ [PLASTIC YIN METAL YIN I [ [ [ [ [UTILITY COMPANY NOTIFIED[ [ [ I ! I I I I I I I I I I I I ! I I I I I I I I I I I I ! I I I I I I I I ! ! I I I I I I I I I I I I I I I I I [ [REPORT ID: DPR265 ROUTE TO: BS0508 I [ I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508CECTR-I-CAL�MR IT1 DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS LL.Q5D8 9809.170036 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING A SS: ON FILE EAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TSE P—CA-9178OJ ASSESSOR INFORMATION NUMB R: NEAREST CROSS STREET: 5397-012-043 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE C TY K1 SIGNS, OUTLINE LGT 1.00 SIG 38.85 TENANT: TOTAL FEES 66.60 ISSUED ON:—PROCESSED BY: PLAN BY: EXPIRES CHECK IN GO 09/11/98 UT 09/11 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: CALAC INVESTMENT - 1 —410. tor 3709 xrj SAN DIEGO, CA9211137 DESC F;rf0 -OF-WO —1-_ fLEGi-f-`AL FOR CHANNEL LETTERSIL ILL NATED)-SLGN� APPLICANT: TEL. NO: QUIEL BROS SIGN. (909) 885-4476- 272 S. "I" SPECIAL CONDITIONS: SAN BERNARDINO, CA GE ES CO QUIELABROS:ELECTRIC SIGN SER. (909)N885-4476- X05 ��,'� APPROVALS DATE INSPECTOR SIGNATURE 272 S. "I" LIC. NO TEMPURARY TEMPURAPOWER POLE SAN BERNARDINO, CA 92710 217345 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TE . N0: UFER GROUND LIC. NO: 1111111 ROUGH CONDUIT ROUGHWIRING P USK G` ��j 0�K 6 PLASTIATER LINE �I PLASTIC Y/N METAL Y/N 0 0 TILITY COMPANY OTIFIE O ❑ '':I'� ,IU�. El 46eb blc ElQ Service That f REPORT ID: DPR265 ROUTE TO: SSO5O8