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HomeMy Public PortalAbout5749 ROSEMEAD BLVD_Electrical__ WORKS -'-')MPENSATION DECLARATION CE-806G 10/81 B�PP C ___ON FOR ELECTRICAL PERMIT I hereby affirm tha' 9 a certificate of consent to self insure, CE-806G 9�1P�r f!� "fl or a,certificate of s' Compensation Insurance, or a certified COUNTY OF LC,_ _AGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) /1 �� i olicy�NC/ Company S 7•T ne )eo—mol FOR APPLIbANT TO FILL IN JOBUry Certified copy is hereby furnished. EACH NO. FEE ADDRESS New Residential Bldgs.&Pools rl Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ — $ LOCALITY department. Multi-family Sq.Ft. — NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER R FIRM NAME A CERTIFICATE OFCOMPEXEMPTION NSATION INSURANCE WORKERS' Outlets:Rec—Light_Sw.— ADDRESS () Qa (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.No. eO oe I certify that in the performance of the work for which this permit PLAN CHECK -PPUOANT is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 2.0 ADDRESS Additional Total No. CITY Tel.No. Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT r _ Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPugANT provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS / d� provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. No. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ CITY Tel. 49rq�- I hereby affirm that I am licensed under provisions of Chapter 8Disp. — Room Air Cond. LICENSE OR �� �� `p/D (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER Class. Professions Code,and my license is in full force and effect. DISTRICT NO. PR ED BY Power Apparatus&Large Appliances� �• �O O L G� Size'&Type HP,KW,KVA,or KVAR License NumberS7 9 / y Lic.Class C / Up td 1 Incl. FINAL V _ DATE VALIDATION Over 1 to 10 Incl. � Contractor L G�L L( �° Date '3/-9� Over 10 to 50 Incl. ❑ FINAL V I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C.for this reason Over 100 N Date: Services,Swbd.,MCC&Panelboards ® Z 0-200 Amp.Under 600 V' Signature 201 - 1000 Amp.Under 600 ❑ Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit y I hereby affirm that I am exempt from the Contractor's License Law ,additional Sign Branch Circuits ( for the following reason(Section 7031.5,Business and Professions Code): ❑ 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) and Professions Code). ► 333- CONSTRUCTION LENDING AGENCY :,+j'; 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) :TEN-E. Civ.C.). =A6-S a 00 PLAN CHECKING FEE Lender's Name J �OLECO-'i 4 S°LI1• PERMIT ISSUING FEE _ Lender's Address TOTAL FEE Gi'� ,''HANGS I certify that I have read this application and state that the above information is correct.I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize -�r r r r r r , representatives of this County to enter upon the above-mentioned Ljo€i ,.Itit(; I_j/;:��j �p ty Inspection purposes. D SEE REVERSE FOR EXPLANATORY LANGUAGE ` Signature of Per ee Date L G w 3.— WC WC-------COMPENSATION DECLARATION '20.0019DP..W3/87 I hereby of 3t I have a certificate of consent to self. aAPPL, I►TION R ELE. RICAL PERMIT insure, or a ti ate of Workers'Cpensation Insurance, COUNTY 1 �S ANGELES DEPT. OF PUBLIC WORKS or a cert' ied copy th ��'' Policy N� PY'��Ca ,dpb. C.) _ ---V�7�� ��, FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. ■ iNew Residential Bldgs. &Pools EACH NO. FEE ADDRESS 5747 1 Z&_1112 Mi; Certified copy is filed with the tountY buildin inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY (' tion department. , Multi-family Sq. Ft. NEAREST IF CROSS S7. Date ApplicantM Residential Swimming Fools OWNER OR ,f FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' I Outlets: Ree Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work Involved by First 20 CITY the permit is for one hundred dollars(;100).or less.) Total No. Additional [ PLAN CHECK ,.J I certify that in the performance of the work for which This APPLICANT permitis issued,tshall not employany person in any ma�er Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation La s. e . Additional Total No: CITY 0 Tel. N_q?� 2 22 Date Applicant Fixed Appliance's.Not Over 1 HP PERMIT C �' `t NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION . Exemption, you should become subject to the Workers' Range— Heater—D.W. — y Compensation provisions of the Labor Code, you-must forth- Oven — Dryer —W.M.— ADDRESS /�S 1_ with comply .with such provisions or this permit shall;be Top — FAU _WH. _ deemed revoked. Hood — Fan —Other— CITY Tel. No. . LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. _ Room Air Cond. — Class.d4e. I hereby affirm that I am licensed under provisions of Chapter 9 REG.NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. P O SSED BY d and Professions Code,and my license is in full force and effect. Size&Type HP; KW, KVA, or KVAR �� �� � U License Number 42 YJ` Lic. Class4-74 0��Q Up to 1 Incl. FINAL Contractor `I i�G �� Date 1 *_ �> Over 1 to 10 Incl. DAA VALIDATION 0 aOver 10 to 50 Incl. FINAL I am exempt under Sec. Over 50 to 100 Inc. BY U Ba- _.BP.C. for this reason Over 100 d Servi CC&Ponelboards fn Date: ' -200 A Under 600 V �� i , Z Signature. 201 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 I herebyaffirm that I am exempt from the Contractor's License Sign with One Branch Circuit "'TJL P t�it•4. ■v Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits _ - Professions Code): Z,31_r 'b r ■ =13 0 I, as.owner of the property,.will do the work and the Misc. Conduits 8 Conductors I ITEMS structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)_ , Business and Professions Code). 'kl•i AL 67®00 CONSTRUCTION LENDING AGENCY ;(iEt''••.K 67.0-711 I hereby affirm that there is a construction lending agency for ti{ty�t(L3 1jt] the performance of the work.for which this permit is issued PERMIT FEE (Sub-Total) ■ (Sec. 3097, Civ. C.). PLAN CHECKING.FEE Lender's Name PERMIT ISSUING FEE 0111110-010-19 1 7/3-0/9 i Lender's Address 'f 2O n ■t■ I certify that I have read this application TOTAL FEE and state that the T f AM ar above informWitted cot. I agree to comply with,all County ordinances as regulat' g Electrical wiring, and M)y authofives o this County to enter upon ov. TV rty for nspection pur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig .ure Vote P'P ®' WORKERS'COMPENSATION DECLARATION 20.0019 DPW 3/87 I hereby affirm that I have a certificate of-consent to self � APPLICATION FOR ELECTRICAL PERMIT O insure, or a certificate of Workers'Compensation Insurance, COUNTY OF-LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof(Sec. 3800, Lab. C.) i Policy No. Company FOR APPLICANT TO FILL IN JOB > p ❑Certified'copy is hereby furnished. I' New Residential Bldgs. &Pools EACH NO. FEE ADDRESS 4 mos B i4A.D p LVr) ❑Certified copy is filed with the county building inspec- I 1 &2-Family, Sq. Ft. $ —Is LOCA LITYlk M L.e CI? tion department. Multi-family Sq. CROSS ST. LAS 'TU AJ Date Applicant Residential Swimming NEAREST ing Pools OWNER OR FIRM NAME CNAK0160 fid. CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ I MAILs COMPENSATION INSURANCE First 20' ADDRESS 100 OCL Ad ?Li GOn (This section need not be completed if the work Involved by Total No. Additional CITY L,OMC,. Vac cei Tel. No. 1.137_ 0% the permit Is for one hundred dollars.($100)or less.) I certify that 'in the performance of the work for which this APPLICANT PLAN CHECK L.A.11 L 0 rr permit is issued, I shall not employ any person in any manner j so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 2.0 ADDRESS ?3- Additional j Total No.. CITY `�_ Tel. No. - Date Applicant Wo CdL 7 Z .ZZ 0 NOTICE TO APPLICANT: If, after.making this Certificate of Fixed'Appliances Not Over 1 HP PERMIT e— Heater—D.W. APPLICATION Exemption, you should become subject to the Workers' I Range Compensation provisions of the Labor Code, you,must forth- Oven _ Dryer —W.M.— I ADDRESS with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION Dis _ Room Air Cond. — '' LICENSE OR I hereby affirm that I am licensed under provisions.of-Chapter 9 p• REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business. ;l Power Apparatus&Large Appliances DISTRICT NO. P ESSED BY >- and'.Professions Code,and'my license is in full force.and.effect. (y n. Size&Type HP, KW, KVA, or KVARe� O License Number Lic: Class () Up to 1 Incl. I FINAL MA,i Over 1 to 10 Incl. I DATE 3 /pLIDATION77 Contractor Date I , EJ Jr Over 10 to 50 Incl. j FINAL I Ev U I am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C.for this reason j Over 100 TOTAL 87 m 5ULI Services, Swbd..,MCC&Ponelboards fiaI bb55 .-Date:. CHECK 0-200 Amp. Under 600 V Signature I 201 - 1000 Amp. Under 600 V Sri.120 1-16 CHANGE .00 l ❑ Over 1000 Amp. or Over 600 V j Exemption for Reg. Maint. Elect. i SINGLE FAMILY ;I 101100-11001 11/14/911 HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances I hereby.affirm that I am exempt from the Contractor's License. Sign with One Branch Circuit ;i 3$32 1 PM 5; Law for the following reason (Section 7031..5, Business and Additional Sign Branch Circuits Professions Code): I� Misc. Conduits&Conductors / 1 F-1 1, as owner of the property, will do the;work and the I Other(See Complete Fee Schedule)_ structure is not intended or offered for sale(Section 7044, Pilo v Business and Professions.Code). • 4 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE S� / Lender's Name n PERMIT ISSUING FEE +v]I Lender's Address TOTAL FEE I I certify that I have read this application and state that the above information is correct: I agree to comply with all County I Q ordinances and State Idws.regulating Electrical wiring, and i pL$6 C, 0 tt � hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ®s WORM ;OMPENSATION DECLARATION '2000tvDPW ais7 APPLIf BION FOR ELECTRICAL PERMIT I. hereby offirn. ,�� I have a certificate of consent to self CE�a insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof(See.,3800, Lab. C.) Policy Noll"�—Company 5-M-CL� R716�1� FOR APPLICANT TO FILL IN JOB ua Q Gt �; iLJ�f Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS 7�1 1 I��SEM D 1.��.•� LOCALITY ❑Certified copy is,filed with the county buildin ins ec- 1 &2-Family, Sq. Ft. $ tion department. Multi-family Sq. Ft. NEAREST TU N S �f Residential Swimming Pools CROSS ST. L- Date / ���� Applicant OWNER OR / FIRM NAME I Off • CERTIFICATE OF EXEMPTION FROM WORKERS' J_Li MAIL G�'f �0. COMPENSATION INSURANCE Outlets: Rec ght Sw.� i•qO a $ ADDRESS IOC) O (This section need not be-completed if the work Involved-by First 20 CITY, N Tel. No. the permit is for one hundred dollars.($100)or less.) Total No.� Additional H Ct �F37 $O��o PLAN CHECK .I certify that in the performance of the work for which this APPLICANT L M fsryGIiN permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'.Compensation Laws. Lighting Fixture'�s'�QQ First 20 6 0 ADDRESS 8' t/E. Total No.� Additional CITY Tel. No. 1 O Date Applicant t N �1�412�D� �j'�a'�►�. NOTICE TO APPLICANT: If, after makingthis Certificate of Fixed Appliances Not Over 1 HP PERMIT c� moi. Range_'Heater—D.W. APPLICATION CZ? I C_ Exemption, you should become subject to the Workers' 9 Compensation provisions of the Labor Code, you must forth- Oven Dryer —W.M.— ADDRESS laV0 N iJ vF S'T with: comply with,such provisions or this permit shall be Top FAU —W.H..— deemed revoked. Hood Fan _Other_ CITY A"kff.. cagy6, Tel. No-foo- LICENSED CONTRACTORS DECLARATION LICENSE OR REG.NUMBER Disp. — Room Air Cond. — 5jb99� Class.C 1.O 1 hereby affirm that I am licensed under provisions of Chapte�•9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PRO SSED BY a and Professions Code,and my license'is in full force and effect. tI Size&Type HP, KW, KVA, or KVAR �D P .0 License'Number S�711 a Lic: Class 0 Up to 1 Incl.. FINAL DATE � D�.�,- . � !.... Over 1 to 10 Incl. t0 -11 -411 VALIDATION O Contractor [ CSF ' Date fF Over 10 to 50 Incl: FINAL1-- El❑ I am exempt under Sec. Over 50 to.100 Inc. gy B.&P.C. for this reason Over 100 • a Services', Swbd..;-MCC&Ponelboards ► Z ' - Date:: �p Z 0-20 A�lrtnld � Signature 201 - 1000 1199(1 V � ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600.V SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit t+ — s r I hereby affirm that I am exempt from the Contractor's License AC,C):• Law for the following reason .(Section 7031.5, Business and Additional Sign Branch Circuits. -- Professions Code): 3307 ,a.Lo%I:l Conduits&Conductors❑ E G I, as owner of the property, will do the work and the Misc. f, Z I���• structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)— Business and Professions.Code). TOTAL 3 00. CONSTRUCTION LENDING AGENCY '»1HEL:7K .131; I hereby affirm that there is a construction lending agency for the performanceof the work for which this permit is issued PERMIT FEE (Sub-Total) ANNE Ll (Sec. 3097, Civ. C.). ' PLAN CHECKING FEE t o ,_ Lender's Name PERMIT ISSUING FEE y� 7j.� ijl 00-1311313 7/3'10 `1 Lender's,.Address TOTAL FEE f 3 I CO �'4L ' ` ''" I certify that 1 have read this application and state that the • above i.nformat'ion is correct. I agree to comply with all County ordinances and'State,laws regulating Electrical wiring, and u hereby aut r of this County to enter upon V 9 Lp(�G t ve- . oned,property f o. inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE . 1-M-91 Signature of Permittee Date ®' �/J' I WORT ;OMPENSATION DECLARATION 1gDPW 3/87' APPLII 'ION FOR ELI CTRIQ ►L PERMIT r '�„ 764663 I hereby affirr. (l have a certificate of consent to self cE•eoaG insure; or a ce b of Workers'Compensation Insurance, COUNTY O. �r ANGELES7� DEPT. OF PUBL WORKS 4 or a%rtified copy tfiereof(Sec. 3800, Lab..C.) ou Policy'Nbl1P.914 9 2 8 a-�,Qp7eny_Fremont Ins. J FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. �•-/`-%pZ New Residential Bldgs. &Pools EACH NO. FEE ADDRESS Certified copyis filed with the cou tY buildi g inspec 1 &2=Family, Sq. Ft. $ -_ $ LOCALITY Tem ,le Cit CA. tion depart NEAREST nt. Multi-family Sq. Ft.. "— Tem le CityBlvd. ✓ JResidential SwimmingPools CROSS ST. P Date Applicant: , OWNER OR FIRM NAMEDCI CONSTRUCTION CERTI .CATS OF EXEMPTION FR M WORKERS'. -Li MAIL Outlets: Rec. ght�_Sw.�$ 2698,COMPENSATION INSURANCE 0 �� �O ADDRESS Dawson Ave. First 20 / (This section need not be completed If the work involved by Total No. 101 Additional, r (p0 CITYTnnc Tel. No213) 426 0833 Rea nh the permit is for one hundred dollars($1160)-or less.) PLAN CHECK I.certify that in the performance of the work'for which'this APPLICANT permit is issued, 1 shall not employ any person in any manner ♦� so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 + �a fl ADDRESS Additional Total No. 3.02 CITY Tel. No. Dote Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: 'If, after making this Certificate of APPLICATION Hillik Electric IriCOr Orat Exemption; you should. become subject io the Workers' Range— Heater—D.W. — Compensation provisions of the Labor Code, you must forth- O4en• — Dryer —W.M.— ADDRESS 7353 Canoga Ave. with comply with such provisions or this permit shall be Top . — FAU. —W.H. — deemed revoked. Hbod — Fan —Other— CITY Canoga Park 111156. 70.4-822 LICENSED CONTRACTORS DECLARATION -, LICENSE OR Djgp. _ Room Air Cond'. — Class. I hereby affirm that I am licensed under provisions of Chapter 9 � REG. NUMBER 5 5 6 0. C-�. (commencing with Section 7000)of Division 3 of the Business power Apparatus&Large.Appliances I DIST9ICT NO. P O SSED BY d and Professions Code;and m license is in full force and effect. �h 6.Z 3�'p f. Size&Type HP, KW, KVA, or KVAR d' O License Nimber ; Lic. Class C-10 Up.to 1 Incl. FINAL U Hillik Eleetr`q, 5/22/91 M Over 1 to 101ncl.1'0 /O r DATE 0O Contractor 'I VALIDATION ❑ tran5ford8o to 5o Incl. 2 FINAL - I am exempt under Sec. Over 50 to 100 Inc. BY U W B.&P.C. for this reason Over 100 d z Z. Services, Swbd.,MCC&Panelboar 1 AlI �� O Z Date: 0-200 Amp. Under 600 V Signature. 201 - 1000 Amp. Under 600 V F-1Over 1000 Amp. or Over 600 V Exemption•for Reg. M'aint. 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 ; •I• Law for the following reason (Section 7031.5, Business,and Additional Sign Branch Circuits l�ti�;re:a ftfessions Code): 4316.- _1 ❑ I, as owner of the property, will do the work and the Misc.'Conduits 8 Conductors t--� a- structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)_ '(-1I Business and Professions Code): TO).AL 436 .0 CONSTRUCTION LENDING AGENCY CHECK ;i. I hereby affirm that there is a construction lending,agency for 4`'O'='') the performance of the work,for which this permit is issued ,; PERMIT FEE (Sub-Total) a. © CHAIN-13L aLi (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name • PERMIT ISSUING FEE �� •+ .� L'ender's Address TOTAL FEE 3 �.�d 7 �Li � Ar �, I certify that J have.read this application and state that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby a thorize .�r' resentativ s of this,County to enter upon e o - ntion roperty or inspection rpose). SEE REVERSE FOR EXPLANATORY LANGUAGE Sig a re of Vermitteve Date ®s / .J ////%'XCAL PE Q ,, -W WORKE-°-` -7MPENSATION DECLARATION 20.0019 DPW 3/87 ?I hereby affirm' have a certificate of consent to self CE�806G APPLIC ION FOR ELIC RIMI inLure., or a cert of Workers'Compensation Insurance, COUNTY OF ANGELES DEPT. OF PUBLIC WORKS or a%?,rtifiedcopy Hereof ec. 3800 Lob. C. 1A 011 Policy No. o f � FOR APPLICANT TO FILL IN JOB . . OCertified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS LOCALITY .gyp Certified copy is filed with th4F . 4' ildinjgn ec- 1 &2-Family, Sq. Ft. - $ $ ltion de artment. 1 Multi-famil S Ft. NEAREST CROSS ST. DateIJA .4 Applicant Residential Swimming Pools OWNER OR i FIRM NAME 4,6� CERTIFICATE OF EXEMPTIOWORKERS' 3 MAIL COMPENSATION'INSURANCE Outlets: Rec�Light Sw. >�� D ADDRESS First 20 (This section need not be completed If the work-Involved by I CIN w� Tel. No. Total No. Additional the permit is for one hundred.dollars($.100)or less.) [r- '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 ,A so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS �1,9 �v� Additional Date Applicant Total No. � CITY0 rrvv ` Tel. No. Z72-222_4 Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION Exemption,. you should become subject to the Workers' Range— Heater—D.W. — 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 —W.FI. — deemed revoked. Hood — Fan —Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR — I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG.NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY d and Professions Code,and my license is in full force and effect. y n Size&Type HP, KW, KVA, or KVAR O License Number G - L1c. Class `'! Up-to 1 Incl. IFINAL U �t C�Lif��� Over 1 to l0 Incl. DATE ;O-�(� ,-g VALIDATION cc Contractor^ 'r^''6 to � 1 Over 10 to 50 Incl. U ❑ FINAL I am exempt under Sec..- Over 50 to 100 Inc. BY W B.&P. f r t TS Over 100 EL IQ Services, Swbd..,MCC 8 Paoelboards ® Z te: 0-200 Amp. Under 600 V Signatur 201 -1000 Amp. Under 600 V Exemption for Reg. Mai.nt. Elect. Over 1000 Amp. or Over 600 V 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 Licenseii 2 3 - 8—s 0 Law for the following:reason (Section 7031.5, Business and Additional Sign Branch Circuits j j1_ o Professions Code): - 306.1 Ell, as owner of the•property, will do the work and the Misc. Conduits 8 Conductors ' structure is not,inte.nded or offered for sale(Section 7044, Other(See Complete Fee Schedule)— CHANGE °1313 Business and Professions Code). CONSTRUCTION LENDING AGENCY ? 1i� Lj-�li{si! i'i'E li S I hereby affirm that there is a construction lending.agency for the performance of the work for-which this permit is issued PERMIT FEE (Sub-Total) AVI 80 (Sec.3097, Civ. C.). PLAN CHECKING FEE b O TEM - Lender's Name 0 � PERMIT ISSUING FEE ,3 Q!� �i���1_ ��� Lender's Address n ti ''^ I certify that I have read this application and state that the I TOTAL FEE Q P �Q t:.E�1E��� 1t ii°-13 above information is correct. I agree to comply with all.County a di nes and State aws reg lating Electrical wiring, and CHANGE here uth 'ze rept a to of this County to enter upon the a o - IS, ed erty or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE -+ i =r`/1 s/Signtu . ttee D to 7M 1 Art .3^(•ice' ®' WORK OMPENSATION DECLARATION 76-663 to/st AuC�!tom'L� ifli3lp C 0®N FOR ELECTRICAL PERMIT I hereby affirm th, re a certificate of consent to self insure, CE-806G or a certificate of .......rs' Compensation Insurance, or a certified COUNTY OF Lu, ANGELES BUILDING AND SAFETY copy thereof 3 0 CC 7,� /►�p fl. Policy � ""companyJOB k FOR APPLICANT TO FILL IN ADDRESS - ❑ C ified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE LOCALITY 1 &2-Family,Sq.Ft. $ — $ Certified copy is filed with the coun build! g ! p on _ NEAREST de tment. Multi-family Sq.Ft. CROSS ST. A Date v Applicant °� Residential Swimming Pools OWNER OR q FIRM NAME �y N1 v C RTIFI ATE OF EXEMPTI FROM WORKERS' Outlets:Rec—Light_.Sw.— MAIL COMPENSATION INSURANCE First 20 ADDRES ac (This,section need not be completed if the work Involved by the CIT el.Nor—'112 permit Is for one hundred dollars($100)or less.) Total No. Additional !RAH I 40)3361a,a I certify that in the performance of the work for.which this permit PLAN ECK APPLICANT is issued, I shall not employ any person In any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel.No. Date Applicant I Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. provisions of the Labor Code.,.you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS r provisions or this permit shall be deemed revoked. Top —. FAU _ W.H.. ' LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ CITY T.I.No I hereby affirm that I am licensed under provisions of Chapter 9LICE E OR (commencing with Section 7000)of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER 6� Clams C�t� Professions Code,and my license!s in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. PROC SSED BY Size&Type HP,KW,KVA,or KVAR .D aI License Num er c.Class Up to 1 Incl. FINAL ggzr7 �� Over 1 to 10 Inc[. DATE f O ��1 VALIDATION � Contractor a!9Wte '[ Over 10 to 50 Incl. 1 ❑ FINAL V I am xempt under Sec. Over 50 to 100 Inc. BY W BAP.C.for this reason Over 100 N' Services,Swbd.,MCC&Panelboards ® VzI Date: 0-200 Amp.Under 600 V r' Signature 201 - 1000 Amp.Under 600 V ❑ Elect. -Exemption for Reg.MainOver 1000 Amp;or Over 600 V t: SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign.with One Branch Circuit 1 ¢ ..,_. .. I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits `j�'' "ZL for the following reason(Section 7031.5,Business and Professions Code): �•1'_t = ii LL 61,t� Misc.Conduits&Conductors ❑ I,as owner of the property,will do the work and the structure i 17011:1 I:.i1'_ is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) �_ and Professions Codej. :i:nL 333 a 010 CONSTRUCTION LENDING AGENCY CHECK L�Sot=; I hereby affirm that there is's construction lending agency for the _ -3 I• performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub total) 3— Civ.C.). PLAN CHECKING FEE Lender's Name O `l I:L=j—'PLU1 i L41 Y.. PERMIT ISSUING FEE Lender's Address 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 regulating Electrical wiring, and hereby authorize representatives of thi County to en r pon th bove-mentioned property for'101 pe fp0 Q SEE REVERSE FOR EXPLANATORY LANGUAGE Ign ure of Permittee Date LOUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 05.08 9802'f70005r BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: GA ID: FEES AID G—ADDRESS' ON FILE5749 ROS-EBEA"L3 FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: EMP CA 91780 ASSESSOR-INFORMATION NUMBER: NEAREST CROSS STREET: ROSEMEAD 5397-012-043 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY G2 LIGHTING FIXTURES 52.00 LGT 82.20 TENANT: TOTAL FEES 109.95 ISSUED ON: PROCESSED BY: PAN BY- EXPIRES ON: T.J. MAXX N 02/17/98 UT 02/17/99 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: CALAC INVESTMENT - 3709 SAN DIEGO, CA9211137 DESC —G WGR C REVAMP HT�I•NG APPLI L. NO: J. K. BAKER CONSTRUCTION (408) 882-0199- 2175 STONE AAVE. #11 SPECIAL CONDITIONS: SAN JOSE, CA CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE JK BAKER CONSTRUCTION (408) 882-0199- 2175 STONE AVE. #11 LIC. NO s ,' a ��' TEMPORARY POWER POLE SAN JOSE, CA 95125 636446 B �`, •`= _ • '- - � UNDERGROUND CONDUIT ARCHITECT 0 GI ER: TE 0: FER GROUND LIC. N0: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 sl • ' COUNTY OF LOS ANGELES + TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1106070028 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: f FEES PAID I BUILDING ADDRESS: I ON FILEI I 5749 ROSEMEAD BL 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780 I (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 15397-012-043 IA1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, C I IG2 LIGHTING FIXTURES 19.00 LGT 36.90 1 1 ITENANT: TOTAL FEES 64.70 ISSUED ON: PROCESSED BY: PLAN BY: 1 TJ MAXX I 106/07/11 SR 1 (OWNER: TEL. NO: 1 IFINAL DAT FIN BY CODE: TJX COMPANIES INC. (508) 390-5180- 1 I I 8 770 COCHITUATE RD. 1 � ) IFRAMINGHAM, MA 01701 I ID CRIPTI N OF WORK 1 I IREPLACE 19 LIGHT FIXTURES 1 [APPLICANT: TEL. NO: 1 1 1 IMICHAEL HAM (858) 792-6855- 1 1 1 13025 CALLCOTT WAY 1 ISPECIAL CONDITIONS: I SAN DIEGO, CA 92130 I I I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IDEL MAR BUILDERS (858) 792-6855- 1 1 1 113025 CALLCOTT WAY LIC. NO 1 ITEMPORARY POWER POLE I I 1 ISAN DIEGO, CA 92130-1329 594663 I 1 1 1 1 (UNDERGROUND CONDUIT [ARCHITECT OR ENGINEER: TEL. NO: I 1UFER GROUND I I I ISCOTT GIBSON ARCH (530) 343-7447- ,1 1 I I I 12540 ZANELLA WAY STE 60 LIC. NO: [ IROUGH CONDUIT I I ICHICO, CA 95928 NONE I I I (ROUGH WIRING I [MAIN WATER LINE I I I 1PLASTIC YIN METAL YIN 1 I I I (UTILITY COMPANY NOTIFIED( I I I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 [ [ [ I