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HomeMy Public PortalAbout6330 ROSEMEAD BLVD_Electrical__ WORKER'S COMPENSATION DECLARATION 20-0019DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT • I hereby affir khat I have a certificate of consent to self insure, 76A663 or :.`ertifica;^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.)_ . r.o Policy No. Company FOR APPLICANT TO FILL IN JOB DDRESS ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE " $ $ LOCALITY ❑. Certified copy is filed with the county building inspection 1&2-Family,Sq.Ft. - NEARESTde department Multi-family Sq.Ft. CROSS ST. ✓� ��y�g, Dat r Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR Outlets:Rec. �- Light Sw. FIRM NAME COMPENSATION INSURANCE �� O First 20 A ^ , (This section need not be completed if the work involved by the permit is for one hundred dollars($100)or less.) Total No. �'4 Additional ADDMAILRESS I certify that in the performance of the work for which this permit CITY �^ Tel.No.a 6% is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws: Lighting Fixtures First 20 PLAN CHECK f p 9 9 APPLICANT Total No. Additional ��{" ADDRESS Date 3 Applicant ��•a"— RESIDENTIAL APPLIANCES NOT OVER 3 HP. �NOTICE'TO A PLICANT: If, after making this Certificat of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS VV `rlhl jG I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. q 1�$ (commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. y, LICENSE B ,t,� Class. •� Over 50 t0 100 Incl. REG.NUMBER � ����oq--- L�� d License Number a LIC.Class 16 Over 100 DISTRICT NO. /hh PPOESSED BY O Services,Swbd.,MCC&Panelboards v� l yri 0: ?j �� lV 0-399 Amp.Under 600 V FINAL O Contractor Date DATE q M— ❑ I am exempt under Sec. —r& -f-7 400-1000 Amp. Under 600 V 4 5 l VALIDATION LILI Over 1000 Amp.or Over 600 V FINAL IZ B.&P.C.for this reason BRANCH CIRCUIT FEES BY U) Date: 15A,or 20A, 120V,Lighting or Recept. _ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits 7 Exemption for Reg.Maint. Elect. 15A,20A,208V To 277V Lighting Br.Circuits ACCT. rr Tr SINGLE FAMILY Temp.Power Pole&Appurtenances 014 I a'a HOME OWNER-BUILDER DECLARATION h Circuit u Sign with One it 3,30367[t i I hereby affirm that I am exempt from the Contractor's License Law 69.70 0 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 1TGt 1S Code): d ❑ I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL 69- -70 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , 4r- CK 69.70 and Professions Code). f CONSTRUCTION LENDING AGENCY 4N�`iN�� a00 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) �� .,uU _��Q� � Civ. C.) �/��_tl:O 6 PLAN CHECKING FEE 5498 1 An 9:42 Lender's Name PERMIT ISSUING FEE -;k o Lender's Address ZZ, r/ I certify that I have read this application and under penalty of purjury state TOTAL FEE Zj 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 ent up n the above-mentioned property for inspections. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATU F RMIT DATE WORKER'S COMPENSATION DECLARATION 76A663 9 DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT 76A66 hereby affirm that I have a certificate of consent to self insure, , or a certificate of Worker'p 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.10-85132 Company STATE FUND FOR APPLICANT TO FILL IN JOB 6—'N 3 O R O S EMEAD BLVD. ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS $ _ $ LOCALITY M Certified co Is filed with the count building inspection 1 &2-Family,Sq.Ft. PY Y 9 P — department. MultiNEAREST Sq.Ft. CROSS ST. Date 3/20/96Applicant SIGNS EXPRESS Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light SW. OWNER OR JAMES MONV I LLE "GOLD COMPENSATION INSURANCE FIRM NAME (This section need not be completed if the work involved First 20 MAIL 6330 ROSEMEAD BLVD.by the 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 TEMPLE CITY Tel.r.3.09-1762 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 PLAN CHECK I p 9 APPLICANT Total No. Additional ADDRESS Date Applicant 150R 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 1 1-TO 40 INCLUSIVE EACH- PERMITNTSIGNS EXPRESS MFG. CO . APPLIC provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH LICENSED CONTRACTORS DECLARATION ADDRESS 2446 MERCED AVE . I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,206V TO 277V LIGHTING EACH O (commencing with Section 7000) of Division'3 of the Business and CITY S. EL MONTE Tel.N• 43-3333 0 Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR 5 O 2 0 9 7C Power Apparatus&Large Appliances REG,NUMBER class. License Number 5 51R2 0 9 7 Lic.Class C A5 Size&Type HP,KW,KVA,or KVAR DISTRICT NO. PRO SSEo BY Q -Up to 3 Incl. SIGNS EXPRESS 3/20/96 Over 3to10Incl. FINAL U Contractor Date Over 10 to 50 Incl. DATE A J Ct ❑ I am exempt under Sec. Over 50 to 100 Incl. 'T ( VALIDATION — Over 100 FINAL B.&P.C.for this reason BY _Services,Swbd.,MCC&Panelboards V Date: 0-200 Amp.Under 600 V Signature 201 -1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V 2 Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances ACCT A HOME OWNER-BUILDER DECLARATION it h Ci B with One Branch Circuit �jQ I hereby affirm that I am exempt from the Contractor's License Law Sign w �','y1�03 o for the T following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 1 ITEMS IS Code ❑ I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL 65 .60 is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , �uE�.U, [C a6A and Professions Code). CHECK 65 0 CONSTRUCTION LENDING AGENCY CHANGE v00 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) Civ.C.) 0000-0001 3/26/96 PLAN CHECKING FEE y� PM 6%14 Lender's Name PERMIT ISSUING FEE Q Lender's Address 1 certify that I have read this application and state that the above TOTAL FEE !a 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 I • 3/20/96 11 SIGNATURE OF APPLICANT OR AGENT DATE WORKERS' COMPENSATION DECLARATION 76A66voPw3is7 APPLICATION PP IC /E TION FOR ELECTRICAL L iPLi�MI i O - 76A663 /� 1. it/� I hereby affirm that I have a certificate of consent to self CE-806G insure, or'a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, La/bb C.) Policy No•%� /�-Y�mom any FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS S ertified copy is filed with the county building inspec- 1 &2-family, Sq. Ft. $ _ $ LOCALITY tion depart ent. Multi-family Sq. Ft. NEAREST CROSS ST. Date Z App d^+—� Residential Swimming Pools OWNER OR Q FIRM NAME �l CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ "IL l �C) oZ �G COMPENSATION INSURANCE ADDRESS First 20 (This section need not be completed if the work involved by Total No. CITY Tel. No. the permit is for one hundred dollars ($100)or less.) Additional tom' 7� _ C� PLAN CHECK I certify that in the 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 so as to become subject to the Workers'Compensation Laws. � �. '�✓ Gni Additional Total No. CITY Tel. No�7_0 Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT/ CATION Exemption, you should become subject to the Workers' Range— Heater—D.W. — Compensation provisions of the Labor Code, you must forth- Oven — Dryer_ W.M. ADDRESS with comply with such provisions or this permit shall be Top .— FAU —W`.H. — deemed revoked. Hood — Fan Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. — REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business power Apparatus& Large Appliances DISTRICT NO. NOCESSED BY >_ and Professions Code,and my license is in full force and effect. /1 Q O ^�` / Size &Type HP, KW, KVA, or KVAR af'L/ License Number /�S Lic. Class 0 7� Up io 1 Incl. FINAL U Con or Date Over 1 to 10 Incl. DATE `� } VALIDATION � ❑ Over 10 to 50 Incl. FINAL v F' I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P,C. for this reason Over 100 14p,• Date: Services, Swbd., MCC& Panelboords AV Z Z 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 ��,`_'�'°e Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): :307 25°50 ❑ I, as owner of the property, will do the work and the Misc. Conduits &Conductors 1 TT�MS structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_. Business and Professions Code). , TOTAL 25. 50 CONSTRUCTION LENDING AGENCY CHECK 25 I hereby affirm that there is a construction lending agency for _ °5"0 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) L- 3� °I30 (Sec. 3097, Civ. C.). • PLAN CHECKING FEE Lender's Name _ O00_0001 12/12/89. L4 PERMIT ISSUING FEE Lender's Address TOTAL FEE ' 7456 1 AM L e'5i,3 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 ov -men e property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE z� Signature rmittee Date ©s WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, 76A663 ror 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. Company - FOR APPLICANT TO FILL IN JOB ADDRESS eQL Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE ❑ _ $ $ LOCALITY Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. NEAREST department. Multi-family Sq.Ft. CROSS ST. DateApplicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM.WORKERS' ORNER OR' utlets: ea Light Sw. RM NAME COMPENSATION INSURANCE First 20 (This section need not be completed if the work involved by the MAIL permit is for one hundred dollars($100)or less.) Total No. Additional ADDRESS I certify that in the performance of the work for which this permit CITY Tel.No. IV r is issued, I shall not employ any person in any manner so as to PLAll become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total CHECK ICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances PPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,.KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY T.I.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR "^Q Class. Over 50 t0 100 Incl. REG.NUMBER d /_���"� SQ Over 100 License Number c�[J Lia Class c � DISTRICT NO. P OCESSED BY O J Services,Swbd.,MCC&Panelboards N_�7fr D Contractor 1� Date / T 0-399 Amp.Under 600 V DATE / 0 ❑ 400-1000 Amp.Under 600 V l �l VALIDATION V I am exempt under Sec. Over 1000 Amp.or Over 600 V FINAL U.l B.&P.C.for this reason BRANCH CIRCUIT FEES BY / U) Daty�/ 15A,or 20A,120V,Lighting or Recept. LA Z ��� ��- 1 To 10 Branch Circuits Signature wry 1 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg. Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 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 ( E, for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): d &C i d Conuts Conductors I, as owner of the property, will do the work and the structure Misc. is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , _a x and Professions Code). i 3_j ?3_-- 6_� '�"—' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the �•ff� ,( performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) NAME Civ. C.) ' PLAN CHECKING FEE Lender's Name _: ir:3 —U" y i ;12`5;f PERMIT ISSUING FEE �. o Lender's Address f I certify that I have read this application and under penalty of purjury state TOTAL FEE 3, 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 in�tion purposes. 00, SEE REVERSE FOR EXPLANATORY LANGUAGE ISIGNA;jKE OF PERMITTEE DTE COUNTY OF LOS ANGELES TEMPLE CITY # 0508ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS -EL 0508 9802240002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING-ADDRESS: ON FILE `6330 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801544 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5382-021-026 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY F1 120V, 15/20A BR CKTS 2.00 BR 34.80 TENANT: TOTAL FEES 62.55 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 02/24/98 UT 02/24/99 OWNER: TEL. NO: FINAL DATEF N BY: CO VANNIER WILTON E CO TR VANNIER TRUS (818) 355-1239- v���' 209 OAK MEADOW RD J SIER 910242611 DESCRIPTION OF WORK 'TWO NEW CIRCUITS FOR 1 HOUR PHOTO MAra APPLICANT: TEL. NO: CHUNG'S ELECTRIC (310) 534-1919- 2444 LOMITA BLVD. SPECIAL CONDITIONS: LOMITA, CA CONTRACTOR: TEL. NO: -_ APPROVALS DATE INSPECTOR SIGNATURE CHUNG'S ELECTRIC (310) 534-1919- 2444 34-1919 2444 LOMITA BLVD. LIC. NO ° TEMPORARY POWER POLE LOMITA, CA 652761010 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: - UFER GROUND LIC. N0: - - ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9711120017 ;BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUI D1 G ADDRESS: ON FILE 6330 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801544 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5382-021-026 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, C K1 SIGNS, OUTLINE LGT 1.00 SIG 38.85 TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 11/12/97 VG 11/12/ 8� OWNER: TEL. NO: FINAL DATE FINAL BY: ODE: YANG, KEE CHUN (626) 292-7900- 6330 ROSEMEAD BLVD. TEMPLE CITY 91780 - N`DES RIPTI F WORK ELECTRICAL FOR SIGN APPLICANT: TEL. NO: LIM (213) 734-3361- 2982 W. PICO BLVD. SPECIAL CONDITIONS: LOS ANGELES 90006 � ���� CONTRACTOR: TEL: NO: \�\ ES APPROVALS DATE INSPECTOR SIGNATURE L A NEON SIGN (213) 734-3361- D 2982 W. PICO BLVD. LIC. NO TEMPORARY POWER POLE LOS ANGELES, CA 90006 653806 C35 UNDERGROUND CONDUIT ARCHITECT ORENGINEER: TEL. NO: 1 �> UFER GROUND LIC. NO: I ROUGH CONDUIT L t� 1� ��_J ROUGH WIRING -- - J - _ / L ! ; )I PLAST(c MIN IJCTER Y/NLI NE C�j METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508