HomeMy Public PortalAbout5611 TEMPLE CITY BLVD_Electrical__ WORKERS CI have COMPENSATIONDECLARATION
of corse CE-906 10.81 APPLICATION FOR ELECTRICAL PERMIT
+ I hereby affirm that I have a certificate of consent to self CE-906G �.1
insure or a certificate of Workers Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec 3800, Lob C) (
Policy
No Com n PLIC
FOR APPLICANT TO FILL IN JOB /
� Certified copy is hereby fuurnished New Residential Bldgs 8 Pools EACH NO FEE ADDRESS L5 1//_/0740k-6�1e�� �(.94)
❑ : —
Certified copy is filed with the county budding inspec- 1 8 2 Family, Sq Ft f LOCAUT��iw;)L.c C"V
non department Multi-family Sq Ft — NEAREST / 1✓f Qd K
Residential Swimming Pools CROSS Si L�
Dote Applicant CROSS T -/
;;'�jI! FIRM NAME ESE yA1AA9:k1
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets RepL�Light�_Sw_ �— 77
COMPENSATION INSURANCE � - ADDRESS S6�� LEnMOLE ?'� J3LO)
(This settlors nwd not be complotod If the work Imrolrad by ��/ Fust 20 CITE .L �7
ths,perrsilf Is for one htmdrad dollen 100)or Ins) Total No_Y'2 Additional E.W/7x4. C--7T y Tel No iw
�t�03
RAN CHECK
certify that in the Performanc war uh this , AppUCAI,R
permit is issued I shall not em oy pe n in any onner �,
so as to become subject tot Wor s' mpensoh Lows Lighting Fixtures First 20 ADDRESS
Total No Additional
G Date A pl ca CITY Tel No
/1 NOTICE TO APPLICANT If, after mak ng this Certificate of Fixed Appliances Not Over 1 HP pEp,WT I
((( Exemption you should become subject to the Workers Range_ Heater—&D W APPLICANT
Compensation provisions of the Labor Code you must forth Oven _ Dryer _ W M ADDRESS
with comply with such provisions or this permit sholl be T _ FAU _W H —
deemed revoked - Hood _ Fon —Other_ CITY Tel No
LICENSED CONTRACTORS DECLARATION
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,3 of the Busmess Power Apparatus 8 Large Appliances DISTRICT NO PROCE Y
and Professions Code and my hcense is in full force and effect Type
�O O
Size 8 T HP KW KVA, or KVAR J ,
License Number Uc Class FINAL
Up to I Incl tJ
Over I to 10 Incl DATE �Q ��/� VAUDATION p
Contractor Date O O 10 to 50 Incl Over FINAL
10
I am exempt under Sec Over 50 to 100 Inc BY y_C—r 6
B 8P C for this reason Over 100 N
Date
Services, Swbd MCC 8 Panelboards , 2
0 -200 Amp Under 600 V
Signature 201 1000 Amp Under 600V
❑
Exemption for Reg MoOver 1000 Amp or Over 600 V
Moms Elect ( � �� /
SINGLE FAMILY Temp Power Pole Appurtenances 2 6 6 6 A
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I g r exempt from the Contractors ss and
Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits - # • • • • • 2
Professions Code) i '
1 as owner of the property will do the work and the Misc Conduits 8 Conductors - 1 2--'- 67.00
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , _ _ s s s 6 7 O 0
70" Business and Professions Code)
1
CONSTRUCTION LENDING AGENCY - -- O I6 O 9—'83
1 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 Cw C )
PIAN CHECKING FEE -
Lenders Name
PERMIT ISSUING FEE _
Lender's Address
I certify that I hove read this application and state that the TOTAL FEE
above nformation is correct I agree to comply with all County ,
orch cos laws regulating Electrical wiring, and
h a orize rep esentanve1 of this County to enter upon
ov mention props for inspection purposes '
SEE REVERSE FOR EXPLANATORY LANGUAGE
gignc6re of Permittee .Dote
Cr'! - OF LOS ANGELES ' TEMPLE CITY At 050A PERMIT
DEPARTMFNT OF PUBLIC WORKS 9701 LAS TUVAL U508 0410070072
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITT lJ 91?30 - l
PHONE (626) c85-04W EXT -
CAADDRESS
ON FILE 5611 TEMPLE CITY BL
FEE DFSCRIPTION pIiANTITY UOM a. TR TEMP CA 917807532 l
ASSESSOR ikFORRXrr6l-NDRffPF- NEAREST CROSS STREET BROADWAY
8508 007-014 AI PERMIT ISSUANCE FEE 17 T THOMAS PAGE ^=7 GFID A3 LOLALITi „E CITY
G1 OUTLETS-LGT,SW,RECP 24 00 OUT 44 40
TENANT 02 LIGHTING FIXTURES 10 00 LGT 19 50 TMUM-6W--MRZ3SED BY
_ PLAN BY A—
IB 200 AMP PANELS, MCC 1 00 PAN 30 85 10/08/04 JK 04/0610c ,
OWNER - — 10TAL FEES 130 50 I tln 1l BY U
uE
IPENG LORI
5611 TEMPLE CITY BL
TE-P 917802532 6ESCRIPTIONOfWORK Q
— ELECTRICAL FOR THE RFMODFL
1APPLIL
CHEMP (213) 400-1841
262e BERKLEY AVE pSTOT7I3M�— --
LOS ANGELES CA 90026
I t
IrONTR
A ' ' 1APPROVALS DATE IwsPRTo S! A C
'C CONTRACTOR (213) 413 1904
2626 BERKELEY LIC NO FMPOqARY POWER ROL_
LOS ANGELES CA 90026 386936 9
LiNDERGROU4D CONDUIT
Tn--WO UM GPOLIND
CHEN, IASON (626) 918-3906- _
C/0 1139 GLENVIEW RD LIC NO
W COVINA, CA 91790 C040169
_t F WIRING
-- ---- MAIN NAI RR —
TT-NE-PLASTIC Y/N METAL Y,N
lid? r T€a _z-r c'9
I unur
Air �
PEPORT ID: DPR265 ROUTE TO 850508
COIAITY OF LOS ANGELES TEMPLE CITY 0 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0501310016
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PRONE (626) 285-0488 EXT: _
LEGAL ID' FEES PAID BUILDING
ON FILE 5611 TEMPLE CITY-BL -
FEE DESCRIPTION: - QUANTITY: LEM: AMOUNT TRIP CA 917802532 -
ASSESSOR INFORMATION NEAREST CROSS STREET BROADWAY
8588-007-074 NUMBER: Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY TEMPLE CITY
LN OTHER PML 0-399 AMPS 2.00 PAN _ 77.70
TENANT TOTAL FEES 105.45 .
01/31/05 _ _JK___-_ _ _ - 07/30/05OWNER: FINAL DATE _ .
FINAL BY: E
PENG LORI
5611 TEMPLE CITY SL - rjf--r�47
TEMP 917802532 ))1FSLK7PTLON OF WORK
ADD TO 2 SUBPANELS 100 AMPS.
CHEMP (213) 400-1841- -
2626 BERKLEY AVE - SPECIAL
LOS ANGELES CA 90026CONTRACTOR: APPROVALS DATE ---IMSPn76w-9rmuTuffr--
CONDITIONS:
C S CONTRACTOR (213) 413-1904- -- -
2626 BERKELEY LIC. NO TEMPORARY POWER POLE
LOS ANGELES CA 90026 386936 B
ARCHITECT OR ENGINEER: TEL NO UFER GROUND
CHEN JASON (626) 918-8906-
C/O 1139 GLENVIEW RD LIC NO ROUGH CONDUIT
W. COVINA, CA 91790 CD40169 _
PLASTIC Y/M METAL Y/N
UTILITY COMPANY NOTIrM
REPORT ID: DPR265 ROUTE TO BS0508