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HomeMy Public PortalAbout4816 TEMPLE CITY BLVD_Electrical__ WORKERS Ihave COMPENSATION cafeDECLARATIONcorse "aTamvovware7 APPLICATION FOR ELECTRICAL PERMIT O I hereby affirm that I have a certificate of convent to self 1°P°°s ae �• r p c are copy the of Workers Compensation Insurance COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS or? certified copy thereof (Sec 380D La C ) Policy NatYOO�T- Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS B/x✓ /� Lt< ✓b Cenified copy is filed with the co bui tic 1 8 2-Family Sq Ft $ — $ LOCALITY . C eon department/' i� Multi-family Sq Ft — NEAREST Date � -ZZ i ApPIIc t Residential Swimming Pools OWN �J.'e•' /-7Z A(Sfl �•p / �q QR OR FIRM NAME /vN CERTIFICATE OF EXEMPTI FROM RKERS Outlets Recl.-LLight.G�Sw nn �r COMPENSATIO INSURAN MAIL e C./ (This section need not be co listed If the work imrolved b ¢ First 20 T Total No xLSL Additional CI £ L Tel No the permit Is for one hundred dollars ($100)or leu) CHECK certify that in the performance of the workPIAN for which this PLAN 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 Dote—Applicant CITY Tel No NOTICE TO APPLICANT If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT _/ Exemption you should become subject to the Workers Range— Heater—DW _ APPLICATION A /M..T re 01,44 Compensation provisions of the Labor Code, you must forth Oven _ Dryer —W M — ADDRESS a ryl n2DJ� f�yf� with comply with such provisions or this permit shall be deemed revoked Top FAU —W H — CI Tel IJ 6 LICENSED CONTRACTORS DECLARATION Hood — Fan —other— hereby affirm that Disp _ Room A,rCond UC am licensed under provisions of Chapter 9 REG NENSEUOR MBER Class IF (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO EVIEESSED77 T and Professions Code and my license is in full force and effect /�Q O. a�6�3 j{ Size 8 Type HP, KW KVA, or KVAR !/d O License Number Lic Class ✓_ 1 U q Up to 1 Incl FINAL f !� Contractor-• �2A�r<'S nate•3-W- / Over 1 to,10 Incl DATE S�J �/ VALIDATION O ❑ Over 10 to 50 InCr FINAL � am exempt under Sec Over 50 to 1DO Inc BYU B 8P C for the reason Over 100 LU 11. to Services Swbd , MCC 8 Ponelboardsp ` Z 0 200 Amp_Under 600 V — Signature 201 - 1000 Amp Under 600 V Exemption for eg Moint Elett Over IODO Amp or Over 600 V _ SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor s License Sign with One Branch Circuit AC C.T.i Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits Professions Code) ❑ I as owner of the property will do the work and the Misc Conduits 8 Conductors 1 ITER_ structure is not intended or offered for sale(Section 7064, Other (See Complete Fee Schedule)— , TOTAL - 98 - 20 Business and Professions Code) CONSTRUCTION LENDING AGENCY CHECK, 4S.--�I I hereby affirm tfat there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) CHA%-E .IJI: (Sec 3097 Civ C ) �� RAN CHECKING FEE - Lender s Name ! d)J00—0001 3118G /+I PERMIT ISSUING FEE ` Lander a Address � 6112 1 AM E-51 I certify that I have read this application and state that the TOTAL FEE above information is correct I agree to comply with all County ordinances and State ows regulating Electrical wiring and hereby hon a sentahves of this County to enter upon - the ve nt property inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 3 /b' y) Sig e o P rmotee Date ®s COMITY OF LOS ANGELES TEMPLE CITY F 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0411300006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID: FEES PAID Bull- TR 14467 LT 4 4816 TEMPLE CITY SL FEE DESCRIPTION O(IANTITY ZION. AMOUNT _ TEMP CA 917804235 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET: LONER AZUSA 6589-015-003 Al PERMIT ISSU Nd FEE 27 75 THOMAS PAGE: 597 GRID A5 LOCALITY TEMPLE CITY, C TENANT F1 120V 15/20A BR CKTS 12 00 BR 202 65 IB N-REi YTR HTR LT 3HP 1 00 (ITR 15 30 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON RELIABLE DENTAL STUDIO JB AC UNITS +3-10HP 1 00 AC 19 65 11/30/04 JK 05/29/05 K1 SIGNS, OUTLINE LGT 1 00 SIG 38 85 OWNER: TEL. NO. LS 200 AMP PANELS, MCC 2 00 PAN 77 70 FINqL DATE FINAL BY --cmy- TSAI, RON - (626) 237-1218- TOTAL FEES 381 90 4816 LONGDEN AV ep- TEMP 917801609 DESCRIPTION OF WORK ELECTRICAL FOR LAB ADDITION APPLICANT- TEL NO BARBER CONSTRUCTION COMPANY (310) 704-1582- 312 N. LONG BEACH BL SPECIAL CONDITIONS LONG BEACH CA 90221 CONTRACTOR TEL. NO APPROVALS DATE BARBER CONSTRUCTION CO (310) 704-1582- 312 N LONG BEACH BLVD LIC. NO TEMPORARY POWER POLE COMPTON CA 90221 351114 B UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: POLY DESIGN GROUP _ (626) 679-5238- PO BOX 6854 LIC NO ALHAMBRA, CA 91801 NONE ROUGH CONDUIT RMWWIRINEi MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY MOTI"M REPORT ID' DPR265 ROUTE TO BSD508 y COUNTY OF LOS ANGELES TEMPLE CITY 0 0508 CELECTRICAL-PERMIT— DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL•D508 9805060006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE (818) 285-0488 EXT LEGAL ID FEES PAID 'U'LD'NGOA"'rlE" TR' 14467 Li 4 FEE DESCRIPTION QUANTITY LION AMOUNT CTTEEMIP CA 917804235 BL ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LOWER AZUSA 8589-015-003 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID A5 LOCALITY TEMPLE CITY TENANT LB 200 AMP PANELS, MCC 1 00 PAN 38 85 TOTAL FEES 66 60 ISSUED ON- PROCESSED BY PLAN BY ERFTM ON 05/06/98 UT 05/06/99 OWNER TEL NO FINAL DATE CODE MAUREY PIERRE X,PHEBE,CHU YUN-HANFINAL BY - ! '�l A 9431 LONGDEN AV J- 'i TEMP 917801609bESCIt10TTWdF_ _ < NEW2DO-AMP-SERVICE PANEL-UPGRADE___::, APPLICANT TEL NO JOHNNY J LIN ELECTRICAL (626) 446-7852- 425 DANIMERE SPECIAL CONDITIONS ARCADIA, CA CONTRACTOR TEL 5 PNGELES Co APPROVALS DATE INsFECTOFTMUTUff— JOHNNY J LIN ELECTRICAL (626) 446-7852- 425 DANIMERE LIC NO SEI POLE ARCADIA, CA 91006 419580 UNDFKGROUND CONDUIT ARCHITECT OR ENGINEER TEL NO: UFER GROUND LIC NO lltil 11ROUGH CONDUIT ROUGH WIRING C� MAIN WATER LINE 3DU Ic-1)L C V1 0[�[� PLASTIC Y/N METAL Y/N UTILITY COMPANY kOTrFM �b/�c ❑ mot Service Thai Arr]�J/Z, REPORT ID DPR265 ROUTE TO BS0508