HomeMy Public PortalAbout9933 WORKMAN AVE_Electrical__ WORKERS'COMPENSATION DECLARATION 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self CE-806G
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insure, or cf certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof(Sec. 3800, Lab. C.) l
FOR APPLICANT TO FILL IN. /
PJOB
❑oli�y No. Company ADDRESS � v
Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE
❑ LOCALITY r''
Certified copy is filed with the county building inspec- 1 8 2-Family, Sq. t. $ — $ C J
tion department. Multi-family Sq. Ft. — NEAREST te�rr//
Residential Swimming Pools CROSS S7. iyV
Date Applicant OWNER OR
FIRM NAME -m. /O
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ 'MAIL
COMPENSATION INSURANCE ADDRESS
(This section need not be completed if the work Involved by First CITF) + Tel. No.
the permit Is for one hundred dollars($100)or less.) Total No. Additional
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 an er
so as to becdme subject to the Warke VCoens ws. Lighting Fixtures First 20 ADDRESS
AdditionalTotal No. CITY Tel. No.
Date pplicant
NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT r
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 shall be Top _.FAU —W.H.. —
deemed revoked. Hood _ Fan _Other_ CITY Tel. IVo.
LICENSED CONTRACTORS DECLARATION LICENSE OR
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 Business DISTRICT NO PROCESSED BY
and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances
Size 8 Ty�ie HP, KW, KVA, or KVAR' r
License Number Lic. Class F Up to 1 Incl. FINAL
_ — Over 1 to 10 Incl. DATE �t' VALIDATION
Contractor Date Over 10 to 50 Incl.
V
FINAL
❑ 9L
I am exempt under Sec. Over 50 to 100 Inc. BY c.!'
Over 100
B.BP.C. for this reason
Date: Services, Swbd., MCC 8 Panelboards
0 -200 Amp. Under 600 V
Signature 201 - 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 affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and
Pr fessions Code):
Misc. Conduits 8 Conductors
I, as owner of the property, will do the work and the
structure is not intended or offered for sate (Section Other(See Complete Fee Schedule)_
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY 1 1 2 5 A
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) n n n 0,0
(Sec. 3097, Civ. C.). I ;
PLAN CHECKING FEE n
Lender's Name
PERMIT ISSUING FEE
Lender's Address rn
I certify that I have read this application and state that the TOTAL FEE n ,1 1 7_ z
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives o ' County to enter upon
the above-mentione operty f ction purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
ignature ofermittee Date
. WORKERS'COMPENSATION DECLARATION M0019 DPW 3/87 "
I hereby affirm that I have a certificate of consent to self 76A66G APPLICATION
®PS a®LICA 1®gyp I® FOR ELECTRICAL PERMIT
insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or a certified copy thereof(Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
"IRSertified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRE q� `
❑Certified co is filed with the count building inspec- 1 &2-Family, S Ft. $ — $ LOCALIT9�� ell I
PY � Y 9 P Y� q•
tion department. T
—Cl I , Multi-family Sq. Ft. CROSS T. I
Date / ( tl 1 Applicantw6 f_ Residential Swimming Pools OWNER OR
FIRM NAME ` v
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLight Sw.� MAIL Cr
COMPENSATION INSURANCE ADDRESS
First 20 n
(This section Hood not be completed if the work involved by Total No. Additional Cl0_L Tel. N �t
the permit is for one hundred dollars($100)or lees.) PLAN tHECK
I certify that in the performance of the work for which this APPLICANT
permit is issued, I shall not employ any person in any manner
1.41 V
so as to become subject to the Workers'Compensation Lowsi Lighting Fixtures First 20 ADDRE t,_
Additional
Date Applicant Total No. CITY�� Tel. N
NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT
Exemption, you should become subject to the Workers' Range— Heater—D.W. _ APPLICATION
Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— AQ
SS
with comply with such provisions or this permit shall be Top — FAU —W.H. —
deemed revoked. CITY Tel. No.
Hood — Fan —Other—
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. — REG. NUMBER
(commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY >_
and Professions Code,and my license is in full force and effect. Size&Type HP, KW, KVA, or KVAR O'
License Number 42 LR 9 Lic. Class Up to 1 Incl. I FINAL U
Contract J Date Over 1 to 10 Incl. DATE VALIDATION 0
ID +� Over 10 to 50 Incl. F
FINAL U
I am exempt under Sec. Over 50 to 100 Inc. BY LU
B.&P.C. for this reason Over 100 a
Services, Swbd., MCC&Ponelboards
Date: t,_:, ,s
0-200 Amp. Under 600 V Z�/ , �
Signature 201 - 1000 Amp. Under 600 V ' -
❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V / i _t ate
SINGLE FAMILYD
HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances �:�(fz; .�. o •_-
I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit v'•i:f 4 7 c-,
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits
Professions Code):
❑ 1, as owner of the property, will do the work and the Misc. Conduits&Conductors
structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ -t
D ;;-.--t_
1 �?
Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for' j
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address
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
Aigniature
arttee
laws regu ting Electrical wiring, and
esentati s o t i County to enter upon)
prop y for i ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1211050041
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 6561 LT: 407 9933 WORKMAN AV
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802231
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: ROWLAND
18587-030-024 IA1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl
I IG1 OUTLETS-LGT,SW,RECP 30.00 OUT 52.40 1 I
TENANT: G2 LIGHTING FIXTURES 3.00 LGT 6.00 JISSUED ON: PROCESSED BY: PLAN BY:
IH1 RES ELEC OVEN LT 3HP 1.00 OVE 11.00 111/05/12 SR
1H7 RES EXHAUST FANS 1.00 EX 11.00 1
OWNER: TEL. NO: I TOTAL FEES 108.20 1 FINAL DATE FIIJAL BY: CODE:
YANG, NAI C (626) 922-5781- 1 /J�
19933 WORKMAN AVE
ITEMPLE CITY CA 91780 IDESCR PTIO OF WORK
(ADD ELECTRICAL OUTLETS TO EXISTING I
(APPLICANT: TEL. NO: I I I
ILIM, WAI (626) 280-1234-
2223 LENTA LANE I ISPECIAL CONDITIONS: I
IARCADIA, CA 91006
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE
ISUNWAY BUILDER INC (626) 280-1234- I I I
2223 LENTA LANE LIC. NO I ITEMPORARY POWER POLE I I
ARCADIA CA 91006 850050
(UNDERGROUND CONDUIT I I
]ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND I I I
_ I I I
LIC. NO: I IROUGH CONDUIT ] I I
IROUGH WIRING I I I
I I ]
IMAIN WATER LINE I ] I
(PLASTIC Y/N METAL Y/N I I ]
UTILITY COMPANY NOTIFIEDI 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
I I I I
I* ADDITIONAL DATA ON FILE I I I I
IREPORT ID: DPR265 ROUTE TO: BS0508 I ] I I
I I I I I I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS
EL 0508 1209270020
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
JTR: 6561 LT: 407 1 19933 WORKMAN AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917802231
ASSESSOR INFORMATION NUMBER: I INEAREST CROSS STREET: ROWLAND
18587-030-024 JAI PERMIT ISSUANCE FEE 27.80 1 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl
JE1 TEMP SERV POWER POLE 1.00 TMP 43.70
ITENANT: 1 TOTAL FEES 71.50 JXSSUED ON: PROCESSED BY: PLAN BY:
09/27/12 SR
(OWNER: TEL. NO: 1 AL DATE FI Y: CODE:
YANG, NAI C _ l l
9933 WORKMAN AVE
��
TEMPLE CITY CA 91780 IDESCRIPTION OF WORK
TEMPORARY POWER POLE
APPLICANT: TEL. NO:
ISUNWAY BUILDER INC. (626) 280-1234-
12223 LENTA LN. (SPECIAL CONDITIONS:
IARCADIA, CA 91006
(CONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE
ISUNWAY BUILDER INC. (626) 280-1234-
2223 LENTA LANE LIC. NO TEMPORARY POWER POLE
ARCADIA, CA 91006 850050-B
(UNDERGROUND CONDUIT
(ARCHITECT OR ENGINEER: TEL. NO: _ 1 JUFER GROUND
LIC. NO: ROUGH CONDUIT
ROUGH WIRING
MAIN WATER LINE
PLASTIC YIN METAL YIN
(UTILITY COMPANY NOTIFIED
I I I I
I
1
I I I 11
I
I* ADDITIONAL DATA ON FILE
(REPORT ID: DPR265 ROUTE TO: BSO508
' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1208130030
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAID I BUILDING ADDRESS: I
ITR: 6561 IT: 407 1 9933 WORKMAN AV I
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917802231
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: ROWLAND
18587-030-024 IA1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl
I IG1 OUTLETS-LGT,SW,RECP 20.00 OUT 40.00 1 1
TENANT: G2 LIGHTING FIXTURES 10.00 LGT 20.00 ISSUED ON: PROCESSED BY: PLAN BY:
1 IHA FAU LESS 3HP 1.00 FAU 11.00 108/13/12 SR 1
1 IH1 RES ELEC OVEN LT 3HP 1.00 OVE 11.00 1 I
(OWNER: TEL. NO: IH2 RES GRBG DISP LT 3HP 1.00 DIS 11.00 IFINAL DATE FINAL BY: CODE:
IYANG, NAI C - IH3 RES DISHWASHR LT 3HP 1.00 DIS 11.00 1 I
19933 WORKMAN AVE IH4 RES RANGE HDS LT 3HP 1.00 H00 11.00 1' I
ITEMPLE CITY CA 91780 IHS RES WASH MACH LT 3HP 1.00 WAS 11.00 IDESCRIPTI N OF WORK
I ILA 100 AMP PANELS, MCC 1.00 PAN 38.90 120 OUTLETS, 10 LIGHT FIXTURES, A/C, FAU UNIT, KITCHEN APPLIAI
1 I TOTAL FEES 192.70 INCES AND UPGRADE SERVICE PANEL 100 AMP 1
(APPLICANT: TEL. NO: I I I
ICHEN, GEORGE (626) 233-7130- 1
1217 CAROLWOOD DR. 1 ISPECIAL CONDITIONS:
1ARCADIA, CA 91006
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE
ISUNWAY BUILDER INC. (626) 280-1234- 1 1 1
12223 LENTA LANE LIC. NO I ITEMPORARY POWER POLE I I I
IARCADIA, CA 91006 850050-B * 1 1-1
UNDERGROUND CONDUIT 1
(ARCHITECT OR ENGINEER: TEL. NO: 1 1UFER GROUND 1
ICHEN, GEORGE (626) 233-7130- I 1 I 1 1
1217 CAROLWOOD DRIVE LIC. NO: I IROUGH CONDUIT1 I I
1ARCADLA, CA 91006 850050-8 * *1 1
I I TROUGH WIRING I 1
I 1 IMAIN WATER LINE 1 [ [
I 1 IPLASTIC YIN METAL YIN I I 1
[ I [UTILITY COMPANY NOTIFIEDI II
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I I I I I
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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 I I
I* ADDITIONAL DATA ON FILE
I IREPORT ID: DPR265 ROUTE TO: BS0508 I 1 1 [
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