HomeMy Public PortalAbout4932 TEMPLE CITY BLVD_Electrical__ WORKER Save a certificate
DECLARATION 20�0019 DPW a/ea APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certlircate al consent to Bell Insure 7eA8�
or a cenlhcate of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
mpg thereof(Sec 3800 Lab C) - _
Policy No Company FOR APPLICANT To RLL W gE6g 93a '(•E MPL E c 1 Tl-BL.vv
❑ Candied copy b hereby to nisMd EACH, NO -FEE ` tea
❑ ,. New Residential Boge 'Paas s _ s LOCALITY -`E A4 LE G k TY C A q 418 O
Ce a"M copy U filed with the county budding Irropedlm 1 a 2 Fatly 3F Ft tE 'S
department MDnrramilysg Ft — cams3aT SpA42K1_E.TT
Dale tApplicant1 r Residential Swimming Pods , ASSESSOR
Px1E PARCEL
CERTIFICATE OF EXEMPTK>N FROM WORKERS Outlets R. ID Wj__Sw J— FOWNER NAOR ._rUDS ON LEoNG _
o COMPENSATION INSURANCE ,. First 20 �' (� MAIL �. AS �8 O
(This section need not be oitompieted the work Involved by the Total No _ Addalonal - ADDRESS SAM Y
permit Is for one hundred dollen(Ill or less) -
I certify that in the performance of the work for which this permit CITY -_ TN Noa87-23
63
is issued I shall not employ any peraon In any manner,so as to
become subject to the Workers Compensation Laws Lighting Fixtures Firm 20 71) APPLICCAANT
Total No Additional -
ADDRESS
Date Applicant I
16 OR 20A 120V BRANCH CIRCUITSNOTICE TO APPLICANT It after making this Certificate of CITY Tal No
Exemption you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH
provisions of the Labor Code you must forthwith comply with such 11 TO 40 INCLUSIVE EACH A�ppLNRjpAHT -
provisions or this permit shall be deemed revoked 41 OR MORE BRANCH CIRCUITS EACH }
LICENSED CONTRACTORS DECLARATION - - - N - ADDRESS d
I hereby affirm that I am licensed under provisions of Chapter 8 150R2oA 2o6VT027LIGHTINGEACH C)
(commencing with Section 7000) of Division 3 of the Business and _ --.. _ CITY Tel No V
Professions Code and my license is in full force and effect RESIDENTIAL APPLIANCES UP TO 3HP UHCENW OR Gm cc
Appliances Apparatus a Large Appltes _ REO NUMBER O
License NumberLx Class Size a Type HP KW KVA wKVAR OlaTacT NO PROCESSED BY
..._ Up b 31nd - �O Lt-L�-La/ a
Over 3 to 10 Ind FiltAL Tit
Otrector Data - Over 10 to 50 Ind DATE Z�> Z
I am exempt under Sec Over 50 to 10.0 Ind 0 G VALIDATION
B DAP C for this reason Over 100 BY
Services Swbd MCC a Panalboards _
r- - Date - 0 200 Amp Under 600 V
Signature 201 1000 Amp Under 600 V
r Over 1000 Amp or Over 600 V
ElExerrpiLaL for Reg Maim Elect -
SINGLE FAMILY Temp Power Pole a Appurteravmes_
HOME OWNER BUILDER DECLARATION
I hereby affirm that I em exempt from the Contractor a License Lew Sign with One Branch Circuit
for the following reason(Section 7031 6 Business and Professions Additional Sign Branch Circuits
Code)
I-+EO�
® Mmc Conduits a Conductors - - - - TOIAL 70 e �...�
I u owner of the property will do the work end the Business
}
re not Intended air offered for sale (Section 7044 Buelneae 011ier(See Complete Fee Schedule)
and Professions Cade) _ -' - , r CTFEU, 710•Z_
CONSTRUCTION LENDING AGENCY _ _ - CHARGE •1,jT
1 hereby affirm that there is a construction lending agency for the
performance o1 the work for which this permit is issued (Sec 3087 PERMIT FEE_ _ _ _ (Sub-Total) r'
Cir C) PLAN CHECKING FEE.
7
Lander a Name PERMIT ISSUING FEE •
fL I A(1 .1_
Lander a Address
I certify that I have read this application and state that the above TOTAL FEE
information Is correct I agree to comply with all County mdmancate
and Slate laws regulating Electrical wiring and hereby authorize
representatives of this County to enter upon the above mentioned _ t
property for Inspection purposes; REVERSE FOR EXPLANATORY LANGUAGE
o)
81—dMA OF AfPLIfJlli OR ADENt a DATE —
i
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0201310014
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE- (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS:
TR: 14467 LT 16 4932 TEMPLE CITY BL ,
FEE DESCRIPTION: QUANTITY UOM: AMOUNT TEMP CA 917807868
ASSESSOR INFORKATION NUMBER, NEAREST CROSS STREET: SPARKLETT -
8589-014-001 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE. 597 GRID: A5 LOCALITY TEMPLE CITY
G1 OUTLETS-LGT,SW,RECP 8 00 OUT 15.60
TENANT TOTAL FEES 43 35 ISSUED ON -
01/31/02 JK 07/30/02 -
TE
YAG; DIAMA AND CRUZ , LA J
CODE
4932 TEMPLE CITY BL (626) 285-1319- '�/6/per �/
TEMP 917803868 -- - I DESCRIPTION OF WORK
C/O OUTLETS TO GFCI
APPLICANT TEL NO
NICK TIMKO (909)- 392-8287-
4095 N FRUIT ST #809 - - - - - - - - SPECIAL CONDITIONS
-
LA VERNE
iaNGELE SCo
APPROVALS DATE INSPECTOR SINUTaff
TEL NO
NICK'S REMODELING (909) 392-8287-
4095 N FRUIT STREET LIC. NOTEMPORARY POWER POLL
SPACE 809 _ _ _409663 8
�C/
__
LA VERNE, CA 91750 -- i� UNDERGROUND CONDUIT
i \ \
7
—rrjY'�ARCHITECT OR ENGINEER UFER GROUND
I^
LIC M0I ,�I� MAIN WATER LINE
ROUGH CONDUIT
ROUGH WIRING
17 J ;j�� PLASTIC Y/M METAL Y/N
UTILITY COMPANY NOTIr M
REPORT, ID DPR265 ROUTE TO: BSD508