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Home My Public Portal About5783 ROSEMEAD BLVD_Electrical__ WORKER NCOMPEN�ATIONDECLARATION 200019 DPW 8/89 APPLICATION FOR ELECTRICAL PERMIT L ,�` 76A663 I hereby affirri/that I have a certificate of consent to self insure, i or a certificate7•of Worker's CompeiVsation insurance,or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C.) ;' 1 I . Policy No. Company. FOR APPLICANT TO FILL IN JOB ADDRESS ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE/ LOC LIN' ❑ 1&2-Family,Sq.Ft.-•- $ _ $ Certified.copy is filed with the county building inspection I , NEAREST �yyn� f L V� department. Multi-family Sq.FL CROSS ST. i Residential Swimming Pools AssEssbR Date Applicant i' +. 1 �,. (Jf P BOOK PAGE PARCEL 1 CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light' Sw. FIRMA NAME 1 d COMPENSATION INSURANCE._ MAIL (TFils section need not be completed if the work Involved by the. First 20 Total`No. Additional ADDRESS /`» permit is for one hundred dollars($100).or less.) I certify that In the performance of the work for which this permit CITY Z:LTel.NjAjp 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 Total No. Additional ADDRESS Data D ',c_/'�Applicant 6, �� ' 15 OR 20A,120V BRANCH CIRCUITS NOTICE TO APPLICANT: If, after making this Certificate of 1 . CITY Tel.No.. Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code.,you must forthwith comply with such 117 40 INCLUSIVE EACH APPLIIT CANT_ provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH LICENSED CONTRACTORS DECLARATION ADDRESS d I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,?08V TO 277V LIGHTING EACH � 0 (commencing with Section 7000)of Division 3 of the Business and CITY G _ �s73 el.No1/•.��l3� _ V Professions Code,and my license is In full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR Q Power,Apparatus&Large Appliances REG.NUMBER ole 0 �Q PP. l:S O._/� License Number 1�Q , Lid.Class e Size.l&Type HP,KW;KVA,or KVAR DISTRICT NO. p PR SED BY Up-to 31ncl. pox CL Over 3 to 10 Incl. FINAL a Contractor �� ate /O �� DATE Z � Over 10 to 50 Incl. Z I am exempt under Sec. Over 50 to 100 Incl. '` ` VALIDATION —' { FINAL B.&P.C:for this reason Over 100 BY Services,Swbd'.,MCC&Panelboards Date: 0-200 Amp.Under 600 V Signature 20.1-1000 Amp:.Under'600 V ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. �• SINGLE FAMILY TemI' p.Power Pole&.Appurtenances HOMEOWNER-BUILDER DECLARATION + Sign with One Branch Circuit, I heFeby affirm that I am exempt from the Contractor's.License Law g „w�€.. 5 1 4 r�• for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits ❑ Misc.Conduits&Conductors ' 'fi 7°' I,as owner of the property,will do the work and the structure I Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) �,;.•. •. and Professions Code). d , CONSTRUCTION LENDING AGENCY - .� ��:r�;`sta='• 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 i PLAN CHECKING FEE Lender's Name I j fj i PERMIT ISSUING FEE 7 l Lender's Address TOTAL,FEE y 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 representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGN RE 0219APPC 021PCANTOR AGENT DATE I ION DECLARATI WOthat I have a certificate of consent to 7SA669bPwe,e9 APPLICATION FOR ELECTRICAL PERMIT 'I.hereby affirm that I have a certificate of consent to self Insure, 78A663 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. 9.?5 `9 Company 0/7 ,0�. FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ❑ 1 &2 Family,Sq.Ft. — LOCAL - $ $ I ` Certified copy is filed with the county building inspection NEAREST dep rtment. Multi-family Sq.Ft. CROSS U. Date Applicant ` rl, Residential Swimming Pools pssESsoR / ;I' MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rea._Light Sw. OWNER OR COMPENSATION INSURANCE i FIRM NAME effAvheW tV U O W f (This section need not be completed if the work'involved b�the First 20 MAIL permlt,is for one hundred dollars($100)or less.) Total No. Additional ADDRESS jV ZT� L(Yj,Q I certify that in the performance of the work for which this permit CITYTel.No. Is issued, I shall not employ any person in•any manner so as to PLAN CHECK Ctg94 become subject to the Workers'Compensation Laws. Lighting Fixtures First;20 APPLICANT .. To(41 N6. Additional ADDRESS Date Applicant 20A,120V BRANCH CIRCUITS NOTICE TO APPLICANT: If, after making this Certificate of 1 15 OR OR 20ACLUSIVE EACH CITY Tel.No. Exemption,you should become subject to the Workers'Compensation ` provisions of the Labor Code,you must forthwith comply'with such 11APPL TO 40 INCLUSIVE EACH APPLICANT provisions or this.permit shall be deemed revoked. 41 OR MORE BRANCH:CIRCUITS EACH ; LICENSED CONTRACTORS DECLARATION ADDRESS.V .✓ d I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH /� -� — - S! (commencing with Section 7000)of Division 3 of the Business and CITY Tel.No. 73.Sy�6` V Professions Code,and my license Is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR n O Power Apparatus&Large Appliances REGO NUMBER 2_ License Number -�Lim Class Slzel&Type HP,KW,KVA,or KVAR DISTRICT NO. PBOCESSED BY Up to 3 Incl. y� W /9 �> Over 3 to 10 Incl. FINAL d Contractor�¢f/ 2 4x£•,G, DATE co z i Over 10.to 50 Incl. �� — `�❑ VALIDATION I am exempt under Sec. Over 50 to 100 Incl. FINAL B.&P.C.for this reason Over 10.0. BY I, Services,Swbd.,MCC&Panelboards, Date: 0.;,,200 Amp.Under 5.00 V Signatur 201-1.000 Amp.Under 600'V Over 1000 Ampt or Over 600 V ❑ Exemption for tR g.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances c HOME OWNER-BUILDER DECLARATION Sign with'One Branch Circuit I,hereby affirm that I am exempt from the Contractor's License Law i •�.;,;: ,Z. for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits _ Code): ..- +!ti Lj� ❑ 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). , — ,�'tz' IL'`5 m •.:_„,• -CONSTRUCTION LENDING AGENCY 1 -' •~* 4' z �� 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 i.FEE (Sub-Total) Civ.C.)• PLAN CkECKING.FEE Lender's Name PERMIT ISSUING FEE A_1/ 2 � Lender's Address I I cerftfy 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 this County to enter upon the above-mentioned pro for Insp�tio. rpos SEE'REVERSE FOR EXPLANATORY LANGUAGE OF APPU • COUNTY OF IAS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0904060017 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 1 5783 5785 ROSEMEAD BL 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 91780 1 (ASSESSOR INFORMATION NUMBER: I. I NEAREST CROSS STREET: 1 15397-012-043 IA1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, Cl IG1 OUTLETS-LGT,SW,RECP 1.00 OUT 1.95 I I TENANT: I TOTAL FEES 29.70 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I TEMPLE CITY MARKETPLACE 1 104/06•/09 SR 10/03/09 1 I (OWNER: TEL. NO: I IF AL DATE FINAL BY: CODE: I IPROPERTY MANAGEMENT 15783 ROSEMEAD BLVD. I I ITEMPLE CITY CA 91780 1 IDESCR PTIO OF WORK 1 1 II 1ELECTRICAL WALL PLUG 1 (APPLICANT: TEL. NO: I I I IBEN TOMLIN (818) 341-6500- 1 19233 ETON AVE. 1 ISPECIAL CONDITIONS: ICHATSWORTH CA 91311 1 1 ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IKAPING CONSTRUCTION (818) 341-6500- 11 I 19223 ETON ST. LIC. NO 1 ITEMPORARY POWER POLE i I I ICHATSWORTH CA 91311 450320 B I I I I I 1UNDERGROUND CONDUIT I I I (ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND I I I 1 LIC. NO: I IROUGH CONDUIT I I I I I I 1 1 1ROUGH WIRING I I I IMAIN WATER LINE I I 1PLASTIC YIN METAL YIN I I I (UTILITY COMPANY NOTIFIED( I I I I I I I I I I I I I 1 I I I I I 1 I I I 1 I I I I I I I I I I I I 1 I 1 I I I 1 1 1 I i 1 I I I I I I I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 1 I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1202210020 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID I BUILDING ADDRESS: ON FILE I 5783 ROSEMEAD BL FEE DESCRIPTION: QIIANTITY: UOM: AMOUNT:j TEMP CA 91780 ASSESSOR INFORMATION NUMBER: INEAREST CROSS STREET: 5397-012-043 jA1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, Cl JK1 SIGNS, OUTLINE LGT 1.00 SIG 38.80 (TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: SANRIO TEMPLE CITY I +02/21/12 SR OWNER: TEL. NO: IFINAL DATE FINAL BY: CODE: ILEW, SUSAN _ 3709 SAN DIEGO, CA9211137 DESCRIPTION OF WORK ILLUMINATED WALL SIGN APPLICANT: TEL. NO: IMOCAL SIGNS (310) 941-2017- SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE IMOCAL SIGNS (310) 941-2017- 11432 W. 166TH STREET LIC. NO ITEMPORARY POWER POLE IGARDENA, CA 90247 910859 C45 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: _ I JUFER GROUND LIC. NO: i ROUGH CONDUIT (ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N (UTILITY COMPANY NOTIFIED E 3 2) Eu i i (REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508ECTRICAL na DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS 1I BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGALFEES PAID BUILDING ADDRESS: ON FILE 5783 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780 ASSESSOR I0 0 NUMBER: NEAREST CROSS STREET: 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 66.60SS E . PROCESSED A - EXPIRES ON: FANTASTIC SAM'S 03/04/97 TC 03/04/98 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: 3AALLAAC INVESTMENT - q SAN DIEGO, CA9211137 U91-CATMON up wulm ONE CHANNEL LETTER ILLUMINATED SIG P T: T RITE LITE SIGNS (818) 767-2059- SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: 1' ; ��-�u i\ p APPROVALS DATE INSPECTOR SIGNATURE RITE LITE SIGNS (818) 767-2059- 0 O 11116 TUXFORD LIC. NO 0 TEMPORARY W PO SUN VALLEY, CA 91352 577974C45 ��®nOJl�t9J�Q1\ �� UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: E 0: R GROUND LIC. NO: `1 ROUGH'�;i' CONDUIT ` ROUGH WIRING MAIN WATER LINE BLASTIC Y/N METAL Y/N UTILITYP 0 I D "® ca® REPORT ID: DPR265 ROUTE TO: BS0508 7 • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ` DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL O'5tf 9702180029 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL D: FEE D I ADDRESS: ON FILE 5783 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 G1 OUTLETS-LGT,SW,RECP 20.00 OUT 39.00 TENANT: G2 LIGHTING FIXTURES 1.00 LGT 1.95 ISSUED 0PROCESSED : PLAN BY: EXPIRES 0 : FANTASTIC SAMIS TOTAL FEES 68.70 02/19/97 TC 02/19/98 OWNER: TEL. NO: FINAL DATE FINAL Y: CODE: CALAC INVESTMENT 3709 SAN DIEGO, CA9211137 DESCRIPTION OF WORK ELECTRICAL FOR TENANT IMPROVEM NT APPLICANT: 0: JIM WALTERS CONS. (714) 993-1274- SPECIAL CONDITIONS: CONTRACTOR: TEL. N0: JIM WALTERS CONSTRUCTION (714) 993-1274- ::% ❑ s APPROVALS DATE INSPECTOR SIGNATURE 4681 TORIDA WAY LIC. NO o C/ �T-EMPORARY POWER POLE YORBA LINDA, CA 92688 554219 B )�0)m 01 1 C n ci UNDERGROUND CONDUIT ARCHITECT 0ENGINEER: TE 0: 00 GROUND LIC. NO: �; ROUGH CONDUIT ROUGH I MAIN WATER LINE :�LASTIC Y/N METAL Y/N UTILITYC-MR97-07=0 REPORT ID: DPR265 ROUTE TO: BS0508