HomeMy Public PortalAbout5550 BALDWIN AVE_Electrical__ • 1
t.
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0307100008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGA ID: FEES PAID BUILDING ADDRESS:
TR: 16957 LT: 12 5550 BALDWIN AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802627
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BOGUE
8586-022-012 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY
JB AC UNITS +3-10HP 1.00 AC 19.65
TENANT: LA 100 AMP PANELS, MCC 1.00 PAN 38.85 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
TOTAL FEES 86.25 07/10/03 JK 01/06/04
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
BRISCOE KENNETH W;DIVA V TRS (626) 579-2760-
5550 BALDWIN AV c?) --y- Q�
TEMP 917802627 DESCRIPTION OF WORK
UPGRADE ELECTRICAL PANEL TO 100AMP PANEL; ADD A/C TO CENTRAL
HEATING SYSTEM
APPLICANT: TEL. NO:
SAME AS OWNER (626) 857-0024-
SPECIAL CONDITIONS:
RICHARD BURNS
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO TEMPORARY POWER POLE
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND
LIC. NO: ROUGH CONDUIT
ROUGH WIRING
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED e
�l6 03
REPORT ID: DPR265 ROUTE TO: BS0508
WORKERS'COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT
reby affirm ih�q�l.,hpv�.,a certificate of consent to self CE-806G
re, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
certified copy thereof (Sec. 3800, Lab. C.)
cy No. Company FOR APPLICANT TO FILL IN JOB t
Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS
S — $ (' �f
Certified copy is filed with the county building inspec- 1 &2-Family, q' Ft. $ LOCALITY NEAREST
tion department. Multi-family Sq. Ft. CROSS ST. k
Residential Swimming Pools OWNER OR
e Applicant FIRM NAME 0,fusar
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw. MAIL
COMPENSATION INSURANCEFirst 20 ADDRESS /L✓I 1 11r.,
6
s section need not be completed if the work involved by Total No. Additional CITY , Tel No. 1760
permit is for one hundred dollars ($100)or less.) PLAN ECK
rtify that in the performance of the work for which this APPLICANT
mit is issued, I shall not employ any person in any manner
as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
iS
J y*�/ Total No. Additional - CITY Tel. No.
We J'Z7IV / Applicant Fixed Appliances Not Over 1 HP
TICE TO APPLICANT: If, after making this Certificate of APPLICANT
mpt,an, you should become subject to the Workers' Range_ Heater—D.W. —
mpensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS
th comply with such provisions or this permit shall be Top _ FAU —W.H. — CITY Tel. No.
erred revoked. Hood _ Fan _Other— .
LICENSED CONTRACTORS DECLARATION LICENSE OR
ereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. NUMBER Class.
mmencing with Section 7000) of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PRED BY
d Professions Code,and my license is in full force and effect.
Size&Type HP, KW, KVA, or KVAR' 7 0
ense Number Lic. Class Up to 1 Incl. —FINAL �
V
Over 1 to 10 Incl. DATE v t VALIDATION
ntractor Date Over 10 to 50 Incl. FINAL C U
I am exempt under Sec. Over 50 to 100 Inc. BY r t L LU
Over 100 V)
B.BP.C. for this reason
Services, Swbd., MCC& Panelboards ► Z
Date: 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&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
aw for the following reason (Section 7031.5, Business and
rofessions Code):
Misc. Conduits&Conductors " d 0 4 A
I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ , 7' 0 0'a 0 0 2
7044, Business and Professions Code). Z'o o [� S Q
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for o c c G 0 a
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.). ? 2 9—8 G.
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
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the bove-mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
ignature of Permitlee Date