HomeMy Public PortalAbout5528 BALDWIN AVE_Electrical__ 76•A6%3-CE80ea/63 APPLICATION FOR •.ELEC �ICAL PER ��
COUNTY OF-LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN.A. LAMBI•E. COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY E iC G/TG
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT.F`• TOTAL NO. EACH FEE ,J /
f�LISHT OUTLETS FIRST 20 !$••20..ffi MWNER' /`T ✓
SWITCH. a�J DVER 20 .10 AIL
ADDRE1 C /' p
LIGHTING TOTAL FIRST 20 .20 • CITY TEL.N0.13"1 O'3`7�•sI
FIXTURES I OVFR 20 ADD'L .10 ELECTRICIAN O A4fZ_L
RANGES CLO.ORYERI30 WTR.HTRS 0 1.00 ADDRESS
GARB.DIBP. STA.COOK
- CITY TEL.NO.� O fT
DISHWASH..' AUTO.-WASH. STATE
SPACE HTRS. STA.APP.('/a H.P.MAX.) ,50 LICENSE NO.'
MOTORS: OVER N.OT OVER H:P. DISTR O. G OUP ONE P ESSED BY
O 1 1.00
1 s isREC
o! INSPECTION ORD
S 15 2.80 O
Is s0 9.00 O
r%• �°'F Y' n�
SO 100 s:00 t w V
IL
NO.TRANS.
BIGNBt NO.LAMPS
SERVICE 0.600V-N0T OVER 200A 1.00
SERVICE 0-600V-OVER 200 A. 2:00. v
SERVICE OVER 600V 5.00 '
MISC.
PERMIT ISSUING FEE 2.00 f` All-l0
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE s
I HEREBY ACKNOWLED69 THAT'1 HAVE READ THIS APPLI /1TION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL-COUNTY ORDINANCES'AND STATE LAWS REGULATING
ELECTRICAL WIRING.• WIRING
1 HEREBY CERTIFY HAT•I AM PROPERLY REGISTeRE
T 0 AN131OR 1
LICENSED AS REQUIRED BY LOS ANGEL88 COUNTY AND STAT 2.OF FIXTURES Y_
CALIFORNIA OR THAT 1 AN THE G L OWNER OF THE ABOVE 9.
DESCRIBED RE EN PROP POWER y� A-
SIGNATURE _ / UTILITY CO.NOTIFIED 'g �Is�
OF PERMI FINAL iq 1121934-
LIDATION ARTHuIR C. VEIT
NO CASK SUPERVISING.ELECTRICAL ENGINEER
L,jUo'4 8' 1 8 G OCT 13 2 0 4.8 0n
1
WORKERS'COMPENSATION DECLARATION
CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT
CE-806
f I 7iereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES / BUILDING AND SAFETY
insure, or a certificate df Workers'Compensation Insurance,or r
a certified copy thereof(Sec.3800,Lab.C.) _ y
f Policy No.ox Company � FOR APPLICANT TO FILL IN JOB Q ` �
New Residential Bldgs.&Pools EACH NO. FEE ADDRESS (� ( tom/�N
❑ Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ $ LOCALITY
Multi-family Sq. Ft. — NEAREST
❑
Certified copy is filed with the county building inspection CROSS ST
department. g Pools Residential Swimming_ OWNER
FIRM NAME
Date Applicant OR kAl /Z
Outlets: Rec. Light Sw. ` MAIL
First 20 5 �- ADDRESS
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. AdditionalCITY Tel No.
COMPENSATION INSURANCE
PLAN CHEC
APPLICANT
(This section need not be completed if the work involved O
by the permit is for one hundred dollars Fixtures First 20
s ($100) or less.) � Additional ADDRESS �
Total No. O
I certify that in the performance of the work for which this CITY Tel No.
permit is issued, I shall not em Fixed Appliances Not Over 1 HP
p employ y an y person in any manner PERMIT O
so as to become subject to the Workers' Compensation Laws. Range_ Heater. D.W. APPLICANT CL
Oven _ Dryer_W.M. ADDRESS
Date Applicant Top FAU _W.H..
Hood Fan —Other CITY . `���3 y Tel No.
NOTICE TO APPLICANT: If, after making this Certificate of Disp. — Room Air Cond._ LICENSE OR
Exemption, you should become subject to the Workers' REG.NUMBER
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCE SED BY
with comply with such provisions or this permit shall be Size&Type HP,KW, KVA,or KVAR �,U d[/
deemed revoked.
Up to 1 Incl.
_
Over 1 to 10 Incl. FINAL
DATE � �'
LICENSED CONTRACTORS DECLARATION VALIDATION
r Over 10 to 50 Incl.
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY
ness and Professions.Code, and my license is in full force and (,P
effect. Services (�
License Number Lic.Class L O 0-200 Amp.Under 600 V S
41
J 201-1000 Amp. Under 600 V
`ontractor Date AQ Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit
License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits
ness and Professions Code):
Misc.Conduits&Conductors
❑ I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— 1 4 9,7 R
structure is not intended or offered for sale (Section
7044, Business and Professions Code). i% a o 0 0 0 2
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency 2 0 6-0 0
for the performance of the work for which this permit is PERMIT FEE (Sub-Total) -
issued Sec. 3097,Civ.C. . —
Lender's Name ) c 0 o`c ci
PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE -2 I Q 0 9 —a 1
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
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the o e-mentioned property for inspection purposes. SEE-REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
COUNTY OF LOS ANGELES.. TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9806230063
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 16957• LT: 8 5528 BALDWIN AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802627
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BROADWAY
8586-022-008 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY:/FEMPLE CITY
G1 OUTLETS-LGT,SW,RECP 5.00 OUT 9.75
TENANT: HA FAU LESS 3HP 1.00 FAU 10.80 ISSUED ON: PROCESSED BY: PLAN BY: EXP RES ON:
JB AC UNITS +3-10HP 1.00 AC 19.65 06/23/98 UT 06/923/99
TOTAL FEES 67.95
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
CHIDESTER JEANETTE P (818) 448-3451- pp
5528 BALDWIN AV �V'✓
TEMP 917802627 DESCRIPTION OF WORK
GFCI'S, ELECTRICAL FOR A/C AND HEATING HOUSING REHAB
APPLICANT: TEL. NO:
NICK'S REMODELING (626) 442-7985-
9941 HOWLAND SPECIAL CONDITIONS:
TEMPLE CITY, CA
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
NICK'S REMODELING (626) 442-7985-
9941 HOWLAND DRIVE LIC. NO TEMPORARY POWER POLE
TEMPLE CITY, CA 91780 409663 B
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND
LIC. NO: ROUGH CONDUIT
ROUGH WIRING
MAIN EATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
REPORT ID: DPR265 ROUTE TO: BS0508