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