HomeMy Public PortalAbout9914 BROADWAY_Electrical__ � �
]61Tb63-CEBOfi 12-65 APPLICATION FOR ELECTRIC PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION AODREse
JOHN A. LAMBIE. COUNTY ENGINEER �7
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY L�
NEAREST L�
FOR APPLICANT TO FILL IN I CROSS ST. /
RECEPT. —1 TOTAL IN IEwcH FEE
Jly OUTLEjS I FIRST 20 A i $ C OWNER
LIGHT C/X('/ 4/— MAIL '
SWITCH ADD'L 10 ADDRESS
OVER 20 ��
l TOTAL FIRST 20 �� .20 } CIT 1 TEL. NO
LIGHTING l FIXT RES
FIXTURES I ADD'L 10 CONTRACTOR
OVER 201
RANGES DRYERS WTR.HTRS. 1 1.00 1 ADDRESS
GARB.DISP. STA.COOK
CITY TEL. NO.
DISHWASH. AUTO..WASH. STATE
SPACE HTRS. STA. APPL. .50 LICENSE NO.
MOTORS: OVER NOT OVER H.P. DISTRICT N GRFJJP I ZrP E E Y
O 1 1.00
1 s1.so INSPECTION RE RD D_
G _ O
3 S 2.00 Q T , / C PC>CL. V
C
8 15 2.50 �.I f� Com. Q
15 50 3.00 L..Gt�G U
W
Q-
50 100 5.00 N
Z
SIGNS: NO.TRANS-
NO.LAMPS
SERVICE 0.60OV-NOT OVER 200A 1.00
SERVICE 0-60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 APPROVALS DATE INSPECTOR'S BIGNATURE
TOTAL FEE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION UNDERSLAB WORK
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. 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 1 M THE LEGAL OWNER OF/�NO INTEND TO POWER
RESIDE IN.THE ABO E/OE SCRIBED RESIDENT L PROPERT
SIGNATURE / UTILITY CO.NOTIFIED If
OF PERMITTEE
FINAL S�
f VALIDATIO JOSEPH C. ROOHAN
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
Lilo 5 3 1 ?:E OCT 17 2 D 5.3 0-
Gi%i%rC�-ems
WORKERS' COMPENSATION DECLARATION 16A6l53 rI0,81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self �-BWG n
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 N.LJ36 25 mpany, L u.4 FOR APPLICANT TO FILL IN JOB q
Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS `�t O Q w
❑ Certified copy is filed with the count but ing inspec- 18 2-Family, Sq. Ft. S — S LOCALITY ��19 FG
y NEAREST
tion department •-p0 4U, a (N C. Residential
family Sq.Swimming
NEAREST
tion Q' Lc+Jh
Residential Swimming Pools OWNER OR
Date -7-30—Rv Applicon
FIRM NAME
CERTIFICATE OF EXEMPT ON FROM WORKERS' Outlets: Rec_6_Light�p_Sw.� IL
COMPENSATION INSURANCE First 20 ADDRESS
(This section need not be completed if the work involved by Total No. Additional CITY {rst
the permit is for one hundred dollars ($100)or less.)
I certifythat in the performance of the work for which this PIAN CHECK
P APPLICANT
permit is issued, I shall not employ any person in any manner / r
so as to become subject to the Workers'Compensation laws. Lighting futures First 20 t � G `T ADDRESS
Total No. (I Additional
CITY Tel. No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT SLy V Lst
Exemption, you should become subject to the Workers' Range_ Heater—D.W. —
Compensation provisions of the Labor Code, you must forth- Oven _ Dryer — W.M._ ADDRESS
with comply with such provisions or this permit shall be Top — FAU —W.H. —
deemed revoked. Hood _ Fan _Other_ CITY Tel. No. LOL�-97
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG. NUMBER y Z Class.
(commencing with Section 7000) of Division 3 of the BusinessDISTRICT NO. PROCE$ D BY
and Professions Code, and my license is in full force and effect. Power Apparatus 8 Large Appliances >
Size 8 Type HP, KW, KVA, or KVAR' Q Q
License Number if 33S py z Uc, Class U to 1 Incl. FINAL _ V
Controctor S%?v &3,1u4 /441),te 7'3`0- Over I to IO Incl. DATE -7 ( — VALIDATION 0
❑ / Over 10 to 50 Incl. FINA /J V
am exempt under Sec Over 50 to 100 Inc. BY d
B.BP.C. for this reason Over 100 ) N
Date:
Services, Swbd., MCC 8 Ponelboards ► / 3,� Y
0 -200 Amp. Under 600 V
Signature (dr8✓l 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Mainz. Elect. 23 1
3 ) .3 ,( A
SINGLE FAMILY Temp. Power Pole 8 Appurtenances '
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # o o e,o e 2
` 1 hereby affirm that I am exempt from the Contractor's License ' 1
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits 2 o to 4.275
Professions Code):
❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors ;o o•e Q 27 5 lu
► t
structure is not intended or offered for sole (Section Other (See Complete Fee Schedule)_
O•�O ) _ 4
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) -32
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE -'
Lender's Name '
PERMIT ISSUING FEE Q
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 n,
the above-men'o d pr perty for inspection purposes. - • L9
SEE REVERSE FOR EXPLANATORY LANGUAGE
/Signature of Permittee Date
WORKERS'have a certificate
DECLARATION 76A863 10/81 APPLICATION FOR ELECTRICAL PERMIT
� r hereby a4irm that I have a certificate of consent to self insure, CE-806G '
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.)
Policy No. - C0mp8ny FOR APPLICANT TO FILL IN JOB I ,^ l
❑, fietl copy is hereby furnis d. New Residential Bldgs.& Pools EACH NO. FEE ADDRESS r U W
Certified copy is ailed with my aiding inspection
1 & 2-Family, Sq.FL $ — $ LOCALITY
department. Multi-family Sq.Ft. NEAREST
CROSS ST.
Residential Swimming Pools --
Dap�te 1 31-9f Arbil t OWNER OR } ,A
1�_ FIRM NAME
-CERTIFICATE OF E MPTION FROM WORKERS' -(/ MAIL
Outlets:Rec Light _ Sw. —
COMPENSATION INSURANCE - - ADDRESS Vp 1'Y v[i
(This section neednot be'completed if the work involved by the Firs!20.
ion
Total No. Additional CITY Tel.No.
p
ermit-is for one hundred dollars ($100)or less.), -
PLAN CHECK
ssued,.1 h the performance of the work any
manner.
.s permit - APPLICANT
issued, shall not employ any,person in any manner so as to I -
ome'subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS '
r !� Additional
Total No. - CITY Tel.No.
e Applicant - - - Fixed Appliances Not Over 1 HP -
TICE TO APPLICANT: If, after making this Certificate o(' PERMIT
mption,you should become subject to the Workers Compensation Range_ Heater_ D.W. APPLICANT
visions of the Labor Code, you must forthwith comply,with such Oven _ Dryer _ W.M._ ADDRESS
Provisions or this permit shall be deemed revoked. Top — FAU _ W.H. CITY ' 1.No.
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_
ereby affirm•that I am licensed under provisions of Chapter 9 " Disp. Room Air Cond. LICENSE OR 'Class: G Z'
mmencing with Section 7000) of Division 3 of the Business antl REG.NUMBERfessions Code,antl my license is in full force'and effect. DISTRICT NO. P SED BYPower Apparatus& Large Appliances � a',q7 'VifSize& Type HP,KW,KVA,or KVAR (/nse Numbers Lia Class Up to 1 Incl. FINAL 8
! Over 1 to 10 Incl. DATE ^tractor rVl✓� ate ���� � ^�/ - -� VALIDATION
Over 10 to 50 Incl. F-
FINAL
I am exempt under Sec. - Over 50 to 100 Inc. �r gy � W
BAP.C. for this ason_ - .Over 100 N
Services,Swhd.,MCC&Panelboards - BY L' Z
Date: 0- 200 Amp.Under 600 V
Sign a 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 y -
I hereby affirm that I am exempt from the Contractor's License Law tr• s
for the following.reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits - - " #'}•�I •'i. "
Coda): 7117. +G -,{,.
i tL„
❑ I,as owner of the property,will do the work and the structure Misc.Conduits 8 Conductors - '
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ �' 11E 3
and Professions Code). - ► - TOTAL IS'- 76
CONSTRUCTION LENDING AGENCY - i,Htt_P, tom.h
I hereby,affirm that there is a construction lending agency for the1=1-
A+,: _ '
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE
Civ.C.). - ' - (Sub-Total) Q l.'{'�nl il: •
PLAN CHECKING FEE -- - - - r
Lender's Name
-PERMIT ISSUING FEE
Lender's Address 0767 1, All n-57
1 certify that I have read this application and state that the above TOTAL FEE
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
,Signahlreof Permittee Date -
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF' PUBLIC WORKS 9701 LAS TUNAS EL 0508 0705170026
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 .
PHONE: (626) 285-0488 EXT:
(LEGAL ID: FEES PAID BUILDING ADDRESS:
ITS: 13805 LT: 37 19914 BROADWAY 1
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917002618 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
IBSBS-016-012 IA1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl
I IG1 OUTLETS-LGT,SW,RECP 1.00 OUT 1.95 I
ITENANT: IG2 LIGHTING FIXTURES 2.00 LOT3.90 TISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1
TOTAL FEES 33.60 105/17/07 SR 11/13/07
OWNER: TEL. NO: �: ` FI L DA E FI/Iy/y� Y: CODE:
IPERSON NEAL R;NANCY (626) 664-6616- " � ✓lam
19914 BROADWAY �� I
ITEMP 917802618 DENtRIPTION OF WORK
11 SWITCH E 2 LIGHT FIXTURES
(APPLICANT: TEL. NO:
INEGRETE (951) 232-6668- 1 I I
1297 N. SIERRA PL 1 1SPECIAL CONDITIONS: 1
UPLAND, CA 91786 I
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(CONTRACTOR: TEL. NO: I 1 (APPROVALS DATE INSPECTOR SIGNATURE
(AMERICAN HOME REMODELING INC. (909) 393-8932- I I I
115370 FAIRFIELD RANCH RD LIC. NO I ITEMPORARY POWER POLE I I
(UNIT 1 807029 B
ICHINO HILLS CA 91709
IUNDERGAOUND CONDUIT
I
ARCHITECT OR ENGINEER: TEL. NO: IUFER GROUND I I I
LIC. NO: I IROUGE CONDUIT
ROUGH WIRING yygy�'�y'gL,`/^'I�UII'
MAIN WATER LINE
IPLASTIC YIN METAL YIN
I I (UTILITY COMPANY NOTIFIED( 1 I
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[REPORT ZD: DPR 265 ROUTE T0: 850508 I I I
I I I I I I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0707240003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 13805 LT: 37 1 9914 BROADWAY
I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: 1 TEMP CA 917802618 1
(ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: BALDWIN
16588-016-012 IA1 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl
IG1 OUTLETS-LGT,SW,RECP 21.00 OUT 40.35
TENANT: IG2 LIGHTING FIXTURES 10.00 LOT 19.50 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
TOTAL FEES 67.60 107/24/07 SR 01/20/08
OWNER: TEL. N0: F NAL DATE FIII,�VVVT}}},a�iwlBY: CODE:
(PERSON NEAL R;NANCY (626) 285-0441-TEMP 917802618 I I �
9914 BROADWAY ID�1 0 OF WORK Q
ELECTRICAL FOR KITCHEN REMODEL
(APPLICANT: TEL. NO:
WATSON (626) 836-8350-
1150 S. BALDWIN AVE 1 ISPECIAL CONDITIONS: 1
SIERRA MADRE 91024
I I I
CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE
WATSON CUSTOM CONSTRUCTION INC. (626) 836-8350-
1150 S. BALDWIN AVENUE LIC. NO TEMPORARY POWER POLE _
(SIERRA MADRE, CA 91024 388016 B
(UNDERGROUND CONDUIT I
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ARCHITECT OR ENGINEER: TEL. NO: IUFER GROUND
LIC. NO: (ROUGH CONDUIT
(ROUGH WIRING I
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
(UTILITY COMPANY NOTIFIEDI
VIII VIII I III II I
I I III II I I
III � i III
II II I I I II
I I I I
_ 1REPORT ID: DPR265 ROUTE TO: BS0508
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