HomeMy Public PortalAbout5239 BALDWIN AVE_Electrical__ 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