Loading...
HomeMy Public PortalAbout6404-6414 ROSEMEAD BLVD_Electrical__ 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 or rcertificate 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 ADDRESS 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. — $ $ A department. Multi-family Sq.Ft. CRROSS ST. /VC�EA /5�-A/ /#-V7— 7— t� Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' r OWNER OR /� COMPENSATION INSURANCE Outlets:Rec. Light Sw.4- FIRM NAME 1Q_4 c� (This section need not be completed if the work involved by the First 20 Q MAIL 3�- /' , ,. permit is for one hundred dollars($100)or less.) Total No. Additional ADDRESS t,r ( ! j I certify that in the performance of the work for which this permit CITY Tel.No. n ! 7 is Issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Compens ion Laws. Lighting Fixtures First 20 APPLICANT 7 . t' Total No. Additional ADDRESS ate Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. OT ICE TO APPLICANT: If, after ma Ing this Certificate of CITY Tel.No. �?xemption,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 ERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances PPLICANT „l1__4 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 Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. } Over 50 to 100 Incl. LICENSE OR REG.N ®��� Class. Il UMBER +2 Over 100 DISTRICT NO. PROCESSED BY O License Number Lic.Class� h yrf U Services,Swbd.,MCC&Panelboards !/O cc Contractor �. ""� Date ly 0-399 Amp.Under 600 V DATE FINAL O �l 400-1000 Amp.Under 600 V () LJ I am exe ipt under Sec. Over 1000 Am or Over 600.V ^ VALIDATION W Amp. FINAL B.&P.C.for this reason BRANCH CIRCUIT FEES BY f/) Date: ` - 15A,or 20A, 120V,Lighting or Recept. z_ 1 To 10 Branch Circuits Signature \` s 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 2 SINGLE FAMILY Temp.Power Pole&Appurtenances f.-,,. HOMEOWNER-BUILDER DECLARATION (t (_.Ic2 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 =titl [ !{ Code): ❑ I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors a� is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) 1 i TA 48 0 and Professions Code). CHECK 4,:;XUU CONSTRUCTION LENDING AGENCY L,HAN I -t=( 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.) PLAN CHECKING FEE 0E-i1fU-'Li91iF� Lender's Name -tiir� r=;;-42: PERMIT ISSUING FEE �'M t j Q = 'z`• Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE Ihat 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 unty to enter upon the above-mentioned property for inspection purpose . ' SEE REVERSE FOR EXPLANATORY LANGUAGE NATURE OF PERMITTEE\ DATE WORKERS'COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT } 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 BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ❑ — LOCALITY Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ � $ C. tion de artm nt. Multi-family Sq. Ft. NEAREST p / �� -Olv d /yf S�3 �� Residential Swimming Pools CROSS ST. �V r/ Date Applicant_ n FIRMN ME (/ y 'N �G�� /{ ERTIFICATE OF EXEMPTION FROM WORKERS' �� MAIL , Outlets: Rec Li ht Sw._ s°Q{��D(�✓!/l0 4�,✓ COMPENSATION INSURANCE g � � ADDRESS This section need not be completed if the work involved b First 20 ? ( P T Total No.� Additional C�' CITY HECK 11 7e1. No. U r� the permit is for one hundred dollars ($100)or less.) I certifythat in the performance of the work for which this PLAN CHECK P APPLICANT permit 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 J sADDRESS —_ Additional Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP f PERMIT NOTICE TO APPLICANT: If, after making this Certificate of f APPLICANT M749 G / 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 g3/� i34[-D P U with comply with such provisions or this permit shall be Top — FAU .--_W.H. ,n l, deemed revoked. CITY J4 R r!{4'0//- 6� Tel. No.yy7—46 LICENSED CONTRACTORS DECLARATION Hood _ Fan —OTher_ Disp. Room Air Cond. LICENSE s Class. I hereby affirm that I am licensed under provisions of Chapter 9 _ REG. NUMBER (commencing with Section 7000) of Division 3 of the BusinessDISTRICT NO. PROCESSED BY and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances •� Size &Type HP, KW, KVA, or KVAR' O License Number/ 73'.x. Lic. Class —�O Up to 1 Incl. FINAL y� Over 1 to 10 Incl. DATE (rA�-7�p�X(L_._ VALIDATION Contractor Date Over 10 to 50 Incl. °J/ U l V FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc. BY c— Over 100 A. B.&P.C. for this reason Services, Swbd., MCC& Panelboards Z Da 0 -200 Amp. Under 600 V, Signature 2'0 - 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 - 4 9 7. 1 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 {' c; c,, o o o 2 Professions Code): .2 0 1 6 7 15 Q ❑ Misc. Conduits&Conductors C I, as owner of the property, will do the work and the o 0 1 6 7, � structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 7044, Business and Professions Code). Q Q,0 5— 3 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE 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 inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatule of Permittee Vte '-WORKERS'COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT 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 BUILDING AND SAFETY or a certified r�co�pyy thereof (Sec. 38000,,�Lab. C.) Policy No.63 Company,51 L 176 E(AN it, FOR APPLICANT TO FILL IN JOB. !!0 R O,�y-SCME r Tb Certified copy is hereby furnished. New Residential Bldgs. / EACH NO. FEE ADDRESS& Pools , ❑ 1 & 2-Famil S Ft. $ — $ LOCALITY 'Tr-,AA PL L"r Certified copy is filed with the county building inspec- Y- q tion department. Multi-family Sq. Ft. — NEAREST J Residential Swimming Pools CROSS ST. Date Applicant i' Clh OWNER OR A� y FIRM NAME JVl.0H/4MEb CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL Outlets: Rec Light Sw._ 6 S L�iRLl+� 0E COMPENSATION INSURANCE ADDRESS This section need not be completed if the work involved b First 20 ( p Y Total No. Additional the permit is for one hundred dollars ($100)or less.) CITY S(4}V GI.38I IELTe1. No.3()q qS& that in the performance of the work for which this PLAN CHECK I certify P APPLICANT permit 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 Total No. Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT �- NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT �3 t&N �n% - 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 15,)41 ?-qsoo SQ,NP i !Z; R with comply with such provisions or this permit shall be Top _ FAU —W.H. — deemed revoked. CITY �,�1-"9.J Tel. Na. ��� • LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other— Disp. — Room Air Cond. LICENSE OR / i / Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER -} �J" �+7_' (commencing with Section 7000) of Division 3 of the Business Z11D�BY _ DISTRICT NO. PROand Professions Code, and my license is in full force and effect. Power Apparatus& Large Appliances �) �/ � Size &Type HP, KW, KVA, or KVAR' L 6 b License Number 4-t t'5 7-'::; Lic. Class CT Up to 1 Incl. FINAL DATE Over 1 to 10 Incl. VALID ION Contractor Date Over 10 to 50 Incl. 0 ❑ IA I am exempt under Sec. Over 50 to 100 Inc. By BY9L Over 100 W B.&P.C. for this reason Services, Swbd., MCC& Panelboards Date: 0 -200 Amp. Under 600 V 1 i Signature 201 - 1000 Amp. Under 600 V ElExemption 1000 Amp. or Over 600 V 1 0 3,7 A Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole &Appurtenances # o 0 0 0 0 2 HOME OWNER-BUILDER DECLARATION ign with One Branch Circuit. I o o 25 O I hereby affirm that I am exempt from the Contractor's License Additjonal'Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): o o 0 2 S-5 Q v IDI, as owner of the property, will do the work and the Misc. Conduits&Conductors 04 1] structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , ( 1,0 8-�8 4 7044, Business and Professions Code). 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address y� I certify that I have read this application and state that the TOTAL FEE �� V 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 inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Pekrhittee Date WORKERS' COMPENSATION DECLARATION CE-806 10i81 APPLICATION FOR ELECTRICAL PERMIT 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 BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) /�^ Policy No G 2 �E'�Company S•Tb-EG C.G HIY FOR APPLICANT TO FILL IN JOB 1 Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS y O f o- dt Cc NG Ac Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ $ LOCALITY 7-C EA tion department. Multi-family Sq. Ft. NCR T. ST. 6.-1�-F7 �• ` 5."6� C d Residential Swimming Pools OWNER OR L, Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE First 20 ADDRESS -7-C,, ( ( O (This section need not be completed if the work involved by Total No. CITY Tel. No. the permit is for one hundred dollars($100)or less.) Additional EC .1 i IJ /� ��r/�O I certifythat in the performance of the work for which this PLAN CHECK P APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT — Exemption, you should become subject to the Workers' Range_ Heater_D.W. — Compensation provisions of the Labor Code; you must forth- Oven _ Dryer — W.M.— ADDRESS with comply with such provisions or this permit shall be Top _ FAU —W.H. — deemed revoked. Hood Fan _Other_ CITY L -,j Tel. o. G c,G J LICENSED CONTRACTORS DECLARATION LICENSE OR c� I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER -� / Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NOj� PROC SED Power ABY and Professions Code,and my license is in full force and effect. Apparatus& Large Appliances �/J� A. q Size & Type HP, KW, KVA, or KVAR' ' License Number3` `rr / A. Lic. Class C' � Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE &t Contractor R•C' S.6/J P0 Date 6-/s �cf VA ATION ❑ Over 10 to 50 Incl. U FINAL 1 am exempt under Sec. Over 50 to 100 Inc. BY BlW B.&P.C. for this reason Over 100 CA CA Date: Services, Swbd., MCC & Ponelboards ® 7 4 2'6 A 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp:Under 600 V # o 0 o o o 2 ❑ fOver 1000 Amp. or Over 600 V E ( o 0 2 5 5.0 Exemption or Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole & Appurtenances o o o2.55070- HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Q 7,0$�=8 7Law for the following reason (Section 7031.5, Business and Professions Code): I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 7044, Business and Professions Code). 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE SS 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 thea ove-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 1 67 Signature 6f Permittee Date WORKERS'COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRI, AL .PERMIT 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 ej BUILDING AND SAFETY or a certified'copy thereof (Sec. 3800, Lob. C.) Po cy No* "'L�Company J STI G 1 � FOR APPLICANT TO FILL IN. JOB -^ Certified co is hereby furnished. EACH NO. FEE ADDRESS o PY Y New Residential Bldgs. & Pools — Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ $ LOCALIT tion department. Multi-family Sq. Ft. — 'NEAREST CROSS ST. —10 - -1D .-,g-'-I AJ Residential Swimming Pools OWNER OR. Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS �F� P-15leted if the work involved b First 20 (This section need not be completed y Total No. Additional CITY 804 Tel. No. the permit is for one hundred dollars ($100)or less.) I certifythat in the performance of the work for which this PLA E e P APPLICANT permit is issued, I shall not employ any person in any manner ATAI_ 51(3-AJ so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel. No. 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' 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 DISTRICT NO. PROCE ED BY and Professions Code,and my license is in full force and effect. Power Apparatus & Large Appliances �,,�1 Size &Type HP, KW, KVA, or KVAR' O License Number 36 a�� Lic. Class �'S Up to 1 Incl. FINAL -7-720t �� ` Over 1 to 10 Incl. DATE '0 VALIDATION Contractor Z to f IJAI) Date J 20 t Over 10 to 50 Incl. I" F A KI❑ I am exempt under Sec. Over 50 to 100 Inc. UA B.&P.C. for this reason Over 100 Ato Services, Swbd.,.MCC& Panelboards //�s– Date: 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole &Appurtenances r 3 0 76 A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit }. 0,0 0 0 0 2 I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and 2 0 0 2 v.'S 0 Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits &Conductors u'o 2 5.E 0 )— ( Complete Fee Scheduleom lSee C , t structure is not intended or offered for sale (Section Other 7044, Business and Professions Code). C, 7.3 0-8 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE o2 above information is correct. I agree to comply with all County ordinances and State I s regulating Electrical wiring, and here uthorize re a ntatives of this County to enter upon the -m do ed roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature f Permittee Date WORKERS' COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT 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 ''J'� P _ BUILDING AND SAFETY /'or a certified copy thereof (Sec. 3800; Lab. C.) / Policy No. Company FOR APPLICANT TO FILL IN JOB QT�rP Q�Jr, , Certified co is hereby furnished.. EACH NO. FEE ADDRESS' PY Y New Residential Bldgs. & Pools /�' � ❑ 1 & 2-Famil S Ft. $ _ $ LOCALITY /'C.. h Certified copy is filed with the county building inspec- Y q• tion department. Multi-family Sq. Ft. NEAREST a CROSS ST. Date Applicant Residential Swimming Pools I`+ OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets: Rec Light Sw._ ADDRESS section completed if the work involved b First 20 (This tin need not b p y Total No. Additional CITY Tel. Noa9, 7(l the permit is for one hundred dollars ($100)or less.) I certifythat in the performance of the work for which this PLAN CHECK yRt P APPLICANT �Y�sv , permit is issued, I shall not employ any person in any manner 4x- so as to become subject to the Worker Com ensation Laws. Lighting Fixtures First 20 ADDRESS ,�S Total No. Additional CITY � ��5. 64tl Tel.No. ;? -7 Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making is Certificate of APPLICANT 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. CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood , Fan ,Other— Disp. Room Air Cond. LICENSE �// �D[6 Class. (o I hereby affirm that I am licensed under provisions of Chapter 9 - - .REG. NUMBER �"'/ _ _ !/ (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSYD BY and Professions Code,and my license is in full force and effect. Size &Type HP, KW, KVA, or KVAR a d License Number ' Lic. Classp� Up to 1 Incl. FINAL Contractor Am I Date fl f"'s/'f 09 Over 1 to 10 Incl. DATE j'7 y VALIDATION ❑ Over 10 to 50 Inc). FIN 4, I am exempt under Sec. Over 50 to 100 Inc. BY '^ r B.&P.C. for this reason Over 100 N1 Date: Services, Swbd., MCC & Ponelboards ! U ,Z 2 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 `7J 4 d R HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 4 o'o o o o 2 I hereby affirm that I am exempt from the Contractor's License ' I ' , Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits 2 0 0 2 S 5 0 Professions Code): ❑ I, as owner of the property, will do"the work and the Misc. Conduits &Conductors o o o 2515 0 C6 , structure is not intended or offered for sale (Section O 8 0 1 7044, BusOther (See Complete Fee Schedule)_ iness and Professions Code). 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE G Lender's Address I certify that I have read this application and state that the TOTAL FEE >4D 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 mentio ed property for inspection purposes. ¢{ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of FVrmittee Date WORKERS' COMPENSATION DECLARATION 76A663 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT I hvFeby 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 ceraified copy thereof (Sec. 3800, Lab. C.) Policy NTb. Company FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS , ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ ❑ $ LOCALITY t1� tion department. Multi-family Sq. Ft. NEAREST Residential Swimming Pools CROSS ST. OWNER OR Date Applicant FIRM NAME .0 CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL Outlets: Rec Light Sw._ 6 SIPCOMPENSATION INSURANCE First 20 ADDRESS s- (This section need not be completed if the work involved by Total No. Additional CITY Tel. No. 3p the permit is For one hundred dollars ($100)or less.) PLAN CHE,&12CK 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 so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS C� f�'�'/ //�� Additional Dater `�®- `e ApplicantULtW,,,'2 1CCt>t'�� Total No. CITY Tel. No. Fixed Appliances Not Over 1 HP PERMIT f NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION A lect / 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.— ADDRESStq .� with comply with such.provisions or this permit shall be Top — FAU —W.H. — deemed revoked. CITYt Rf,144>c Tel. No.�7(r•�'� 3 LICENSED CONTRACTORS DECLARATION Hood — Fan —Other— Dis — Room Air Cond. — LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 P REG. NUMBER (�Q Q j Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PR ESSED BY >_ and Professions Code,and my license is in full force and effect. YP � r/ O y Size &Type e HP, KW, KVA, or KVAR d" 4���� License NumbertQOVO I Lic. Class "/C% U Up to 1 Incl. FINAL r/ 2 J_C!_0a Over 1 to 10 Incl. I 7 DATE VALIDATION Cc Contractor Date Over 10 to 50 Incl. F- ❑ I am exempt under Sec. -�� Over 50 to 100 Inc. FINAL (� U Over 100 W t1 B.BP.C. for this reason U)Services, Swbd.,-MCC& Panelboards , Z Date: 0- 200 Amp. Under 600 V — Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION ` I herebyaffirm that I cim exempt from the Contractor's License Sign with One Branch Circuit s^ E P r3 i t•a Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): _,UTP i s�•f ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors ] yN`�; structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , Business and Professions Code). l_1 I•i;i 17 m 549- Business CONSTRUCTION LENDING AGENCY _HECK il'a._,, I hereby affirm that there is a construction lending agency for rNGE •{ a; ) the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) •'H (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name "Y'Li PERMIT ISSUING FEE /� /j n __ Lender's Address 7014 i AN s=`_i I certify that I have read this application and state that the TOTAL FEE 17 Sol 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 o e-mention.22d_2=prty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE gnReYMMIIee Date ©s WORKERS' COMPENSATION DECLARATION 10i81 APPLICATION FOR ELECTRICAL PERMIT TCE-806G affirm that I have a certificate of consent to self CE-806G +insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES T e BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C. i r Policy No. Company FOR APPLICANT TO FILL IN JOB Jr/ Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS (J ❑ 1 & 2-Family, S Ft. $ — $ LOCALITY Certified copy is filed with the county building inspec- Y q• tion department. Multi-family Sq. Ft. — NEAREST CROSS ST. Residential Swimming Pools OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw.� MAIL V COMPENSATION INSURANCE ADDRESS s on need completed if the work involved b First 20 (Thisectind not bp y Total No. Additional CITY Tel. No. the permit is for one hundred dollars (;100)or less.) 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 so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY I. N 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' 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 �,�j�r� ( Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCES D BY and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances 0. ^� Size&Type HP, KW, KVA, or KVAR .LU License Number �2� Lic. Class_ Up to 1 Incl. FINAL t9 jj Over .1 to 10 Incl. DATE *� i VALIDATION O Contractor 1 Date / Over 10 to 50 Incl.. FINA1_, (— ❑ 1 am exempt under Sec. Over 50 to 100 Inca BY j LU B.&P.C. for this reason Over 100 Date: Services, Swbd., MCC & Panelboards ► �j 0 -200 Amp. Under 600 V �C Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V -Exemption for Reg. Maint. Elect. SINGLEJAMILY Temp. Power Pole & Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 3'(l�, A I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits o o 0 0 0 2 Low for the following reason (Section 7031.5, Business and 1 Professions Code): Z.P - 2550 ❑ 1, as owner of the property, will do the work and the Misc. Conduits & Conductors structure.is not intended or offered fof sale (Section Other (See Complete Fee Schedule)_ ► o 0 0 2 OC 5 0 3 7044, Business and Professions Code). t CONSTRUCTION LENDING AGENCY 0 20-184 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). 13 PLAN CHECKING FEE Lender's Name f PERMIT ISSUING FEE /p Lender's Address !p ° I certify that I have read this application and state that the TOTAL FEE r 7 above information is correct. I agree to comply with all County ordinances and State laws reguI ' g Electrical wiring, and he by authorize representatives f t s County to enter upon th bt ve-mentioned pr e ty r i s ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee WDate WORKERS'COMPENSATION DECLARATION 76A663CE-806 ,D,B, APPLICATION FOR ELECTRICAL PERMIT hereby affirm that I have a certificate of consent to self CE-806G nsure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY )r a certified copy thereof (Sec. 3800, Lob. C.) 'olicy No. Company FOR APPLICANT TO FILL IN JOB I� Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESSz Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ _ $ LOCALITY tion department. Multi-family Sq. Ft. NEAREST 7� Residential Swimming Pools CROSS ST. Date Applicant OWNER OR FIRM NAMEj�l�/ CERTIFICATE OF EXEMPTION Out FROM WORKER MAIL Outlets: Rec Light Sw._ � COMPENSATION INSURANCE ADDRESS j% �• ���/ ,6f' ' This section need not be completed if the work involved b First 20 ( P Y Total No. Additional CITY � �� Tel. No. � G j the permit is for one hundred dollars(;100)or less.) certifythat in the performance of the work for which this PLAN CHECK p APPLICANT hermit 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 f Total No. Additional CITY Tel. No. 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' Range_ Heater—D.W. — Oven Dryer Compensation provisions of the Labor Code, you must forth- = W.M.— ADDRESS a-y fs � �1`1/S� 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. j (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCES BY and Professions Code,and my license is in full force and effect. O �- Size &Type HP, KW, KVA, or KVAR' License Number Lic. Class Up to 1 Incl. FINAL Contractor Date Over 1 to 10 Incl. DATE �D /r VALIDATION ❑ Over 10 to 50 Incl. FINAL I am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C. for this reason Over 100, DServices, Swbd., MCC& Ponelboards ► ;Eat 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. It 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 65.0 4 P Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): # o 0 0 0 o 2 ❑ I, as owner of the property, will do the work and the Misc. Conduits & Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , 2;0 0 2-:5.5 0 I 7044, Business and Professions Code). o o o 2 5,5 0 35 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 0 .1 '-8 3 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) I (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the TOTAL FEE above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and i hereby authorize representatives of this County to enter upon the above- entioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE j STnafurg o Per i tee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0210250011 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL D: FEES PAID BUILDING ADDRESS: ON FILE 6404 6414 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB CA 917751958 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5382-021-044 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 152.00 OUT 217.20 TENANT: G2 LIGHTING FIXTURES 74.00 LGT 111.90 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: JB AC UNITS +3-10HP 5.00 AC 98.25 10/25/02 JK 04/23/03 LA 100 AMP PANELS, MCC 5.00 PAN 194.25 CHANG; LU & RAESHIAU (626)L291-2345- TOTAL FEES 649.35 FI AL DATE FINAL,B -` .CODE: 922 PARK AVENUE /1 //9 ARCADIA 91007 DESCRIPTION OF WORK REPAIR OF FIRE DAMAGE APPLICANT: TEL. NO: DOTY (818) 681-0888- 26406 CITYLIGHT CT SPECIAL CONDITIONS: SANTA CLARITA 91351 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE DOTY ELECTRIC (818) 681-0888- 26406 CITYLIGHT CT LIC. NO i TEMPORARY POWER POLE SANTA CLARITA, CA 91351 HIC UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND H C HANSEN ENG (714) 573-0073- 17371 IRVINE LIC. NO: ROUGH CONDUIT ✓, TUSTIN CA 92780 3027 ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED * ADDITIONAL DATA ON FILE REPORT ID: DPR265 ROUTE TO: SS0508