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HomeMy Public PortalAbout5803-5807 ROSEMEAD BLVD_Electrical__ DEC TION WORKERS' I have a cerci .cafe of corse �� 76A663 DPW 3/07 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self �E� 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.) f ® `F Policy No. Company ; FOR APPLICANT TO FILL IN JOB QZGSL IhLI.D BLT Certified co is hereby furnished. EACH NO. FEE ADDRESS 5803 0 0 PY Y New Residential Bldgs. &Pools _ Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ $ 'LOCALITY Tle Lg tion department. ! Multi-familyS Ft. NEAREST .-� q' CROSS ST: Y U W R Date Applicant ! Residential Swimming Pools p FlRM NAME (;HAM iO.a DEV CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets: Rec •Light Sw._ ADDRESS 100 0C—br1&lJ X V (Q0 This section need not be completed if the work involved b First ti CITY Tel: No. p P Y .s Total No. Additional 4.ECK $ Lu Gr; ., —%GqC the permit Is for one hundred dollars(:100)or less.) PLAN CHECK � �3 I certify that in. the performance of the. work for which this APPLICANT L.L LN permit is issued, I shall nat employ any person in any manner °g so as to become subject to.the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS 8C 3$ ' Additional Total No. CITY Date Applicant Fixed Appliances Not Over 1 HP PERMIT w Te��No '2220 NOTICE TO APPLICANT: If, after making this Certificate of � 'APPLICATION �•, �u Exemption, you should becbme subject to the Workers' Range— Heater—D,W. — r" m 0 Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— (!ADDRESS i with comply.with such provisions or this permit shall. be Top FAU —W.H. GHE9K ' deemed revoked. 11 CITY ,T I, Hood — Fan. —Other— :•k n {}(3 LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. — Room Air Cond. — ''REG.NUMBER Class. I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000),pf Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. CESSED BY and Professions Code,and my license is in full force and effect. Size&Type HP, KW, KVA, or KVAR 0 __ License Number Lic. Class I — � 8 °W Up to 1 Incl. (FINALFf. i`I. f°�.� Contractor Date 4= ' `= Over 1 to 10 Incl. ','DATE VALIDATION 00 El4-TMW F Over 10 to 50 Incl. ;FINAL Au,I 4 � I am exempt under Sec. U Over 50 to 100 Inc. gy ' Over 100 I �y3307 5224.[W B.&P.C. for this reason ; .� Services, Swbd., MCC&Panelboards I► 1 IT EMS Z Date: ; 0 m.200 Amp. Under 600 V 8 ©O TOTAL 524.OID Signature 201 - 1000 Amp. Under 600 V 5 0 ' Exemption for Reg. Maint. Elect. Over 1000 Amp, or Over 600 V O 0-01 CHECK .524°00({({ SINGLE FAMILY Temp. Power Pole&Appurtenances CHANGE ° HOME OWNER-BUILDER DECLARATION ! Sign with One Branch Circuit I hereby affirm that I aro exempt from the Contractor's License -Low for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits 130030-13013 11/14/9,0 Professions Code): i I 3830 1 P ° ,, 1, as owner of the property, will do the work and the Mist. Conduits&Conductors i structure is not intended or-offered for sale(Section 7044,;; + Other(S a Complete Fee Schedule)_ Business and Professions Code). I 20 L. G G O D CONSTRUCTION LENDING AGENCY r I OL. C ,5 (� (}O I hereby affirm that there is a construction lending agency for ` the performance of the work for which this.permit is issued I PERMIT FEE (Sub-Total) 104-8 � 00 f� �0 ��•r�� (Sec. 3097,.Civ. C.). PLANCHECKING FEE 5 00 Aa2I QC Lender's Name I PERMIT ISSUING FEE Lender's Address TOTAL FEE 1[ ~! I certify that I have read this application and state that the above information is.correct. I agree to comply with all County j ordinances and State laws regulating Electrical wiring, and :I B U 1.L.D 113 C, ' 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 ®' WORN -- 'I have cerci DECLARATION 7 DPW 3/87 APPLIi CION FOR ELECTRICAL PERMIT' a �, I hereby affirrt I have a certificate of.consent to self ;ce-eobc insure, or a ce, ,of Workers'Compensation Insurance, COUNTY C. -" ANGELES DEPT. OF PUBLIC WORKS g or a q rtifi((d COP thereof(Sec. 3800; Lab. C.) _ _ + 1 1 � FOR APPLICANT TO FILL IN JOB ��^� t L Poli. No. Company O Certified copy is hereby furnished. -3 1 -� New Residential Bldgs. &Pools • EACH NO. FEE ADDRESS ❑ _Certified copy is filed with.the, cou t'y buildin 'ns ec- 1 &2-Family, Sq. Ft. $ $ LOCALITY_ E?'t1 I� cmz tion department. Multi-family Sq. Ft. NEAREST CROSS CROSS ST. �I�S v S Ip� Date A licant Residential Swimming Pools OWNER OR PP FIRAM NAME Outlets: Re CERTIFICATE OF EXEMPTION FROM WORKERS' c Light- Sw.JFI am' 04 D I �� ADDRESS 00 �CO'}N COMPENSATION INSURANCE T #�0� First 20 l (This section need not be completed if the work Involved by Total No.AAdditional . � CITY NG- {Qv�CA Tel. No. j the permit is for one hundred dollars($100)or less.) PLAN CHECK I certify that in .he 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 q so as•to become subject to the Workers'Compensation Laws. g g Z%3 p Additional Date Applicant Total No. CITY' oR(jt(j�c Tel. No.-j', Q 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 FAL_ `�-�C(/�f C- .Exemption, provisions of the Labor Code,.you must forth- Oven — Dryer —W.M.— ADDRESS QTO h3 OVE- sl`` with comply with such provisions or this permit shall be Top FAU _W.H. — deemed revoked.. Hood Fan —Other— CITY �--f ` Tel. No..��jO LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. .— Room-Air Cond. — REG.NUMBER , Class.C 10 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. PRp SED BY a and Prdfessions Code,and my license is in full force and effect. o�f.� .Size&Type HP, KW, KVA, or KVAR 0 IF O License Number Sk ' ( / Lic. Class Up to 1. Incl. C~r . FINAL. I U ` Er C, � Over 1 to 10 Incl. DATE r - VALIDATION O Contra..ctor�E�t- Date 3 �^�'►a ❑ h Over 10 to 50 Incl. FINAL F- I am exempt under Sec. Over 50 to 100 Inc. BY LU B.&P.C. for this reason Over 100 d Services,Swbd., MCC&Panelboards p p U Date: 0-200 Amp. Under 600 V �t7&0 � �-0 0 Z Signature 201 - 1000 Amp. Under 600 V `j ec S140 F1Over 1000 Amp, or Over 600 V �. Exemption for Reg,.Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances 4 Signwith.One Branch Circuit 'HOME OWNER-BUILDER DECLARATION T.a�• I hereby affirm that I am exempt from the Contractor's License . �;•�• Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits I 3307 ,,. Professions Code): ;9I"'°" ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors 1t:tt,7 structurals not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)_ TOTAL :L pC)a �Q Business and Professions Code). ,' ••i F• CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for {HAINGE the performance of the work for which this permit-is issued PERMIT FEE (Sub-Total) 17 7 OC0 (Sec. 3097, Civ.C.). Lender's Name 111011-0011"11 PLAN CHECKING FEEj 'PERMIT ISSUING FEE' / 81 d ° Lender's Address Q ° TOTAL FEE I certify that I have read this application and state that the �. Us. above information is correct. I agree to complywith all'County ordinances and Stat laws regulating Electrical wiring, and BV)Lbi INCA here nze represen Ives of this County to enter upon L J V I above- tioned pro y for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE CY ®a Signature of Permittee Date WORKE ) a certificate DECLARATION CE-806G 10/e1 APff711] IQ ON FOR ELECTRICAL PERMIT I hereby affirm that : a certificate of consent to self insure, CE-8D6G I>°'L'� or a certificate of�...,,.....i Compensation Insurance, or a certified COUNTY OF LGA mAGELES BUILDING AND SAFETY copy thereof(Sec.3800.Lab.C.) �? Poli No%�Company ' FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. EACH NO. FEE ADDRESS /�✓E New Residential Bldgs.&Pools rl Certified copy is tiled with the county building inspection 1 &2-Family,Sq.Ft. $ — $ LOCALITY department. /� Multi-family Sq.Ft. CROSS ST. NEAREST Dae4-Q-7--0// Applicant`' Residential Swimming Pools OWNER R FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL / Outlets:Rec—Light Sw.— Q� COMPENSATION INSURANCE ADDRESS � (This section need not be completed If the work Involved by the First 20 permit is for one hundred dollars($100)or less.) Total No. Additional CITY , Tel. I certify that in the performance of the work for which this permit PLAN CHECK -PPLICANT 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..r CITY Tel.No. ' 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'Compensation Range_ Heater D.W. _ APPLICANT provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_: W.M._ ADDRESS b �� provisions or this permit shall be deemed revoked. Top _. FAU W.H. CITY Tel.No�&0�-A?/ LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER Class.. Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. PRC SED BY >0 Inr Size&Type HP,KW,KVA,or KVAR �� Q License Number Lic.Class G/�1 Up to 1 Incl. BQ FINAL �+ VC-C-4Date.,s -����� Over 1 to 10.Incl. Q DATE �^ VALIDATION I= Contractor / Over 10 to 50 Incl. FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C.for this reason Over 100 n' Services,Swbd.,MCC&Panelboards Data. 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect: SINGLE.FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign.with One Branch Circuit ` I hereby affirm that I am exempt from the Contractor's License Law •r• for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits H�•i , °C Code): -r Misc.Conduits&Conductors Other(See Complete Fee Schedule) ° ElYI' I,as owner of the property,will do the work and the structure — . _ is not intended or offered for sale (Section 7044, Business ` `I�'-"` and Professions Code). ► , i; AL 175 o 40 CONSTRUCTION LENDING AGENCY 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'X Civ.C.). PLAN CHECKING FEE Lender's Name U'l �_.r y�si+: PERMIT ISSUING FEE. - Lender's Address I certify that I have read this application and state that the above TOTAL FEE 7< �/ll> "- information is correct.I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize e�,7 ` representatives of this County to enter upon the above-mentioned P� Z. /'D Lei.... property for nsp ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE /-0-'a7-V/ Signaturee J Date