HomeMy Public PortalAbout5781 ROSEMEAD BLVD_Electrical__ ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0612050034
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PRONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS: _
ON FILE 5781 ROSEM$AD BL
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 'EMP 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, C
X1 SIGNS, OUTLINE LGT 1.00 SIG 38.85
TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
S & R BLOCK 12/05/06 JK 06/03/07
OWNER: TEL. NO: FINAL DAFXp BY: CODE:
3709 INVBSTMENT
3709
SAN DIEGO, CA9211137 DESCRIPT 0 W
ELECTRICAL FOR NEW SET OF CHANNEL LETTERS
APPLICANT: TEL. NO:
ROBERT SMITH (949) 689-8944-
26871 CALLE ALCALA SPECIAL CONDITIONS:
MISSION VIEJO
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
ROBERT SMITH (949) 689-8944-
26871 CALLS ALCALA LIC. NO TEMPORARY POWER POLE
MISSION VIEJO, CA 92692 597275 C45
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND
LIC. NO: ROUGH CONDUIT
ROUGH WIRING
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
REPORT ID: DPR265 ROUTE TO: BS0508
y WORKERS'COMPENSATION DECLARATION .20-0019 3% APPLICATION FOR ELECTRICAL PERMIT DPW 87 L
I hereby affirm that I have a certificate of consent to self cE-"G 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
❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS
❑Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY ; _ C-17- 7
tion department. Multi-family Sq. Ft. NEARECEASES T. r -1 r� L�
Residential Swimming Pools OWNER OR
Date Applicant ; FIRM NAME .� �.G
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw.— MAID
COMPENSATION INSURANCE First 20 ADDRESS
(This section need not be completed if the work Involved by, i Total No. Additional CITY Tel. No.
the permit is for one hundred dollars($100)or less.)
PLAN CHECK [,6 1
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 '� 1 jV' ,J—
so as to become subject to the Workers'Compensation Laws. -
Additional
—1 �l/� Al O L/ > I Total No. CITY Q « Tel..No. —�1
Date l Applicant Fixed Appliances Not Over 1 HP PERMIT n�
NOTICE TO APPLICANT: If, after making this Certificate•o IAJ
Exemption, you should become subject to the Workers' Range— Heater—D.W.
APPLICATION Uwl/ -�
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. Hood — Fan —Other— CITY Tel. No.
LICENSED CONTRACTORS DECLARATION I LICENSE OR
Disp. — Room Air Cond. REG. NUMBER `6 Classr'"�'
I hereby affirm that I am licensed under provisions of Chapter 9'
(commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PR SSED BY
and Professions Code,and my lice a Is in full force and effect. p d
d/��� •3� Size&Type HP, KW, KVA, or KVAR I 8 O 1:C�y�e.� O
License NumberLic. Class I Up to 1 Incl, FINAL U
_ i
�9 '/,► �� �� ,—� j V l Over 1 to 10 Incl. DATE VALIDATION O
Contracto, Date Over 10 to 50 Incl.
❑ FINAL U
I am exempt under Sec. Over 50 to 100 Inc. BY W
B.&P.C. for this reason Over 100 a
Services, Swbd., MCC&Panelboards ® Z
Date: Services,
-200 Amp. Under 600 V Z
Signature 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect.
SINGLE FAMILY I ;=
HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances ., J.
I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits ;Y..l_ =E:
Orofessions'Code): I
❑ will
e I, as owner of the property, wil I do the work and the I Mise. Conduits&Conductors t
-,I-i�•r;; ;�-
structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Scheduled r_ _n? �, e5
®
Business and Professions Code). //'i _:•�. -r•, c•
CONSTRUCTION LENDING AGENCY I ,
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 a! (_I_f-i:`i '
r} f.F f i?a'',-t '
Lender's Name
PERMIT ISSUING FEE
Lender's Address ��•^
I certify that I have read this application and state that the TOTAL FEE 7
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby uthorize rep sentativ's of this County to enter upon '
ab ve- en i'n propert for inspection purpose
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permttt a Date ®`