HomeMy Public PortalAbout10778 DAINESWOOD DR_Electrical__ COUNTY OF LOS ANGELES - TEMPLE CITY H 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0906020034
BUILDING AND SAFETY-/ LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 13613 LT: 110 10778 DANESWOOD DR
FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917802922 -
ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET:
18573-008-009 1A1 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE. 597 GRID: C3 LOCALITY: TEMPLE CITY, C
G1 OUTLETS-LGT,SW,RECP 2.00 OUT 3.90 - I
1 TENANT: TOTAL FEES 31.65 JISSUED ON: PROCESSED BY: PLAN BY: . EXPIRES ON:
106/03/09 SR 11/30/09
OWNER: -TEL. NO: 1
FINAL DATZ FINAL BY: CODE:
IDESHON, ERIC & BRENDA - lr �-�M �.
10778 DAINESWOOD DR I /n .
TEMP 917802922 •� 13ESCRIPTII N OF WORK
. INSTALL 2 NEW ELECTRICAL RECEPTICALS FOR CHRISTMAS LIGHTS
1 APPLICANT: TEL. NO:
MATT (626) 716-0269-
11661 FIRST ST. - (SPECIAL CONDITIONS:
�DUARTE, CA 91010
(CONTRACTOR: TEL. NO: - � APPROVALS � DATE INSPECTOR SIGNATURE 111
1NELSON ADD COMPANY (626) 716-0269- _
1661 FIRST STREET LIC. NO _ TEMPORARY POWER POLE
DUARTE, CA 91010 638056 B
UNDERGROUND CONDUIT - -
ARCHITECT OR ENGINEER: TEL. NO: IUFER GROUND
LIC. NO: IROUGH CONDUIT
1 1 IROUGH WIRING I -
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED(
1 1
REPORT ID: DPR265 ROUTE TO: DS0508
` COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT, OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0601100005 -
BUILDING AND SAFETY'/ LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESSi _
TR: 13613 LT: 110 10778 DANESWOOD DR
FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917802922
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: PARMERTON
8573-008-009 Al PERMIT ISSUANCE FEE - 27.75 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY, C
G1 OUTLETS-LGT,SW,RECP - B.00 OUT 15.60
TENANT: G2 LIGHTING FIXTURES 2.00 LGT 3.90 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
TOTAL FEES 47.25 01/10/06 JK 07/09/06
OWNER: TEL. NO: - FINAL DATE FINAL BY: CODE:
DESHON, ERIC A (661) 510-0918- _
10778 DAINESWOOD DR �/�
TEMP 917802922 DES- PTION OF WORK
ADD 8 OUTLETS, 2 LIGHT FIXTURES
APPLICANT: TEL. NO:
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. NO: UFER GROUND
LIC. NO: ROUGH CONDUIT
ROUGH WIRING
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
REPORT ID: DPR265 ROUTE TO: BS0508
WORKERS'COMPENSATIONDECLARATION 76A663*
6A66 CE-806 ',G (280) APPLICATION FOR ELECTRICAL PERMIT
, IJ1 hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec.3800, Lab. C.)
FOR APPLICANT TO FILL IN JOB
Policy No. Company New Residential Bldgs.&Pools EACH NO. FEE ADDRESS
Certified copy is hereby furnished. 1 &2-FamilySci. Ft. S — $ LOCALITY Fe4
❑ — ES
Certified copy E Multi-family Sq. Ft. NEAR
filed with the county building inspection CROSS STT
department. Residential Swimming Pools OWNER OR n
FIRM NAME Sv a
Date Applicant Outlets: Rec•Zight_ Sw. ADAl L
DRESS
First 20
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional
COMPENSATION
COMPENSATION INSURANCE CITY Tel No.
PLAN CHEC }
APPLICANT IL
(This section need not be completed if the work involved O
U
by the permLighting Fixtures First 20
it is one hundred dollars-($100) or less.) ADDRESS
Additional
Total Nc
I certify that in the performance of the work for which this CITY Tei No. 0
Fixed Appliances Not Over 1 HP
permit is issued, I shall not employ any person n any manner - PERMIT Q/ V
so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT V G.lt L A W
//� p Oven _ Dryer _W.M. ADDRESS
Date ` Applicant 'G
•�iJ/� IdNu,-(�./ Top _ FAU _W.H.
Hood _ Fan _Other_ CITY J� R Tel No.
NOTICE TO APPLICANT: If, after making this Cdrtificate of Dista. _ Room Air Cond.— LICENSE OR �rp
Exemption, you should become subject to the Workers' REG.NUMBER .7 SrrPP '/'Class - ^l
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. P E SED BY
with comply with such provisions or this permit shall be
deemed revoked. Size&Type HP,KW,KVA,or KVAR �j v Q s
' Up to 1 Incl. v �f
FINAL
Over 1 to 10 Incl. DATE
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. VALIDATIO
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
9 (commencing with Section 7000) of Division 3 of the Busi. Over 100 BY /. .
ness and Professions.Code, and my license is in full force and.
effect. Services
License Number -S•S,GY Lic.Class ��� �dQ'200 Amp. Under 600 V .
pp 201-1000 Amp. Under 600 V - -
Contractor e3Jr&,1,WX A- Date� .-2�dA7 Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances
'
I hereby affirm that I am exempt from the Contractus'- Sign with One Branch CircuitAdditional Sign Branch Circuits
License Law for the following reason (Section 7031.5, Busi- •
ness and Professions Code):
Misc.Conduits& Conductors
1, as owner of the property. will do the work and the Other (See Complete Fee Schedule)—
structure is not intended or offered fur sale (Section
7044, Business and Professions Code). -
CONSTRUCTION LENDING AGENCY1 9 3 2 A '
I hereby affirm that there is a construction lending agency '
for the performance df the work for which this permit is PERMIT FEE (Sub-Total) #;e a e`o e '2
issued (Sec. 3097.Ci,C.).
Lender's Name PLAN CHECKING FEE Ione-Fourth Permit Fee) 2.0 0 2 O.5 O
Lender's Address PERMIT ISSUING FEE io e e2.Q 5 O
I certify that 1 have read this application and state that the TOTAL.FEE O x218-80
above information is correct.I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and '
hereby pryhorize representatf this County to enter upon
thea 6v 'm1ernC�rt d p Cyfor insp tion purposes. SEE`REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date