HomeMy Public PortalAbout5805 1/2 ENCINITA AVE_Electrical__ COUNTY OF LOS ANGELES TEMPLE CITY 4 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1102080026
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91760
PHONE: (626) 285-0488 EXT:
(LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 46828 LT: 1 UN: 5 I 5805 1/2 ENCINITA AV
I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ( TEMP CA 910802457 I
(ASSESSOR INFORMATION NUMBER I I . NEAREST CROSS STREET: LAS TUNAS T
15387-017-056 IA1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl
I IG2 LIGHTING FIXTURES 8.00 LOT 15.50 1
(TENANT: I TOTAL FEES 43.30 (ISSUED ON: PROCESSED BY: PLAN BY:
102/08/11 SR
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TOWNER: TEL. NO: I IFIN TE FINAL BY: CODE:
SAWADA, ATSUKO (626) 292-7117- i
15805 1/2 ENCINITA AV ✓
ITEMP 917802457 1 IDESCRI TION bF WORK 1
I ICHANCE EIGHT RESSES LIGHTS
1APPLI CANT: TEL. N0: I I I
IYUKI YOSHI (818) 789-1903- T
13418 VISTA HAVEN RD 1 ISPECIAL CONDITIONS: 1
SHERMAN OAKS 91403
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1CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATORE 1
T ABE CONTRACTORS INC. (818) 789-1903- 1
13418 VISTA HAVEN RD. LIC. NO TTEMPGFAR Y POWER POLE .
SHERMAN OAKS, CA 91403 701656/3
(UNDERGROUND CONDUIT
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1ARCHITECT OR ENGINEER: TEL. NO: I 1UFER GROUND I I I
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ROUGH WIRING
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PLASTIC YIN METAL YIN
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REPORT ID: DPR265 ROUTE T0: 050508 I I
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.WOthht I have
a certificate
SATION DECLARATION 20-0019DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT ll
I hereby affirm that I have a certificate Of consent to Sell insure, 76A663
or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy therem,(Sec..3800 Lab. C.) ,
Policy N0. Company FOR APPLICANT TO FILL IN JOB
ADDRESS 7C Kl A 4�,
Certified copy Is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY
❑ 1 &2-Family,Sq. Ft. _/�/ — $ ' $
Certified copy is filed with the county building inspection _ NEAREST
department. _ Multi-family Sq.FL CROSS ST.
Date " Applicant
Residential Swimming Pools ASSESSOR,MAPBOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNEROR c
COMPENSATION INSURANCE Outlets:Rea—Light Sv. FIRM NAME Lrr G'v�C
First 20 MAIL
(This sectlon need not be completed if the work involved by the ADDRESS
permiYis for one hundred dollars(5100)or less.) Total No. Additional
I certify that in the performance of the work for which this permit CITY 1-Gac�.i Tel.No.
i5 issued, I Shell not Worley any person ih any mdOnef en as to PLAN CHECK
become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT
Q
Total No. Additional ADDRESS
T
Date/0 �� Applicant� - r+ y �'4� RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE.TO APPLICANT: If, after making this Certificate of CITY Tel.No.
Exemption,you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Code, you must forthwith coo with such PERMIT
p y comply Power Apparatus&Large.Appliances APPLICANT - �U• ��/[, .
provisions or this permit shall be deemed revoked.
I LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3to 10 Ind. 3sJ
(commencing with Section 7000) of Division 3 oftheBusiness and CITY r 'L Tel.No.
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl.- LICENSE OR }'
Over 50 to 100 Il CL REG.NUMBER O Class. C�O d
License Number Lia Class Over 100 DISTRICT NO. PROCESSED BY O
� � C� j/
/� ' ,l Services,Swti MCC&Panelboards e--- O t-�'c �, CL
Contractor CWE'U-C/- (JAIL A"`6Date /C2/���- 0-399 Amp.Under,600 V pIA7E
F-1 1 am exempt under Sec. 400-1000 Amp.Under 600 V Q C)
Over 1000 Amp.or Over 600 V —`_� VALIDATION LU
FINAL _ / CL
B.&P.C.for this reason BRANCH CIRCUIT FEES BY Com/ Z
`f
Date: 15A,or 20A, 120V, Lighting or Recept
1 To 10 Branch Circuits
Signature 11 To 40 Branch Glows
El Exemption
Or More Branch Circuits
Exemption for Reg.Maint. Elect. 15A,20A,208V To 277/Lighting Br.Circuits
SINGLE FAMILY Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION• n with One Branch Circuit - qq
I hereby affirm that I am exempt from the Contractor's License Law Sig
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits
Code)
❑ d
&C
d
Conuits Conductors
on . _-may'
I, as owner of the property,will do the work and the structure Misc. 1 UT
is not intended or offered lot sate (Section 7044, Business Other(See Complete Fee Schedule) _ 19_
and Professions Code).
CONSTRUCTION LENDING AGENCY "" fir
hereby affirm that there is a construction lending agency for the '•Jr.=1(;`r Coll
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) �a �•' '-
Civ. C.)
PLAN CHECKING FEE _
Lender's Name /- -x f3 "'Er`rfh_l11 plt1�.5r%Iz.
PERMIT ISSUING FEE
Lender's Address - '^^ Ail
I certify that I have read this application and under penalty of purjury state TOTAL FEE 12that the above 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 en upon the above-mentioned property •
for inspectio pu SEE REVERSE FOR EXPLANATORY LANGUAGE
1G1 TUR PERMITTEE DATE