HomeMy Public PortalAbout4509 TEMPLE CITY BLVD_Electrical__ WORKERS COMPENSATION DECLARATION 863 I0i81 APPLICATION FOR ELECTRICAL PERMIT
I hereby offum that I hove a certificate
icote of consent to self �Bo6G
insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec 3800, Lab C )
1
Policy No Company FOR APPLICANT TO RLL IN JOB
Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE ADDRESS
FCertified copy is filed with the county building inspec- I &2 Family Sq Ft s — $ LOCALITY`
bon deportment Multifamily$q F1 ` CR�05NEAREST
G /• 4! J/
/� �W
Residential Swimming Pools OWNER OR 1
Dote Applicant ` ? t i1 FIRM NAME 7
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec_Light_Sw_ �' MAIL
COMPENSATION INSURANCE First 20 ADDRESS
(This section need not be completed H the work Ineeltred by Total No Ratio nal CITU Tel No
the permit is for one hundred dollars($180)or less) RAN
I certify that in the performance of the work far which this tFECK
APPLICANT
permit is issued I shall not employ any person in any manner
so as to become subject to the Workers Compo aIV I
ion Laws Lighting Fixtures First 20 ADDRESS
Total No Additional
Date lf—� Applica CITY Tel ogJli.y l4t�
NOTICE TO APPLICANT If a er ak g t is Cerhf a of Fixed Appliances Not Over 1 HP PERMIT
Exemption you should 6e oer s le ro the kers Range_ Heoter_D W _ APPLICANT '
Compensation provisions of he r e you forth Oven _ Dryer —W M ADDRESS S�
with comply with such prove ions or this permit shall be Top _ FAU —W H
_ 41141
deemed revoked Hood _ Fan _Other_ CITY Tel N gt tJ{
LICENSED CONTRACTORS DECLARATION Disp _ Room Air Cond LICENSE OR Clens
I hereby offum that I am licensed under provisions of Chapter 9 REG NUMBER }
(commenting with Sectors 7000) of Division 3 of the Business power Apparatus d Large Appliances DISTRICT NO P BY d
and Professions Code and my license is in full force and effect C 8
Size 8 Type HP KW KVA or KVAR S 61
License Number Lic Class Up to I Incl FINAL _
Over 1 to 10 Incl DATE ,r 2 Z f-
Contactor Dote VALIDATION U
❑ Over 10 to 50 Incl FINALY IW
I am exempt under Sec Over 50 to 100 Inc BV N
B BP C far this reason Over 100 Z
Dote Services Swbd MCC 8 Punelboards ,
0 200 Amp Under 600 V 2 3 8 8 4 A
Signature 201 1000 Amp Under 600V # • • • • • '2
❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V
SINGLE FAMILY Tem Power Pole 8 ( e e 25 50
HOME OWNER-BUILDER DECLARATION p Apircuit onces e - - 25500
Sign with One Branch Grant
L hereby affirm that I g r exempt from the 31 5 Business
s License 1.2 1 +8 6
Law for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits
Professions Code)
M,sc Conduits 8 Conductors
as owner of the property will do the work and the Other (See Complete Fee Schedule)_ ,
structure is not intended or offered for sole (Section
7044 Business and Professions Code)
CONSTRUCTION LENDING AGENCY - !
I hereby affirm that there is o construction lending agency for
the performance of the work for which this permit is issued PERMIT FEE (Sub-Totol)
(Sec 3097 Civ C )
PLAN CHECKING FEE
Lender s Name
PERMIT ISSUING FEE
Lender s Address
I certify that I have read this application and state that the TOTAL FEE Lj t,Sz/
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 a ove mentioned roperty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
Si t rmmee Date
• COUNTY OF LOS ANGELES TEMPLE CITY q 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1404020029
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
ILEGAL ID FEES PAID BUILDING ADDRESS
ITR 12998 LT 23 I 4509 TEMPLE CITY BL
IFEE DESCRIPTION QUANTITY DOM AMOUNT TEMP CA 91780 I
ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET LOWER A SA 1
8592-001-037 IA1 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE GRID LOCALITY TEMPLE CITY CA
K1 SIGNS OUTLINE LOT 1 00 SIG 38 90
TENANT TOTAL FEES 66 70 ISSUED ON PROCESSED BY PLAN BY
SUPREME INVESTMENT CORP _ _ - 04/02/14 SR _
TOWNER TEL NO FjtVk/l,_DATE FID]�+G�)PY CODE
1WUTONY (626) 617-7848-
14545 09 TEMPLE CITY BL
TEMP 917804232 I ]DESCRIPTION OF WORK
ZONE LED ILLUMINATED WALL S N
IAPPLICANT TEL NO I
IQUEENIE FLING (626) 643-3333- 1
11438 SANTA ANITA AVE (SPECIAL CONDITIONS
S EL MONTE CA _
CONTRACTOR TEL NO I 1APPROVAIS GATE INSPECTOR SIGNATURE 1
SIGNS EXPRESS MANUFACTURINp COMPANY (626) 443-3333-
1438 SANTA ANITA AVE LIC NO TEMPORARY POWER POLE J I
SOUTH EL MONTE CA 91733 552097
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER TEL NO i UFER GROUND
LIC NO IROUGH CONDUIT
I 1
ROUGH WIRING I
MAIN NATER LINE
I _ IPLASTIC YIN METAL YIN
UTILITY COMPANY NOTIFIED]
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• ADDITIONAL DATA ON FILE ]
REPORT ID DPR265 ROUTE TO 9S0508
I
CVJNTY OF IAS ANGELES TEMPLE CITY 0 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1311180066
BUILDING AND SAFELY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
(LEGAL ID FEES PAID BUILDING ADDRESS
ITR 12998 - LT 23 -
1 4509 TEMPLE CITY BL
(PEE DESCRIPTION QUANTITY 00M AMOUNT I TEMP CA 91780 1
(ASSESSOR INFORMATION NUMBER - NEAREST CROSS STREET LOWER AZUSA
18592-001-037 AN PC CITY $109 35 MIN 0 00 164 10 I THOMAS PAGE GRID LOCALITY TEMPLE CITY CAI
Al PERMIT ISSUANCE FEE 2780
TENANT G1 OUTLETS-IAT,SW,RECP 20 00 OUT 40 00 ISSUED ON PROCESSED BY PLAN BY
SUPREME FUNDING CORP G2 LIGHT NG FIXTURES 8 00 LGT 16 00 02/05/14 SR -
JB AC UNITS a3-10HP 4 00 AC ]8 BO �//, 1
OWNER TEL NO TOTAL FEES 326 70 iFIIWL'/ �
LY 1V \W �'FINAL CODE
SUPREME FUNDING CORP (626) 617-7898- NAL E`(/
4509 TEMPLE CITY BL
1TEMP 917804232 ]DDSCCRIPTI0 OF WORK
IT/I ELECTRICAL 20 OUTLETS, 8 LIGHT FIXTURE AND 4 A/C UNITS 1
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APPLICANT TEL `,
YEH, JEREMY (626) 226-6-8585- �r
119537 BLUFFWOOD ST
SPEC IAL CONDITIONS
ROWLAND HTS CA 91748 (
I
CONTRACTOR TEL NO w�e�er\ o4s C^`VCEtII S
IJK DESIGN AND ASSOCIATES INC (626) 226-8585- (APPROVALS DATE INSPECTOR IGNATURE 1
1665 BREA CANYON ROAD LIC NO TEMPORARY POWER POLE
_1WALNUT CA 91789
1 — -- -- (UNDERGROUND CONDUIT
(ARCHITECT OR ENGINEER TEL NO 1UFER GROUND 1 1
CBD AND C LLC
1665 BREA CANYON ROAD LIC NO 1 ROUGH CONDUIT
WALNUT CA 91789 NONE -
R000H WIRING
(MAIN WATER LINE
PLASTIC Y/N METAL Y/N
1 (UTILITY COMPANY NOTIPIID 1
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REPORT ID OPR265 ROUTE TO BS0508
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