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Home My Public Portal About5787 ROSEMEAD BLVD_Electrical__ :' ' WORKERS'COMPENSATION DECLARATION 78A883 fo/B, ePLfC 06� ®� ELECTRICAL PE CE=808G I hereby affirm that'i have a certificate of consent to.self insure, ' or a certificate of Workers` Compensation Insurance,or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(See.3800,Lab.C.)8 Policy No. 2!0?A Company2&P L flLMS t r40+ FOR APPLICANT TO FILL IN- JOB q Certified copy is hereby furn..ished. EACH• NO. FEE ADDRESS 7 p7 S �-• New Residential Bldgs.&Pools Certified co- is filed with the county building inspection 1.&.2=Family,Sq.Ft.. $ $ LOCALITY r Y NEAREST department. Multi-family Sq.Ft. CROSS ST. L,A S %Ui JP) Date Applican Residential Swimming Pools • OWNER OR FIRM NAMEWI�115DEM CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets:Ret_Light_Sw.— ADDRESS $7 $ BL. (This,section need.not be completed if the work Involved by the First 20 permit is for one hundred dollars($100)'or less.) Total-N.o. Additional CITY L& C 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 in any manner so as. to APPLICANT Et�T. INS-• become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 'ADDRESSa w vLo �. Total No. Additional , CITY Tel.N . Date• Applicant U K ' NOTICE .TO APPLICANT: If, after making this Certificate ..of Fixed Appliances Not Over 1 HP PERMIT' APPLICANT OAPA CVS C- Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. provisiops of the Labor Code,you must forthwith comply With such Oven Dryer_ WM:_ ADDRESS'- E . provisions or'this perm $ :W. MA-1109-22 ,A,rtA ., it shall be deemed revoked. 'Top FAU _ W.H. — LICENSED CONTRACTORS DECLARATION CITY V � Tel.N g)b Hood.— Fan T Other_ I hereby,affirm that I am licensed under provisions of Chapter 9 LICENSE OR (commencing with Section'7000.)of Division 3 of the Business and Disp. — Room Air Cond. °REG.NUMBER SII 2A Claw G►O Professions Code,and my license is in full force and effect. DISTRICT NOPROC SED BY Power App'are .tus&Large Appliances f/ Size.&Type HP,KW,KVA,or KVAR iij .. .License Number'Sli 3 Lie.•Class f✓1 C Up to 1 Incl. FINAL :' t INC- I Over 1 to 10 Incl. DATE ` `' a. .ContractorM CFRs 'CA&M SVS Date. 1 f �11 X71 (4�L.:_.a IL_Over 10 to.5'0 Inc[. .• 3 2E K FINAL ❑ I am exempt.under Sec. Over 50 to 100 Inc. gY ;_,";' L;=y " B&P..C.for this reason Over 100 'y i,'Z, ,r-- N Services,Swbd.,MCC&Panelboards Date: 0-200 Amp.Under 600 Vr�: 1:25. rte• Signature' 201 - 1.000 Amp.Under 600 V �,f4 Over 1000 Amp.or Over 600 V � � '� A, 5O,� ❑ Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 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 li!;ig�—:;1�lt;_. p,L� �,:1; Code): C.RA?K HILI Conduits&Conductors ❑ I,as owner of the property,will do the work-and the-structure is not intended or offered for sale(Section 7044, Business : Other(See Complete Fee Schedule) and Professions Code). CONSTRUCTION LENDING AGENCY rw _i,,L w 22• 121 1 y 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 An 311-4- Civ.C:). PLAN CHECKING FEE Lender's Name ` ' PERMIT ISSUING FEE ir[ Lender's Address I certify that I have read this application and state that the above TOTAL FEE B.p information is correct.I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County toe ter upon the above-mentioned ..p (nspget' n p7V, _JLZj SEE REVERSE FOR EXPLANATORY LANGUAGE /91 ignature of PerWee ee d 1(6col Date WORKERS'COMPENSATION I DECLARATION 70/81 PE-806G • APPIUCATI®N FOR ELECTRICAL PERMIT I herebi,affirm that I have a certificate of consent to self insure, PE-806G or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(.Seo.3800,Lab.C:) .r .- - . . . . fl Policy No. 1 Company y,-Q7r AVN0 FOR APPLICANT TO FILL IN JOB 0 Certified copy is hereby furnished. EACH NO. FEE ADDRESS r p 06 New Residential Bldgs.&Pools ' Certified•copy is filed with the-county building inspection 1 &.2-Family,Sq:Ft. $ _ $ LOCALITY depart 'ant. Multi=family Sq.Ft: NEAREST lyaf/ l .✓ir��>r� �lQAJ/S CROSS '�" 's Date-/9 9Applicant Residential Swimming Pools, OWNER OR n , FIRM NAME G d4 CERTIFICATE.OF EXEMPTION FROM WORKERS' —Light S _ MAIL Outlets:Re c— — w. COMPENSATION INSURANCE ADDRESS ao - QsEa (This section need not be completed if the work involved,by the First 20 permit is for one hundred dollars($iQ0)or.less.) Total No. Additional CITY Tel.. PLAN CHECK i,certify that.in the performance of the work for which this permit APPLICANT .1 y" 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 Total No. • CITY Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT:• If, after making this Certificate of APPLICANT Exemption,you should become subject to the Workers'Compensation Range_ Heater— 6w. provisions of the Labor Code,you must forthwith comply with such Oven ,_ Dryer_ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top FAU _ W.H. _ 'CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm. that 1 am licensed under provisions of Chapter 9 LICENSE.OR Disp.. Room Air Cond. Class. (commencing with Section 7000)of Division 3 of the Business:and REGINUMBER o9So� 16- (commencing Code,and.my license is In full force and effect. DISTRICT NO: PROCE • Power Apparatus&Large Appliances �....®^ Size.&Type HP,KW,KVA,or KVAR .License Number �0��/8� Uo.Class C /IQ .. Up to 1 Inc[. FINAL � Contractor J�E�>T� ate ��.�a i/ / Over 1 to 10 Incl. DATE VALIDATION Over 10 to 50 Incl. FINAL ] ❑ I am exempt under Sec.. .Over 50 to 100 Inc. ` BY W Over 100 t' LL' BAP.C.for this reason - N Services,Swbd.,MCC&Panelboardsj . Z Date: 0-200.Amp.Under'600 V .Signature 2.01 - 1000 Amp.Under 600 V Over 1000 Amp..or Over 600 V Exemption for Reg.Maint.Elect. i I SINGLE FAMILY " Temp:Power Pole&.Appurtenances I HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit -+*•` r L 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 Code): E_r 1; Misc.Conduits&.Conductors ❑ I,as owner of the property,will do the work and the structure Other(See Complete Fee Schedule) _ R: is not intended or offered for sale(Section 7044,Business , r r s,_ •_�9 .55 and Professions Code). CONSTRUCTION LENDING AGENCY j I hereby affirm that there is a construction lending agency for the ;i�hiillt performance of the work for which this permit is issued(Sec.3097,. PERMIT FEE (Sub Total) o , Civ.C.): ! PLAN-CHECKING FEE ` Lender's Name j PERMIT ISSUING FEE pZ ,tom=%t; Lender's Address I certify 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 roper n>/! ion purposes. 1` SEE REVERSE FOR EXPLANATORY LANGUAGE gnature.of Pe ittee Date j COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0205130026 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGALD: FEES PAID BUILDING DDRE S: ON FILE 5787 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780 ASSESSOR INF0 ON BER: 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 68.00 OUT 103.80 G2 LIGHTING FIXTURES 42.00 LGT 68.70 ISSUED 0 D B LA Y: EXPIRES ON: CINGULAR WIRELESS TOTAL FEES 200.25 05/13/02 JK 11/09/02 OWNER: TEL. NO: FINAL DATE FI AL Y: CODE: CALAC INVESTMENT (858) 565-8333- /' �0 SAN DIEGO, CA9211137 DESCRIPTION OF WORK INTERIOR TENANT IMPROV MENT FOR CELLULAR PHONE STORE APPLICANT: EL. 0: ANTHONY ENDE (818) 501-7932- 16817 WEDDINGTON ST SPECIAL CONDITIONS: ENCINO CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE CONTRACTOR MANAGEMENT GROUP (310) 343-3430- 525 S DOUGLAS ST LIC. NO TEMPORARY POWER POLE STE 230 647870 B EL SEGUNDO, CA 90245 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 C014PANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1306070028 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: 1 ON FILE 5787 ROSEMEAD BL [FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ TEMP CA 91780 [ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LAS TUNAS 15397-012-043 [AW PC CITY $109.35 MIN 0.00 1,318.90 I THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY CAI [A1 PERMIT ISSUANCE FEE 27.80 I [ ]TENANT: [F1 120V, 15/20A BR CKTS 40.00 BR 605.90 ISSUED ON: PROCESSED BY: PLAN BY: IMURATA (DAISO) YOSHIHIDE [F2 208, 277V LGT BR CKT 6.00 BR 163.80 107/31/13 SR [G1 OUTLETS-LGT,SW,RECP 53.00 OUT 83.30 I [OWNER: TEL. NO: [G2 LIGHTING FIXTURES 98.00 LGT 143.80 [F AL DATE FINAL BY: CODE: ILEW (S.LEW & ASSOCIATES INC), SUSAN (858) 565-8333- [IC NRES SHOWCASE IT 3HP 36.00 SHW 550.80 3709 CONVOY STREET [JB AC UNITS +3-10HP 6.00 AC 118.20 1SAN DIEGO CA 92111 [JT TRANSFORMERS, 75 KVA 1.00 XFM 86.30 IDS I N OF WORK [J5 OTHER PWR APP IT 3HP 1.00 PWR 15.30 ITENANT IMPROVEMENT - ELECTRICAL PROJECT TO CONSTRUCT NEW [LA 100 AMP PANELS, MCC 1.00 PAN 38.90 IRETAIL SHOP, OFFICE, STORAGE AND RESTROOMS APPLICANT: TEL. NO: [LC 225 AMP PANELS, MCC 2.00 PAN 77.80 IBLIZMAN, YOSHIKAZU (310) 768-2700- TOTAL FEES 3,230.80 1879 W 190TH STREET [SPECIAL CONDITIONS: ]GARDENA CA 90248 ]CONTRACTOR: TEL. NO: [APPROVALS DATE INSPECTOR SIGNATURE [SATOH BROTHERS INTER., INC. (310) 768-2700- I [ 1879 W. 190TH #935 LIC. NO [TEMPORARY POWER POLE [GARDENA CA 90248 743636 • I 1UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: I [LIFER GROUND [SATOH BROTHERS INTERNATIONAL (310) 768-2700- 1 I I [ 1879 W. 190TH STREET #910 LIC. NO: 1 ROUGH CONDUIT 1 GARDENA,CA 90248 743636 B 1ROUGH WIRING I I MAIN WATER LINE 1 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- ADDITIONAL DATA ON FILE [ I [ 1REPORT ID: DPR265 ROUTE TO: BS0508 I I [ += COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0705020012 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: 1 ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I ON FILE I I 5787 ROSEMEAD BL 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:I TEMP CA 91780 T (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I 15397-012-043 Al PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, Cl 1X1 SIGNS, OUTLINE LGT 1.00 SIG 38.85 T I (TENANT: TOTAL FEES 66.60 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I IAT & T i 105/02/07 JK 10/29/07 I I TOWNER: TEL. NO: 1 IFI DA FI Y: CODE: IS LEW AND ASSOCIATES (858) 565-8333- T I 13709 CONVOY ST. 300 1I ISAN DIEGO, CA9211137 I I IPTI N OF WORK IINSTALL ONE ILLUMINATED WALL SIGN AND REPLACE 2 FACES ON T I I 1EXISTING DOUBLE FACED ILLUMINATED POLE SIGN. T (APPLICANT: TEL. NO: 1 T 1 IJEFF REICH (818) 675-5849- 1 I 112439 MAGNOLIA #113 ISPECIAL CONDITIONS: INO.HOLLYWOOD 91607 I I I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE IMALL SIGNS AND SERVICE (818) 764-1909- 1 1 112439 MAGNOLIA BLVD #113 LIC. NO 1 ITEMPORARY POWER POLE II I IN HOLLYWOOD CA 91607 811074 C45 1 I I I 1 I I (UNDERGROUND CONDUIT I I II I I (ARCHITECT OR ENGINEER: TEL. NO: I 1UFER GROUND ILIC. NO: 1 IROUGH CONDUIT TROUGH WIRING I I TMAIN WATER LING I I I I IPLASTIC YIN METAL YIN I I I (UTILITY COMPANY NOTIFIED( I I I I I I I 1 I I i I I T I I I I I I 1 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 IREPORT ID: DPR265 ROUTE TO: BS0508 I I I I I