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Home My Public Portal About5810 TEMPLE CITY BLVD_Electrical__ WORKERS'COMPENSATION DECLARATION 1081 APPLICAUION FOR ELECTRICAL PERMIT I hereby aCE-806G I have a certificate of consent to self CE-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.) Policy No. '"t Company ��''h^�y�� FOR APPLICANT TO FILL IN JOB 5(kl G Te v►► `Q f. Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS O hid ❑ 1 &2-Family, S Ft. $ _ $ LOCALITY �H,L e Ctr Certified copy is filed with the county building inspec- y� q• tion department. Multi-family Sq. Ft. NEAREST / T...rlr✓S �(, (/,,� Residential Swimming Pools CROSS ST. L&-.s I Date L u—�� Applicant WC «"'� OWNER OR FIRM NAME ��Q vr CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec___(0_Light r Sw.a MAIL COMPENSATION INSURANCE First 20 t3 ADDRESS ✓rn Y/ (This section need not be completed if the work involved by Total N0. 13 Additional CITY Tel. No. the permit is for one hundred dollars($100)or less.) I PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any mannerj so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 00ADDRESS Total No. Sr Additional CITY Tei. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of Range— Heater—D.W. APPLICANT acv, N CA_ Exemption you should become subject to the Workers' 9 If r`' Compensation provisions of the Labor Code, you must forth- Oven _Dryer _W.M.— ADDRESS 5-L 3 1,� W rr(t yyrgti S"� with comply with such provisions or this permit shall be Top FAU —W.H. -2— rrnnJ 33 3 deemed revoked. CITY L�.� t7't.-t w�@ Tel. No. S� Hood _ Fan _Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR ((��I� ` t I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER 'I-LU 17 / Class.eAO (commencing with Section 7000) of Division 3 of the Business rDISTRICT NO. PROCESS BY and Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances ^�/ Size&�ype HP, KW, KVA, or KVAR , License Number n �n Lic. Class —)U FINAL �4 I Up to 1 Incl. ` _yam I Over 1 to 10 Incl. DATE 29 VA .ATION Contractor �l1 c►.rr Et 2t� Date I Over 10 to 50 Incl. FINAL (, $2 4 7 A I= ❑ I am exempt under Sec. Over 50 to 100 Inc. BY LU B.&P.C. for this reason II Over 100 #)0000 J J C0 h Services, 5wbcl_ MCC&Panelboards Date: 50 0 -200 Amp. Under 600 V d 0 0 0 7j Jr Signature 201 - 1400 Amp. Under 600 V Amp. or Over 600 V 03o-87 ❑ Over 1000 Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with'One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): ❑ owner he work and the Misc. Conduits&Conductors structu esthe property, not offered r oe ed tfor ale (Section Other(Seg Complete Fee Schedule)_ 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I 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) '21 s (Sec. 3097, Civ: C.). PLAN CHECKING FEE I Lender's Name PERMIT ISSUING FEE 110 Lender's Address 1 certify that I have read this application and state that the TOTAL FEE 33.a 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 above-mentioned//propert for inspection purposes. SdE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date I rWORKERS'COMPENSATION DECLARATION 76Pde3 10/81 APPLICATION FOR ELECTRICAL PERMIT I h mby o�firm that I hove a certificate of consent to self CE-806G insure, or a certificate of*orkers'rCompensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY d' or a certifiec py thereof(Sec. 3800, Lab. C.) ��i � Policy No. ® mpony VEACA►/sl FOR APPLICANT TO FILL IN JOB EACH NO. FEE ADDRESS Certified copy is hereby furnished. New Residential Bldgs. 8 Pools $ _ $ LOCALITY Certified copy is filed with the county building inspec- 1 8 2-Family, Sq. Ft. tion department. �f Multi-family Sq. Ft. NEAREST Dat e�f� Applicant& - Residential Swimming Pools CROSS ST. �t/�� f OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: t Rec 5 Light�Sw.7/ '72 COMPENSATION INSURANCE �Q ADDRESS D l/f � G� This section neenot e competethe work involved First 20'x, v a ( d bcompleted If k ld b Total No. Additiondi CITY�'L�� f T.I. NO-Z!57 the permit is for one hundrod dollars($100)or loss.) PLAN CHECK I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner APPLICANT so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS��j� 1DP�i�Gri'Zi Total No. 1' Additional CITY Tel. No,�� Date Applicant Fixed Appliances Not Over 1 HP PERMIT �y� �/�d� NOTICE TO APPLICANT: If, after making this Certificate of APPLICANTA/- zf'-C; j Exemption, you should become subject to the Workers' Range_ Heater—D.W. — Compensation provisions of the Labor Code, you must forth- Oven —Dryer —W.M.— ADDRESS�� QOif'�y/�e?_., with comply with such provisions or this permit shall be Top — FAU —W.H. deemed revoked. Hood _ Fan _Other— CITY Tel. N LICENSED CONTRACTORS DECLARATION Z LICENSE OR c/J I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG.NUMBER ` 6 Class (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. P CES D BY and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances JJ`` Size 8 Type HP, KW, KVA, or KVAR �. O License Number Lic. Class_ Up to 1 Incl. FINAL -7, Over 1 to 10 Incl. DATE VALIDATION 99 Contractor'+ L/ z//`�'C Date 7 Over 10 to 50 Incl. 2tf � ❑ FINAL I am exempt under Sec. Over 50 to 100 Inc. BY 16161 Over 100 U) B.BP.C. for this reason Date: Services, MCC 8 Panelboards 0 -2000 Amp. Under 600 V � 5 Signature 1201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby off irm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and , Professions Code): ❑ 1, as owner of the property, will do the work and the M.sc. Conduits 8 Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ 7 a 8 A 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for c 02 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). o 0 o c.7 r_ �15 i PLAN CHECKING FEE 7 G ' 7 Lender's Name PERMIT ISSUING FEE 7 all Lender's Address 7 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 laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 7�� Signature of Perm'tee Date f r , COUNTY OF IAS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1302120024 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID' I FEES PAID I BUILDING ADDRESS: I ITR: 6561 LT: 593 I 1 5810 TEMPLE CITY BL 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917802112 I ASSESSOR INFORMATION NUMBER: I NEAREST CRASS STREET: WORKMAN I 8587-018-029 IAl PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY CAI I IF1 120V, 15/20A BR CKTS 4.00 BR 69.20 I I TENANT: G1 OUTLETS-LGT,SW,RECP 20.00 OUT 40.00 (ISSUED ON: PROCESSED BY: PLAN BY: I DR LIN CHIAO IG2 LIGHTING FIXTURES 2.00 LGT 4.00 103/05/13 SR 1 I IJX MOTORS, LT 3 HP 2.00 MOT 30.60 (OWNER: TEL NO: I TOTAL FEES 171.60 IF AL DATE FINAL Y: CODE: IHOM ROBERT (626) 383-8166- 15810 TEMPLE CITY BL ITEMPLE CITY CA 91780 I 109SCRIPTI N OF WORK U I ] I (ELECTRICAL FOR TI ] ]APPLICANT: TEL. NO: 1 I ]RUPERT MOK ARCHITECT (909) 468-0099- 1 829 S. LEMON AVE I SPECIAL CONDITIONS: WALNUT CA 91789 I I I I I � I CONTRACTOR: TEL. NO: I (APPROVALS LATE INSPECTOR SIGNATURE ] IKHANH CONSTRUCTION CO (714) 299-0807- I12683 PALM VIEW WAY LIC. NO I TEMPORARY POWER POLE I I I RIVERSIDE CA 92503 608313 * 1 UNDERGROUND CONDUIT I I I ] I I (ARCHITECT OR ENGINEER: TEL. N0: I IIFER GROUND I I I 1RUPERT MOK AND ARCHITECTS (909) 468-0099- 1 I � I 1829 S LEMON AVE SUITE All-B LIC. NO: I IROUGH CONDUIT �IrLfJ /(�II- I (WALNUT CA 91789 NONE { I i TROUGH WIRING � 1 I IMAIN WATER LINE I I PLASTIC YIN METAL YIN I I I (UTILITY COMPANY NOTIFIEDI I I I ] 1 I ] I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 I* ADDITIONAL DATA ON FILE i ] I I I j I (REPORT ID: DPR265 ROUTE TO: BS0508 I I I