HomeMy Public PortalAbout4941 CAMELLIA AVE_Electrical__ WORKERS COMPENSATION of°`ARAT.°" "663 °r61 APPLICATION FOR ELECTRICAL PERMIT
GE-6n6G
.Thereby affirm that I have a certificate of consent to self insure, .
or a certificate of WorkersCompensation insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec. 3800,Lab.C:)
Policy Na '% ' Company ' ' , FOR APPLICANT TO FILL IN !JOB.
Certified copy is hereby furnished
EACH NO.
FEE. ADDRESS 4941-CAMELLIA AVE T:C.. CA 9 780
.❑ ,. : . New Residential Bldgs.8 Pools
°'❑ 'Certified copy is filed"with"the county builtling•inspection 1 &'2-Family, Sq. Ft. S — S - LOCALITY - - -
department. - a REST
Multi-family Sq Ft. CROSS ST' LA'ROSA DRIVE •.
_ .. .'.
Date r ,'
Residential
tial Swimming Pools ApplicanOWNER OR'
FIRM NAME.
IRENEMAC
`CERTIFICATE OF EXEMPTION FROM,WORKERS - - Outlets'Roc'k Light Sw t - MAIL I�
COMPENSATION INSURANCE,, „ ./O. xADDRESS SAME
Inis'section need not be completed if the work involved by the {r First 20
•.permit.is,for one hundred dollars($100) or,less:) Total No. V ',Additional' `CITY. _ Tel Na
d certify thst MA he performance of the work mi which•this permit .. ,,,;, PLAN CHECK _
is,issued, I-shall,not employ,,any. person in.any.manner so as to AFPUCANT,.
become subject to the Workers'Compensation Laws., Lighting Fixtures First 20' - ADDRESS. '
`' C' r• Additional
; r
+ - Total No. . Y CITY ,. - Tel No
Date- Applicant -Fixed Appliances Not Over 1 HP r
NOTICE'TO APPLICANT If, •after making'lathis Certificate of PERMIT -
Range— Heater_ D.W, APPLICANT' IRENE T. 'MAC
Exemption,you should became subject to the Workers;Compensation 9 . .,r ...
provisions of the LaborCode,.you must forthwith comply with such Oven _-Dryer _ W.M. _ ADDRESS' 4941 .CAMELLIA AVE.
provisions or this permitshall.be-deemed revoked. _ Top _FAU W.H,_•- .. i _ -
LICENSED CONTRACTORS DECLARATION. . - Hood Fan Other_ CITY'."` TEMPLE CITY . •Tel No. $18)448 2509
I hereby affirm that l am licens6d under provisions:of Chapter 9d.- _ LICENSE OR
(commericing with Section 7000)of Division 3 ot,the Business and Diso _ Room Air'Con ':Class' -
_ REG.NUMBER
- Professions Code,and my license iI full force,.and=effect DISTRICT NO� - P ESSED BY'
. _ Power Apparatus& Large Appliances .. --� p w- _
- Size& Type HP KW KVA,.or KVAR a p
License Number. Lic.Class Up to 1 Incl. FINAL
.._, -' ^+ •' ' ; Over 1 to 10 Incl-, 0.'
DATE //
S b - -. VALIDATION. _ O
Contractor � Date _ Over 10 to 50 Incl � � FINAL W r L
U
❑ , am exempt,under-Sea r . . .Over 50 to 100 Inc. BY _d
.8.&P.C, for this reason Over 100 .-
N
,. - •.. '_. - ._. , . .. - - Servicees, 200 Amp.C&_Pa600 V rd's' ,... - - _ - . . ._ e_. _ Z .
Data: -
Signature - ' 201 1000 Amp. Under 600 V - '., • •1 ,... _ , .. - .
.. _ . .._-
❑ ,
Over 1000 Amp.,or Over.600 V '• - ._ ,._ _ - _- .
Exemption for'Reg.Maint.Elect. "' - • - - -
SINGLE FAMILY " Temp-Power Pole& Appurtenances . , _ ' ,'` - _
HOMEOWNER-BUILDER DECLARATION .Sign with One Branch Circuit ' a
I hereby affirm that I am exempt from the Contractors License Law, ACCT •
for-the following reason(Section 7031.5, Business and Professions' ''Additional Sign Branch Circuits•. - - - - -
Cnd ): 3303 41.30.
I as owner of the property;will do the workland the Structure. Mica &Conduits Conductors - - - " '
is not intended or offered for sale (Section 7044,.-Business Other (See Complete Fee Schcdule)
and Professions-0ode).; _ •'' ' '.' TOTAL
1 ITEMS ' -
D . '. .1 ®3O
•. a, �yK•r.Vx '41.30
CONSTRUCTION LENDING AGENCY - • . _ , '•
I hereby-affirm that there is•a'construction'lending,agency for the - - CHANGE 00.
' performance of the work for which thispermit is issued(Sec.3097 - PERMIT FEE (Sub-Total)"
Civ.C.). �' .. .. -
PlANCHECKING'FEE ' - - -• -0000'0001 . 7/26/95.
Lender's Name • `
.} •. .. . PERMIT ISSUING FEE,-. ... ..-_. ._ .. x .,r 1,-'PM+5:[3
Lenders Address X1575
J certify that J have read this.application and state'that the above. TOTAL FEE
information is correct. I agree 4o comply with all County ordinances
Lani..laws re Mating Electrical wiring, and hereby authorizetive f is County io enter upom the above-mentionedoci eci purposesSEE'REVERSE FOR EXPLANATORY LANGUAGEof r e ate .
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0302280025
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
GAL ID: FEES PAID BUILDTNG ADDRESS:
TR: 14467 LT: 36 4941 CAMELLIA AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803864
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA
8589-014-023 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY
Gl OUTLETS-LGT,SW,RECP 22.00 OUT 41.70
TENANT: G2 LIGHTING FIXTURES 8.00 LGT 15.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
TOTAL FEES 85.05 02/28/03 JK 08/27/03
OWNER: TEL. NO: FINAL D El FINAL BY: CODE:
MAC IRENE T (626) 475-9631-
4941 CAMELLIA AV
TEMP 917803864 DES IP ION OF WORK
ELECTR CAL FOR CONVERSION & GARAGE
APPLICANT: TEL. NO:
ELITE DESIGN INC (KAMEN) (626) 288-2651-
8748 VALLEY BLVD #K SPECIAL CONDITIONS:
ROSEMEAD 91770
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
OSMOND CONSTRUCTION AND DEVELOPME (621) 451-0699-
1108 S. CALIFORNIA ST. LIC. NO TEMPORARY POWER POLE
SAN GABRIEL, CA 91776 7913698
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: EL. NO: UFER GROUND
LEE, PETER (626) 280-9000-
8748 VALLEY BLVD., #L LIC. NO: ROUGH CONDUIT
ROSEMEAD, CA 91770 3948
ROUGH WIRING
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
REPORT ID: DPR265 ROUTE TO: BS0508
• COUNTY OF LOS ANGELES TEMPLE CITY # 0508 .ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 9910050006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 14467 LT: 36 4941 CAMECCIA AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803864
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: SPARKLETT
8589-014-023 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY, C
G1 OUTLETS-LGT,SW,RECP 48.00 OUT 76.80
TENANT: G2 LIGHTING FIXTURES 12.00 LGT 23.40 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
HA FAU LESS 3HP 1.00 FAU 10.95 10/05/99 UT 04/02/00
H7 RES EXHAUST FANS 2.00 EX 21.90
OWNER: TEL. N0: B AC UNITS , P 1.00 AC 19.65 FINAL DATE FINA BY n CODE:
L
MAC IRENE T (626) 285-6659- LB 200 AMP PANELS, MCC 1.00 PAN 38.85 ./<-i„�\
4941 CAMELLIA AV TOTAL FEES 219.30 C
TEMP 917803864 DESCRIPTION OF WORK
ELECTRICAL FOR ADDITION, NEW HEATING AND COOLING SYSTEM
AND SERVICE PANEL (200 AMP)
APPLICANT: TEL. NO:
MAC (626) 285-6659-
SPECIAL CONDITIONS:
PNGELES CO
CONTRACTOR: TEL. N0: SGS ���,y APPROVALS DATE INSPECTOR SIGNATURE
MAC, IRENE (626) 448-2609-
4941 CAMELLIA AVE. LIC. NO TEMPORARY POWER POLE
TEMPLE CITY, CA 91780 NONE
/ UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL NO: ( UFER GROUND
KAO, PEN (626) 839-938
2321 FALLEN DR. LIC. NO: 1111711 ROUGH CONDUIT
ROWLAND HEIGHTS, CA 91748 NONE
ROUGH WIRING
G�(I (I D n �C n (\ /JOR()/J MAIN WATER L[NE
U ILIA 11V1/\L11// IIJK\1 PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
0
O 0 TIT
A 0 C,
✓✓b/7c Serviicce'fha��o`
REPORT ID: DPR265 ROUTE TO: BS0508