HomeMy Public PortalAbout10526 DAINES DR_Electrical__ 7BA66r APPLICATION 7■
9
DBS•SA 3 53 FOR ELECTRIC PERMIT
DIVISION OF BUILDING AND SAFETY
Department of County Engineer GEREMEMMIMM
County of Los Angeles BUILDING �®���
WM.J FOX, COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN.SUPT OF BUILDING
WMM�jjLOCALITY A i
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES cRoss sr 1
NUMBER EACH FEE
OWNER
LIGHT OUTLETS
RECEPTACLES MAIL
,0I ADDRESS
WALL SWITCHES �7� -4 �*P
TOTAL OUTLETS }/J 5¢ $ If—I, CITY iI T91- 116r/
ELEC RANGES o—p -25 — ELECTRICI
_ELEC HEATERS 17 125 U ADDRESS A . /+�U/L�� 7 +G �f�y
KW EA SAI CITY O�YTT ` _i TEL NO
FIXTURES lR 5 � LICENSE NO
NUMBER OF LIGHT CIRCUITS - DISTRICT NO. I GROUP I O I I READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS
MOTORS
NUMBER HORSEPOWERFEE INSPECTION RECORD
NEW MVD HP OVER I INC EACH
V2&LESS $ 25
1/2 2 50
2 5 100
5 15 150
15 50 250
50 200 5 00
MISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING $1 00 v
FIXTURES $100
SUPPLEMENTARY 50 APPROVALS
TOTAL FEE S ® DATE INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICA ION CONDUIT
ANSTATE THAT THE ABOVE IS CORRECT AND AGREE TO C
D OMPLY WIRING %lam? SFJ'
WITH ALL COUNTY ORDIN dJCES AND STATE LAWS REGULATING
ELECTRICAL WIRING ,'
I HEREBY CERTIFY 1 AM PROPERLY REGISTERED�AND/OR FIXTURES
I HEREBY CERTIFYLICENSED AS REOUI D BY LOS ANGELES COUNTY AND/STATE OF
CALIFORNIA OR TH AM THE' LEGA-1� OWNER OF TH ABOVE POWER
DESCRIBED RESIDENT PROPER ����` /
SIGNATURE UTILITY CO NOTIFIED
OF PERMITTEE FINAL
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION A. C.VEIT,CHIEF ELECT. INSPECTOR
LIAL108865 AN 5 2 5.90 � o
t ' WORKERS'COMPENSATION DECLARATION - 76A663 10/81 APPLICATIONFOR, ELECTRICAL 'PERII�IT
CE-806G
I hereby affirm that I have a certificate of consent to self insure, -- - • •
or a certificate of Workers' Cc Insurance, or a certified COUNTY OF L''OS ANGELES' , , BUILDING AND SAFETY
co,�e-of(Sec 3800,Lab C) r a.
w
t, FOR APPLICANT TO FILL IN h - - -. JOB ` }
Fy Company �� y r- ADDRESS
❑
Certfied copy is hereby furnished ,+ , New Residential Bldgs & Pools .; EACH NO .? FEE ,
1 & 2-Famd S Ft'
�41g — $• LOCALITY
Certified copy is.filed"with the'county building inspection i y' q a -q•• +NEAREST' •- - 'a+
de�nt, �•, Multi-family Sq Ft% CROSS ST'A hcant h 'Residential Swimming PoolsiOWNER ORr �' r,PP, t r J s, FIRM NAME f« >,t f� i. . r,
CERTIFICATE OF•EXEMPTION f ROM WORKERS' '• 1 1 J MAIL .r
ne+` Outlets Rec— Light _'Sw a `
COMPENSATION INSURANCE _1 a 0 ADDRESS
(This section need not be completed if the work involved by the First 20 7 ,`4
permit is for one hundred dollars($100)or less) Total No AdditionalPLA
CITY Tel No X
I,certify that in thetperformance of the work for which this,permit ` ,'� •APPLICANT CHECK-'
s,issued, I shall not employ any person in any:' nanner so as'to y - a
• become subject to the Workers"Compensation`Laws Lighting.Fixtures First 20 ADDRESS
Additiorial,
t+ Total No _ CITY s Tel No
Date App licant r
NOTICE,TO APPLICANT If, after making=this Certificate of Fixe1.d Appliances Not Over 1 Hf? PERMIT
Exemption„you should become subject to the Workers'„Compensation Range_IHeater_ DW APPLICANT / .rS
provisions of,the`Labor Code, you must forthwith comply With'such �+ Oven Dryer W, ADDRESS'
provisions or this permit shall be deemed,revoked To FAU WH W.
LICENSED CONTRACTORS DECLARATION`"v p CITY �- Tel 'No ?:
;Hood Fan Other_ %I17 � /n 'i
I 'hereby affirm,that I am`licensed under provisions of-Chapter,9 i66(J (� LICENSE OR
(commencing with Section 7000) of Division 3 of the Business and Disp —.Room'Air_Cond Class
REG NUMBER .,
Professions Code'and my license is in full force and effect DISTRICT NO 'PROCESS BY
;Power Apparatus& Large Appliances
'Size& Type HP,KW,KVA,or KVAR
License Number -
Lic Class � Up to 1 Incl` FINAL_ _ • U '-
Over'1 to 10 Incl i w DATE O -
Contractor <- „ VALIDATION
❑ Over 10 to 50 Incl «a FINAL ' V
I am exempt under Sec Over 50 to 100 Inc gYV144N W+
B&P C for this reason " Over 100 N
i
Services,Swbd;MCC& Panelboards > , Z
Date 0- 200 Amp Under 600 V
Signature - -,,201,- 1000 Amp,Under 600 V'-
Over
'Over 1000-Amp or Over 600 V r `,
Ekemption for Reg Maint Elect
_
' SINGLE FAMILY +` Temp Power Pole& Appurtenances,
HOME OWNER-BUILDER'DECLARATION Sign with One Branch Circuit - '*A”
I'hereby*affirm that I-am exempt from the,Contractor's License Law r „ f'•CU.v
for,the following reason (Section,7031 5, Business and Professions 'Additional Sign Branch Circuits
Code) j�« +a i3d7 a4.. S4.7I
Miec'Condwts &=Conductors �T� °
U I,"as owner of the property,will'do,the work and the structure a
is not intended"or offered for,°sale (Section 7044, Business Other (See Complete Fee,Schedule) _
and Professions., " ; _I. • x s• ® , .�f_ITAL,
)
CONSTROCTION LENDING AGENCY - e-. CHECK
l,hereby affirm'that there is a construction,l ending agency.for`the' l ryi ANISE t' j(�e _
performance of the work for which this permit is issued(Sec 3097, _ PERMIT FEE N ;(Sub-Total).•. f. `
Civ C) t
r PLAN-CHECKING FEE
: , tt "Lender's Name. 00c - 7 �,
PERMIT ISSUING FEE X, `
Lender's Address - .'_•442 r i AMID`
r
' I 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 3 ;1
r o'
•:arepresentatives of this unty to enter upon the above-mentioned
pro r for inspectio rposes
a ,,SEE REVERSE FOR EXPLANATORY,LANGUAGE ,
Sognature of Permittee - Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0401020008
,BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: S PAID BUILDING ADDRESS:
TR: 7690 LT: 13 UN: .002 10526 DAINES DR
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802812
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: HALIFAX
8586-029-019 - Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C3 _ LOCALITY: TEMPLE CITY
G1 OUTLETS-LGT,SW,RECP 16:00 OUT 31.20
TENANT: G2 LIGHTING FIXTURES 8.00 LGT 15.60 U D 0 L ON:
TOTAL FEES 74.55 01/02/04 VG 06/30/04
OWNER: TEL. NO: FI�a DATE FINAL B COD :
GARIBAY ROBERTO S (626) 452-8729- n�
10526 DAINES DR /`4-.p
TEMP 917802812 �E-RPPPT ONQRK
INSTALL ADDITIONA OUTLETS AND FIXTURES
APPLICANT: E 0:
SAME AS OWNER
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: , APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO TEMPORARY POWER POLE
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. 0: UFER GROUND
LIC. NO: ROUGH CONDUIT
ROUGH RING
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANYNOTIFIED
REPORT ID: DPR265 ROUTE TO: BS0508