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Home My Public Portal About10793 BLACKLEY ST_Electrical__ • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 9905190041 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 13613 LT: 88 10793 BLACKLEY ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803502 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: MCCULLOCH 8573-007-016 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY LB 200 AMP PANELS, MCC 1.00 PAN 38.85 TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 05/19/99 UT 11/15/99 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: WINSTANLEY ERIK C;CATERINA RIZZI 10793 BLACKLEY ST TEMP 917803502 DESCRIPTION OF WORK UPGRADE ELECTRICAL PANEL TO 200 AMP APPLICANT: TEL. NO: SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: / ( APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO /� � "�� v TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT OR. ENGINEER: TEL. N0: / \ UFER GROUND LIC. NO:� I �� 1 ROUGH CONDUIT ROUGH WIRING -IgA 1 MAIN WATER LINE �� J� ( �1 ��',� � Oi�' I� PLASTIC Y/N METAL Y/N - -- - ---- - -- UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 9904200039 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 13613 LT: 88 10793 BLACKLEY ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803502 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: MCCULLOCH 8573-007-016 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 16.00 OUT 31.20 TENANT: G2 LIGHTING FIXTURES 4.00 LGT 7.80 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: H7 RES EXHAUST FANS 1.00 EX 10.80 04/20/99 UT 04/20/00 TOTAL FEES 77.55 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: WINSTANLEY ERIK C;CATERINA RIZZI 10793 BLACKLEY ST TEMP 917803502 DESCRIPTION OF WORK ELECTRICAL FOR NEW ADDITION (748 SQ. FT.) APPLICANT: TEL. NO: SAME AS OWNER ,_- SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: � �1' APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO / TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO:� � I F 1111111 ROUGH.CONDUIT �� ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N 1`- - - --- - - -- -- -- - - - --JI UTILITY COMPANY NOTIFIED c REPORT ID: DPR265 ROUTE TO: BS0508 .4 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0209230006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL D FEES PAID BUILDING ADDRESS: TR: 13613 LT: 88 10793 BLACKLEY ST FEE DESCRIPTION: PQUANTITY: UOM: AMOUNT: TEMP CA 917803502 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: MCCULLOCH 8573-007-016 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY F1 120V, 15/20A BR CKTS 2.00 BR 34.50 TENANT: G1 OUTLETS-LGT,SW,RECP 10.00 OUT 19.50 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: G2 LIGHTING FIXTURES 4.00 LGT 7.80 09/23/02 JK 03/22/03 H1 RES ELEC OVEN LT 3HP 1.00 OVE 10.95 Fft OWNER: TEL. NO: H2 RES GRBG DISP LT 3HP 1.00 DIS 10.95 FINAL DATE [TEY: CODE: WINSTANLEY ERIK C;CATERINA RIZZI (626) 448-7853- H3 RES DISHWASHR LT 3HP 1.00 DIS 10.95 10793 BLACKLEY ST TOTAL FEES 122.40 TEMP 917803502 DESCRIPTION OF WORK REWIRE KITCHEN 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. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING j 2� MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 t {j WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT u I hereby affirm that I have a certificate of consent to self insure, 76A663 or a certjficate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(See..3800 Lab. C.) • P❑oliicy No. Company FOR APPLICANT TO FILL IN JOB �ry ADDRESS f V /q J 6 e L�(�p*1L41y� Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE $ $ LOCALITY eft- Ci Certified co is filed with the count building inspection 1 &2-Family,Sq.Ft. PY Y 9 P NEAREST e C (I_ ` department. Multi-family Sq.Ft. CROSS ST. v Date Applicant Residential Swimming Pools - ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' NER OR COMPENSATION INSURANCE Outlets:Rea _Light Sw. FIRM NAME �� /�U �"� i (This section need not be completed if the work involved by the First 20 MAIL No. �= Additional Q ADDRESS j v, permit is for one hundred dollars($100)or less.) ' ��, CITY Tel.No. I certify that in the.performance of the work for which this permit, s l , j��. / ilD '"� 1 i( t{c{ is issued, I shall not employ any person in any manner so as to ✓ /�8�`-` PLAN CHECK become subject to the Workers'Compensation Laws, Lighting Fixtures `> First 20 D APPLICANT Total 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,KV KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 (3vcr 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. LICENSEClass. } Over 50 t0 100 Incl. REG.NUMBB ER a Over 100 DISTRICT NO. PRO SSED BY O License Number Lic.Class V Servic ,S, .,MCC ,&PaannelboardsF NAL ✓ �� f/X Contractor Date 0/ Ar�ii-.UTSdkr 600 V DATE El I am exempt under Sec. 400-1000 Amp.Under 600 V ✓Jj.Z ~ VALIDATION U FINAL Over 1000 Amp.or Over 600 V W B.&P.C.for this reason BRANCH CIRCUIT FEES BY �/ U) //�� Date: 15A,or 20A,120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ED 41 Or More Branch Circuits w Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp. Power Pole&Appurtenances € •_•`r==, HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit 77177 i49.4 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits IT Code): . ym Misc.Conduits&Conductors 'sT` tz r 9 = 40 I, as owner of the property, will do the work and the structure i':;}•{ .3.. I is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). (_;HE ,' =} CONSTRUCTION LENDING AGENCY +_•i'!ANG EE I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) ) CIV. C.). 001110-000•{ ,{,L.",4�4f A I `11 PLAN CHECKING FEE Lender's Name `(�f _ n w 7 iJWI� PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE � that the above information is correct. I agree to comply with all County oldinances and State laws regulating Electrical wiring,and hereby authorize representatives of this County to enter upon the above-mentioned property /for i pe ,on purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ✓ , 14 63 SIGNATURE O EE DATE -