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Home My Public Portal About5819 ROSEMEAD BLVD_Electrical__ WORKER'S COMPENSATION DECLARATION 20-0019.1 DPW 9189 76AAPPLICATION FO,R ELE TRICAL PERMIT u affirm•that I have a certificate of consent to self insure, S631 I hereby , or 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.) p j� } Policy NO i Z r .Company E 1?, FOR APPLICANT TO FILL IN JOB / ADDRESS l e 8L V.� Certified copy Is hereby furnished. New;Residential Bldgs.&Pools EACH NO. FEE $ _ $ LOCALITY mm P L Certified copy is filed with the coun bulldingjnspe n 1&2-Family,Sq.Ft. NEAREST department. Multi-family Sq.Ft. CROSS ST. 'p-S Date —�T-��' Applica Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXE PTI FROM WORKERS' Outlets:Rec._Light Sw. OWNER OR COMPENSAT INSURANCE FIRM NAME 4 ^ (This section need not be completed If the work involved by the First 20 MAIL. T0181 No. Additional ADORN,, l f o Ls+ permit is for one hundred dollars($100)or less.) I certify that in the performance of the wor env iI'ch this permit CI Tel.No. Is Issued, I shall not employ any in any manner so as to LP CHECK become subject to the Worker mpensation Laws. Lighting Fixtures First 20 APPLICANT ^j•a' /(Ej/V'S Total No. Additional ADDRESS 9333 Data Applicant f 75 OR 20A,120V BRANCH CIRCUITS NOTICE T PLICANT: If, after making this Certificate of CITY , Tel.No.47 Exemptio .ou should become.subject.to the Workers'Compensation 1 TO 10 INCLUSIVE EACH provi a of the Labor Code,you must forthwith comply with such 11 TO 40 INCLUSIVE EACH - PERMIT pr sions dr this permit shall be deemed revoked. '41 OR MORE BRANCH CIRCUITS EACH .LICENSED.CONTRACTORS DECLARATION ADDRESS a I hereby affirm that I am licensed under provisions of Chapter 9 ;15 OR 20A,208V TO 27N LIGHTING EACH (commencing with Section 7000)of Division 3 of the Business and CITY Tel.No. C Professions.Code,and my license is In full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR Power Apparatus&Large Appliances REO.NUMBER Clew' C License Numb e Lic.Class�.. ISIze&Type HP,KW,KVA,or KVAR DISTRICT NO. PR SED BY Up to 3 Incl. LL Cont r Date 77- :71 ' 1Z Over 3 to 10 Incl. DATE Cr ❑ 'Over 10 to 50 Incl: Z exempt under Sec. it Over 50 to 100 Incl. VALIDATION B.&P.C.for this reason Over 100 FINAL Y AL Services,Swbd.,MCC&Panelboards Date: / 0-200 Amp.Under 600 V Signature 201-1000 Amp.Under 600 V Over 1000 Amp.or Over 600 V ❑ Exempt/.rt eg.Malnt.Elect. „ SINGLE FA Y Temp.Power Pole&Appurtenances ' WNER-BUILD DECLARATION f'r I hereby affirm m exempt fr m the Contractor's License Law Sign with One Branch Circuit ! i ;u k for the followinon(Section. 031.5; Business and Professions Additional.Sign Branch Circuits wLL t ii Code)! q ❑ Misc.Conduits&Conductors I,as owthe p arty,will'do the work and the structure 1 ''1 " "` Is not id or ffered for sale(Section 7044, Business Other(See Complete Fee Schedule) , "('�( i �+" and Prns ode). I � RUCTION LENDING AGENCYhereby affirmere!s a construction lending agency for theperformance ofrk for which this permit is issued (Sec.3097, pE)aMIT E. (Sub-Total) _ Civ.C.) PLAN CHECKING FEE ' S;s"•,-1j ,^-n=;` tri?{,-Sry Le/Ste. ' e PERMIT ISSUING FEE e;b�- Leass I c 1 have read this application and state that the above TOTAL FEE f Infis correct. I agree to comply with all County ordinances I anws regulating Electrical wiring, and hereby authorize reves of this County to enter upon the above:mentioned prInspection purposes. ! SEE REVERSE FOR EXPLANATORY LANGUAGE ; SIGNATURE OF APPLICANT OR AGENT DATE. ' WORKER'S COMPENSATION DECLARATION w_oo19 DPW 9/1190 76A663 APPLICATION FOR ELECTRICAL PERMIT I heteby affirm that I have a certificate of consent to self Insure, P a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND.SAFETY DIV. Jtcopy thereof(Sec.3.800 Lab.C.) ��. � Policy No. Company i �v FOR APPLICANT TO FILL IN JOB ❑ ADDRESS �J Certified copy is hereby.furnished. New Residential Bldgs.&Pools EACH NO. FEE LOCALITY Certified copy is filed with the county building Inspection 1&2-Family,Sq.Ft. $ _ $ el apartment77 Multi-family Sq.Ft. NEAREST Date. 2 Applicant Residential Swimming Pools ASSESSOR -MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' J5 -76—SWI-2OWNER OR COMPENSATION INSURANCE Outlets:Rec._.Light / O V. FIRM NAME (This section need not be completed If the work Involved by the First 20 MAIL permit is for one hundred dollars($100)or less.) Total No.&Z Additional ADDRESS I certify that in the performance of the work,for which this permit CITY Tel.No. is issued, I shall not employ any person in any manner so as to DPLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixture First 20 i _ APPLICANT Total No. Additional ADDRESS Date Applicant 15 OR 20A,120V BRANCH CIRCUITS NOTICE TO APPLICANT: If, after making this Certificate of 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 11 TO 40 INCLUSIVE EACH PERMIT provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH. LICENSED CONTRACTORS DECLARATION ADDRESS } j Z IL I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH (commencing with Section 7000)of Division 3 of the Business and CITY Tel.No.q � V Professions Code,and my license is in full force'.and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR Class. .elf C� f Power Apparatus&Large Appliances REG.NUMBER CJ . License Number / LID.Clara Size& pe'HP,KW,KVA,or KVAR DISTRICT NO. P. CESSED BY .Up'to 3 Incl /4f. t.7� Lij �T/� Over 3.to 10 Incl. L FINAL a Contractori'�'t'—h. �^�'.� Date DATEcoo Over 10 to 50 Incl. 2 ❑ D I am exempt under Sec. Over 50 to 100 Incl. /v VALIDATION AL B.&P.C.for this reason. Over 100 gy Services,Swbd.,MCC&Panelboards Date: 0-200•Amp.Under 600 V Signature.. 201-1000 Amp.Under 600 V ElExemptionfor Reg.Maim.Elect. Over 1600 Amp.or Over 600 V ACCT■T 8 SINGLE FAMILY Temp.Power Pole&Appurtenances337. HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 2 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 ACCUTL Code): ❑ 86 l,.as owner of the property,will do the work and the structure Misc.Conduits&Conductors 3307•■ Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) , 2 ITEMS and Professions Code). 8415 CONSTRUCTION LENDING AGENCY TOTAL 4. o I hereby affirm that there is a construction lending agency for theMECK 554.86 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) CII4C7E eCC Civ.C.) ' PLAN CHECKING FEE o? . Lender's Name PERMIT ISSUING FEE .. '/ 0000--10001 8f27f92 Lender's Address ,Q � ■ I certify that I.have read this.application and.state that the above TOTAL.FEE ..6 %•�� 5231 1 All 8■5b Information is correct. I agree to comply with all County ordinances and State laws regulatin Electrical-wiring, and her by authorize 6. rep rese Ives of t ' unty.to enter upon the. ve-mentioned pro for Ins purposes, SEE REVERSE FOR EXPLANATORY LANGUAGE I APP ICAW1OFFACIENT DATE ' OVORKER'S COMPENSATION DECLARATION 20.0019 DPW 9/88 � 76A663 1 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self Insure, :or a certificate.of Worker's Compensation,Insurance, or a crrtIfIed COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy ther f Sec.3800Lab. Policy NO Company. FOR APPLICANT TO FILL IN JOB ❑ ADDRESS 47/0) Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE LOCALITY 116 . Certified copy is filed with the cou bui ng I e Ion 1&2-Family,Sq.Ft. $ _ $ NEAREST pprtm Multi-family Sq.Ft. NEAREST. Date Z Applicant ` Residential Swimming Pools ASSESSOR { MAP BOOK PAGE PARCEL t;ERTIFICATE OF EXEM FROM WORKERS' FIR NAME ( !� COMPENSATION URANCE Outle}s:Rec._Light Sw. !i First 20 MAIL �,� (This section need not be completed if the work involved y the Total No. Additional ADDRESS 7 oy permit is for one hundred dollars.($100),or leas.) I certify that in the performance of the work hich this permit CITY Tel. is issued, I shall not employ any perso any manner so.as to I PLAN CHECK become subject to the Workers'Com ation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional' ADDRESS Date plicant 15 OR 20A,120V BRANCH CIRCUITS NOTICE TO APP NT: If, after making this Certificate of 1 TOR 21A,120V BRANCH CITY Tgl.No. 'Exemption,you uid become subject to the Workers'Compensation PERMIT provisions a Labor Code,.you must forthwith comply with such 11 TO 40 INCLUSIVE EACH APPLICANT provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH �. LICENSED CONTRACTORS DECLARATION ADDRESS 41133 I w. S 0. I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,20BV TO 277V LIGHTING EACH (commencing with Section 7000)of'Division 3 of the Business and CITY CIC.vC.G I. o.y S-3 V Professions Code,and my license is in full force-and effect. RE..SIDENTIAL APPLIANCES UP TO 3HP LICENSE OR Power Apparatus&Large Appliances REO.NUMBER y Gass.L ` . G� Size&Type HP,KW,KVA,or KVAR DISTRICT NO. P o ED BY V License Number Lic.Class �/ i. Up to 3 Incl. d W f( �_ S -7 3 t6-1 3 Over 3 t0 70 Incl. FINAL a Contractor ate DATE Z Over 10 to 50 Incl. U^( VALIDATION' 0 I am exempt under Sec. —[� i Over 50 to 1.00 Incl. FINAL B.&P.C.for this reasonOver 100 .BY i Services,Swbd.,.MCC&Panelboards Date: 0-200 Amp:Under 600 V 4, Signature- 201-1000 Amp.Under 600-V ❑ Over 1000 Amp.or Over 600 V t Exemption for Reg.Maim.Elect. SINGLE FAMILY Temp:Power Pole&Appurtenances - HOME OWNER-BUILDER DECLARATION r S I hereby affirm that 1 am exempt from the Contractor's License Law Sign with One Branch Circuit 60 3 b I =•'•. .,• for the following reason Section 7031.5, Business and P ofessions Additional Sign Branch Circuits l ';Ts`— 'C Code): 9 ( 9 t; L. o!•.� Misc.Conduits&Conductors I,as owner of the property,will do the rk and the structure Is not Intended or offered for as action 7044, Business Other(See Complete Fee Schedule) ' >:n �z and Professions Code). _ ;-ECK e:.��Y.eµie CONSTRU LENDING AGENCY I hereby affirm that the ra A construction lending agency for the �.h1:+�-' .� performance of the for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE Lender's e 1 PERMIT ISSUING FEE I :a Lender's Address I certify that] have read this application and state:that the-above TOTAL FEE information is correct. I agree to comply with all County ordinances and Stat- laws regulating EJe.t cal.wiring, and hereby authorize represstatives t menter upon the above-mentioned propertfor Ins ec on p poSEE REVERSE FOR EXPLANATORY LANGUAGE 2, SIGNAKFf OF APPLICANTOR AGENT DRTE i COUNTY OF LOS ANGELES ( TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0403220005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 5819 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, C K1 SIGNS, OUTLINE LGT 3.00 SIG 116.55 TENANT: TOTAL FEES 144.30 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 03/22/04 VG 09/18/04 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: CALAC INVESTMENT g q 3709 CONVOY ST. 1 SAN DIEGO, CA9211137 DESCRIPTION OF WORK ELECTRICAL FOR ILLUMINATED SIGNS I APPLICANT: TEL. NO: SUCCESS SIGN PRINTING INC. (626) 444-8181- SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SUCCESS SIGN PRINTING INC. (626) 444-8181- 2812 PECK RD LIC. NO TEMPORARY POWER POLE EL MONTE CA 91731 739177C45 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFERiGROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED I i i i i REPORT ID: DPR265 ROUTE TO: BS0508