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Home My Public Portal About5779 ROSEMEAD BLVD_Electrical__ WORKER'S COMPENSATION DECLARATION 200019 DPW(12=91) APPLICATION FOR ELECTRICAL PERMIT 76A663 I hereb.�.8ffirm zth�at 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.C:= ¢ CompanyFOR APPLICANT TO FILL IN .JOB C" v�v ;�" ADDRESS J Certified copy Is hereby furnished New Residential Bldgs.&Pools NO.1 EACH FEE $ $ LOCALITY ❑ Certified coy is filed with the county-building buildin inspection 1 1 &2-Family,Sq.Ft. P tY 9 P _ NEAREST deepartn�ent. Q� I Multi-family Sq.Ft. CROSS ST. Date 9 Applicant / ll l I. Residential Swimming Pools MAPASSESSORK //// MAP BOOK PAGE PARCEL CEF�TIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rao.-Light Sw. OWNER OR COMPENSATION INSURANCE FIRM NAME �/1 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.) 1 Total No. Additional 1 certify that in the performance of the work for which this permit I CITY A/ T661 JO 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 APPL- N. Total No. Additional ADDRESS Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of[ RESIDENTIAL APPLIANCES NOT OVER 3 NP. CITY Tel.140. Exemptionr.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 PER Power Apparatus&Large Appliances APPLICANT ,provisions or this permit shall be deemed revoked. LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 310 10,lnci. (commencing with Section 7000) of Division 3 of the Business and i CITY Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. } Over 50 to 100 Incl. LICENSE OR Over 100 DISTRICT NO. PROCESSE O License Number A en ��0/ Lic.Class�� _ U Services,Swbd.,MCC&Panelboards mop fY Contractor Date i 0-399 Amp.Under 600 V FATE 0 ❑ I am exempt under Sec. 400-1000 Amp.Under.600 V �� VALIDATION W Over 1000 Amp.or Over 600 V FINAL Il B.&P.C.for this reason BRANCH CIRCUIT FEES BY Date: I 15A,or 20A,120V,Lighting or Recept. i Z 1 To 10 Branch Circuits Signal _ 11 To 40 Branch Circuits El 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A.20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&AppurtenancesA44ToJL HOME OWNER-BUILDER DECLARATION Sign with One Brarich Circuit31,917 I hereby affirm that I am exempt'from the Contractor's License Law 65.60 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): 1 ITEMS ❑ I,as owner of the property,will do the work and the structure- Misc.Conduits&Conductors i TOTAL 65.6113 is not Intended or offered for sale(Section 7044, Business Other(See Complete Feb Schedule) L�y and Professions Code). , CHECK 65.4..0 CONSTRUCTION LENDING AGENCY y CHANGE o00 I hereby affirm that there is a construction lending agency for the I performance of the work for which this permit is issued(Sec.3097, -TotPERMIT FEE (Sub al) d civ.C.) 0000-0001 2/ 5/96 PLAN CHECKING.FEE I Lender's Name 4707 1 PM .50-42 PERMIT ISSUING FEE p2 7 Q 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 County to enter upon the above-mentioned,property r r I action oses. SEE REVERSE FOR EXPLANATORY LANGUAGE -'PERM DATE i r I Wm that I COMPENSATION DECLARATION CE 8066 tcist APPLIOATION FOR EL TR AL ERM •I heresy'affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance,or a certified ;j COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) Policy No. Company, FOR APPLICANT TO FILL IN JOB 2 ❑• Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS ' _ , ❑ 'Certified copy is filed with the county building Inspection 1 &2-Family,Sq.Ft. $ $ LOCALITY department. Multi-family Sq.Ft. NEAREST Residential Swimming Pools CROSS ST.. Date Applicant OWNER OR FIRM NAME G joAl LVil CERTIFICATE.OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE' i•Outlets:Rec_Light_ t 20— ADDRESS` wb (This section need not be completed It the work Involved by the' First 2 permit is for one hundred dollars($100)or less.) Total No. Additional CITY Tel.-No. I certify that in the performance of the work for which this permit i PLAN CHECK is issued; I shall not employ any person'i manner so as to APPLICANT 1 /V V become subject to the Workers'Compe.. ti n ;Lighting Fixtures First 20 ADDRESS Additional Applicant ' Total No. CITY Tel.No: Date ju— NOTICE TO APPLICANT: If, afte maki thi Cer ifica of ;Fixed Appliances Not Over 1 HP PERMIT , Exemi�tion,you should become sulije to the rke.:'Co pen on Range_ Heater D.W. APPLICANT provisions of the Labor Code,you mu fort ith co with ch Oven _ Dryer'_ W.M.= ADDRESS C provisions or this permit shall be'deeme kdd. I Top FAU W.H: 1 LICENSED CONTRACTORS DECLARATION + Hood — Fan _ Other_— ° CITY Tel.No. ` I hereby affirm that I'am licensed under provisions of Chapter 8LICENSE OR (commencing.with Section 7000) of Division 3 of the Business and I Disp. — Room Air Cond. REG.NUMBER Class. ,Prgfessions Code;and my license is in full force and effect. .'!Power NO.. PROCESSED BY. • � Power Apparatus&Large Appliances - } Size&Type HP,KW,KVA,or KVAR Q 0�• L'icense Number 01c.Class Up to 1 Incl: FINAL V Over 1 to 10 Incl. DATE. Contractor S S Date Z I VALIDATION O �' Over 10 to 50 Incl: FINAL F" ❑ I am exempt under Sec.. I Over 50 to 100 Inc. gY '/ � �"1 �. a B:&P.C.for this reason Over 100 I Ll�. V N Services,SWbd.,MCC&Panelboards , Z Date: 0-200 Amp.Under 600 V Signature_ ; 201 - 1000 Amp.Under 600 V i ❑ i Over 1000 Amp.or Over 600 V + Exemption for Reg.Maint.Elect. SINGLE FAMILYTemp.Power Pole&.Appurtenances- _ _ X ' HOME OWNER-BUILDER DECLARATION Sin with One Branch Circuit ' a. I hereby-affirm that I am exempt'from the Contractor's License Law g for the following reason(Section 7031.5,Business and Professions 'Additional Sign Branch Circuits Code): i . J307 ,5 IMisc.Conduits&Conductors 1 ITEM'S) ❑ I,as owner of the property,,will do the work and the structure ;Other(Sed Complete Fee Schedule) _ is not intended or offered for sale (Section 7044,Business ► r- i and Professions Code). I TO H'"' '-``9 a s' CONSTRUCTION LENDING AGENCY. CHECK =9°°' 1-hereby affirm that there is a construction lending agency for•the !(:�Lt �.�sw' performance of the work for which this permit is issued(Sec.3097, '6ERMIT PEE (Sub Total) Civ.C.). I PLAN CHECKING FEE. Lender's Name ' D. LIC('-�(I i PERMIT ISSUING PEE Lender's Address, ' ' j 'rills a 5`71 I certify that'I have read.this application and state that the above L)IOTAL FEE Information is correct.I agree fo comply with all County ordinances j s and State laws nagUlating Electrical wiring, and hereby authorize t representati of I County to enter upon the above-mentioned j property f inspe i pure s s. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu o Pe i tee Date ' I i i COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0211070020 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: S AI G AD RE S: ON FILE 5779 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780 ASSESSOR OR ON 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 TOTAL FEES 66.60 ISS E 0 : ROC SS BY: PLAN BY: EXPIRES ON: ACM SECURITY SYSTEM 11/07/02 JK 05/06/03 OWNER: TEL. 0: FINAL DATE FINAL BY: CODE: CALAC INVESTMENT SAN9DIEGO, CA9211137 D CPIP N OF WURIZ ONE SET ILLUMINATED CHANNEL LETTER SIGN APPLICANT: YU (626) 444-8181- 2812 PECK ROAD SPECIAL CONDITIONS: EL MONTE 91731 CONTRACTOR: TEL. 0: APPROVALS DATE INSPECTOR SIGNATURE SUCCESS SIGN PRINTING INC. (626) 444-8181- 9363 VALLEY BLVD #A LIC. NO TEMPORARY POWER POLE EL MONTE CA 917'31 739177C45 UNDERGROUND CONDUIT a1 ! ARCHITECT OR ENGINEER: 0: UFER GROUND LIC. NOS% - ROUGH CONDUIT i; ROUGH WIRIG MAIN WATER LINE PLASTIC Y/N METAL Y/N - - - TI -C-d FPX WY-00 I I 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 9902250004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: -]LEGAL ID: FEES PAIDB D AD R SS: ON FILE 5779 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780 ASSESSOR INFORMATION NUMBER: 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 ISSUED ON: PROCESSED BY: EXPIRES ON: BEAUTY SOLUTIONS 02/25/99 UT 02/25/00 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: 3709C INVESTMENT - / SAN DIEGO, CA9211137 DESC PTIO OF ORK 7 ELECTRICAL FOR SIGN-ILLUMINATE APPLICANT: TEL. NO: ITAL CUSTOM SIGN (626) 444-6027- 2651 N. LEE SPECIAL CONDITIONS: SO. EL MONTE, CA E1�.ES CO CONTRACT R: EL. N444-6027- SOS ��Ay APPROVALS DATE INSPECTOR SIGNATURE KYI CHOW2651 N LEE AVE LIC. NO TEMPORARY POWER POLE #2 & 3 652665 C45 SOUTH EL MONTE, CA 91723 / UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TE �/ R GROUND LIC. NO 1111111 ROUGH CONDUIT ROUG_ff WIRING u 1 U pD L U W O K vg MAIN WATER LINE , PLASTIC Y/N METAL Y/N T ITY COMPANY NOTIFI D ❑ all El 46� El of i� Servuce That * ADDITIONAL DATA ON FILE REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 :ELECTRI'CAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS E 0508 240018 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: EG ID: FEES PAID 8 D.I. G- DD SS: ON FILE '5779 ROSEMEAD•BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780 ASSESSOR NFOR IO NUMBER: 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 6.00 OUT 11.70 TENANT: TOTAL FEES 39.45 ISSUED 0 : PROCESSED B B EXPIRES 0 : BEAUTY SOLUTIONS 03/24/99 UT 03/24/00 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: 3709C INVESTMENT - IF SAN DIEGO, CA9211137 DESCRIPTION OFWORKC 'INSTALLATION-OF-6-NEW-O eTS FOR-BEAUTY-SALON _ APPLICANT: TEL. 0: JAMES JIAMA XU (626) 446-8320- 41 ALTA ST. SPECIAL CONDITIONS: ARCADIA, CA ES Co JONTRAC OR:AMA XU T-E-F N446-8320- �.�s ��,'� APPROVALS DATE INSPECTOR SIGNATURE Al ALTA STREET LIC. NO � R OWER POLE APT C 696511 Cll .-ARCADIA, CA 91006 UNDERGROUND CONDUIT OR ENGINEER: -TEL. NO: - GROUND l LIC. N0. I 1111111 ROUGH CONDUIT L , ROUGH WIRING UDD' LV��O u u PLASTICTER Y/NLINE METAL Y/N T L CO 0 D O 0 v ❑ Service That * ADDITIONAL DATA ON FILE REPORT ID: DPR265 ROUTE TO: BS0508