The URL can be used to link to this page

Home My Public Portal About5773 ROSEMEAD BLVD_Electrical__ i WORKERS'COMPENSATION DECLARATION 20.0019�DPW 3/87 Q I h�rre y affirm that I have a certificate of consent to self .7 APPLICATION FOR ELECTRICAL PERMIT • insures or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof Sec. 3800, Lab. c.) Poli No.�()� ��~��ompany�T�/l L FLf A2 0 FOR APPLICANT TO FILL IN JOB �r� Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS v! 71 27. 0 Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ = $ 1 LOCALITY tion d part ent. Multi-family Sq. Ft. NEAREST (J 2 Residential Swimming Pools CROSS ST. Date v Applicant J7 j( CAA)�K••� OWNER OR FIRM.NAME CERTIFICATE OF:EXEMPTION FROM WORKERS' Outlets: Rec Li ht Sw.Z MAIL _ .' COMPENSATION INSURANCE Q ADDRESS First 20 62 (This section need not be completed if the work involved by Total No. Additional CIN Tel. No. the permit is for one hundred dollar's($100)or less.) I certify that in the performance of the work for which this A PLICCANTK 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 20ADDRESS Total'No. Additional CITY? Tel. No. Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT Exemption, you should become subject to the Workers' Range— Heater—MW. _ APPLICATION ,%i M- Compensation provisions of the Labor Code,you must forth- Oven — Dryer —W.M.— ADDRESS /G A with comply.with such- provisions or this -permit .shall. be Top FAU —W.H. — deemed revoked. Hood Fan —Other— CITYTel. No.[ar LTJ M.►/'c.AYJI� LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. _ Room Air Cond. — 3 7(� Class. I hereby affirm that I am licensed under provisions.of Chapter 9 REG.NUMBER t}'!p ✓-- (commencing with Section 7000)of Division 3 of the Business Power Apparatus•&Large Appliances DISTRICT NO. P f SSED BY a and Professions Code,and my license is in full force and effect. Size&Type HP, KW., KVA, or WAR �� O License Number .y76.12Z L'ic. Class Up-to 1 Incl. JBY NAL U Over 1 to 10 Incl. ATE• 1 �'L VALIDATION Contractor C� Date [o 0 L O Over 10 to 50 Incl. FINAL 0 I am exempt under Sec. Over 50 to 100 Inc. W B.&P.C. for this reason' Over 100' 1d, Services,Swbd.,MCC&Panelboards. , Z • Date: • 0=200 Amp. Under 600 V _ Signafu %% 201 - 1000 Amp: Under 600 V Over 1000 Amp. or Over 600 V Exemption for R19g. Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances "t HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit 41;t;'M Law for the following reason (Section 7031.5; Business and Additional Sign Branch Circuits Professions Code): tiliscConduits&Conductors � T""E I, as owner of the property, will do the work and the . a ! structure is not intended or offered for sale Section 7044, Other(See Complete Fee Schedule)— 7.1VI r 5 Business and Professions Code). NL+:fit CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending.agency for (;iCjav 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 a 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 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 Signature of Permittee Date es WORKERS'COMPENSATION DECLARATION :=;DPW 9,187 APPLICATION FOR ELECTRICAL PERMIT Q I liereby affirm that I have a certificate of consent to self cE iasu ,.or a certificate of Workers'Compensation Insurance, i COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS &0 ertified copy thereof(Sec. 38 Lab. C.) Policy FOR APPLICANT TO FILL IN ADDRESS �� / � /c bSeL[.7o7o Cert, ied copy is he eby furnished. New Residential Bldgs. &Pools EACH NO. FEE ❑Certified copy is filed with the county building inspec- 1 &2-Family,Sq. Ft. $ = $ LOCALITY tion department. Multi-family Sq. Ft. NEAREST /`/�- - 1 Residential Swimming Pools OWN St. SOR y / Date —Applicant c"�w FIRM NAME (, e- CERTIFICATE OF EXEMPTION FROM.WORKERS' Outlets: Rec Li ht Sw._ MAIL �+ COMPENSATION INSURANCE I g First 20 ADDRESS: 6-f L T h V (This section need not be completed IF the work Involved by Total No. Additional CITY 2�L Q Tel. No. the permit Is for•one hundred dollars($100)or less.) PLAN CHECKS "�! 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 Lighting Fixtures First 20 ADDRESS (o ZS S so as to become subject to the Workers'Compensation Laws. T �- ��• _ Additional Total No. CITY _Z2 . Tel. No. y.t/� Date Applicant 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 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.H. — deemed revoked. CITY Tel. No.,f91•Ifo LICENSED CONTRACTORS DECLARATION f Hood — Fan —Other—nd. LICENSE OR /��` r� Disp. _ Room Air Cond. _ fL 4 Class. • 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 Appliarices DISTRICT NO. PRC SED BY d and Professions Code and my license is in full force and effe t. fes: - /'ry�S.' e� _�P Size&Type HP, KW, KVA, or KVAR �-�'d U License Number i b Lic.Class... �I I Up to 1 Incl. FINAL (' y Over 1 to 10 Incl. DATE 1�. 1(`LJ Z� VALIDATION 0 Contractor J ��Ddte '�-� Over 10 to 50 Incl. 7 [ U ❑ FINAL I am exempt under See. � Over 50 to 100 Inc. BY W B.&P.C. for this're Over 100 N Services, Swbd.,MCC&Panelboards , Z 0-200 Amp. Under 600 V Signot 201 - 1000 Amp. Under 600 V ❑ Exemption or Reg.WILY Over 1000 Amp. or Over 600 V SITemp.. Power Pole&AppurtenancesHOME OWNERI hereby affirm that I am etor's License Sign with One Branch.Circuit Law for the following reason (Section.7031.5, Business and Additional Sign.Branch Circuits Professions ❑ I, 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)— TO;;.L 515" s-•.5 Business and Professions Code). -A CONSTRUCTION LENDING AGENCY Eict.- 55 a 55 I hereby affirm that there is a construction.lending agency for .'i j the performance of the work for which this-permit is issued I .PERMIT FEE _ (Sub-Total) (Sec:3097, Civ. C.). PLAN CHECKING FEE -i I�I"-1�''z _j�4-Ftl= Lender's Name PERMIT ISSUING FEE c� y'y :r fhj i �:�- Lender's Address . iS `�'"�` 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 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 ®s Signature of Perm! Date i ` COUNTY OF LOS ANGELES TEMPLE CITY # 0508 VLECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL-L0508-98.12020005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (818) 285-0488 EXT: LEGAL EES PAID B 140IJ"DDR S ON FILE 71 RQMEAD-BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: CA 91780 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 5397-012-043 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: WORLDWEAR K1 SIGNS, OUTLINE LGT 1.00 SIG 38.85 TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED Y: PLAN BY: EXPIRES ON: 12/02/98 UT 12/02/99 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: CALAC INVESTMENT - 3709 L2 SAN DIEGO, CA9211137 DESCRIPTIWOF WORK ILLUMINATED CHANNEL LETTERS ON WALL SIGNS APPLICANT: TEL. NO: LORENZO VILLASENOR MARTINEZ (213) 829-2033- 825 S. MAPLE #2SPECIAL CONDITIONS: MONTEBELLO, CA pxaELES Co CONTRACTOR: TEL. NO: C. ly APPROVALS DATE INSPECTOR SIGNATURE LORENZO VILLASENOR MARTINEZ (213) 829-2033- �. 825 S. MAPLE LIC. NO TEMPORARY POWER #2 432339CIO MONTEBELLO CA 90640 UNDERGROUND-CONFUIT - ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: , �;�� ROUGH CONDUIT J 7 _ ROUGH WIRING r --- �U��L C VA O0Fro-lia K8 INWATER LINE r� PLASTIC Y/N METAL Y/N UTILITY COMPANY OT D Z2 0 ❑ j� ,1 t: f n Servicet►a��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 0305130015 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL FEES PAID BUILDING ADDRESS: ON FILE 5773 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780 ASSESSOR 0 0 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 154.00 OUT 219.90 TENANT: G2 LIGHTING FIXTURES 87.00 LGT 129.45 ISSUED 0 EXP I RES ON: BANK OF EAST ASIA TOTAL FEES 377.10 05/13/03 JK 11/09/03 OWNER: TEL. NO: FINAL DATE FINAL BY- CODE: 3709C INVESTMENT SAN DIEGO, CA9211137 DESCRIPTION OF WORK TENANT IMPROVEMENT FOR BANK APPLICANT: JOHN GONG (714) 368-9881- 28071 IRVINE BLVD SPECIAL CONDITIONS: TUSTIN 92780 CONTRACTOR: TEL. NO: APPROVALS DATE IN SIGNATURE SINGPOLI HOP KIN CONSTRUCTION AND (714) 368-9881- DECORATION NEVADA INC LIC. NO TEMPORARY POWER POLE 28071 IRVINE BLVD 761247 B TUSTIN, CA 92780 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: 0: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH G MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITYPANY NOTIFIED- REPORT 0 FIEDREPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0305050008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PA BUILDINGADDRESS: ON FILE 5773 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780 ASSESSOR 0 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 0ISSUED 5/05/03 ' PROCESSED B 11/01/03 • BANK OF EAST ASIA OWNER: TEL. NO: FINAL ATE FINAL BY: CODE: CALAC INVESTMENT 3709 SAN DIEGO, CA9211137 R 0 OF WORK APPLICANT-- E CTRI AL FOR CHANNEL LETTER SIGNAGE FOR 'THE BANK OF EAST ASIA" L. N JOHN YU (626) 448-1616- 9647 E RUSH STREET SPECIAL CONDI IONS: S EL MONTE 91733 CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE FIRST SIGN CO. (626) 448-1616- 9647 E. RUSH ST. LIC. NOMPO R OWER POLE SOUTH EL MONTE, CA 91733 B/L27903 UNDERGROUND CONDUIT ARCHITECT-OR ENGN ER: 7 9 17,go: UFER GOOD LIC. NO: ROUGH CONDUIT ROUGHR MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED * ADDITIONAL DATA ON FILE REPORT ID: DPR265 ROUTE TO: BS0508