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Home My Public Portal About4948 SERENO DR_Electrical__ (2) WORKERS COMPENSATION DECLARATION : CE 8061 la,f>} APPLICATION FOR ELECTRICAL PERMIT I hereby affirm mot J have a certificate of consent to self ' insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 3800 b C ) zp ADDRESS q S Policy No y Ir Company FOR AMWANT TO FILL IN JOBB ` I'fLgYY'J�A�I Certified copy is hereby furnished ' New NO FEE New Residential Bldgs 8 Pools f — s LOCALITY t tion department copy is filed with the c un budding in 18 2 Family, of t NEAREST tion department Mulb-family Sq Ft — CROSS ST �,� LJ. Residential Swimming Pools OWNER OR Dote J�J—_Applicant / FIRM NAME CERTIFICATE OF EXEMPTION F DDRM OMPENSATION INSURANCE WORKERS' Outlets RecALLight_Sw_ s�l(a �I gMnit •v Q First 20 1✓ V p (This section no"not be hundred dollars H the work involved by Total No Additional CITY .� Tel No �3 4 the pormll IF for one hundred dollen($100)or loss ) 1 certify that in the performance of the work for which this RAtJ CK PLAN CHECK E E permit is issued I shall not employ any person in any manner ANT so as to become subject to the Workers'Compensation Lows Lighting Fixtures First 20 ADDRESS Total No AdditionalCITYTel No Dote Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If after making this Certificate of APPLICAMle Exemption you should become subject to the Workers' Range_ Heater D W y - Compensation provisions of the Labor Code you must forth- Oven _Dryer 3Z W M V ADDRESS 3 S /) with comply with such provisions or this permit shall be T _ FAU —W H 1 II � deemed revoked o an UO ✓ lD CITYS Tel No LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other-y I t I g 0 I hereby offnRm that I am licensed under provisions of Chapter 9 Disp — Room Au Cond ]L NUMBER Class (commencing with Section 7000) of Division 3 of the Business power Apporatw 8 Large Applroncas DISTRICT NO PROCE BY >.and Professions Code,and my license a in full force and effect _ �-(/• _ d Size 8 Type HP KW KVA or KVAR Q I O License Num Lic Class / W Up to 1 Incl DATE C //�f—,1�� 11 Over I to 101nc1 K Contractor Date_ / VALIDATION O ❑ Over 10 to 50 Incl FINAL I am exempt under Sec Over 50 to 100 Inc BY d B 8P C for this reason Over 100 �'/ Z Dote Services Swbd MCC 8 Ponelboords 0o 15 O� ► 0 - 200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V ❑ Over 1 ODD Amp or Over 600 V �[/[Exemption for Reg Moms Elect " / 7 SINGLE FAMILY _ Temp Power Pole 8 Appurtenances _ _ (♦ �l 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 9 2 6 —8 4 Law for the following reason (Section 7031 5, Business and Professions Code) 3 Z Z 1- e4' ❑ I as owner of the property will do the work and the Mix Conduits 8 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) q. (Sec 3097, Ctv C ) PIAN CHECKING FEE - O - Lenders Name ' PERMIT ISSUING FEE Lender s Address I certify that 1 have read this application and state that the TOTAL FEE above information is correct I agree to comply with all County ordmo and Sbte laws regulating Electrical wiring and her out nze representatives of this County to enter upon the ve ntioned props for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE i afire of PermiHee pate COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0403030030 ' BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT: LEGAL ID FEES PAID BUILDING ADDRESS ON FILE 4948 SERENO DR FEE DESCRIPTION QUANTITY LON: AMOUNT: TEMP CA 917803036 ASSESSOR INFUKRATION NUMBER NEAREST CROSS STREET ENCINITA 5388-012-020 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE- 596 GRID: H5 LOCALITY: TEMPLE CITY, C G1 OUTLETS-LGT,SN,RECP - 130 DO OUT 187 50 TENANT G2 LIGHTING FIXTURES 33 00 LGT 56 55 ISSUED ON PROCESSED BY' PLAN BY EXPIRES ON HA FAU LESS 3HP 1 DO FAU 10 95 03/03/04 VG - 08/30/04 H2 RES GRBG DISP LT 3HP 1 00 DIS 10 95 OWNER TEL NO H3 RES DISHNASHR LT 3HP 1 00 DIS 10 952 _ KONG, KELVIN (626) 242-8939- H4 RES RANGE HOS LT 3HP 1 00 HOD 10 95 S 6026 PRIMROSE AVE H5 RES WASH MACH LT 3HP 1 00 WAS 10 95 -- TEMP 91780 H7 RES EXHAUST FANS 4 00 EX 43 80 MERtSF ION OF WORK H9 RES APPL LT 3HP 1 00 RES 10 95 ELECTRICAL FOR ADDITION LB 200 MMP PANELS, MCC 1 00 PAN 38 85 APPLICANT TOTAL FEES 420 15 ELITE DESIGN INC (626) 288-2651- SPECIAL CONDITIONS CONTRACTOR —79F-o APPROVALS bArF----TWECTOR SIGNATURE KONG, KELVIN (626) 242-8939- 6026 PRIMROSE LIC NO TEMPORARY POWER POLE TEMPLE CITY, CA 91780 NONE ARCHITECT OR ENGINEER TEE--0— UFER GROUND PETER LEE ENGINEERING (626) 200-9000- 8748 VALLEY BLVD LIC NO ROUGH CONDUIT ROSEMEAD, CA NOME ROUGH WIRING Unr'MMR LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED REPORT ID DPR265 ROUTE TO SS0508