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Home My Public Portal About5549-5549 1/2 SANTA ANITA AVE_Electrical__ WORKERS'COMPENSATIQN DECLARATION 76A663 10/81 PP 17 0 I hereby,affirm that a have a certificate of consent to self CE.806G APPUCAVOON FOR EL EC TROCAL PERMIT 'nsgre, o'�'6 certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES MOLDING AND SAFETY or a ce'ified copy thereof(Sec. 3800, Lab. C.) 'P❑olic 'No. WC64717c ,pony Homelnad In• FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS 55492 Santa Anita l S Ft. $ — $ LOCALITY Temple Cit 1 &2-Fami Certified copy is filed with the county building inspec- y q• 1— tion department. Multi-family Sq. Ft. — NEAREST 04/01/87 i Residential Swimming Pools CROSS ST. ` OWNER OR Date Appli FIRM NAME San Gabriel Properties CERTIFICATE OF EXEMPTION FROM WORKERS' -MAIL Outlets: Rec Light Sw._ COMPENSATION INSURANCE ;' . .ADDRESS 217 W. las Tunas Dr. G First 20 s °,.'� (This section need not be completed If the work Involved by Total No. Addition ` , ' CITY San Gabriel Tel. No. the permit is for one hundred dollars($100)or less.) ��• � ,•+t�. �, 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. i 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 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 W.H. — deemed revoked. Hood Fan _Other_ CITY Alhambra Tel. No. 282_0315 LICENSED CONTRACTORS DECLARATION 1 LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ARoom Air Cond. — 5 REG. NUMBER 229847 Class. C10 (commencing with Section 7000)of Division 3 of the Business DISTRICT NO, P E ED BY and Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances �,� '`QO 229847 Size&Type HP, KW, KVA, or KVAR' V License Number Lic. Class C 1� Up to 1 Incl. FINAL u 11/30/87 1 k V aOver i to 10 Incl. DATE ✓!!f VALIDATION 99 Co Date Over 10 to 50 Incl. FIN V I am exempt under Sec. Over 50 to 100 Inc, B 916 B.&P.C. for this reason Over 100 Services, Swbd., MCC&Panelboards Date: 0 -200 Amp. Under 600 V 1 D 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 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 i structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ D ;9_5 5 7.5 A 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY # 0 0 0 0 0 2 1 hereby affirm that there is a construction lending agency for ) o o 6$•� 0 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). ' 00 -� Tokai Bank of California PLAN CHECKING FEE S� � 0 6 1 O v Lender's Name _ PERMIT ISSUING FEE 1 D 5 0 1 0 6 8 6 Lender's Address 534 w 6th Si'_ _ I A 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 10 hereby authorize representatives of this County to enter upon the above-mentio erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 10/03/86 Signature of Permittee Date 1YVORKERS:COMPENSATION}DECLARATION 76A663 10/81 a p ; I hereby affirm that I have a certificate of consent to self CE-8066 APPLOC AVOO IN POR ELEC�UPUCAd PERAMT insure,.or d'certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUOLDING ARID SAFETY oP a certified copy thereof(Sec.:3800, Lab..C.) Policy No.006471733Company Homeland Ins. FOR APPLICANT TO FILL IN JOB ADDRESS 5549 Santa Anita. ❑ Certified copy is hereby furnished. New Residential Bldgs. $ ools EACH NO. FEE ® Certified co is filed with the count building - p $ — $ LOCALITY PY� Y 9 ins ec- 1 &2-Family, Sq. Ft. 57 6 Temple City tion department. Multi-family Sq. Ft. — 'NEAREST 04/01/87 Residential Swimming Pools CROSS S7. Date Apply, , OWNER OR M NAME San Gabriel Properties • � FIR CERTIFICATE OF EXEMPTION FROM.WORKERS' ,MAIL COMPENSATION INSURANCE Outlets:.Rec Light Sw.._ +• ADDRESS 2.17 .W. Las Tunas Dr. . G First 20 �.." (This section need not be completed if the work Involved byTotal No \ I CITY San Gabriel Tel. No. the permit Is for one hundred dollars($100)or less.) . Additional4.-•: t`•'.` `N 4 .-PLdi{�I CHECK I certify that in the performance of the work for which this APPLICANT Permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, ,after making this Certificate of APPLICANT CbOine Electric Co. Inc. Exemption, you should become subject to the Workers' Range_ Heater_D.W. Compensation provisions of the Labor(;ode., you must forth- Oven -.Z!.Dryer —W.M.— ADDRESS 1607 Chestnut St. with comply with such provisions or this permit shall be Top FAU ,1_W.H. — deemed revoked. CITY Alhambra Tel. Na2.82-03 15 . LICENSED CONTRACTORS DECLARATION Hood �• Fan _Other._ 'Disp. 'Room Air Cond. 5 17 5 LICENSE OR Class. 1 hereby affirm that I am licensed under provisions.of Chapter 9 REG.NUMBER 229847 C 10 (commencing with Section 7000)of Division 3 of the Business DISTRICT NO.,---N S$ED BY and Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances D L 229847 XI$XR� C 1 O Size&Type HP; KW, KVA, or KVAR' f �Q 0 License Number. Lic. Class FINAL Up to l,Incl. IN —aOvet 1 to 1.0 Incl. DATE. r. — •VALIDATOON ' ' 0 0 ate 11/30/87 Over 10 to 50 Incl. - F/� I am.exempt under Sec. Over 50 to 100 Inc, . B.&P.C. for this reason Over 100 U) Date. Services, Swbd.,MCC&Panelboard.s 1 15 30 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 I hereby affirm that I•arn exempt from the Contractors License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): ❑ 1, 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)_ D / 7044 ;2557.4A., Business and Professions Code). ' 557,4A CONSTRUCTION LENDING AGENCY # a 0 0 0 0 2 I,hereby affirm that there.is a construction lending agency for �. a 06 8 1 Q� the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). 0 0 0 Lender's Name (j�i,•1/a PERMIT ISSUING FEE O 1.0 bb Tokai Bank Of California PLAN CHECKING FEE . , Lender's Address 534 W.6th St. LA 1 O . 8 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 6F,1 Z) f/ hereby authorize representatives of this County to enter upon / the above-mentioned erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE / 10/0.3/86'CW ' gnature of Permittee Date // WORKERS'COMPENSATION DECLARATION .. crow 10,91 APPLICATION FOR ELECT ; ICAC PERMIT CE{806G i� I hereby affirm. that 14,ave a certificate of consent to self.insure, or a certificate,of"Workers°,Compensation Insurance, or a cert'led COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3$00`L C.) �/7y Policy No.. Company FOR APPLICANT TO FILL IN JOB I . ❑ Certified copy is hereby furnished. law Residential Bldgs.&Pools EACH NO. FEE ADDRE S Certified'popy is filed with'the county. building inspection 1 &2-Family,Sq.Ft.. $ _ $ LOCA TY �ep rtment. Multi-family Sq.Ft. NEAREST Residential Swimming Pools CROSS ST. Date Q Applicant OWNERIOR FIRM Npd'ME CERTIFICATE OF EXEMPTION FROM WORKERS Outlets:Rec Light Sw.� MAIL COMPENSATION INSURANCE ADDRE S (This section'need not be completed if the work Involved by the First 20 permit is for one hundred dollars($100)or less.) Total No. Additional CITY C. Tel.No. I certify that in the performance of the work for which this permit PLAN CHECK APPLICF�Nl' / 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 ADDR SS Total No.� Additional ' CITY ;I Tel.No. Date Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of i PERMIT APPLIC/kN Exemption,.you should become subject to the.Workers'Compensation Range_ Heater D.W. provisions of the.Labor Code,you must forthwith comply with such .I Oven,_ Dryer.— W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top — FAU _ W.H. LICENSED CONTRACTORS DECLARATIONi CITY tl Tel.No.Hood — Fan. Other— I hereby affirm that I am licensed.under provisions of Chapter 9 LICENSE OR. (commencing with Section 7000)of Division 3 of the Business and Disp. — Room.Air Cond. REG.NUMBER {o Class• Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRI ,No. P ES 61qSize&Type HP,KW,KVA,or KVAR Tlzlk License Number Lie.Class f Up to.1 Incl. FINAL ' Aoel L�-s+ ! b / Over 1 to 10 Incl. DATE b J74 VALIDATION Contractor Date Over 10 to 50 Incl.. O FINA l d VI— ❑ f am exempt under Sec. Over 50 to 100 Inc.1. V BAP.C.for this reason Over 100 f N I Services,Swbd.,MCC&Panelboards Z Date: 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V 1 Over 1000'Amp.or Over 600 V ❑ Exemption for Reg.Mamt.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances ''�� j e ( HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law i I ITEMS ' for the following reason(Section 7031.5,Business and Professions. Additional Sign Branch Circuits TOTAL ' 0r} vc.t� Code): _ 1 isc.Conduits&Conductors 23.8f' El1,as owner of the property,will do the work and the structure I is.not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ and,Professions Code). AET g t• t e F CONSTRUCTION LENDING AGENCY I 3307 •23.80 1 hereby affirm that there is a construction lending agency for the I performance of the work which this permit is issued(Sec.3097, I "MIT FEE Civ.C.).Lender's Name (Sub-Total) I ITEMS PAN CHECKING FEE TOTAL . 23.801 h • PJ RMIT ISSUING FEE CHECK 23.80 Lender's AddressCHANGE .00 I certify that I have read this application and state*that the above TPTAL FEE information is correct.I agree to comply with all County ordinances and State Laws regulating Electrical wiring, and hereby authorize represen ives of this County to enter upon,the above-mentioned OUO —OL11 �i,5 �1'[ properor inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 2344 t AM 8425 Signa ure of Permittee Date 1-1-1..- WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT �J I hereby affirm that I have a certificate of consent to self insure, 76A663 or 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 N PN��•' F .Eompany-•_.: FOR APPLICANT TO FILL IJOB ❑ ADDRESS _ ✓ El Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY E Certified.co is filed with the count building inspection 1 &2-Family,Sq.Ft. — $ $ PY Y 9 , P� _ NEAREST department. ! Multi-family Sq.Ft. CROSS ST. Date"le I ' I Applicant Residential Swimming Pools ASSESSOR JY' 1 MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec.—Light Sw. n NAME COMPENSATION INSURANCE% First 20 MAIL (This section need not be completed if the work involved by the Total No. r 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 Tel.No. is issued, I shall not employ any person in any manner so as to PLAN become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT K 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 P P y 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 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. LICESE OR Over 50 to 100 Incl. REGNNUM ER �' Class. - V Over 100 DISTRICT NO. PROCESSED BY LL License Number Lic.Class J Services,Swbd.,MCC&Panelboards LL_ 0-399 Amp.Under 600 V FINAL Contracto[ Date DATE ❑ 400-1000 Amp.Under 600 V I am exempt under Sec. VALIDATION Q Over 1000 Amp.or Over 600 V FINAL cc B.&P.C.for this reason BRANCH CIRCUIT FEES BY Q a ,nate: I 15A,or 20A,120V,Lighting or Recept. 1 To 10 Branch Circuits LL Signature 11 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 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , r 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 (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE 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 inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r SIGNATU E OF PERMITTEE DATE