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Home My Public Portal About10781 BLACKLEY ST_Electrical__ t 76A6B3 DBS-SA 9.55 APPLICATION FOR ELECTRIC PERMIT ERMIT 1 � DIVISION OF BUILDING AND SAFETY ` Deportment of County Engineer // ,L County of Los Angeles ANG DDREISS Ia7e� C/G/�°G1 �I WM.J. FOX, COUNTY ENGINEER CASSATT D.GRIFFIN, SUPT OF BUILDING f LOCALITY FOR APPLICANT TO FILL IN NEAREST /7 PERMIT FEES CROSS ST. )9,4/1* NUMBER EACH FEE OWNER O/� LIGHT OUTLETS MAIL RECEPTACLES ADDRESS WALL SWITCHES /,Q TOTAL OUTLETS 5¢ S CITY / l [ TEL.NO. ELEC. RANGES 25 ELECTRICIAN _ELEC. HEATERS 25 ADDRESS f5tf_1W KW EA CITY TEL.NO. FIXTURES 5 < LICENSE NO. NUMBER OF LIGHT CIRCUITS - DISTRICT NO. I GROUP( ZONE I READY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS .MOTORS NUMBER HORSEPOWERFEE INSPECTION RECORD NEW MVD. HP OVER - INC. EACH I�&LESS $ .25 1/2 - 2 .50 _ 2 5 1.00 5 15 1.50 15 50 .2_50 50 200 '5.00 MISC. NO.SIGNS .NO.TRANS. NO.SIGNS NO.LAMPS FOR EACH PERMIT: WIRING $1.00 FIXTURES 51:00 SUPPLEMENTARY .50 APPROVALS TOTAL FEE s 9-717 DATE INSPECTORS SIGNATURE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE IS, CORRECT AND AGREE TO COMPLY A� 1� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. - - 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS-ANGELES COUNTY AND STATE OF - CALIFORNIA OR THAT I AM THE LEGAL OWNER OF'T A60VE POWER DESCRIBED RES IDENTI OPERTY//( UTILITY CO.NOTIFIED i\ SIGNATURE /Av OF PERMITTEE FINAL �� WILLIAM J. FOX,COUNTY ENGINEER VALIDATION A. C.VEIT.CHIEF ELECT. INSPECTOR �0 7 6 3 ?� SEP -7 } 2 2.70 Ir .' WORKERS' COMPENSATION DECLARATION 10/81 -affirm, APPLICATION FOR' ELECTRICAL PERMIT I herebzi that I have a certificate of consent to self CE-806G CE-806 riture;ter a ceftificate•of Workers' Compensation Insurance, COUNTY OF LOS ANGELES o BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab C ) Policy No Company FOR APPLICANT•TO FILL IN JOB Certified copy is hereby furnishedNew Residential Bldgs & Pools EACH NO FEE ADDRESS ❑ Certified copy is filed with the county building inspec- 1 & 2-Family, Sq Ft. $ — $ LOCALITY / tion department Multi-family Sq NEAREST Ft CROSS ST. J Date Applicant Residential Swimming Pools. OWNER OR 1 FIRM NAM CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec��j Light 7 Swry 7 MAIL 'COMPENSATION INSURANCE ' Tr g T T' ,• p�, �' ADDRESS First 20s (This.section need not be completed if the work involved by Total NoAdditional+ CIT C el.-No'. the permit is for one hundred dollars ($100)or less.) 0,01 I certif that'in the performance of the work for which this PLA C E K Y P APPLICANT permit is issued, I shall not employ any person in any manner so as tobecomesubject to the Workers'C ' pensation Laws Lighting Fixtures First 20 ADDRESS Total No.2_ Additional Date Applicant CITY Tel No. NOTICE TO APPLICANT If, after along this Certificate of Fixed Appliances Not Over 1 HP PERMIT 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.' — �•r�/' f} deemed revoked. Hood Fan _Other_ CITY L9 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 PRO C S BY 1- Power Apparatus& Large Appliances and Professions Code,and my license is m full force and effect �(� 0 Size &Type HP, KW, KVA, or KVAR' I 0 License Number. ' 4C Lic Classi Up to 1 Incl FINAL Ji o Over 1 to 10 Incl. DATE /f VALI ATION I ' Contractor l„�'r �" Date �� Over Inch O 10 to 50 Il ` � ❑ FINAL W I am exempt under Sec. Over 50 to 100 Inc BY U- B&P.0 for this reason Over 100 z Date Services, Swbd , MCC &Ponelboards 0 -200 Amp Under 600 V 'p Signature -201 - 1000 Amp. Under 600 V ❑ Exemption for Reg MaOver 1000 Amp. or Over 600 V mt Elect SINGLE FAMILY Temp. Power Pole &Appurtenances ;36 1.2 A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License #,s Q- 0-o 2 Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits -'a 3 2 5 0 Professions Code) Misc. Conduits& Conductors o 0 0 3 2 5 0 v El 1, 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)_ - ► )'2 0 6-•8 5 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY 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) �z (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 ESQ above information is correct. I agree to comply with all County ordinances•.and State laws regulating Electrical wiring, and hereby authors a representatives of this County to enter upon the above- honed property for i ction purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Si a re of Per ` ee Date WORKERS'COMPENSATION DECLARATION 10/81 CE-806G APPLICATION FOR ELECTRICAL PERMIT, I hereby affirm that I have a certificate of consent to self CE-806 insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 3800, Lab C ) Policy No. Company FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. New Residential Bldgs & Pools EACH NO FEE ADDRESS ❑ 1 & 2-Family, S Ft $ _ $ LOCALITY-'r �yf dG� �7d0 Certified copy is filed with the county building inspec- Y. q• hon department. Multi-family Sq. Ft. CROSS ST /r ! 6Ll�[- Residential Swimming Pools Date Applicant FIFIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Li ht Sw_ MAIL COMPENSATION INSURANCE 9 ADDRESS J177XI Thbe completed First 20 _ ( is section need not pleted if the work involved b y Total.No. Additional CITY'�� {� �!� Tel. No. the permit is for one hundred dollars ($100)or less.) 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 any manner / .so as to become subject to the Wor s' o p ns n L s Lighting Fixtures _ First 20 ADDRESS J�9 Total No Additional CITY Tel No Date' Applicant Fixed Appliances Not Over 1 HP PERMIT .�;NOTICE TO APPLICANT: If, e r making this tificate of APPLICANT / Exemption, you should become -subject to the •Workers' Range_ Heater—D.W 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. — - CITY / Tel. No deemed revoked. 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/ Class. (commencing with Section 7000) of Division 3 of'the Business Power Apparatus & Large Appliances DISTRICT NO PROC BY D, and Professions Code,and my license is in full force and effect. d Size &Type HP, KW, KVA, or KVAR O License Number Lic Class Up to 1 Incl. FINAL U Over 1 to 10 Incl DATE VALIDATION Q Contractor Date Over 10 to 50 Incl FINAL ❑ I am exempt under Sec Over 50 to 100 Inc. BY A B.&P C for this reason Over 100 h Date: Services, Swbd., MCC & Panelboards �) 0 -'200 Amp Under 600 V V Signature 201 - 1000 Amp. Under 600 V - ❑ Over 1000 Amp. or Over 600,V J9_2,.0 2 5 A Exemption for Reg. Maint Eject SINGLE FAMILY Temp. Power Pole &Appurtenances ;# o 0 0 0 o 2 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 - - 2S50 Law for the following reason (Section 7031.5, Business and Professions Code): • j, as owner of the property, will do the work and the Misc Conduits&Conductors �o o.o 2 S 5 0 5 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ , 0 5 1 4 8 5 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY 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) (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 S� above information is correct I agree to comply with all County ordinances and State jaws regulating Electrical wiring, and hereb/ya th izrep sentatry sof this County to enter upon the a ; enh propert for i pection purposes. SEE REVERSE FOR'EXPLANATORY LANGUAGE ' J7 /� gnature of Permit Date c 1 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0502170019 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: EGL D: FEES PAID BUILDING ADDRESS: TR: 13613 LT: 86 10781 BLACKLEY ST FEE DESCRIPTION: --- -QUANTITY: UOM: - -AMOUNT: TEMP CA 917803502 SSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: FREER 8573-007-014 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY, C G1 OUTLETS-LGT SW,RECP 9.00 OUT_ 17.55- _ TENANT: JX MOTORS, LT HP 2:00 MOT - 30.60 ISSUED 0 PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 75.90 02/17/05 JK 08/16/05 OWNER: TEL. NO: FIN DATE FINAL BY: CODE: FEBRIANI, JUDO (626) 428-2317- r 10781 BLACKLEY ST TEMP 917803502 DESCR PTIO OF WOR 9 OUTDOOR LIGHTS 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. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY 0 F ED REPORT ID: DPR265 ROUTE TO: BS0508