HomeMy Public PortalAbout9825 WENDON ST_Electrical__ tWORKER'S COMPENSATION DECLARATION X63 DP�"91a9 ���L'ICATI;®IV. ®R ELECTRICAL PERMIT
I KereW'affirm that•I have a certificate of consent to self insure, '
op a certificate of Worker's Compensation Insurance, or a certified ('COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DTIV.
copy thel'0of(Sec.3800 Lab.-C.) L/ ( {
Policy No. Company JAM/ 011FOR APPLICANT TOFILL IN JOB
ADDRESS
M
❑ Certified copy is'hereby furnished. New Residential Bldgs.&Pools NO? 'FEE -
EACH
_' $ LOCALITY '
1��7p Certified copy is filed with the-county building Inspection 1&2-Fam..ily,Sq.Ft. _ N��1
' department. ,!, Multi-family Sq.Ft. CROSS ST..
Q ..5_2 R,oge l 5 Aik:e� Residential Swimming Pools AS
Date 7'' Applicant �: P:BOOK PAGE � PARCEL���7
t1A
CERTIFICATE OF EXEMPTION FROM WORKERS' Oirtlets:Rea. Light. _Sw.J-9-. OWNER OR
COMPENSATION INSURANCE + 0 Ba
FPR NAME
First 20
his section.need not be com le ed if.the work Involved b the L - '
R P rt �; y I+Total No.1S Additional Q' ADDRESS ed
permit la for one hundred dollare'($1.00)or less.)
I certify that in'the performance'of the work for which CITY
this permit e— Tel.No: /(f3 F
Is issued, I.shall not employ any person in any mannei so as to ' PLAN,CHECIC
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional
ADD
Date. Applicant.
15 OR 20A;120V BRANCH CIRCUITS
NOTICE'TO APPLICANT:..If, after making-this Certificate of I. CITY Tel.No..
Exemption,you should become subject to:(he Workers'Compensation I' 1 TO 10 INCLUSIVE EACH
provisions of the Labor.Code,you:must forthwith comply wPERMITith such 11 TO 40 INCLUSIVE EACH APPLICANT rr �lQQ�f/!j
provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH 1 }
LICENSED CONTRACTORS DECLARATION ADDRESS —r���r� (e�p� a
I hereby'affirm:that I am licensed under provisions of Chapter 9 115OR.20A,208VTO277VLIGHTING EACH . c
(comm'encing-with Section 7000)of DIVIdloh 3.-of the Business and CITY 1, Ap of aw T� No--)/ ;b CJ
Professions Code,and my license Is In full force and effect. RESIDENTIAL APPLIANCES UP TO$HP LICENSE OR
Power Apparatus&Large Appliances REO.NUMBER d l(1 Class. Q
License Number S,' (e ff
Lie.Class I'Size&Typq HP,KW,KVA,or KVAR DISTRICT NO. P SED BY U
' �' 11
Up to 3 Incl ' � � d r.�l�aQ�,/
.tJd('S'LI S � � �r Over 3.to 10 Incl. FINAL a
Contractor Date. O 10 50 I `1 DATE {
:. Over 'to. nc
❑ 1 am exem t under Sec...- ` . VALIDATION' _
p. t Over 50 to 1.00 Incl. FINAL
B.&P.C.for this reason r Over 100 BY
Services,Swbd.,MCC&Panelboards_ o7
Date: �.. 0-200..mp.Under 600 V O
Signature 201-1000 Amp.Under 600 V
Over 1000 Amp.or Over 800 V
El Exemption for Reg.Maint..Elect.
: sa�; r��
SINGLE FAMILY Temp.Power Pole&Appurtenances �'l r .i
HOME OWNER-BUILDER DECLARATION T
I hereby affirm that'I am exempt from the Contractor's License Law Sign with One Branch Circuit
for the following reason,(Section 7031.5, Business,and Professions Additional Sign Branch Circuits ',g�•}
Code): �.I AL Ja Ar �:.a•3; C.,J
ElI,as owner of the property,will do the work and the structure Misc.Conduits&Conductors -^' f--•{ +_"i
Is not Intended or offered for sale(Section 7044, Business Oiher(See Complete Fee Schedule) ® y'.jSyi,.31
and Professions Code).
CONSTRUCTION LENDING AGENCY _�' _ + . •r.
hereby affirm that there is a construction Lending agency for the i
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub..-Total) r. ,-,
Civ.-C.) �:•'e s 1 AM L3 a•_C.
PLAN CHECKING FEE
Lender's Name.
PERMIT ISSUING FEE �� S
Lender's Address '
I dertlfy that I have read this application and state that the above TOTAL FEE 200
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. a SEE REVERSE FOR EXPLANATORY LANGUAGE �+ '
RIONATURE OF APPLICANT•OR AGENT' DATE ''
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0910150012
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID BUILDING ADDRESS: 1
ITR: 11386 IT: 2 BL: A UN: .003I 9825 WENDON ST [
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801727 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: GOLDEN WEST
15385-022-015 IA1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, Cl
I IGl OUTLETS-LGT,SW,RECP 8.00 OUT 15.60 1 I
ITENANT: [G2 LIGHTING FIXTURES 6.00 LGT 11.70 [ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
I IH7 RES EXHAUST FANS 1.00 EX 10.95 110/15/09 SR 10/15/10 1
TOTAL FEES 66.00 1 I
IOWNER: TEL. NO: I [FINAL DATE FINAL BY: CODE: [
ITHOMAS, EDWIN (626) 374-4998-
19825 WENDON ST I I I
ITEMP 917801727 I [DESCRIPTION OF WORK I
I [ 1BATHROOM REMODEL (5) S.P.SW (3) RECEPTACLES, (6) FLOURESCENTI
I I [CAN LIGHTS (1) EXAUST/HEATER COMBO [
(APPLICANT: TEL. NO: I [ I
ICOLEMAN ELECTRIC (626) 665-9017- I [ [
15042 CALMVIEW AVE. I [SPECIAL CONDITIONS: 1
IBALDWIN PARK 91706
ICONTRACTOR: TEL. NO: 1 [APPROVALS DATE INSPECTOR SIGNATURE ]
ICOLEMAN ELECTRIC (626) 665-9017- 1 1I I I
I5042 CALMVIEW AVE LIC. NO 1 ITEMPORARY POWER POLE
BALDWIN PARK CA 91706 819050 C10 1 I [
UNDERGROUND CONDUIT I I
1ARCHITECT OR ENGINEER: TEL. NO: 1 1UFER GROUND I [ I
LIC. NO: I IROUGH CONDUIT I I I
I I (ROUGH WIRING I[
l /
I I IMAIN WATER LINE I I I
I I PLASTIC YIN METAL YIN I [ [
]UTILITY COMPANY NOTIFIED( I [
I I I I I I
I I ] I I I
I I I I I I
(REPORT ID: DPR265 ROUTE TO: BS0508 I I I I
I I I I I [