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Home My Public Portal About5239 BALDWIN AVE_Electrical__ (3) ION ARATION WORKER'S I have a certificate ofC Venfto 76A669DPW(12.91) APPLICATION FOR ELECTRICAL PERMIT 76A663 I hereby affirm that I have a certificate of �rM;enf to self insure, or a certificate of Worker's Compensation Insurance,or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS a3 ' Certified co Is hereby furnished. NO. EACH FEE PY Y New Residential Bldgs.&Pools $ $ LOCALIT ❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. dedepartment. Multi-family S Ft. NEAREST P Y q CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' g 2 N OR COMPENSATION INSURANCE Outlets:Rec. Light , First PO D FIRM NAME f (This section need not be completed if the work involved by the '`/` MAIL Additional ADDRESS �? 1 permit is for one hundred dollars($100)or less.) Total No. I certify that in the performance of the work for which this permit CITY Tel.No. S is issued, I shall not employ any person in any manner so as to PLAN become subject to the Workers'Compensation Laws. Li�/�'n Fixtures First 20 APPLICANTKl No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT / LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. >_REG.NUMBBER Over 50 to 100 Incl. LICENSE Class. a License Number Lic.Class Over 100 DISTRICT NO. P ED BY Q U Services,Swbd.,MCC&Panelboards �� Q Contractor Date 0-399 Amp. Under 600 V DATE O ❑ 400-1000 Amp.Under 600 V j� l� �� VALIDATION am exempt under Sec. Over 1000 Amp.or Over 600 V FINAL w B.&P.C.for this reason BRANCH CIRCUIT FEES BY Date: 15A,or 20A, 120V,Lighting or Recept. r Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits El41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 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 Ai 's A. for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits _ ;r Code): I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors I ITEi i'= is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). ® U U. i HLHL 58 - 130 CONSTRUCTION LENDING AGENCY t_.HED-f, `_t`(° Ij I hereby affirm that there is a construction lending agency for the :•L A t,- performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) a C III,�I_i _G 4 1 Civ. C.) PLAN CHECKING FEE _ {r_ Lender's Name U;.+=1�)" __}; .:' 01 `I> PERMIT ISSUING FEEAMILD35 Lender's Address QvT I certify that I have read this application and under penalty of purjury state TOTAL FEE v 6 that the 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. / p SEE REVERSE FOR EXPLANATORY LANGUAGE '�" SIGN FE��6 DATE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0106140043 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDINGADDRESS: TR: 6755 LT: 39 5239 BALDWIN AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803202 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8589-006-009 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY HA FAU LESS 3HP 1.00 FAU 10.95 TENANT: JB AC UNITS +3-10HP 1.00 AC 19.65 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: LB 200 AMP PANELS, MCC 1.00 PAN 38.85 06/14/01 UT 12/11/01 TOTAL FEES 97.20 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: GRAHAM MICHAEL J;VICKIE L (818) 452-0823- 5239 BALDWIN AV TEMP 917803202 DESCRIPTION OF WORK RENEW PERMIT # EL9706300025 APPLICANT: TEL. NO: SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. N0: UFER GROUND LIC. N0: ROUGH CONDUIT i ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 r COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL_0508 9706300025 BUILDING"AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) .285-0488 EXT: LEGAL ID: FEES PAID BUILDING-ADDRESS: TR: 6755 LT: 39 *.5239 BALDWIN -AV 1 FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: "TEMP CA 917803202 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:' 8589-006-009 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: 64 LOCALITY: TEMPLE CITY HA FAU LESS 3HP 1.00 FAU 10.80 TENANT: JB AC UNITS +3-10HP 1.00 AC 19.65 ISSUED ON: PROCESSED BY: PLA .B EXPIRES ON: LB 200 AMP PANELS, MCC, 1.00 PAN 38.85' 06/30/97 TC 06/30/98 TOTAL FEES 97.05 - OWNER: TEL. NO: FINAL DATEFINAL BY: CODE: GRAHAM5239 MICHAELDWIN J;VICKIE L (818) 452-0823- JaV jar e_ TEMP 917803202 DESCRIPTION F WORKl' (� NEW 200 AMP SERVICE PANEL UPGRADE AND ELECT. FOR HEAT/A/C APPLICANT: TEL. N0: SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO // - TEMPORARY POWER POLE UNDERGROUND CONDUIT+ AR -CHITECT OR ENGINEER: TEL. 0: - %� / �t. �� . UFR GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N T I L L TY COMPA Y 0 I IED REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 'ELECTRICAL "PERMIT? DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL-0508 9608150045 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 6755 LT: 39 5239 BALDWIN AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803202 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: OLIVE 8589-006-009 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 11.00 OUT 21.45 TENANT: G2 LIGHTING FIXTURES 2.00 LGT 3.90 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 53.10 08/15/96 TC 08/15/97 OWNER: TEL. NO: FINAL DATE FINAL Y CODE: GRAHAM MICHAEL J;VICKIE L (818) 279-9223- /5) �Q 5239 BALDWIN AV � !/ u TEMP 917803202 ITESCRIPTION OF WORK ELECTRICAL FOR NEW ADDITION (2 BEDROOM) APPLICANT: TEL. NO: SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. NO � y� --'= � APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO � �� TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. N0: - �� ¢✓r. �/_ UFER GROUND LIC. N0: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N �� `��, �� ;✓ (P/ UTILITY COMPANY NOTIFIED J REPORT ID: DPR265 ROUTE TO: BS0508