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Home My Public Portal About5751 ROSEMEAD BLVD_Electrical__ WORKER'S COMPENSATION DECLARATION 20.0019 DPW(t2-91) APPLICATION FOR ELECTRICAL PERMIT LJ I hereby affirm that I have a certificate of consent to self insure, 76A663 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.380000 Lab.C.)2— /1 Policy Nt�W • mpany Mil Np'� 1 ha. FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. 1//01/73 New Residential Bldgs.&Pools NO. EACH FEE LOCALITY - C 1 &2-Family,Sq.Ft. _ $ $ Certified copy is filed with the county building in Cti NEAREST department. Multi-family Sq.Ft. CROSS ST. Date v`A Applicant Residential Swimming Pools ASSESSOR MA 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 b the First 20 permit is for one hundred dollars($100)or less.) y Total No. Additional ADDRESS Additional MAIL I certify that in the performance of the work for which this permit CITY CO!, rel.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 Vk Total No. Additional ADDRESS ' Co Date Applicant M NOTICE TO APPLICANT: If, after making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP. CITY 6:)MAM- Tel. eY17� 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 y p y Power Apparatus&Large Appliances APPLICANT ^t_ provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS OSS C0L2r` I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. N CITY el. (commencing with Section 7000)of Division 3 of the Business and Over 10 to 50 Incl. O Professions Code,and my license is in full force and effect. LICENSE OR d T d Over 50 t0 100 Incl. REG.NUMBER CI Q License Number V O `� Over 100 DISTRICT NO. P O SSED BY U Lic.Class�� Services,Swbd.,MCC&Panelboards 0-399 Amp.Under 600 V FINAL Contra Date DATE V ❑ am exempt under Sec. 400-1000 Amp.Under 600 V -/ .—9 VALIDATION LLI Over 1000 Amp.or Over 600 V FINAL d B.&P.C.for this reasonBY (n BRANCH CIRCUIT FEES Date: 15A,or 20A,120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ Al Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits ;y SINGLE FAMILY Temp.Power Pole&Appurtenances ACCT. HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit v 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 3M7 59.55 Code): ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors 1 T 1 Gt 1 is not Intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) TOTAL 59.55 and Professions Code). CHECKn CONSTRUCTION LENDING AGENCY 5955 /+ I hereby affirm that there is a construction lending agency for the {rHAHE n00 Performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE 1 1I 6/93 Lender's Name PERMIT ISSUING FEE 7469 1 0.11a-05 Lender's Address 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 representatives of this unty ante upon the above-mentioned property pection purpos SEE REVERSE FOR EXPLANATORY LANGUAGE _6•� SIG. O M.ITTEE D E WORKERS'COMPENSATION DECLARATION 20-6014 DPW hereby affirm that I have a certificate of consent to self � 3/87 APPLICATION FOR ELECTRICAL PERMIT O insure, or a certificate of Workers'Compensation Insurance, I COUNTY OF LOS ANGELES DEPT. OF'PUBLIC WORKS or a certified copy thereof(Sec. 3800; Lab. C.) Policy No.olfflZc Company A�'° i FOR APPLICANT TO FILL IN JOB n s Certified copy is hereby furnished. New Residential Bldgs. 8.Pools EACH NO. FEE: ADDRESS S /�/ cd /77 J56 Certified co is filed with the count building LOCALITY'.7. copy ' y g inspec- 1 &2'-Family, Sq. Ft. $ '— $ .OS �WY �J UNO. tion department. Multi-family Sq. Ft. -- NEAREST Residential SwimmingPools CROSS ST. Date 9 �ppl.icant IA) �-0Z&_ + OWNER OR. ` FIRM NAME' Ld ER FICATE;OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL, COMPENSATION INSURANCE ADDRESS First 0 (This section need not-be completed If the work Involved by Total No. Additional CITY'"-k._r; Le, Tel. No. the,permit is For one hundred dollars(:100)or less:) I'certify that in the performance of the work for which this PLAN.CHECK APPLICANT permit 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 Additional Date Applicant. Total No. CITY. Tel. No. NOTICE TO APPLICANT: If, after making this,Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. _ APPLICATION ) d Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS I t 7.pyo W. with comply with such provisions or.this permit shall be Top — FAU —W.H. — , deemed revoked. CITY a Tel. No. Hood — Fan —Other— LICENSED CONTRACTORS DECLARATION LICENSE OR' Disp. — Room Air Cond. — REG.NUMBER .2 Class. 1 hereby affirm that.I am licensed under provisions of Chapter i (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. P ESSED BY >_ and Professions Code,and my license is in full force and effe t. r� p P-� 0 • � Size&Type HP, KW, KVA, or KVAR p� O �9 X L`FJ U License Number ��Lic. Clas§. Up to 1 Incl. 1 FINAL Contractor N% y 124ektie Q -Date t Z, Over I to 10 Incl. DATE '�.r1#_ VALIDATION 0 Over 10 to 50 Incl. FINAL F_ I am exempt under Sec.' 4 Over 50 to 100'Inc. BY U di ,B.&P.C. for this reason I Over 100' N Date: Serdll0-200 Amp. Under ces, Swbd., MCC 8 Ranelboards ►I Z 600 V — Signature 2Q1 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V -I Exemption for Reg.Maint. Elect. SINGLE FAMILY HOME OWNER-BUILDER'DECLARATION Tem Power Pole.&Appurtenances i Sig with One Branch Circuit: n.,..•,. I'hereby affirm that I am exempt from the Contractor's License t Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits ;' °� f S 1 Professions Code): ..;3C Mi Conduits&Conductors � I., as.owner of the propperty, will do the work and the y _e=i 1 structure is hot.intended or offered for sale(Section 7044, Other(See Complete•Fee Schedule)— Business and.Professions Code). , r`C _ " -_1= CONSTRUCTION LENDING AGENCY 11 1 hereby affirm that there is a construction lending agency for j i tie performance of the work for which this permit is issued PERMIT FEE Sub-Total P ( ) e iii (Sec. 3097, Civ. C.). PLA I CHECKING FEE L'ender's Name l'-i l:i -i t_i".s j 2/ PE IT ISSUING FEE C Lender's Address I i 2-'L:;! i i=E='�I�_i� I%certify that.I have read this application and state that the TOTAL FEE ,55 _ above information is correct. 1 agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon a the above-mentioned pr perty for inspection purpose . SEE REVERSE FOR EXPLANATORY LANGUAGE i I a ., Os Signature of Permittee to '' WORKERS'COMPENSATION DECLARATION 7 baws�e7 APPLICAT10WF R ELE !_'f VC L 4r_t_e1-' MIT I hereby affirm that I have a certificate of consent to self .CE-soap O insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT.. OF PUBLIC WORKS or a certifieA copy thereof(Sec. 3800, Lab/. C. ICA It A21 do Poli' o. 4 ompany �Cg' _ZlU a FOR APPLICANT TO FILL IN JOB Certified copy is he eby furnished. / •— New Residential Bldgs. &Pools EACH NO.. FEE ADDRESS ® !� ❑Certified copy is filed with the'county building inspec- 1 l 2-Family, Sq. Ft. $ _ $ LOCALITY ��' (✓ tion dep rtme t. Multi-family Sq. Ft. NEAREST / 7 l Residential Swimming Pools CROSS ST. <' (�,�j s � 4 : ws WNER OR Date 1'Applicant �r �A1 g J FOIRM NAME . �� A - S4we CERTIFICATE OF EXEMPTION FROM WORKERS' tlels:.,Rec6d Light Svc® MAIL COMPENSATION INSURANCE JA 60 ADDRESS First 20 (This section need not be completed if the work Involved.by 7 I ?.� CITY Tel. No. the permit Is For one hundred dollars($100)or less.) Total No. Additional PLAN CHECK I certify that in the performance of the work for which this 1 APPLICANT permit is issued, I shall not employ any person in any m nner i• so as to become subject to the Workers'Compe�glio Lig i'I ong Fixtures First 20 ADDRESS Gf/ Ad itional' b Total No. CITY! Tel. No. Date pplicarit��6s+ �" ixed'A Appliances Not Over 1 IT NOTICE TO APPLICANT: If, after making t s Certi i ate of Il pp d APPPERLICATION �� ,p i E \ 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 (rte with comply with such provisions or this permit shall be Top.l FAU —W.H. — deemed revoked. CITY Tel. No . . Hood — Fan _Other_ ®� ��.� ' Zo .� LICENSED CONTRACTORS DECLARATION LICENSE OR y I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. — REG.NUMBER" �p Clas (commencing with Section 7000)of.Division 3 of the Business Power Apparatus&.Large Appliances DISTRICT NO. PR C ED BY O and Professions Code,and my license is in full force and effect. ), Size&Type HP, KW, KVA, or KVAR License Number #If 7�7 Lic.•Class d Up to 1 In FINAL V �+� �r jun Over 1 to 1'0 Incl. DATE - �_ VALIDATION 0 Contractor. ate Over 10 to 50 Incl. F- Over 50 to 100 Inc. gY ❑ I am exempt under Sec. FINAL LLJ 9Z U B.&P.C. for this reason — Over 100 o.. Date: - ServicE.s,:Swbd..;MCC&Panelboa.rds , Z 01-200 Amp. Under 600 V Signature 201 It 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. `' I SINGLE FAMILY Temp.113ower Pole&Appurtenances HOME OWNER-BUILDER DECLARATION . . s Sign ouith One Branch Circuit ; (:i1 j ,it 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 3307 -g i Professions Code): � - � ts30 El1, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale(Section 7044, Other;(See Complete Fee Schedule)_ , INIT i 72 = 35 Business and Professions Code): li t i�I FiL. CONSTRfJCiION'LENDING AGENCY CHECK_ I hereby affirm that there is a construction lending agency for CHANGEi'r; the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) p (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name ' 5 13 4- -;;;/ /94 PERMIT'ISSUING FEEv lig:` Lender's Address I certify that I have read this application and state that the 'TOTAL FEE above information is correct, I agree to comply with all County q ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon l the above-mentioned property for inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE ®s Simi Signature of Perttee: Date i 46 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS 508-96i4G400C BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUIL_ DING AD SS: ON FILE 7 1 ROSEMEA�WBL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: C1�A 9'x/80 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY Kl SIGNS, OUTLINE LGT 1.00 SIG 38.85 TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED Y: PAN PIRES ON: APPALET 11/04/96 TC 11/04/97 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: CALA3709C INVESTMENT - T_wo-1-/—?9/ � SAN DIEGO, CA9211137 `E5& IPTIO WORK �J SIGN FOR NEW BUSINESS APPLICANT: TEL. O: L. A. NEON SIGN (213) 734-3361- 2982 W. PICO BLVD. SPECIAL CONDITIONS: LOS ANGELES, CA CONTRACTOR: TEL. NO: 41 -APPROVALS DATE INSPECTOR SIGNATURE L A NEON SIGN (213) 734-3361- 2982 W. PICO BLVD. LIC. NO ;y� ,r+� if TEMPORARY POLE LOS ANGELES, CA 90006 653806 C35 / UNDERGROUND CONDUIT ARCHITECTOR ENG L. 0: _�' i!, ,/ itld � `�� II �- FER GROUND LIC. N0: j ROUGH CONDUIT ROUGH WIRING PLASTICTY/NLINE METAL Y/N UTILITY COMPANY NOTIFIED 63� REPORT ID: DPR265 ROUTE TO: BS0508 • COUNTY OF LOS ANGELES TEMPLE CITY DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS # 0508 ELEO 0801207020032 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 5751 ROSEMEAD BL IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 91780 ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 15397-012-043 IAl PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY CAI I In SIGNS, OUTLINE LGT 1.00 SIG 38.90 (TENANT I TOTAL FEES 66.70 107/02/12N: PROCESSED BY: PLAN BY: BEAUTY LEGEND SR (OWNER: TEL. NO: (FINAL DATE FI BY: CODE: I I3709 �CALAC INVESTMENT I IN44 �7 ISAN DIEGO, CA9211137 ID SCRIPTION OF WORK ILLUMINATED CHANNEL LETTER WALL SIGN APPLICANT: TEL. NO: JAD ELECTRICAL ADVERTISING INC. ISPECLAL CONDITIONS: I CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE IAD ELECTRICAL ADVERTISING INC. (626) 448-1166- I IDBA AD SIGNS LIC. NO ITEMPORARY POWER POLE I I 19437 VALLEY BLVD. 927951 C45 I I IROSEMEAD, CA 91770 (UNDERGROUND CONDUIT I ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND I I I _ I I I LIC. NO: I IROUGH CONDUIT I IROUGH WIRING I I IMAIN WATER LINE I IPLASTIC Y/N METAL Y/N (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 I I I I I I I I I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1204160046 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: 1 ON FILE I 5751 ROSEMEAD BL I 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 91780 1 (ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: I 5397-012-043 LAW PC CITY $109.35 MIN 0.00 187.30 I THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY CAI I IA1 PERMIT ISSUANCE FEE 27.80 I 1 ITENANT: 1F1 120V, 15/20A BR CKTS 6.00 BR 103.80 (ISSUED ON: PROCESSED BY: PLAN BY: 1 I IF2 208, 277V LGT BR CKT 6.00 BR 163.80 105/17/12 SR I TOTAL FEES 482.70 1 I (OWNER: TEL. NO: I IFINAL DATE FIVAL BY: CODE: I ICALAC INVESTMENT _ I I 1lg�lin 13709 SAN DIEGO, CA9211137 I IDEISCAIPTION OF WORK I ITENANT IMPROVEMENT ELECTRI I (APPLICANT: TEL. NO: I I I IXU, JENNY (626) 388-4919- I I 1 16260 TEMPLE CITY BL I [SPECIAL CONDITIONS: I TEMPLE CITY CA 91780 I [ I I I I [CONTRACTOR: TEL. NO: I [APPROVALS DATE INSPECTOR SIGNATURE I IJ Y CONSTRUCTION (626) 570-9978- I 112368 E VALLEY BLVD LIC. NO I (TEMPORARY POWER POLE 1 I 1EL MONTE CA 93.732 895102-B * I I I [ (UNDERGROUND CONDUIT 1 (ARCHITECT OR ENGINEER: TEL. NO: - I IUFER GROUND I I I 1 LIC. NO: I IROUGH CONDUIT I I (ROUGH WIRING I I I IMAIN WATER LINE (PLASTIC Y/N METAL Y/N I I I 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 1 I I 1 I I* ADDITIONAL DATA ON FILE I I I I I 1 IREPORT ID: DPR265 ROUTS TO: BS0508 I I I I I I