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Home My Public Portal About6119 ROWLAND AVE_Electrical__ WORKERS'COMPENSATION DECLARATION 7BA663 to/st APPLICATION FOR ELECTRICAL PERMIT _ I hereby affirm that I have a certificate of consent to self insure, CE-808-806G or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFE copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB f ❑ Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRESS I ❑ Certified copy is filed with the county bui!ding inspection 1 & 2-Family,Sq Ft. $ — $ LOCALITY �T department. Multi-family Sq.Ft. — NEAREST cO- CROSS ST 1i� Date Applicant Residential Swimming Pools OWNER OR . FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec—�(2 Light tQ Sw. V�� MAIL _ — U COMPENSATION INSURANCE ADDRESS ', yy)G (This section need not be completed if the work involved by the 7 First 20 permit is for one hundred dollars($100)or less.) Total No.�� Additional I CITY Tel.No. I certify that in the performance of the work for which this permit PLAN CHECK APPLICANT is issued, I shall not employ any person in any manner so as to become s bject/tp the Workers'Compensation La)el. Lighting Fixtures First First 20 ADDRESS '(jj�� / V Total No. te Additional CITY Tel.No. Date f Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, afte akin this Certificate of PERMIT ` Exemption,you should become su ' ct to the%forkers'Compensation Range_ Heater_ D.W. _ APPLICANT.JO��`^/¢/" provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top — FAU _ W.H. CITY G A�l t C Tel.No.—CW LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR C lass. (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER J / �d Cd �V Professions Code,and my license is in full force and effect. DISTRICT NO. PROCESS11 Power Apparatus&Large Appliances Size&Type HP,KW,KVA,or KVAR � 1 License Number �� Lic.Class � � Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE ) VALIDATION 0 Contractor Date Over 10 to 50 Incl. FINAL �'I ! ! I� ❑ I am exempt under Sec. Over 50 to 100 Inc. gY V C W BAP.C.for this reason Over 100 N 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 r. HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law �-•r a for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits X11.I of Code): 3307 3 .o 0-0❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors 1 1TEt E is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). ® TOTAL 37 o 60 CONSTRUCTION LENDING AGENCY CHECK 370eG 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) CHANGE �0 Civ.C.), PLAN CHECKING FEE Lender's Name / OOLO-1300 6/ 7r 9113 PERMIT ISSUING FEE 1�,15 j r�t3 <<_ Lender's Address I certify that I have read this application and state that the above TOTAL FEE 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 rasps ion p r4oses. D SEE REVERSE FOR EXPLANATORY LANGUAGE Signature mer Dafte i 76AG63C CEB0613 f2/7S APPLICATION FOR ELECTRICAL PERMIT �1 w BUILDING"AND SAFETY DIVISION FOR APPLICANT TO FILL IN JOB New Residential Bldgs.&P ols EACH NO. FEE ADDRESS 1 &2 Finally Sq. Ft. LOCALITY Multi-family Sq.Ft. CROSS ST . Residential Swimming Pools OWNER-OR FIRM NAME Outlets: Light,Switch&Receptacle MAI L First 20 ADDRESS ! Additibnal CITY Tel. Nd. PLAN CHECK Lighting.Fixtures APPLICANT First 20 ADDRESS Additional CITY Tel.No. PERMIT Fixed Appliances Not Over 1 HP APPLICANT 6!.* Range_. Heater_ D.W. ADDRESS Oven Dryer _ W.M. _ Top FAU _ W.H. CITY Tel. No. Hood Fan _. LICENSE OR w o REG. NUIIABE Class. Disp. A.C. _ c-2 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND 'AGREE TO COMPLY 0 Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING H. . Size&Type HP,KW,KVA,or KVAR ELECTRICAL WIRING. Up to 1 Incl. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR Z Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 'CALIRO,RNIA OR TH'A M T LEGAL O' ER THE VE Over 10 to 50 Incl. DESCRIBED RES TIAL OP RTY. Over 50 to 100 Incl. PERMIT S t Over 100 SIGNAT DISTRICT NO. PROCESSED BY Services 0-200 Amp. Under 600'V 201 -1000 Amp.Under 600 V APPROVALS DATE INSPECTOR'S SIGNATURE Over 1000 Amp.or Over 600'V TEMP.POWER POLE Temp.Power Pole&Appurtenances U'NDERSLAB WORK Sign with One Branch Circuit ROUGH CONDUIT Additional Sign-Branch Circuits. (Other) WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (Sub-Total) UTI LITY CO.NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL PERMIT ISSUING FEE TOTAL FEE NOTES a 1. CASH PERMIT VALIDATION CK. M.O. CASH 'OLICY HOLDER: 9 3. 5 APR 117 2 D 5 (5.13 a 'OLICY NUMBER: 0SW7e 5-ao r7 - i r COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 9910150020 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: GA FEES PAID- - BUILDING ADDRESS: TR: 32644 LT: 2 6119 ROWLAND AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801723 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 5385-024-043 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, C HA FAU LESS 3HP 1.00 FAU 10.95 TENANT: JB AC UNITS +3-10HP 1.00 AC 19.65 ISSUED ON: PROCESSED L XPIR ON: TOTAL FEES 58.35 10/15/99 VG 04/12/00 OWNER: TEL. N0: FINAL DATE FINA B E: TYRE STEVEN S;TYRE SUSAN S (626) 287-1408- 11-I&-ell 6119 ROWLAND AV TEMP 917801723 DESCRIP11ON Of WORK ELECTRICAL FOR FAU AND A/C APPLICANT: EL. NO: CONNOR AIR CONDITIONING (626) 286-3157- SPECIAL CONDITIONS: ES C® CONTRACTOR: TEL. NO: SOS �/�Ty APPROVALS DATE INSPECTOR SIGNATURE CONNOR AIR CONDITIONING (626) 286-3157- 4931 ENCINITA AVE LIC. NO TEMPORARY POWER POLE TEMPLE CITY, CA 91780 403735 C20 UNDERGROUND CONDUIT ARCHITECT OR GINEER: TEL. N0: UFER GROUND LIC. N0; 1111111 ROUGH CONDUIT ROUGH WR G �E n O L�� n/]O�n�J I WATER LINE Iu� U \1vf/\v�/ lu^u�lu�`U PLASTIC Y/N METAL Y/N UTILITYCOMPANY NOTIFIRY O ❑ O ❑ °:. ❑ � r� 46��c Service REPORT ID: DPR265 ROUTE TO: BS0508