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Home My Public Portal About9059 WOOLLEY ST_Electrical__ '{t WORKERS'COMPENSATION DECLARATION CE 80OG t0/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY u copy thereof.(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB f'��9 /,Zv®��f_•�/ �+� ❑ Certified copy is hereby furnished. EACH NO. FEE. ADDRESS (J / New Residential Bldgs.&Pools ❑ 1 &2-Family,Sq.Ft. — LOCALITY Certified copy Is filed with the county building inspection � $ — $ f NEAREST 4 &DC n department. Multi-family Sq.Ft. CROSS ST. JJ`A Date Applicant Residential Swimming Pools OWNER OR 1� ,�,r� d` FIRM NAME /�I�� ° G CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL �� •� s COMPENSATION INSURANCE Outlets:Rec_Light—Sw.— ADDRESS (This section need not be completed If the work Involved by the: First 20 CITY r� �i/� Tel.No -? permit is for one hundred dollars($100)or less.) Total No. Additional �� 72�✓7 I,certif that in the erformance of the work for which this permit PLAN CHECK Y. P P is issued, I shall not employ any person in any manner so as to APPLICANT become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS Additional Applicant Total No. CITY //V I Date Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLI. ANT: If, .after makin this Certificate of APPUCANT Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. _ provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top _ FAU W.H. CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood — FanO e I hereby affirm that I am licensed under.provisions of Chapter 9 Disp. — Room Air Cont LICENSE OR Class (commencing with Section.7000)of Division 3 of the Business and .REG.NUMBER Professions Code,and m license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. PROCESS D BY y Size&Type HP,KW,KVA,or KVAR �!L,IJ License Number LIC.Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE r ` �G#' /1QAnONIV Contractor Date. Over 10 to 50 Incl. FIN (J V ❑ I am exempt under Sec. Over 50 to 100 Inc. W - B.&P.G,for this:reason Over 100 0 N Services,Swbd.,MCC&PanelboardF� � Z� Data: 0-20Q Amp.Under 600 V I� Signature 201 - 1000 Amp.Under 600 V F1 Exemption 1000 Amp.or Over 600 V 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 Law for the following reason(Section 7031.5,Business and Professions. Additional Sign Branch Circuits Code): I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors a Is not Intended or offered for sale (Section 7044, Business., Other(See Complete Fee Schedule) _ ® 33tL•T.� •'1 and Professions Code). - 7 a 1.50 CONSTRUCTION LENDING AGENCY 1 ITEMS I hereby affirm that there is a construction lending agency for the- performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total) di TOTAL 32 50 Civ.C.)• PLAN CHECKING FEE CHECK 32.5- Lender's Name. r r �1L1 PERMIT ISSUING FEE CHANICE Lender's Address �'^^ I certify that I have read this application and state that the above TOTAL FEErJV information is correct.I agree to comply with all County ordinances I]1�11l�—ii[� 1 x/89 and State laws regulating Electrical wiring, and hereby authorize 007 • 1 AM O#019 representatives of this County to enter upon the above-mentioned proarty for inspection purpo9spes�. j SEE REVERSE FOR EXPLANATORY LANGUAGE' L Signature o ermittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0304240002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: - FEES PAID $: ON FILE 9059 WOOLLEY ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801348 ASSESSOR0 NEAREST CROSS STREET: SULTANA 5382-019-028 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY E1 TEMP SERV POWER POLE 1.00 TMP 43.65 TOTAL FEES 71.40 SS S ON: 04/24/03 JK 10/21/03 OWNER: TEL. NO: FINAL DATE '2vl FINAL BY: CODE: PHUNG-SAM (626) 212-1873- 3 XL,3211 MINNESOTA ST LA CA 90031 CRIPTION OF WORK TPP FOR CONSTRUCTION L. . SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO TEMPORARY POWER UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: L. R GROUND - NGUYEN, FRANK (626) 960-8078- 1208 MAYLAND AVE LIC. N0: ROUGH CONDUIT VALINDA CA 91746 NONE ROUGH IN WATER 11-FE- PLASTIC I EPLASTIC Y/N METAL Y/N UTILITY0 I REPORT ID: DPR265 ROUTE TO: SS0508 \ t ` COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0304070012 �. BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGALD: FEES PAID BUILDING AD . ON FILE 9059 WOOLLEY ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801348 ASSESSOR IOR NEAREST CROSS STREET: SULTANA 5382-019-028 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY 82 1 OR 2 FAMILY DWELL 2576.00 SQ 270.48 TOTAL FEES 298.23 ISSUED 0 S : PLAN BY: E . 04/07/03 JK 10/04/03 . OWNER: TEL. NO: FINALUATK FINAL BY: CODE: PHUNG;SAM (626) 212-1873- 3211 MINNESOTA ST LA CA 90031 ]PESCRIPTrUW-drVoW ELECTRICAL FOR ADDITION/REMODEL APPLICANT: TEL. 0: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO 0 P UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: T5L. NO: UFER GROUND NGUYEN, FRANK (626) 960-8078- 7208 MAYLAND AVE LIC. NO: ROUGH CONDUIT VALINDA CA 91746 NONE ROUGH WIRING z MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIF15D REPORT ID: DPR265 ROUTE TO: BS0508