HomeMy Public PortalAbout5702 ENCINITA AVE_Electrical__ WOthat I haveCOMPENSATIONcertificate
DECLARATION 7bAC63 DPW(t2-91) APPLICATION FOR ELECTRICAL PERMIT
6-963.
I hereby affirm that I have a certificate of consent to self insure,
.or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec. 3800 La/bb C.) 'A
Policy No/;n!�!5#—" Company ✓��TL+ I u/N✓ FOR APPLICANT TO FILL IN ADDRESS �7 ��'L —'W��J�J/xY ��
Certified copy is hereby furnished. New Residential Bldgs.&Pools NO.5EACH FEE LOCALITY
1&2-Family,Sq.Ft. S
❑ Certified copy is filed with the county builtling inspection NEAREST
d pariment. Multidamily Sq.Ft. CROSS ST. �r dDate �L�—Applicant ��� //6 Residential Swimming Pools ASSESSOR
MAP BOON PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rea. /A Light 3 Sw. OWNEROR F•—
COMPENSATION INSURANCE 0 FIRM NAME %� AS Uq
Flret 20 MAIL(This section need not be completed if the work involved by the Total No.1S Additional ADDSE6S 70z fia/C//`J/T/�
permit Is for one hundred dollars($100)or less.)
I certify that in the performance of the work for which this permit CITY!-yry JI C77 TBI.No.
is issued, I shall not employ any person in any manner so as to _ PLAN CHECK
become subject to the Workers' Compensation Laws. Lighting Fixtures a First 20 APPLICANT
Total No. S Additional Q
ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITY Tal.No.
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
IT
provisions of the Labor Code, you must forthwith Comply with such APPLICANT % 1 �/.//Ju$ L,@/L 6
provisions or this permit shall be deemed revoked. Power Apparatus 8 Large Appliances
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESSo'Z[.Ss J•=•GL C`79 6 ,4 5
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Ind. 3
(commencing with Section 7000) of Division 3 of the Business and CITY np ,/T�K<.. Tal.No
Professions Code, and my license is in full force and effect. Over 10 to 50 Incl.
Over 50 to 100 Incl. LICEREGNSE NUMBER .5"7, a J 5 class. �j,,) T
/A� ) a
Over 100 DISTRICT NO
License Number -� �/��/ Lic.Class . PROCESSE 0
Services,Swbd.,MCC&Panelboards l.•
��/14Di/ G TC([>C✓ —�— 0-399 Amp.Under 600 V FINAL
Contractor/� Date DATE
❑ 400-1000 Amp.Under 600 V6 VALIDATION
~
I am exempt under Sec. �I ., V
Over 1000 Amp.or Over 600 V FINAL 0 W
BAP.C.for this reason BRANCH CIRCUIT FEES BY U)
Date: 15A,or 20A, 120V,Lighting or Recept Z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
❑ 41 Or More Branch Circuits a
Exemption for Reg.Maint.Elect. 15A,20A,208V To 2T7V Lighting Br.Circuits ACCT•4
SINGLE FAMILY Temp.Power Pole&Appurtenances 3303 84'30
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 1 ITEMS IS
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits TIITAL e 30
Code):
❑ h as owner of the property,will do the work and the structure Misc.Conduits&Conductors CHECK 84.30
is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule)_ D CHANGE .00
and Professions Code).
CONSTRUCTION LENDING AGENCY nfln
I hereby affirm that there is a construction lending agency for theL+ 0000'0001 4/ 5/96
7
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) J
06 57?3 1 AM 4:31
Civ.C.)
PLAN CHECKING FEE
Lender's Name �f
PERMIT ISSUING FEE
Lender's Address Zw
I certify that I have read this applicatio end under penalty of purjury state TOTAL FEE 36
that the above information is orreI ar a to comply with all County
ordinances an Stat WgulnXis'log1pall wiring,and hereby authorize
represent of is n the above-mentioned property
ech pu os SEE REVERSE FOR EXPLANATORY LANGUAGE
TUREO PERMITTE GATE
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9609260024
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 6561 LT: 66 BL: .001 5702 ENCINITA AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802417
ASSESSOR INFORMATIO NUHBER: NEAREST CROSS STREET: LIVE OAK
8587-003-024 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY
LA 100 AMP PANELS, MCC 1.00 PAN 38.85
TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIR ,ON;
09/26/96 TC 09/26/97
/
OWNER: TEL. NO: FINAL DATE I FINAL BY: /) (-�/ CODE:
SUN PETER C;DOROTHY J -
TEMP 917800032 DESCRIPTION OF WORK
UPGRADE ELECTRICAL SERVICE TO 100 ALV
APPLICANT: TEL. NO:
T. 1. INDUSTRIES (213) 724-9366-
r9 SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
T. I. INDUSTRIES (213) 724-9366-
268 E GLEASON ST LIC. NO :Fn J ✓ TEMPORARY POWER POLE
MONTEREY PARK, CA 91755 572215/6-14
v,
�� V
UNDERGROUND CONDUIT
ARCHITECT-OR ENGINEER: TEL. N0: �_S �� fP-�I�. ""' � � �� �'� UFER GROUND
LIC. NO: � �� i ����. ROUGH CONDUIT
J_ ��. � �� -�� ROUGH WIRING
MAIN WATER LINE
- PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
f" S
II1l���y
REPORT ID: DPR265 ROUTE TO: BS0508