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Home My Public Portal About5753 ROWLAND AVE_Electrical__ * � WORKERS'COAAPENa cerci DECLARATION .onse 76A663 10/81 1D/81 APPLICATION FOR ELECTRICAL PERMIT I ht§reby affirm that L have a certificate ofgqonsent to self insure,ora certific9Qte of Workers'Compentatlon Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY U or;,a cet t i6rd copy thereof(Sec. 3800PILdo. it.) Policy No. Company--.— FOR APPLICANT TO FILL IN JOB FEE' ADDRESS Certified copy is hereby furnished. I New Residential Bldgs. &Pools EACH NO. LOCALITY Certified,copy is filed with the county building inspec- 1 &2-Family; Sq. Ft. $ —Is Lf Tion department. Multi-family Sq. Ft. — NEAREST CROSS ST.. Date Applicant Residential Swimming Pools NAME OWNER OR FIRM Z�(y CERTIFICATE OF EXEMPTION FROM WORKERS' f`j MAIL Outlets: Rec Light Sw._ CWit /L/J COMPENSATION INSURANCE I -• 'ti DRESS tThis section need not be completed if the work Involved b First 20 �' he permit Is for one hundred dollars($100)or less.) it Total Na. Additional CITY �l'V*n el. No. I certify that in the performance of the work for which this PLAN CHECK ( APPLICANT permit is issued I shall not employ any er On in any manner I 1 7J so as to bec subject to the Work r pensati Lighting Fixtures First 20 ADDRESS Total No. Additional 7. CITY No. Date - pplicani J 'rix-ed Appliances Not Over 1 HP PERMIT NOTICE TO PPLICANT: 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. i CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood Fan _Other_ �j� LICENSE OR Disp. _ Room Air Cond. 'ISO Class. I hereby affirm that I am licensed under provisions of Chapter 9 � REG.NUMBER (commencing with Section 7000)of Division.3 of the Business ; DISTRICT NO. PROC SE Y Power Apparatus&Large Appliances and Professions Code,and my license is In full force and effect. y Q Size&Type HP, KW, KVA, or KVAR- t.,)t U Q C� License Number Lic. Class J Up to 1 Incl. i V� FINAL Over 1-to 10 Incl. a DATE _Z11 A—d VALI ATION Contractor Date' Over 10•to 50 Incl. ❑ FINA W' I am exempt under Sec. Over 50 to T00Inc. BY N B.&P.C. for this reason Over 1.00 `i Z Services, Swbd., MCC&Ponelboards i..l Date: 0 -200 Amp. Under 600 V , (Jr/ 3 4 8 A Signature i 201 - 1000 Amp.'Under 600 V N Over 1000 Amp. or Over 600'V 0 0 0 0 0 Exemption.for Reg. Maint. Ele2t. 0 o50,2 SINGLE FAMILYo a 0 = HOME OWNER-BUILDER DECLARATION I Temp. Power Pole&Appurtenances Sign with One Branch Circuit. I hereby affirm that I am exempt from the Contractor's License a Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and K WPfsions 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 F above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereb au oriie representatives of this County to enter upon the entioned a or inspection purpos s. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dat IORKERS'COM ,.NSATION DECLARATION 76A663CE-806 ,D,B, APPLICATION FOR ELECTRICAL PERMIT %-- r oifi..t'thot, ve�p certificate of consent to self CE-806G a ceriifiw.Q't .,;,f ers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY ie{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 ❑ Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY JLC tion.department. Multi-family Sq. Ft. — NEART. CR SEST Residential Swimming Pools OWNER OR Date Applicant FIRM NAME mar-11 XL&AVK CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL n_, COMPENSATION INSURANCE First 20 ADDRESS `j&120W f.+¢PC-410 (This section need not be completed If the work Involved by Total No. Additional CITY Tel. No. —� 2 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 c permit is issued, I shall not employ any person in any manner so as to become subject to the Work r'Compensation Laws. Lighting Fixtures First 20 ADDRESS 517/ Total No. Additional CITY o. Date �� pplicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after aking 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. — CITY Tel. No. revoked. Hood — Fan —Other_ 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. PROLES BY and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances y rte( AL Size&Type HP, KW, AIA, or KVAR (1 O License Number Lic. Class Up to 1 Incl. alp FINAL to Over 1 to 10 Incl. 7.Gt> DATE �Z VALID TION Contractor Date Over 10 to 50 Incl. FI � ❑ 1 am exempt under Sec. Over 50 to 100 Inc. W B.&P.C. for this reason Over 100 Services, Swbd., MCC&Panelboards Date: 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600.V 1 -2 19 9.8 A ❑ Exemption for Reg. MainT. Elect. Over 1000 Amp. or Over 600 V # o 0 0 0 0 2 SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION ( o 0 2 5 5 O Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits o 0 0 = Law for the following reason (Section 7031.5, Business and 2 5 5 Q 5 Professions Code): RLI, as owner of the property, will do the work and the Misc. Conduits&Conductors508-85 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 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 th ove-mention roperty for inspection purposes. 'SEE REVERSE FOR EXPLANATORY LANGUAGE 05102 i Signature of Permitter Date Y r COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1004220042 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: 1 ITR: 6561 IT: 406 I 1 5753 ROWLAND AV I (FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917802617 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: WORKMAN I 18587-029-011 IA1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl I ILB 200 AMP PANELS, MCC 1.00 PAN 38.85 I I (TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: 104/22/10 SR 1 (OWNER: TEL. NO: I IFIN))AL DATE FI Y: CODE: I IBROWN, GLENN R (626) 286-8224- 15753 ROWLAND AV 1 TEMP 917802617 I IMSCRIPTION OF WORK I I IRLADING 100 AMP ELECTRICAL PANEL TO 200 AMP ELECTRICAL I PANE (APPLICANT: TEL. NO: I I I 1SAM AS OWNER [SPECIAL CONDITIONS: I I (CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE I ISAME AS OWNER - I I I I LIC. NO I ITEMPORARY POWER POLE I I I I I (UNDERGROUND CONDUIT I I 1 1ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND �I I LIC. NO: I IROUGH CONDUIT 1 I I I I I I I IROUGH WIRING I [ I IMAIN WATER LINE I I 1 I PLASTIC YIN METAL YIN I I I I I I UTILITY COMPANY NOTIFIED I I I I �F�6►-�I I I 1 I I I I I 1 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 ! ! { f I I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 I I I I I I I I COUNTY OF LOS AN46ELCS TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0101290022 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 { PHONE: (626) 285-0488 EXT: LEGA ID: FEES-PAID BUILDING DD SS: TR: 6561 LT: 406 5753 ROWLAND AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ITEMP CA 917802617 ASSESSOR IN OR TION MBER: INEAREST CROSS STREET: WORKMAN 8587-029-011 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 8.00 OUT 15.60 1 TENANT: G2 LIGHTING FIXTURES 1.00 LGT 1.95 ISSUED ON: PROCESSED BY: PLAN Y: EXPIRES ON: LN OTHER PNL 0-399 AMPS 1.00 PAN 38.85 01/29/01 UT 07/28/01 TOTAL FEES 84.15 OWNER: TEL. NO: FINALITE FIN CODE: BROWN GLENN R;ELAINE M (626) 286-8224- �r 5753 ROWLAND AV 4 1 TEMP 917802617 CRIPTION OF WOR ELECTRICAL FOR ADDITION DEN APPLICAN : TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: s ij4GELES CONTRACTOR: TEL. NO: /~ L�J� APPROVALS ATE INSPECTOR SIGNATURE SAME AS OWNER !'� LIC. NO �`�f� ' TEMPORARY POWER POLE ` UNDERGROUND CONDUIT ARC ITEC OR GIN ER: TEL. NO: �r r--. \1 ER GROUND LIC. NOI:� ROUGH CONDUIT �l ROUGH WIRING 1,4 n MAIN WATER LINE D cl ��1 PLASTIC Y/N METAL Y/N LLL��JJJ J J-u ----- UTILITY COMPANY NO IFIED L/ Lj K,7� y� REPORT ID: DPR265 ROUTE TO: BS0508