HomeMy Public PortalAbout5853 SULTANA AVE_Electrical__ "tVO�2KEth COMPENSATION DECLARATION CE-&M j0/81 APPLICATION FOR ELECTRICAL PERMIT
��,,hsr`eb -,taffirm'that I have a certificate of consent to self CE-806G
�iinswe,''gr-a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
;'or a certified copy thereof.(Sec. 3800,.Lob. C.)
Policy No. Company FOR APPLICANT TO FILL.IN JOB
Certified copy is hereby furnished. ez
New Residential Bldgs. &Pools. EACH NO. FEE ADDRESS G1^
Certified'copy is filed with the county building inspec- 1 &2-Family, Sq. Ft, d'a $ — $ J7 W LOCALITY
tion d par e Multi-family Sq. Ft. — ARRESST
Date Appl'ica.nt' Residential Swimming Pools OWNER OR.
,Q 1�
CERTIFICATE OF EXEMPTION FROM WORKERS' FIRM NAME
Outlets: Rec"Light�Sw./� I ; MAIL
COMPENSATION INSURANCE First 20 ADDRESS a
/
(This section need not be completed if the work involved by Total.No.�"� CITY Tel.
the permit Is for one hundred dollars($100)or less.) Additional �. dO
I certify that in the performance of the work for which this PLANA CHECK
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
Date Applicant CITY Tel. No.
Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption, you should become subject to the Workers' Range / . Heater_D.W. APPLICANT Q a7
Compensation provisions of the Labor Code, you must forth- Oven —Dryer L W.M. ADDRESS
with comply with such provisions or ,this permit shall be Top _ FAU —W.H. — CITY Tel. No
deemed.revoked. Hood Fan _Other_
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG. NUMBER / Class.;
(commencing with Section 7000)of Division.3o the Business DISTRICT NO. �) PRO D BY
y Power Apparatus 8 Large Appliances �� i'✓U
and Professions Code;and m license is in full force and effect. o
Size&Type HP, KW, KVA, or KVAR %
CL
License.Number Lic. Cl.
O
�j V
ss Up to.1 Incl. FINAL b 6
Over 1 to 10 Incl. DATE VALI TION O
09
Contractor Date Over 10 to 50 Incl. u
❑ FINAL
I am exempt under Sec. Over 50 to 100 Inc. FI
B.&P.C. for this reason Over 100 in
Date: Services, Swbd., MCC&Panelboards
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 Polo 8 Appurtenances
�2.84.4A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit '#'o a o o o 2
1 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 o 0 4113 4
Professions Code):
I, as owner of the property, will do.the work and the Msc'. Conduits&Conductors 6,0 - 493450
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ ►
7044, Business and Professions Code).
0'904=85
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 105-0
Lender's Address
I certify that I have read this application and state that the TOTAL FEE 8
above information is correct. I agree to comply with all County i + ,
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives.of this County to enter upon
;the ve- entione property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature o e mittee 1-60 1 e
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0202250006
+ BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL D: FEES PAW BUILDING ADDR S•
,TR: 5905 LT: 110555-3 51a a 1tio-.
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801841
ASSESSOR INFORMATION U BER: NEAREST CROSS STREET: ROSEMEAD
5387-014-007 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY
G1 OUTLETS-LGT,SW,RECP 7.00 OUT 13.65
TENANT: G2 LIGHTING FIXTURES 2.00 LGT 3.90 ISSUED am: PROCESSED BY: PL EXPIRES ON:
TOTAL FEES 45.30 02/25/02 JK 08/24/02
OWNER: TEL. 0: FINAL DATE FIN BY: / CODE:
WALKER WILLIAM R;MARTHA J -
9044 HERMOSA DR �' `0c-
TEMP 917801841 CR ON Of WORK
ADD BATH AND EXTEND DRM
APPLICANT: TEL. 0•
WILLIAM LEONG (562) 698-0571-
11713 E WASHINGTON SPECIAL CONDITIONS:
WHITTIER 90606
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
HAMMERFORD CONSTRUCTION (562) 698-0571-
11713 E WASHINGTON BLVD LIC. NO TEMPORARY POWER POLE
WHITTIER CA 195413 B
UNDERGROUND CONDUIT
ARCHITECT OR E G R: TEL. NO: UFER GROUND
LIC. NO: ROUGH CONDUIT
ROUGH I
MAIN ATER LINE
PLASTIC Y/N METAL Y/N
UTILITY 0 PAY OTIFIED
REPORT ID: DPR265 ROUTE TO: BS0508
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS
EL 0508 0911160003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID I BUILDING ADDRESS:
ITR: 5905 LT: 110 5853 SULTANA AV
[FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801841
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
15387-014-007 JAI PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl
I JHA FAU LESS 3HP 1.00 FAU 10.95 1 1
ITENANT: JJA HEAT PUMPS +3-10HP 1.00 HT 19.65 JISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: ]
1 I TOTAL FEES 58.35 111/16/09 SR 11/16/10 J
(OWNER: TEL. NO: 1 IFINAL DATE FINAL Y: CODE: 1
1WALKER WILLIAM (626) 291-2652-
15853 SULTANA AVE. •[ l j7`(+/"V ' 1
ITEMP 917801841 ] [DESCRIPTION OIF WORK 1
1 ]CIRCUITS (2) FOR NEW HVAC ]
JAPPLICANT: TEL. NO: J
ICOMFORT ZONE INC. (626) 963-8383- 1 1 1
1144 B VALENCIA 1 ISPECIAL CONDITIONS: 1
IGLENDORA CA 91740
I I J I
JCONTRACTOR: TEL. NO: ] JAPPROVALS DATE INSPECTOR SIGNATURE 1
ICOMFORT ZONE INC. (626) 963-8383-;I 11
�
1144 B VALENCIA LIC. NO I ITEMPORARY POWER POLE [ I 1 GLENDORA, CA 91740 760955 C20 I
]UNDERGROUND CONDUIT I I ]
1ARCHITECT OR ENGINEER: TEL. NO: 1 1UFER GROUND I I I
_ 1 I J
LIC. NO: I (ROUGH CONDUIT
IROUGH WIRING
IMAIN WATER LINE 1 1
1 IPLASTIC Y/N METAL Y/N ]
1 I [UTILITY COMPANY NOTIFIED] ] 1
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[ IREPORT ID: DPR265 ROUTE TO: BS0508 J ] J ]
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