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Home My Public Portal About5821 ROSEMEAD BLVD_Electrical__ r WORKER'S COMPENSATION DECLARATION 20.0019 DPW 9189 I herdoy+a)firm that I have a Certificate of consent to self insure, 76A663 APPLICATION FOR ELECTRICAL PERMIT or a cerflIficate 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. Company FOR APPLICANT TO FILL IN JOB �O� 9 R0_qei�yrW_d (.� R j ADDRESS (7 dri (� Certified copy Is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE 1&2-Family,Sq.Ft. $ — $ LOCALITY T,H PGE f T ❑ Certified copy is filed with the county building inspection — NEAREST /1� department. Multi-family Sq.Ft. CROSS ST. /T Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rea--Light Sw. OWNER OR Fl�Yf C �� COMPENSATION INSURANCE First 20 D ®'p FIRM NAME 1�G �T (This section need not be completed If the work Involved by the Additional MAIL _)7 01 3 t�pil�hy� permit is for one hundred dollars($100)or less.) Total No. ADDRESS I certify that in the performance of the work for which this permit CITY rEw& F No. 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 Date �a`-Applicant - v , 15 OR 20A,120V BRANCH CIRCUITS NOTICE TO APPLICANT: If, aft king this Certificate of CITY Tel.No. ma Exemption,you should become subj 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 APPLICANT provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH LICENSED CONTRACTORS DECLARATION ADDRESS �L�2� 63 I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH IL (commencing with Section 7000)of Division 3 of the Business and CITYM&,,.41PALr-7 Tel.No.YZ>— 77l S6-7,gU Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE ORyy _ J Power Apparatus&Large Appliances REG.NUMBER `✓ .537-1% Cless.(�� Q License Numb er '� Lic.Class e— • Size&Type HP,KW,KVA,or KVAR DISTRICT NO. P SED BY I" Up to 3 Incl. Q d r h I _ Z Over 3 to 10 Incl. FINALN ContractoDate A v ❑ Over 10 to 50 Incl. Z I am exempt under Sec. Over 50 to 100 Incl. FINAL Over 100 VALIDATION B.&P.C.for this reason BY Services,Swbd.,MCC&Panelboards Date: 0-200 Amp.Under 600 V Signature 201-1000 Amp.Under 600 V f ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maim.Elect. s SINGLE FAMILY Temp.Power Pole&AppurtenancesT a HOME OWNER-BUILDER DECLARATION ANT.o v I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Z7Q7 7X_.,1 Code): ❑ Misc.Conduits&Conductors ITEMS 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) , TOTAL. 72.31 and Professions Code). -1 CHECK7�0?� CONSTRUCTION LENDING AGENCY CHANGE o I hereby affirm that there is a construction lending agency for the 00 Performance of the work for which this permit is Issued(Sec.3097, PERMIT FEE (Sub-Total) 7 Civ.C.) PLAN CHECKING FEE 0003-0001 9/15/92' Lender's Name PERMIT ISSUING FEE -�t1? 1 AM $:18 Lender's Address / I certify that I have read this application and state that the above TOTAL FEE p?, 3 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 prop ty Xforin77 ectio01rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE a .TURF APPEICANT OR AGENT DATE 1 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0502160021 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: RES PAID BUILDrNG ADDRESS6 ON FILE 5821 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: LION: AMOUNT: TEMP CA 91780 ASSESSOR INFORMATION R: 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 1.00 SIG 38.85 TOTAL FEES 66.60 ISSUED PROCESSED EXPIRES . 02/16/05 JK 08/15/05 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: PHAM, THUY (626) 285-8066- 5821 ROSEMEAD BLVD. f 4n TEMPLE CITY CA 91780 DESCRIPTION OF R ELECTRICAL FOR ILLUMINATED CHANNEL LETTER WALL SIGN APPLICANT: TEL. NO• FIRST SINGS CO. (626) 448-1616- 9647 E. RUSH ST SPECIAL CONDITIONS: S. EL MONTE 91733 CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIG AT E FIRST SINGS COMPANY (626) 448-1616- 9647 E. RUSH STREET LIC. NO TEMPORARY POWER POLE SOUTH EL MONTE, CA 91733 605688045 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. N0: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE T- PLASTIC Y/N METAL Y/N UTILITYCOMPANY 0 IF D REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0501310049 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID ILD NG DD SS: ON FILE 5821 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780 ASSESSOR R NUMBER: NEAREST CROSS STREET: LAS TUNAS 5397-012-043 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, C G1 OUTLETS-LGT,SW,RECP 30.00 OUT 52.50 IB N-RES WTR HTR IT 3HP 1.00 WTR 15.30 ISSUED 0 ROC S ED BY: PLAN BY: EXPIRES ON:- IF NON-RES LAUNDRY MACH 1.00 LAU 15.30 01/31/05 JK 07/30/05 TOTAL FEES 110.85 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: PHAM, THUY (626) 285-8066- _ 5821 ROSEMEAD BLVD. TEMPLE CITY CA 91780 SCRIPTIOON OF WORK ELECTRICAL FOR TENANT IMPROVEMENT. APPLICANT: TEL. NO: SATURN SYSTEMS INC. (310) 329-2728- 15916 S. FIGUEROA ST SPECIAL CONDITIONS: GARDENA, CA 91248 CONTRACTOR: TEL. 0: APPROVALS DATE INSPECTOR SIGNATURE SATURN SYSTEMS INC. (310) 329-2728- 15916 S. FIGUEROA LIC. NO TEMPORARY GARDENA, CA 90248 683127 B UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGK_WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY N0 ED REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0806190038 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAZD I BUILDING ADDRESS: I ON FILE I I 5821 ROSEMEAD BL I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:] TEMP CA 91780 I ]ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I 15397-012-043 IA1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, Cl ] IK1 SIGNS, OUTLINE LGT 1.00 SIG 38.85 I 1 (TENANT: TOTAL FEES 66.60 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I ITHE NAIL BOUTIQUE I 106/19/08 SR 12/16/08 I OWNER: TEL. N0: - I I FINAL DAT EX Y: CODE:jI INVESTMENT 13709 I I ]I 1 ISAN DIEGO, CA9211137 I IDESCRIPTION OF WORK I ] I (ILLUMINATED LED CHANNEL LETTER I I ] I I (APPLICANT: TEL. NO: I I I IJ & H SIGN INC. (626) 448-1166- 1 1 1 19441 VALLEY BLVD. I ISPECIAL CONDITIONS: I IROSEMEAD CA 91770 I I I I I [CONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE I IJ AND H SIGN, INC. (626) 448-1166- I 1 I 9441 VALLEY BLVD. LIC. NO I (TEMPORARY POWER POLE I I I [ROSEMEAD, CA 91770 873439 C45 I I 'II- I I (UNDERGROUND CONDUIT I I ]ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND I I [ LIC. NO: [ IROUGH CONDUIT I 1 I [ IROUGH WIRING I I IMAIN WATER LINE I I I ] I 1PLASTIC YIN METAL YIN I I I ] I ]UTILITY COMPANY NOTIFIEDI 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 � I i I I I I I I I I I 1 (REPORT ID: DPR265 ROUTE TO: BS0508 I I I I ]