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Home My Public Portal About5846 SULTANA AVE_Electrical__ WORKERS'COMPENSATION DECLARATION 78-883 tD�.81 APPLICATION FOR ELEC 1RICAL PERMIT ' I hereby affirm that I have a certificate of consent to self insure, CE-806G or,a certificate of Workers'Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) Policy No. i Company FOR APPLICANT TO FILL IN JOB �u r ❑ Certified egpy is hereby furnished. New Reside tial Bldgs.&Pools EACH NO. FEE ADDRESS /� L ❑ 1 &2-Family,Sq.Ft. $ _ $ NOTL Certified copy is filed with the county building inspection q department. Multi-family Sq.Ft. CROSS ST. ��Qlf u w Date Applicant Resident'al Swimming Pools OWNER OR FIRM NAME AIV CERTIFICATE OF. First 20 EXEMPTION FROM WORKERS' MALI COMPENSATION INSURANCE Outlets:Re _Light- t - ADDRESS ed by the (This section needinot be completed if the work Involved ', permit is for one hundred dollars($100)or less.) Total No Additional CITY Tel.No. I certify that in the'performance of the work for which this permit PLAN CHECK p p „APPLICANT. . is. issued, I shall not employ any person in any manner so as to i become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Total No Additional CITY Tel..No.. Date Applicant Fixed Appli nces Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of Exemption,.you should become subject to the Workers'Compensation Range_ Heater D.W: APPLICANT �/. provisions of the Labor Code,you must forthwith comply with such Oven Dryer_ W.M._ ADDRESS 3O 4;,0,.1,4V,, provisions or this permit shall be deemed revoked. Top FAU W.H.._ CITY/�J Tea.No. ` LICENSED CONTRACTORS DECLARATION Hood '� Fan Other_ 4 � ��« -�� I hereby affirm that I am licensed under provisions: of Chapter 9 �DispRoomAir Cond. LICENSE OR . - Clas�l(� (commencing with Section 7000)of�Division 3 of the Business and �� REGI NUMBER -V'�� Professions Code,and my license Is in full force and effect. Power Apptpte us&Large Appliances DISTRICT O PRO ED e Size& HP,KW,KVA,or KVAR I. O Q License Number s2S+r�l& 9" L.ic.Class r Up to.1 Inc. FINgL - U DATE VALIDATION C Over 1 to 10 Incl. Contractor Date' � /� Over 10 to 50 Incl. O 01 El I am exempt under Sec. FBY IN L �_Over•50 tg 100 Inc. FI B.&P.C.for this reason �-Over 100 N S�rbd.,MCC&Panelboards Z tt Date: p 0-200 Amp.Under 600 V Signature i 1600 Amp.Under 600 V Ix ❑ i Over 1010 Amp.or Over 600 V l Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp,Powe Pole&Appurtenances .i HOME OWNER-BUILDER•DECLARATION Sign with Ol a Branch Circuit $ I hereby affirm that I am exempt from the Contractor's License Law ? I`s for the following reason(Section 7031.5,Business and Professions Additional S gn Branch Circuits 3307 31.00 Code); j Misc.Cond its&Conductors j 1 ITEMS ❑ 1,as owner of the property,will do the work and the structure Other(See omplete Fee Schedule) is not intended or offered for sale (Section 7044, Business TOTAL 31.00 and Professions.Code). I {� i �y CASH 31 o 0.0 CONSTRUCTION LENDING AGENCY I hereby affirm thatithere is a construction lending agency for the performance of the Work for which this permit is issued(Sec.3097, PERMIT FEL (Sub Total) I CHANGE. �� Civ.C.). I PLAN CHE KING FEE [ -� -11 7/26/911 Lender's Name PERMIT ISE000-OO FEE. ® I 2058 • . 1 IAM 7;08 Lender's Address I certify that I havelread this application and state that the.above TOTAL FEE informatiori"is correct.I agree to comply with,a11 County ordinances and State.laws regulating Electrical wiring, and:hereby authorize repre . tat sof ,is Co ty to enter pon the above-mentioned p ty f .ins i sea. S E REVERSE FOR EXPLANATORY LANGUAGE ature of mitti a Date WORKER'S COMPENSATION DECLARATION 7MO83 DPW(12'91) APPLICATION FOR ELECTRICAL PERMIT Nerora , tlfl that I have a certificate of consent to self insure, of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof ec.3800 Lab.C.) �/ `, Policy No. ompany��—�J A.'o FOR APPLICANT TU FILL IN ADDRESS ❑ Certified copy is hereby furnished. New Residential Bldgs.&.Pools NO. EACH FEE LOCALITY —^ ❑ 1 &2-Family,Sq.Ft. _ $ $ Certified copy is filed with the county building inspection NEAREST department. Q,� Multl4amily Sq.Ft. CROSS ST. Date X1"20—9 ' Applicant Residential Swimming Pools ASSESSOR MAP BOOK (� PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' 'Outlets:Rec. Light Sw. FISM N oR f COMPENSATION INSURANCE (� D� FIRM NAME L/ !i✓ /Z.CI 4 First 20 i v (This section need not be completed If the work Involved by the Total No. Additional ADDRESS j r permit Is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit CITY cti Tel.No. C �5— is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers'Cpmpensation Laws. Lighting Fixtures First 20 APPLICANT Total No.— Additional A J,0 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. rovisions of the Labor Code,you must forthwith comply with such PERM p Y P Y APPLICANT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances ._ i� d/1 t G �G LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS r r I 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. LICENIIYOR 4 �j n 6 1 Class. a Over 50 t0 100 incl. REG.NUMBER (Y C- V `7� � 8 C f Lic.Class Over 100 DISTRICT NO. PAQSESSED BY 0 License Number j` ,Services,Swbd.,MCC&Panelboards � dI/�C�q, ��6 ate „�Z 9 0-399 Amp.Under 600 V DATE 0 Contractor V�1�� L: Date 400-1000 Amp.Under 600 V ❑ I am exempt under Sec. VALIDATION [if Over 1000 Amp.or Over 600 V FINAL B.&P.C.for this reason BRANCH CIRCUIT FEES BY (n Date: 15A,or 20A,120V,Lighting or Recept. z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Eliemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY 'Temp.Power Pole&Appurtenances DC7 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit _ - I herebyaffirm that I am exempt from the Contractor's License Law `�_';!i for the ollowing reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits :+ -i �- -`� Code): 1ITEVIS ❑ 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) 1_I r% 3�'00 and Professions Code). pop- CHECK . ! CONSTRUCTION LENDING AGENCY _3: ' ,3: KU 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 q 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 poses. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF PE MITI DATE WORKER'S COMPENSATION DECLARATION 20.0019 DPW(12-91) 7SA683 APPLICATION FOR. ELECTRICAL PERMIT �J I hereby.afflrmp that I have a certificate of consent to self Insure, ` or a:dertificate 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 No. ,1 1 I .ompany FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY ❑ 1&2-Family,Sq.Ft. _ $ $ Certified copy is filed with the county building Inspection NEAREST de art ent. �/ /�1�,,* . Multi-family Sq.Ft. CROSS ST. Date ° Applicant c��i A Y Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM-WORKERS' \ L OWNER OR 0�p COMPENSATION INSURANCE Outlets:Rec._Lig Sw. m0 FIRM NAME V�, First 20 MAIL (This section.need not be completed if the work Involved by the Total No 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 become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 FLAN. Total No. Additional ADDRESS, Date ApplicantRESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT: If, after making this CertiHP. 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 with such PERMIT AA provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS ` I 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 I.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. Over 50 to 100 Incl. LICENSE OR Clew REG.NUMBER IL r License Number Lic.Class �� Over 100 DISTRICT NO.. P SED BY 0 u�76'� J�G� p V Services,Swbd.,MCC&Panelboards Contractor - Date 0-399 Amp.Under 600 V FINAL X04 0 ❑ I am exempt under Seq. 400-1000 Amp.Under 600'V j t 3 pLIDATION' 52.70 V Over 1000 Amp.or Over 600 V FINAL 330 W' B.&P.C.for'this reason BRANCH CIRCUIT FEES BY a CO. Date: 15A,or 20A,120V,Lighting or Recept. 1 ITEMSZ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ - 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,2DA,2DBV To 277V Lighting Br.Circuits jeFAli 52 Z.%- 14� � 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 CHANGE .00 Code): ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors OOM--0001 10/31/95 is not Intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule). and Professions Code). 3079 1 AM10:13 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) ON.C.) PLAN CHECKING FEE Lender's NameB PERMIT ISSUING FEE p �41 Lender's Address I certify that I have read this application end 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 , representativ of.this County to enter upon the above-ment ned prop rty for Inspectic purposes. ^� SEE REVERSE FOR EXPLANATORY LANG E I/ A 11#41,hlaA �. . SIGNA DATE' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1101270024 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: I FEES PAID I BUILDING ADDRESS: I ITR: 5905 LT: 99 I I 5846 SULTANA AV ASSESSOR INFORMATION NUMBER: IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917801838 I NEAREST CROSS STREET: LAS TUNAS 15387-015-015 [Al PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl I IG1 OUTLETS-LGT,SW,RECP 22.00 OUT 41.60 I TAT: IG2 LIGHTING FIXTURES 8.00 LGT 15.50 (ISSUED ON: PROCESSED BY: PLAN BY: IHA FAD LESS 3HP 1.00 FAD 10.90 101/27/11 SR I IJB AC UNITS +3-10HP 1.00 AC 19.70 I I [OWNER: TEL. NO: I TOTAL FEES 115.50 iF � FI Y: CODE: ING, EUGENE (626) 201-0911- [ I 15846 SULTANA AV ITEMP 917801838 I IDESCRIPTION OF WORK I [ I I JELECTRICAL FOR ADDITION AND HVAC SYSTEM (APPLICANT: TEL. NO: [ [ [ ING, EUGENE (626) 201-0911- 15846 SULTANA AVE ISPECIAL CONDITIONS: [ ITEMPLE CITY CA 91780 I I [ (CONTRACTOR: TEL. NO: I [APPROVALS DATE INSPECTOR SIGNATURE [ ING, KIN W. (626) 201-0911- 1 1 [ ILINDA C. NG LIC. NO 1 TEMPORARY POWER POLE I [ [ P.O. BOX 1725 NONE [ [ I I I I I TEMPLE CITY, CA 91780 i JUNDERGROUND CONDUIT [ I ARCHITECT OR ENGINEER: TEL. NO: - i JUFER GROUND [ [ LIC. NO: I IROUGH CONDUIT i I (ROUGH WIRING I MAIN WATER LINE (PLASTIC Y/N METAL Y/N [ [ I I [UTILITY COMPANY NOTIFIEDI I I I I I I I I I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 [ I I I I I I I I I