HomeMy Public PortalAbout9113 BLACKLEY ST_Electrical__ tVOrm that
COMPENSATION DECLARATION CE-806G 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby,affirm that I have a certificate of consent to self
Insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof Sec 3800, C )
Policy N O Pa"Y FOR APPLICANT TO FILL IN JOB
❑ Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS
1 & 2-Famil S Ft $ = $ LOCALITY
Certified copy is filed with the county building inspec- y- q
tion departure Multi-family Sq Ft NEAREST
CROSS ST
1 -1r Residential Swimming Pools OW ER OR
Date Applicant
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKER ' Outlets RecLight�Sw_ IL
*441r__�
COMPENSATION INSURANCE ADDRESS
Thtd t be tour leted if the work involved b 05— First 20
( is secion neenop Y Total No IZ Additional CITY Tel N
' the permit is for one hundred dollars ($100)or less )
PLAN CHECK ) 1
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 Workers'Compensation Laws Lighting Fixtures First 20 ADDRESS
Additional
' Total No - CITY Tel No
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT If, after making this Certificate 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 — ✓ p
deemed revoked CITY Tel No
Hood Fan _ Other— '3 l
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 P CESSED BY
and Professions Code, and my license is in full force and ffect Power Apparatus& Large Appliances � 0.
Size &Type H (Jf P, KW, KVA, or KVAR O
License Numbe� ��L/ "ZLic Class Up to 1 Incl FINAL V
Over 1 to 10 Incl DATE d- VALI TION 0
Contractor Date❑ Over 10 to 50 Incl I.-
FINAL
I am exempt under c ! Over 50 to 100 Inc BY a
B&P C for this reason Over 100 of
Services, Swbd , MCC& Panelboards
Date 0 -200 Amp Under 600 V .110111.
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
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031 5, Business and 2 4 5 5 A
Professions Code) # o o o o o 2
El1, as owner of the property, will do the work and the Misc Conduits& Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)—
7044, Business and Professions Code) ) o o 5 Q Q
CONSTRUCTION LENDING AGENCY o o,o 1 5 0 0 5
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) Q 71 5-8 5
(Sec 3097, Civ C )
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE (J
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 jaws regulating Electrical wiring, and
hereby authorize represen atives of this Coun to enter upon
thea ove-mention d perty for ins n purposes /
SEE REVERSE FOR EXPLANATORY LANGUAGE
7-1�' 5
Si u e o Permittee Date
c COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
VISION O OF COUNTY ENGINEER ELECTRIC 1
DIVISION OF BUII.DING & SAFETY
WILLIAM J. FOR, COUNTY ENGINEER
FOR APPLICANT TO FIFL IN DISTRICT NO GROUP ZONE PERMIT NO.
� ' P
ELECTRICIANj�� �,O
ADDRESS `9 Ib��IJC3 J RECEIVED BY READY FOR DATE ISSUED
`/�`+ FIRST INSPECTION ,y
CITY-j--? iC1lrlf-f—EE TEL NO
COUNTY LICENSE NO v 0S EXPIRES BUILDING
PERM FEES ADDRESS ®iIJ
FEE
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
U A,�
RECEPTACLES Concol T
WALL SWITCHES OWNER .
TOTAL OUTLETS Sc $ 1.7 .6 MAIL
ELEC RANGES 25 ADDRESS 129
ELEC HEATERS -25
CITY fit/ TEL NO
FIXTURES 5 D
MISC I HEREBY ACKNOWLEDGETHAT 1 HAVE READ THIS
NUMBER OF LIGHT CIRCUITS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING
MOTORS I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
New MVD HP OVER I INC EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE
I/2 a LESS $ 25 'y
SIGNATURE OF
I/2 2 s0 PERMITTE
2 s 1 00 INSPECTION RECORD
s '1s 1 50
1S SO 2 s0
SO 200 S 00
200 500 10 00 --1
J
500 1 1000 is 00 Q
OVER 1000 20 00 Z
M G SET%FREQ CHANGER-HP Q
WELDERS AC-KVA
GENERATORS KW
TRANSFORMERS-KVA
TEMP MOTORS (75% OF oRIG )
MOVED MOTORS (75% OF ORIG )
MISC
SIGNS
NO NO TRANS
APPROVALS
NO NO LAMPS
FOR EACH PERMIT DATE INSPECTOR'S NAME
WIRING $1 00 / 00 CONDUIT
FIXTURES $1 00 / Q O WIRIN
I
SUPPLEMENTARY 50 FIXTURES
POWER 4V
p
_- TOTAL FEE $ 3 UTILITY CO NOTIFIED
INAL
IGA•e9 DBS# eA 4-52
I �
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COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1106020040
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ON FILE r 1 9113 BLACKLEY ST
IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803015 1
ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET
15388-011-005 IA1 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID H5 LOCALITY TEMPLE CITY, Cl
I IG1 OUTLETS-LGT,SW,RECP. 7 00 OUT 13 60
ITENANT IG2 LIGHTING FIXTURES 4 00 LGT 7 80 (ISSUED ON PROCESSED BY PLAN BY
TOTAL FEES 49 20 106/02/11 SR
OWNER TEL NO I FTTTp AL DATE FINAL BY CODE
1WEN, PING (626) 286-8629- I '
19113 BLACKLEY ST
(TEMPLE CITY CA 91780 DESCRIPTION OF WORK
17 OUTLETS AND 4 LIGHT FIXTURES FOR ENCLOSED PATIO
1APPLICANT TEL NO _ 1
IJAMES, RALPH (818) 427-0467-
I ISPECIAL CONDITIONS
I
I
I I
(CONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE
IDB CONTRACTING (909) 394-3030- I
1,1251 CITRUS AVENUE LIC NO I ITEMPORARY POWER POLE
1LA HABRA, CA 90631 832929 B * I- I
1UNDERGROUND CONDUIT
(ARCHITECT OR ENGINEER TEL NO IUFER GROUND I
IPLUMP ENGINEER (714) 385-1835-
1914 E KATELLA AVE LIC NO IROUGH CONDUIT
(ANAHEIM, CA 928058 NONE 1
_ s ` IROUGH WIRING
1 IMPIN WATER LINE
I I _ JPLASTIC Y/N METAL Y/N + I 1
1 1
(UTILITY COMPANY NOTIFIED(
1 I I I I I
I 1 I I I I
I 1 I I I I
1 1 I I I I
i I
I I I I I I
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* ADDITIONAL DATA ON FILE
IREPORT ID DPR265 ROUTE TO BS0508 1
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