HomeMy Public PortalAbout5543 1/2 SANTA ANITA AVE_Electrical__ c"bffir th COMPENSATION DECLARATION CE-8 10/81 �i,Pf7LOCA OGN FOR ELECTRICAL
LEC Fj RIC 6�L PERMIT
•I hereby"affirm that'I have a certificate of consent td self, CE-80iiG lT u E1V FOR L5 tl d"tl ®�
insure, or a�cerlificate of Workers'Compensation Insurance, COldmiry OF LOS ANGELES BUILDING AND SAFETY
or 6 certified copy thereof (Sec. 3800, Lab. C.)
Policy �JC64717No. �ompany Homeland Ins. ' FOR APPLICANT TO FILL IN J B 5543-1 Santa Anita
❑
Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS
Xncopy y g ins ec- y, q. 47 LOCALITY Temple Cit
Certified co is filed with the count building 1 &2-Family, S Ft. �-� $ — $ 69. 0 p
tion department. Multi-family Sq. Ft. NEAREST
CROSSST.
Date 04/01/87 Ali gilt-� l Residential Swimming Pools OWNER OR
pp
�T FIRM NAME San Gabriel Properties'
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ AMAIL
DDRESS 217 W. las Tunas D
COMPENSATION INSURANCE First 20
(This section need not be completed if the work Involved by Total No. Additional ;4=: CITY San Gabriel 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 Tel. No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of A APPLICANT Cobine Electric Co. , inc.
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 1607 Chestnut St.
with comply with such provisions or this permit shall be Top _ FAU 2L-W.H.- —
deemed revoked. CITY Alhambra Tel. No282_0315
LICENSED CONTRACTORS DECLARATION Hood Fan _Other—
Disp. 1L_Room Air Cond. 511 7 • LICENSE OR 229847 Class. C10
R
(commencing with Section 7000)•of Division 3 of the Business DISTRICT NO. P CES ED BY
and Professions Code,and my license Is in full force and effect. Power Apparatus&Large Appliances A.
Size 8 Type HP, KW, KVA, or KVAR' UCJ O
License Number 229847 Lic. Class C10 Up to 1 Incl. FINAL V
y~ "�� "~ 11/30/87 09
Over 1 to 10 Ind. DATE 0
Con t"—.
Date VALIDATION O
❑ Over 10 to 50 Incl. FINA U
I am exempt under Sec. Over 50 fo 100 Inc. BY un
B.&P.C. for this reason Over 100 g
Date: Services, Swbd., MCC&Panelbocirds D e
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 Sign with One Branch Circuit
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
Professions Code):
❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors ;25 5 6,9 A
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)— D # 0 0 0 0 0 2
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY I o o 7 9 9 0
I hereby affirm that there is a construction lending agency for o 0 0 7 9 9 Q
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.). 0 1,0 6:8 6
PLAN CHECKING FEE 1109 W
Lender's Name Tokai Bank Of- Cal i fnrni A
+
Lender's Address
534 W. 6th St. LA PERMIT ISSUING FEE
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-menti ed-gpoperty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
10/03/86
nature P mitfe Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1407100057
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I
ITR: 44319 IT; 1 UN: 13 I 1 5543 1/2 SANTA ANITA AV I
(FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917802912 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I
18573-020-054 IA1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY CAI
I IHA FAD LESS 3HP 1.00 FAU 11.00 1 1
(TENANT: JB AC UNITS +3-10HP 1.00 AC 19.70 ISSUED ON: PROCESSED BY: PLAN BY:
1 I TOTAL-FEES 58.50 107/10/14. SR
OWNER: TEL. NO: I �TE FI Y: CODE: 1
CHEN TERESA P (626) 288-8000- I I I
15543 1/2 SANTA ANITA I I I
ITEMP 917802912 1 ID S RIPTION OF WORK 1
1 1 IELECTRICAL FOR HVAC C/O I
1APPLICANT: TEL. NO: I I I
IGORMAN, ROBERT (714) 453-1243- I I I
122911 SAVI RANCH PKW 1 ISPE LNDITIONS:YORBA LINDA �
1CONTRACTOR: TEL. NO: I IAPPR VALS6TATE INSPECTOR SIG E [`
[SERVICE CHAMPIONS HEATING AND AIR (714) 637-0407- 1 I I
22911 SAVI RANCH PKW LIC. NO TEMPORARY POWER POLE
IYORBA LINDA CA 92887 799170 I 1 I I I
I I (UNDERGROUND CONDUIT I I I
I I I I I I
1ARCHITECT OR ENGINEER: TEL. NO: 1 IUFER GROUND 1 1 I
1 LIC- NO: 1 1ROUGH CONDUIT I I I
I IROUGH WIRING I I I
1 1 IMAIN WATER LINE 1 1
[PLASTIC Y/N METAL Y/N
I I I I 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 IREPORT ID: DPR265 ROUTE TO: BS0508 I [ I [