HomeMy Public PortalAbout5830 SULTANA AVE_Electrical__ WORKERS'COMPENSATION DECLARATION to B,
CE-8066 APPLOCATION FOR ELECTRICAL PERMIT
* I hdrtby a{firr 1+at I have a certificate of consent to self ' CE-806
insure, or V cdrtificafe of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof(Sec. 3800, C.) o P
Policy No. 4 Company /Obi� FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS
S —
Certified copy is filed with the county building inspec- 1 8 2-Fomil Y. q• Ft. $ LOCALITY
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tion department. Multi-family Sq. Ft. NEAREST
Date �� F Residential Swimming Pools OWNSCROSS ST �� /✓+��f J
OWNER M 6
Applican ,`� /,rrte� FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light�Sw. MAIL
� JI �p�t ADDRESS
COMPENSATION INSURANCE 6 (I�r.�
Thi;suction nood not bo com lotod if tho work involved b /q First 20
( p Y Total No.��{ Additional ,'� CITY Tel.� Tel. No.�—
th*pormit is for ono hundrod dollars($100)or loss.)
I •. tify that in the performance of the work for which this PLAN CHET
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
Additional
Total No. Cl Tel. No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT py
NOTICE TO APPLICANT: If, after making this Certificate ofAPPLICANT
Exemption, you should become subject to the Workers' Range Heater_D.W. X
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 v FAU W.H. —
deemed revoked. Hood X Fan _Other_ CITY ��f C Tel. No.�'�
LICENSED CONTRACTORS DECLARATIONLICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. & Room Air Cond. LO REG. NUMBER���^c�/ CIOs54:�-I
(commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSFDaY
and Professions Code,and my license is in full force and effect. /(/L/
���•�� -�� Size 8 Type HP, KW, KVA, or KVAR L O
License Number• Lic. Class Up to 1 Incl. FINAL n
Over 1 to 10 Incl:' DATE VALIDAT
Contract Date �!A�_ Over 10 to 50 Iricl.
FINAL IV
❑ I am exempt under Sec. Over 50 to 100 Inc. BY
Over 100
B.BP.C. for this reason
Services, Swbd., MCC&Panelboards
Date: 0 -200 Amp. Under 600 V 1. 01) ! V
Signature 201 - 1000 Amp, Under 600 V f_ ;
Over 1000 Amp. or Over 600 V r
❑ Exemption for Reg. Mainz. Elect. / •, � � �; ., •,
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 G
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits
Professions Code):
❑ j, as owner of the property, will do the work and the M.sc. 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 D
Lender's Address
I certify that I have read this application and state that the TOTAL FEE W
obia e information is correct. I agree to comply with all County
ordina es and State laws regulating Electrical wiring, and
he eb uthorizAreesentatbTer-ST-tFis
to enter upon
tFi above-ments REVERSE FOR EXPLANATORY LANGUAGE
Signature of PeDate
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORHS 9701 LAS TUNAS EL 0508 0603280011
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 ERT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 5905 LT: 102 5830 SULTANA AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801838
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS
5387-015-018 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, C
G1 OUTLETS-LGT,SW,RECP 20.00 OUT 39.00
TENANT: G2 LIGHTING FIXTURES 2.00 LGT 3.90 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
TOTAL FEES 70.65 03/28/06 JK 09/24/06
OWNER: TEL. NO: Fl:WE FINAL BY: CODE:
CHEUNG THOMAS;HELEN TRS CREUNG THUS (626) 548-5093-
5830 SULTANA AVE
TEMP 917801653 DffWOTION OF WORK
ELEPTAICAL FOR ADDITION
APPLICANT: TEL. NO:
CHEUNG (626) 548-5093-
5830 SULTANA AVE SPECIAL CONDITIONS:
TEMPLE CITY CA 91780
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
P S REMODELING CORPORATION (626) 378-2781-
9059 WOOLLEY ST LIC. NO TEMPORARY POWER POLE
TEMPLE CITY, CA 91780 754089B
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND
LIC. NO: ROUGH CONDUIT
ROUGH WIRING
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
REPORT ID: DPR265 ROUTE TO: BS0508