HomeMy Public PortalAbout9147 EMPEROR AVE_Electrical__ TEMPLE CITY
r6A663-CE00610-61 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING - //�
BUILDING AND SAFETY DIVISION ADDRESS /7
JOHN A. LAMBIE, COUNTY ENGINEER r
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
1 T E M NO. EACH FEE PI
OUTLETS: (FIRST 20) $20 $ OWNER t�
LIGHTS RECEPT. SW. ' MAIL r
OUTLETS: (ADD'L UNITS) 10 ADDRESS <G
LIGHTS RECEPT. SW.
LIGHTING FIXTURES: (FIRST 20) .20 CITY TEL. NO.
LIGHTING FIXTURES: (ADDITIONAL) .10 ELECTRICIAN
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS
GARB.DISP. STA.COOK
CITY TEL. NO.
DISHWASH. AUTO.-WASH. STATE
SPACE HTRS. STA.APP.(%H.P.MAX.) .50
LICENSE NO.
MOTORS: OVER NOT OVER H.P. DISTRICT 140. GROUP ZONE P ESSED BY
O 1 1.00
1 3 1.so INSPECTION RECORD }
a
3 8 2.00 O
U
S 15 2.50
w
15 50 3.00 0
50 100 5.00
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
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS /l DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR r
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE B
DESCRIBED RESIDENTIAL PROPERTr
OF PERMITTEE `Y�.. POWER
SIGNATURE WC/ �'�1-- i UTILITY CO.NOTIFIED
FINAL
VALIDATIARTHUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
,LACOO 85 8QI .UN27 2 0 3.00^' 1
DE39�+SA p255M�BRyTB�7�-447 �q ��g g�g�� ®�� �v e� MP CATIO v FOR
PERwr
DEPARTMENT 3L ®Y` BGJ IlY.,�€LDYLiVG AND w�(�,T5'�11 �IIj'� �t'� ��
COUNTY OF LOS ANGF�FS,
WM. J. FOX, CHIEF EN INFER -. I
df' ` DISTR)I'NO. GROUP ZQNE PERMIT NO.
NAME
aADDRESS
�1 REC IVED BY READY FOR DATE ISSUED
CITY TEL.NO. 7 z+ O�
1,
FIRST INSPECTION
WCOUNTY
CERT.N EXPIRES
APPLICANT FILL IN HEAVILY OUTLINED POR'T'ION ONLY
JOB
HDESCIRIPTION OF WORK ADDRESS
'TA �-��i.✓ /,� .�-�."�-/-':h 716
[NUMBER OF OUTLETS ON CIRCUITSV
LOCALITY �/}.tet
LOCATION BY ROOMS NEAREST
LIGHT OUTLETS JSW. PLUGS FIXT CROSS S
CIRCUIT A B C D E F IG H K I NAME
,�. Z MAIL r IDES �ADDRE YACITYITEL NO. /�'OSANG&L= COUNTtCERTIFICATE OF QUALIELEiAMTH%"GAi.OWNEROFTHEPROPERTEDABOVE
�'+rg�
CORRECTIONS
IONS
LY
J
Q
_Z
[7
D
TOTAL
NO:OF OUTLETS $ PP ®VAL
r
NO. OF FIXTURES $ DATE INSPECTOR'S NAAP.E
NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. • $ WIRING
NO. OF RANGES OR HEATERS $ FIXTURES f I
MISCELLANEOUS $ POWER ! j
PERMIT FEE $ ( / ,_UTILITYCO.NOTIFIED 1t s+ I
TOTAL FEE p`S� FINAL
WORKERS;COMPENSATION DECLARATION 76A663 10/81
I t►eceby af(tn4hat I�have a certificate of consent to self insure, CE-806G APPLICATION FOR ELECTRICAL PERMIT
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. Company FOR APPLICANT TO FILL IN - JOB
❑ Certified copy is herebyfurnished. EACH NO. FEE ADDRESS��
New Residential Bldgs.& Pools
❑ 1 & 2-Family,Sq.Ft. $ — $ LOCALITY
Certified copy is filed with the county building inspection
department., Multi-family Sq.Ft. — NEAREST
CROSS ST.
Date Applicant Residential Swimming-Pools OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION'FROM.WORKERS' � �_ MAIL
Outlets:Rec— Light Sw.
COMPENSATION INSURANCE ADDRESS���
(This section need not be completed if the work involved by the First 20
permit is for one hundred dollars ($100)or less.) Total No." Additional CITY el.No.
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 so as to APPLICANT
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Additional
• Total No. CITY Tel.
Date— Applican Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT
Exemption,you should become•subject to the Workers'Compensation Range_ Heater_ D.W.
provisions of the Labor.Code, you must forthwith comply with such Oven Dryer —,W.M._ ADDRESS wo`'
provisions or this permit.shall be deemed revoked. Top FAU _ W.H. —
LICENSED CONTRACTORS DECLARATION Hood Fan Other_ CIT Tel.
I hereby, affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. LICENSE OR
REG.NUMBER�j
(commencing with Section 7000) of Division 3 of the Business and Cias�
Professions Code,and my license is in full force and effect. DISTRICT NO. PROCESSED
Power Apparatus& Large Appliances
Size & Type HP,KW, KVA, or KVARcV U �-
License Number Lic.Class Up to 1 Incl. FINAL {
Contractor Date Over 1 to 10 Incl. DATFJ� _ �� VALIDA N
❑ Over 10 to 50 Incl. FINA// 0
I am exempt under Sec. Over 50 to 100 Inc. BY W
B.&P.C.for this reason Over 100A", d
Service d.,MCC &Panelboards r- N
Date: 20 mp.Under 600 V �Z°
Signature 201 - 1000 Amp.Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole & Appurtenances 9 7[I,8 p
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits # 0 0 0 0 0 1
for the following reason(Section 7031.5, Business and Professions
Code): 1o 4 5 7 5
❑ Misc.Conduits&Conductors
I,as owner of the property,will do the work and the structure
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ , o o 0 4 5,7 5.5S
and Professions Code).
0601 ,-.88
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(Sec.3097, PERMIT FEE (Sub-Total)
Civ.C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address �-�^
I certifythat 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 Zfe
tion oses. .
�� SEE REVERSE FOR EXPLANATORY LANGUAGE
Signaturettee Date
� COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1205240039
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAID BUILDING ADDRESS: 1
ITR: 11990 LT: 10 I 1 9147 EMPEROR AV 1
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 SGAB CA 917752018 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1
15382-012-031 1A1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: H1 LOCALITY: TEMPLE CITY, Cl
1G1 OUTLETS-LGT,SW,RECP 5.00 OUT 10.00 1
(TENANT: IG2 LIGHTING FIXTURES 4.00 LGT 8.00 (ISSUED ON: PROCESSED BY: PLAN BY: 1
1 1H2 RES GRBG DISP LT 3HP 1.00 DIS 11.00 105/24/12 SR
1 IH3 RES DISHWASHR LT 3HP 1.00 DIS 11.00 1
1OWNER: TEL. NO: 1H4 RES RANGE RDS LT 3HP 1.00 HOO 11.00 IFINAL DATE FINAL BY: CODE: 1
ICHEN, STEVEN - TOTAL FEES 78.80 1 I
19147 EMPEROR AV I I I
SGAB 917752018 I IDESCRIPTION OF WORK 1
1 IKITCHEN REMODEL 5 OUTLETS, 4 LIGHT FIXTURES, GARBAGE DISPOSAI
IIL, DISHWASHER AND RANGE HOOD 1
(APPLICANT: TEL. N0: I G��t I
I
1WU, JACK (626) 523-5819- 1 �� I1650 W. HUNTINGTON AV 1 (SPECIAL CONDITIONS:
IARCADIA CA 91007 gRED
CONTRACTOR: TEL. NO: ' APPROVALS DATE INSPECTOR SIGNATURE
1 I I I
(PACIFIC STONEGATE INC. (626) 523-5819- 1 1-
1650 W. HUNTINGTON DRIVE #206 LIC. NO 1 ITEMPORARY POWER POLE I I
1ARCADIA, CA 91007 965340 B I I I
1 (UNDERGROUND CONDUIT II I
(ARCHITECT OR ENGINEER: TEL. NO: 1 1UFER GROUND I I I
1 LIC. NO: I IROUGH CONDUIT I I
I IROUGH WIRING �I_
1 142
IMAIN WATER LINE II I
1 i IPLASTIC YIN METAL YIN I I I
(UTILITY COMPANY NOTIFIED( I I
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1 IREPORT ID: DPR265 ROi7TE TO: BS0508 1 I I I
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