HomeMy Public PortalAbout9861 ESTRELLA AVE_Electrical__ Wm that I have a certificate
DECLARATION 76-666 W/et APPLICATION FOR ELECTRICAL PERMIT �1
I hereby affirm that I have a certificate of consent to self insure, CE-806G LJ
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 '
EACH NO. FEE /+'DRESS
Certified copy is hereby furnished. New Residential Bldgs.8 Pools PLyF n
❑ 1 &'2-Family,Sq.Ft. S = $ LOCALITY C lJ
01
Certified'copy is filed with the county building inspection
department.. Multi-family Sq. Ft. NEAREST
CROSS ST.
bate Applicant _ Residential Swimming Pools OWNER OR , 1
FIRM NAME Ory/
CERTIFICATE OF EXEMPTION FROM WORKERS' _a MAIL
COMPENSATION INSURANCE Outlets:Rae Light Sw. r 00 ADDRESS '
(This section need not be completed If the work involved by the First 20
Total No Addition
permit is for one hundred dollars($100) or less.) al CITY Tel.No.
PLAN CHECK
I certify that in the performance of the work.for which this.permit - APPLICANT
is issued, I shall,not employ any person in any manner,so as to
become subject to the Workers Comps tion Laws. Lighting Fixtures First 20 ADDRESS
10 V
Additional
Tel.No.
Date Applicant FixeTotal No. CITY
d Appliances Not Over 1 HP
NOTICE TO APPLICANT: If, after making thi ertificate of PERMIT '
Exemption,.you should become subject to the Work Compensation Range Heater_ D.W. _ APPLICANT pn� �(/ Jix✓1� _
provisions of the Labor Code, you must forthwith comply with such Oven Dryer W.M._ ADDRESS U V
provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _ CITY rA Tel.No. F Dp/
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LICENSED CONTRACTORS DECLARATION Hood Fan -#— Other_
1 hereby affirm'thal I am licensed under provisions of Chapter 9UCENSE OR �/
(commencing with Section 7000).of Division 3 of the Business and Disp. �— Room Air Cond. REG.NUMBER _ D
Professions Code,and my license is in full farce and effect. Power Apparatus& Large Appliances DISTRICT NO. PROC ED B
Size& Type HP,KW,KVA,or KVAR 5'OK
U
License Number _ Lic.Class Y �1 Up to 1 Incl. FINAL -
r('7 ( �c�1- - J C' "1 Over 1 to 10 Ind. DATE �l VALIDATION Q
Contractor If- U .YVI b'^� Date V - ' Over 10 to 50 Incl. (/ U
❑ FINAL
I am exempt under Sec. Over 50 to 100 Inc. W
Over 100
B.Bl for this reason _ Vl
Services,Swbd.,MCC& Panelboards ® Z
Date: 0- 200 Amp.Under 600 V '
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 --- -------
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit w a
I hereby affirm that I am exempt from the Contractor's License Law - - ACCT.,r - — -
for the following reason(Section 7031.5,Business and Professions- Additional Sign Branch Circuits -
Code): 33507 - 65.60
Misc.Conduits& Conductors 1 ITEMS .
- I
El ,as owner of the property,will do the work and the structure Other See Complete Fee Schedule)
is not intended or offered for sale (Section 7044, Business ( D TOTAL c.•60
and Professions Code).
--"` _.�f-1
CONSTRUCTION LENDING AGENCY - - CHECK 65.60
I hereby affirm that there is a construction lending agency for the `` � -, _ .,. _ -- .00
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE• (Sub-Total) _
Civ.C.).
PLAN CHECKING FEE
Lender's Name =3 O 0000'0001 s/30/90
PERMIT ISSUING FEE 9825 1 AM11:40
Lender's Address
I certify that I have read this application and state that the above TOTAL FEE b ,
information is correct. I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
representative of this County to enter upon the above-mentioned '
prope for
5310 p r es. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signatufne of Permitt Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0601310003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91980
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 16712 LT: B 9861 ESTRELLA AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801417
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BALDWIN
5383-023-008 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: Al LOCALITY: TEMPLE CITY
G1 OUTLETS-LGT,SW,RECP 72.00 OUT 109.20
TENANT: - G2 LIGHTING FIXTURES 32.00 LGT 55.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
HA FAU LESS 3HP 1.00 FAU 10.95 01/31/06 JK 07/30/06
HS RES WASH MACH LT 3HP 1.00 WAS 10.95
OWNER: TEL. NO: H7 RES EXHAUST FANS 2.00 EX 21.90 FINAL DATE FINAL BYCODE:
CAMP RONALD J;KATHLEEN G (626) 286-1595- LB 200 AMP PANELS, MCC 1.00 PLN 38.85
9861 ESTRELLA AV TOTAL FEES 274.80 VJ
TEMP 917801417 DESCRIPTION OF WORK
ELECTRICAL FOR ADDITION AND UPGRADE SERVICE TO 200 AMP
APPLICANT: TEL. NO:
RON SEVERA (626) 796-2256-
3848 E. COLORADO BL - SPECIAL CONDITIONS:
PASADENA, CA 91107
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
ROSEMEAD CONSTRUCTION (626) 796-2256-
3848 E. COLORADO BLVD. LIC. NO TEMPORARY POWER POLE
PASADENA, CA 91107 221S44/B .
UND:RGROUND CONDUIT
I
ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND
NOTT, THOMAS (626) 403-0844-
1508 MISSION ST LIC. NO: ROU13H CONDUIT
SO. PASADENA NONE
ROUGH WIRING
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
* ADDITIONAL DATA ON FILE
REPORT ID: DPR265 ROUTE TO: BS0508
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