HomeMy Public PortalAbout6426 ENCINITA AVE_Electrical__ JsAssa DEB SA 7-51 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES � �� g
WILLIAM J. FOX, CHIEF ENGINEER
DISTRICT NO. GROUP ZONE PERMIT NO.
FOR APPLICANT TO FILL IN
ELECTRICIAN �' � lci
�` RECEIVED BY READY FOR GATE ISSUED
ADDRESS Z.// / /.�.(f e4 .J. ! I �)�{i1 �.. FIRST INSPECTION
CITY
COUNTY LICENSE NO. EXPIRES /-6v BUILDING
PERMIT FEES ADDRESS n //
NUMBER EACH
FEE LOCALITY
_
LIGHT OUTLETS NEAREST
CROSS ST.
RECEPTACLES
WALL SWITCHES OWNER _
TOTAL OUTLETS sc S L MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25 CITY TEL. NO.
FIXTURES 5 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR. 1 AM THE LEGAL OWNER
N[w MVD. HP Gv[R Rc. EACH OF THE RESIDENTIAL,PROPERTY DESCRIBED ABOV_7Ey�///�/J
�/2 A LES. S .25 SIGNATURE
O
/2 2 .50
2 5 1.00 INSPECTION RECORD
5 . is 1.50
_ is _ 50 _ 2.50
_ so 200 5.00 _
200 Sao 10.00 J
Soo 1000 1 15.00 a
_Z
-- OVER 1000 20.00 - [9
M.G. SET/FREQ. CHANGER-HP m
_ WELDERS: AC-KVA
GENERATORS - KW
TRANSFORMERS - KVA _
TEMP. MOTORS (75% Di RI.-) _
MOVED MOTORS (75% OF GRID.)
MISC.
SIGNS
NO. NO.TRANS. I APPROVALS
NO. NO. LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT: pp
CONDUIT
WIRING $1.00
FIXTURES $1.00 WIRING O
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE S UTILITY CO. NOTIFIED
FINAL //
WORKER'S COMPENSATION DECLARATION 20ADPW(12-91)
76-6636t[ APPLICATION FOR ELECTRICAL PERMIT �J
,
I hereby affifm that I have a certificate of consent to self insure,
or a.certificatq,of Worker's Compensation Insurance. or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 Lab. C.) /A
Policy No. Company FOR APPLICANT TO FILL IN ADDRESSYl
❑ 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,Ft. CROSS ST.
Date Applicant Residential Swimming Pools ASSESSOOR K
MAPBO
PAGE I PARCEL
FIRMCERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. - OWN NAME
COMPENSATION INSURANCE 22 First 20 ax�
(This section need not be completed if the work Involved by thea O' MAIL
permit Is for one hundred dollars($100)or less.) Total No. Additional ADDRESS
I certify that in the performance of the work for which this per CITY G Tel.No.
i5 issued, I Shall not employ any person In any manner so as PLAN CHECK
become su lett to the W kers' Compensation S. Lighting Fixtures � First 20 APPLICANT /
.y Total No. Additional ADDRESS
Dale Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTIC TO APPLICANT: If, after making IN ertifi l of D O CITY Tel.No.
Exemption,you should become subject to the Workers'Comp nsation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Code, you must forthwith comply with such PERMIT
P p y
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9Over 3 to tO Incl.
(commencing with Section 7000) of Division 3 of the Business and CITU Tel.No.
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl.
LICENSEClass.
Over 50 t0 100 Incl. REG.NUMBB ER d
Over 100 DISTRICT NO. P ED BY O
License Number Lic.Class C L)
Services,Swbd.,MCC&Panelboards g__me� Q
Contractor Dale
0-399 Amp.Under 600 V FINAL 0
DATE
❑ 400 1000 Amp.Under 600 V I `—`'L , VALIDATION V
am exempt under Sec. Over 1000 Amp.or Over 600 V FINAL W
B.&P.C.for this reason BRANCH CIRCUIT FEES BY ct)
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
Exemption for Reg.Maint.Elect. 1SA,20A.208V To 277V Lighting Br.Circuits 7
SINGLE FAMILY Temp. Power Pole&Appurtenances L a
HOME OWNER-BUILDER DECLARATION ACCT..
I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit n
for the following reason (Section 7031.5. Business and Professions Additional Sign Branch Circuits 3303 122'90
Code): - 1 ITEMS
I, as owner of the property,will do the work and the structure Misc.Conduits&Conductors t i7
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)_ TOTAL 8 -'4Q
and Professions Code). D CHECK 122.90
CONSTRUCTION LENDING AGENCY CHANGE •00
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.) 0000-0001 6/241/96
PLAN CHECKING FEE
Lender's Name 7081 1 PM 5.45
PERMIT ISSUING FEE
Lender's Address Q
TOTAL FEE
I certify that I have read this application and under penally of purjury state
that the above information is correct. I agree to comply with all County )
ordinances and State laws regulati gElectrical wiring,and hereby authorize
representatives of this County t e ter upon the abo -mentioned property
Xfor inspec i"h p ses. � / SEE REVERSE FOR EXPLANATORY LANGUAGE
SOPATUREOFPERMITTEE DATE /Y�
i
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9610170047
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
LEGA ID: FEES PAID BUILDING ADDRESS:
BK: 19 PG: 4 PC: 3 6426 ENCINITA AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801319
ASSESSOR INFORMATION R: NEAREST CROSS STREET: LEMON
5382-017-017 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J1 LOCALITY: TEMPLE CITY
LB 200 AMP PANELS, MCC 1.00 PAN 38.85
TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLA Y: EXPIRES ON:
10/17/96 TC 10/17/97
OWNER: TEL. NO: FINAL DATE FINAL BY:
LO YAM TIN;WONG SHUET MUT - 0
6426 ENCINITA AV
TEMP 917801319 DESICIMPTION OF WORK
���� NEW SERVICE PANEL UPGRADE-200 AMP
APPLICANT: EL. N0:
SAME AS OWNER
SPECIAL CONDITIONS:
z�
CONTRACTOR: TEL- NO: � \ APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO C13, ��,�.- , 0 0 ��TEMPORARY POWER POLE
p1i11>� /py pp�� 1 UNDERGROUND CONDUIT
ARCHITECTOR `JJO V 11 ENGINEER: TEL. O: idJ1La LtiJJ SII-FIJI h��L1J UFER GROUND
LIC. NO: 'Y, '�¶ i- - _ ROUGH CONDUIT
ROUGH WIRING
/ MAIN WATER LINE
�LASTIC Y/N METAL Y/N
a'
TlflTLITY COMPANY NOTI ED �f c
231
REPORT ID: DPR265 ROUTE TO: BS0508 ���