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Home My Public Portal About9502 BLACKLEY ST_Electrical__ 76A663-CEBO6 1.1/76 APPLICATION FOR ELECTRICAL 'PERMIT COUNTS( OF`LOS ANGELES // DEPART'MENT•OF,COUNTY ENGINEER BUILDING hG.bLFL,f BUILDING AND SAFETY DIVISION COLEMAN W. JENKINS 'SUPERINTENDENT OF BUILDING. LOCALITY NEAREST j ` FOR APPLICANT TO FILL�IN CROSS ST 'G�aG£/r LE OUTLETS NO EACH FEE _ OWNER RECEIPT. s $ $ AMAIL DDRESS !�S• �� G��y ' LIGHT c� TO FIRST 20 Zg 0 _ -' " CITY r[C`•ro';S C</ y, TEL NO. SWITCH �O OVER 20 10 PLAN CHECK LIGHTING ) FIRST 20 Zg Q APPLICANT l TOTAL 1( • OVER 20 ADDRESS FIXTURES 10 ' APPLIANCES . • CITY TEL. N0. ' PERMIT - RANGE DRYER_WTR. HTR '` APPLICANT, STA. COOK DI,SP F A;U. ADDRESS i SPACE HTR, AIR COND Cl TY, 49 TEL. NO CLOTHES WASH. DISHWASH. LICENSE NO CLASS' FAN OTHER 100 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP-PLI,CATION AND'STATE THAT THE,ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS-, TRANSFORMERS RATING' WITH ALL COUNTY ORDINANCES SAND STATE ,LAWS REGULATING IND HEATERS, ETC 'HP, KW KVA ELECTRICAL WIRING , SIZE & TYPE ,OVER TO' I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORS Q - 1 1 LICENSED AS,,REOU IR ED BY LOS ANGELES NC STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND�INTEND TO �- ' 1 - 10 300 RESIDE IN, THE ABOV p CRIBED/J RESIDkNTIAL PROPERTY O 10 - 50 500 SIGNATURE` - [/� V OF PERMITTEE J" d' 50 - 100 1000DISTRICT NO CLASS ZONE PROCESSED BY' O 100 - 500 1500 -!14 a SIGN, GAS SIGN AND ONE CIRCUIT 500 "NOTES: N TUBE, OR MARQUEE ADDITIONAL CIRCUITS 100 , SERVICENOTOVER600VOLTS6R200AMP 300 APPROVALS DATE INSPECTOR'S SIGNATURE' ' S ERVI CE OV ER 600 VOLTS OR 200 AM P 1000 TEMP.POWER POLE TEMP SERVICE,POLE, &APPURTENANCES 500 - UNOERSLAB WORK ' TEMP LIGHT`OR RECEPT SYSTEM 300 ROUGH CONDIUT WIRING! - FIXTURES POWER AUTHORIZED + 'PERMIT FEE (SUB TOTAL), I UTILITY,CO NOTIFIED PLAN'CHECK FEE _ - FINAL 1 / 2-�' - PERM'IT ISSUING FEE 300 06, - - JO EPH C. ROOHA-TO 'A PEE OD SUPERVISING QK ' GINEER. -PLAN CHECK VALIDATION CK 'M 0 CASH PERMIT VALIDATION0' CASH SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE - 78A6631Cr fi9e89 f2,75 APPLICATION FOR ELECTRICAL PERMIT - BUILDING AND SAFETY DIVISION G FOR APPLICANT TO FILL IN JOB ADDRESS New Residential Bldgs. & Pools EACH NO FEE 1 &2 Finaily Sq Ft. $ — $ LOCALITY Multifamily Sq. Ft. NEAREST `Lo�['�L�—')I' Residential Swimming Pools, OWNER OR ? ' FIRM NAME Outlets Light,Switch& Receptacle MAI L ADDRESS y�dd �� zE .-ta0 First 20 Additional CITY M4FJ+Q TBI-NO PLAN CHECK Lighting Fixtures APPLICANT First 20 ADDRESS Additional � CITY Tel No PERMIT Fixed Appliances Not Over 1 HP APPLICANT Range_ Heater_ D W CIL ADDRESS Dass N Oven Dryer W M. Top FAU W H CITY Tel No , Hood Fan LICENSE OR nr. REG NUMBER Class Disp. A.0 v I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY O Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING F ELECTRICAL WIRING V Size&Type HP, KW, KVA,or KVAR LLJ Up to 1 Incl. 1 HERE ERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR Over 1 to 1O Incl LICENSED S R UIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR T AM THE LEGAL OWNER OF THE ABOVE Over 10 to 50 Incl. DESCRIBED R IDE AL oPERTY Over 50 to 100 Incl. PERMITEE 'Over 100 - SIGNATURE r DISTRICT NO PR CES D BY Services 0-200 Amp Under 600 V- 201 -1000 Amp Under 600 V APPROVALS DA INSPECTOR'S Over 1000 Amp or Over 600 V SIGNATURE. TEMP POWER POLE Temp. Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit Additional Sign Branch Circuits ROUGH CONDUIT (Other) WIRING FIXTURES ' POWER AUTHORIZED PERMIT FEE (Sub-Total) UTILITY CO'NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL z S'77 PERMIT,ISSUING FEE NOTES TOTAL FEE - j 33-S PLAN CHECK VALIDATION CK MO CASH PERMIT VALIDATION K O CASH 9 9 O'LZ NOV . / 2 U• 1 IJ(�rAS16 WORKER'S COMPENSATION DECLARATION 20-0019DPW(129,) 76A663 APPLICATION FOR ELECTRICAL PERMIT I hereby affsNM th&t I have a certificate of consent to self Insure, or a certrflcate of Worker's Compensation Insurance, or•a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof„(Sec 3800 Lab C) Policy No y Company 11 FOR APPLICANT TO FILL IN JOB ADDRESS 71 -Ceriif ed'copy is F eretiy fuimshecl I New Residential Bldgs &P o NO EACH FEE LOCALITY C I , - .r;E — $ $ e . Certified co Is filed with the count building inspection. 1 &2-Family,Sq Ft }�]J7 PY Y 9 P - NEAREST y d artment r Multi-family Sq Ft CROSS ST Die r, X Date A hcant ” Residential'Swimming Pools ASSESSOR pP •MAP BOOK _ PAGE PARCEL r L'CERTIFICATE OF EXEMPTION FROM WORKERS' a J.. - - Outlets ReC L•Ight Sw / n FOIPM NAME ' COMPENSATION INSURANCE s �C1 �, G SOw 1 •^a< • ., - - - / First 20 MAIL (This section need�not be completed if the work�involJe' by the ADDRESS - Total No Additional permit'is for'one hundred dollars($100)or less.) - •• _ _ - rz• ' - CITY Tel No 1 certify�th'at in the performance'i of'the work for which this permit � ' IS Issued„I,shall not employ Any per'son'in'any'manner so as, PLAN CHECK become subject to the Workers' Compensation Laws, _,Lighting Fixturesr / First 20 APPLICANT 4 Total No - Additional Iru ADDRESS Date a' Applicant '' RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE,T&APPLICANT If, after•making.this Certificate of CITY Tel No Exemption,youlshould,become subject to,the_,Workers;,Compensat16n OTHER APPLIANCES NOT OVER 3 HP rovisions.of the Labor Code, you must'forrtnwlth'com I with,such PERMIT P Y P Y - APPLICANT K)( e"S V�C,-, ` provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances � 't ICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KA,or KVAR ADDRESS 'G` T C511 kt4 I'fiefeby affirm that'I'am licensed-under'lorovsi^ons of,Chapter 9 Over 3 to 10 Incl (commencing with Section 7000) of Division 3.of,the Business and CITY Tel No 33z-o1�t Professions Code,and my license is in full force and effect Over 10 to 50 Incl LICENSE O Class �1 a. ' Over 50 t0 100 IDCI REG NUMBER b O • License Number S• `� �Ic CIeSS Over 100 y' DISTRICT NO �7 P C D BY CZ Services,Swbd,MCC&Panelboards `%/� Contractor �< a Date / 0 393 Amp Under 600 V DATE — O ❑,' 400-1000 Amp Under 600 V I am exempt under Sec VALIDATION V Over 1000 Amp'or Over 600 V FINAL d B&P.C for this^reason BRANCH CIRCUIT FEES BY Date 15A: 120V,,Ligliting or Recept, s. _J Z_ 1 To 10 Branch Circuits- Signature 11 To 40 Branch Circuits - ❑ r 41 Or More Branch Cucuits Exemption`for Reg Maint Elect 15A,20A,208V To 277V Lighting Br_Circuits SINGLE FAMILY Temp Power Pole&Appurtenances A ,g _ HOME OWNER-BUILDER DECLARATION, HC.kTSi n with One Branch Circuit i{ f I hereby affirm that I am exempt from the Cog ntractors License Law ` I_7 1 16a t, for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits Code) 1 ITEMS EM • . FTI,'as owner of-fhe property,will do the v✓ork`and the structure Mlsc Conduits&Conductors 1 _ t is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) 1"I Itt� ® � -and Professions' Code) rI CHECK � o. CONSTRUCTION LENDING AGENCY CHANGE C10 f 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 -Total) Civ C) - PLAN CHECKING FEE � r � gtAi 9 1 � Lender's Name x Oyu f: q+ tti t r�a 2? PERMIT ISSUING FEE ` Lender's Address 1' 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 rdmances and State laws re -lating Electrical wiring,and hereby authorize presen fives ofKkto t enter upon the above-mentioned propertypur SEE REVERSE FOR EXPLANATORY LANGUAGE SI TURE OF PERM1TTEE D TE ' - �� •'• COUNTY OF LOS ANGELES TEMPLE CITY ## 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0807140013 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID -FEES PAID BUILDING ADDRESS 1 ITR 14572 LT 58 9502 BLACKLEY ST 1 IFEE DESCRIPTION QUANTITY: DOM AMOUNT TEMP CA 917803142 _ ASSESSOR INFORMATION NUMBER \1 NEAREST CROSS STREET 18590-007-023 IA1 PERMIT ISSUANCE FEE 27 75 I THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY, Cl I IG1 OUTLETS-LGT,SW,RECP 4 ,00 OUT 7 80 I 1 ITENANT IG2 LIGHTING FIXTURES 1 00 LGT 1 95 JISSUED ON PROCESSED BY PLAN BY EXPIRES ON TOTAL-FEES 37 50 107/14/08 SR 01/10/09 (OWNER TEL. NO I \ (FINAL DATE BY CODE 1 IJACKSON, KEITH (626) 309-1733- 1 19502 BLACKLEY ST \' ITEMP 917803142 1 DESCRIPTION OF WORK 14 OUTLETS, 1 LIGHT FIXTURE FOR MINOR BATHROOM REMODEL I 1APPLICANT TEL NO I DIANE MAROCCHI (562) 631-3684- I I 18407 ENRAMDA AVE ISPECIAL CONDITIONS IWHITTIER, CA 90605 I � CONTRACTOR TEL NO _ (APPROVALS DATE INSPECTOR SIGNATURE ID & T GENERAL CONTRACTING (562) 945-2083- I 18407 ENRAMADA AVE LIC NO ITEMPORARY POWER POLE IWHITTIER CA 90605 - B C10 *_ I I I (UNDERGROUND CONDUIT I I I 1ARCHITECT OR ENGINEER TEL NOI IUFER GROUND I I I I I 1 1 LIC NO 1 IROUGH CONDUIT 1 I 1 I I I I I TROUGH WIRING �� I _ I IMAIN WATER LINE I I I IPLASTIC Y/N METAL Y/N I• _ I - (UTILITY 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 ti I I I I I I I I I I I I* ADDITIONAL DATA ON FILE I I I I I I • - IREPORT ID DPR265 ROUTE TO BS0508 I �•' I I I I I