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HomeMy Public PortalAbout9445 BLACKLEY ST_Electrical__ r ' s 76A663CE806 75Z APPLICATION FOR ELECTRIC PERMIT 1 BUILDING AND SAFETY DMSION Department of County Engineer F DING ����/� County of Los Angeles ESS /j"72J ` JOHN A LAMBIE. COUNTY ENGINEER — may CASSATT D GRIFFIN. SUPT OF BUILDING LITY c FOR APPLICANT TO FILL IN I C OSS ST ]1-47-4 PERNIIT FEESNUMBER OWNEMAILLIGHT OUTLETS ADDRESS �RECEPTACLES CITY /L.dibA.� l,fi TEL NO/,�y WALL SWITCHES FEE _ /L` ..v Jr TOTAL OUTLETS @ 5� $ ELECTRICITAN ✓ ELEC RANGES 25 ADDRESS ELEC HEATERS 25 CITY TEL NO KW EA STATE LICENSE NO FIXTURES 5 MOTORS DISTRICT NO GROUP ZONE I READY FOR INSPECTION NUMBER HORSEPOWER FEE NEW MVD HP OVER INC EACH lb&LESS $ 25 INSPECTION RECORD 1/z 2 so 2 5 1 00 5 15 1 50 15 50 250 50 1 200 1 500 MISC NO SIGNS NO TRANS NO SIGNS NO LAMPS FOR EACH PERMIT ' WIRING PERMIT $1 00 FIXTURE PERMIT $100 SUPPLEMENTARY 50 APPROVALS TOTAL FEE $ 70 DATE INSPECTOR S SIGNATURE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT A h AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIRING 'S�(� 1 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING / ELECTRICAL WIRING FIXTURES { Jl 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANDSTATE OF POWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIA OPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE SINAL JOHN A CAMBERELE VALIDATIQN ARTHUR C.VEIT ELECTRICAL COUNTY ENGINEER SUPERYISISUPERVISINGCTRICAL ENGINEER CK MO CASH {SCO 7 5 5 9 APR 2 6 2 2.7 O to � I • WORKERS' COMPENSATION DECLARATION 20-0019 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT O I hereby affirm that I have a certificate of consent to self CE 806G insure, or a certificate of Workers' Compensaion Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS 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 ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST Residential Swimming Pools CROSS ST. Date Applicant OWNER OR CERTIFICATE OF EXEMPTION FROM WORKERS' v JJ(� FIRM NAME N /N COMPENSATION INSURANCE Outlets: Rec Light�Svv1 MAIL 20 ADDRESS 41 A,4 l 4v7% D (This section need not be completed if the work involved by CITY , Tel. No. the permit is for one hundred dollars ($100)or less.) Total No. Additional e I 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 Workers'Compensation Laws. Lighting Fixtures First 20 1 ADDRESS e.3 -9/ �. .Aoy .E��// Total No.� Additional CITY Tel. No. Date Applicant �ISL!/� �J Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION `V 5 P/ 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 3�1 y O See. with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other_ CITY w ✓l^//} Tel. Nor y3-3& LICENSED CONTRACTORS DECLARATION LICENSE OR / /s Disp. Room Air Cond. REG. NUMBER Class. 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PR SED BY a and Professions Code,and my license is in full force and effect. /�_ �l Size &Type HP, KW, KVA, or KVARIf 4/� �� Q License Number Lic. Class `� /V Up to 1 Incl. FINAL U t�`�"��0� —�/ Over 1 to 10 Incl. DATE VALIDATION 0 Contractor Date Over 10 to 50 Incl. FINAL ~ ❑ I am exempt under Sec. Over 50 to 100 Inc. gY LLJU B.&P.C. for this reason Over 100 ,L' t1 Services, Swbd., MCC & Panelboards ZZ Date: 0- 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole 8 Appurtenances I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit t r 1_'i n i Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits _ Professions Code): F-1I, as owner of the property, will do the work and the Misc. Conduits&Conductors I T structure is not intended or offered for sale Section 7044, Other (See Complete Fee Schedule)_ , r Business and Professions Code). ( (f_I(if_ d -_� - 20 CONSTRUCTION LENDING AGENCY ?ASH 6,5.2 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 =I!i?tE{—fi;_tj;i _• �w�E'-`'s_ 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 above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ©s Signature of Permiftee' Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1108160017 BUILDING AND SAFETY % LAND DTZVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID FEES PAID BUILDING ADDRESS 1 ON FILE 9445 BLACKLEY ST 1 IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803141 ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET CLOVERLY 18590-003-001 IA1 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY, Cl IG1 OUTLETS-LGT,SW,RECP 2 00 OUT 3 90 ITENANT IG2 LIGHTING FIXTURES 1 00 LGT 1 90 (ISSUED ON PROCESSED BY PLAN BY TOTAL FEES 33 60 108/16/11 SR (OWNER TEL NO IFINAL DATE FINAL Y CODE IQIN, ZI-RAN (626) 466-5695- 1l 19445 BLACKLEY ST 1 IQ A4 ITEMP 917803141 IDESCRIPTION OF WORK 0I I I (ELECTRICAL FOR A NEW BATHROOM 1 I I I I (APPLICANT TEL NO I I ISAME AS OWNER I I ISPECIAL CONDITIONS 1 I I I I ICONTRACTOR TEL NO I 1APPROVALS DATE INSPECTOR SIGNATURE ISAME AS OWNER - I I 1 I LIC NO I ITEMPORARY POWER POLE I I I I 1 (UNDERGROUND CONDUIT 1 1 1 I I I I I I (ARCHITECT OR ENGINEER TEL NO I IUFER GROUND I I IARTECH BUILDING PLUS (626) 264-1638- 1 1 1 112121 EAST VALLEY BLVD LIC NO I IROUGH CONDUIT 1 EL MONTE, CA 91732 NONE i TROUGH WIRING 1 IMAIN WATER LINE I I 1 IPLASTIC YIN METAL YIN I 1 I I I I I I 1 IUTILTTY COMPANY NOTIFIEDI I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I IREPORT ID DPR265 ROUTE TO ES0508 I I