HomeMy Public PortalAbout9933 BROADWAY_Electrical__ DEC
TION
WORKERS'that
I have
a certificate
cafe of corse X1 3 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT O
I r::;eby affirm shot I have a certificate of consent to sell Ce�eoeG
insure,'or a certificate of Workers' Compensation 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 oil
❑Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS i133 Q.
❑ OCALITYCertified copy is filed with the county building inspec- 1 8 2-Family, Sq. Ft. $ — $ QiyVl` J _
tion department. Multi-family Sq. Ft. 1 NEAREST 3u 1 G.�•)n
Residential Swimming Pools 'r+, '•� CROSS ST. S
Dote Applicant - OWNER OR J '
t •,,.. `: FIRM NAME A 2 4-(d OW
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec—Light_SW._ MAIL
COMPENSATION INSURANCE First 20 ADDRESS tcC
(This section nerd not be completed if work involved by Total No. Additional CITY'��, Tel. No. '�' h'
VtjS_
the permit is For one hundred dollars ($1$1 00) or less.) `- PLAN CHECK
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner hAPPLICANT
so as to become subject to the Worker 'Compensation Laws. Lig ting Fixtures First 20 ADDRESS
Additional
Total No. CITY Tel.
Date Applicant Ls- Fixed Appliances Not Over I HP
NOTICE TO APPLICANT: If, after making this Ce tiff.ote of PERMIT
PERMIT TION
Exemption, you should become subject to the orkers' Range— Heoter_O.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.
LICENSED CONTRACTORS DECLARATION Disp. _ Room Air Cond. — LICENSE OR Class.
I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER
(commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESS Y l-
and Professions Code,and my license is in full force and effect. /(`� d
Size 8 Type HP, KW, KVA, or KVAR t(/ Q O
License Number Lic. Class Up to 1 Incl. FINAL
Over 1 to 10 Incl. DATE VALID N rr
Contractor Date Over 10 to 50 Incl. FIN O
❑ 1 am exempt under Sec. Over 50 to 100 Inc.
B.BP.C. for this reason �� Over 100 CL
Ser ri ., MCC 8 Pa nelboards .1 /� Z
Dote. 0-200 Amp. Under 600 V (! //,, r'A�/\' —
Signature 201 - 1000 Amp. Under 600 V 2 0 3 5
❑ Exemption for Reg. Mainz. Elect.
Over 1000 Amp. or Over 600 V '#`e v
SINGLE FAMILY Tem Power Pole 8 A ( e,
HOME OWNER-BUILDER IDER DECLARATION P Appurtenances =
I hereby affirm-that I am exempt from the Contractor's License
Sign with One Branch Circuit - • *\s 5 5 p,0
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits
Professions Code): 8,05-88
EiI, as owner of the property, will do the work and the Misc. Conduits 8 Conductors
structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_
Business and Professions Code). �l
CONSTRUCTION LENDING AGENCY 2035 7 A
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.). 2
PLAN CHECKING FEE .I I�.s - 2S 5 O
Lender's Name
Lender's Address PERMIT ISSUING FEE (/ e • e 25 5.0,5
I certify that I have read this application and state that the TOTAL FEE SCS .o a O sa 8
above informmion 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
Signature of Permltt Date
COUNTY OF LOS ANGELES TEMPLE CITY k 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1010200071
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID. FEES PAIDBUILDING ADDRESS:
ITR: 13805 LT: 7 _ III 9933 BROADWAY
I IEEE DESCRIPTION:_. QUANTITY: COM: AMOUNT: TEMP CA 917802635
-y'
(ASSESSOR INFORMATION NUMBER: •- % %,�''`,• .� � , NEAREST CROSS STREET:_ BALDWIN
18588-015-007 1A1 PERMIT ISSUANCE FEE__ i 27.80,1 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl
I IGI,OUTLETS-LGT,SW,RECP 1.00 OUT t. 4,{1.-90• I�
(TENANT: iI JB-AC UNITS T"+3-lOHP--` -.r, 1.00 AC - 19.70 (ISSUED ON: PROCESSED BY: PLAN BY 1
TOTAL 'FEES 49.40I10/20/10 SR I
(OWNER: TEL. NO: - II FINAL DATE FINAL BY: CODE:
HSU, SHIH CHIEH (626) 286-7516-
9933 BROADWAY1',[DESCRIPTIONITEMP 917802635 [DESCRIPTION OF WORK 4
(ADD A/C UNIT
(APPLICANT: TEL. NO:
(DAN, SAN SITYONG (626) 821-0074-
12818 HOLLY AVE SPECLAL CONDITIONS:
1ARCADLA, CA 91007
ICO NTRACTOR: TEL. NO: 1 - APPROVALS DATE INSPECTOR SIGNATURE
IS D AIR CO]YDITIONING, INC. (626) 821-0074-
LIC. NO
12818 HOLLY AVE (TEMPORARY POWER POLE
II ARCADIA CA 91007 630471 C20 1
(UNDERGROUND CONDUIT I
ARCHITECT OR ENGINEER: TEL. NO: IUFER GROUND
I
LIC. NO:
I 1ROUGH CONDUIT 1 1
.I I (ROUGH WIRING
I
f\ - MAIN WATER LINE
PLASTIC YIN METAL YIN
UTILITY COMPANY NOTIFIED
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11 i .'. s-�,' � ;.�:..�,-_:_ -.;,.,�,, • ram_.II I I I
_ /.-e, - ••\\ IREPORT ID: DPR265 ROUTE TO: BS0508