HomeMy Public PortalAbout10766 FAIRVIEW AVE_Electrical__ 76A663 CES05 10 61 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING J
BUILDING AND SAFETY DIVISION ADDRESS/ �J
JOHN A LAMBIE COUNTY ENGINEER -y—�
WILLIAM A JENSEN SUPT OF BUILDING LOCALITY
�.��'� { CwCr<
NEAREST
FOR APPLICANT TO FILL IN cRoss ST
I T E M NO JEACH FEE
OUTLETS (FIRST 20) 7— $20 $ OWNER
LIGHTS RECEPT SWMAIL y' /
OUTLETS (ADD L UNITS) A ADDRESS., _
LIGHTS RECEPT SW 10
LIGHTING FIXTURES (FIRST 20) 20 CITY �' TEL 144
1
LIGHTING FIXTURES (ADDITIONAL) 10 ELECTRICIAN
7
RANGES CLO DRYERS WTR HTRS too ADDRESS/,9,--') y
GARB DISP STA COOK CITY J / TEL N-06
7
DISHWASH AUTO WASH STATE
SPACE HTRS STA APP (1/z H P MAX ) rr.0 LICENSE NO /jvr
MOTORS 'OVER NOT OVER HP DISTRICT NO GROUP Z NE P ESSED BY
w
0 1 too
1 3 150 INSPECTION RECORD I }
3 8 200
f�Jir� Lv� G►�'j/ O
8 15 250 k ��
V
ad
15 50 300
50 100 1500 e'
SIGNS NO TRANS z
NO LAMPS !
SERVICE O 600V NOT OVER 200A 100 � i'
3 14 Z— 6r�,; /4��r�
SERVICE O 600V OVER 200 A 200
SERVICE OVER 600V 500
MISC
PERMIT ISSUING FEE 200
SUPPLEMENTARY PERMIT ISSUING FEE 1100 '
TOTAL FEE $ LP°°
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
APPROVALS DATE INSPECTOR S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT 17 `l
ELECTRICAL WIRING WIRING / � � 4 /
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR �
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES e+�
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE i
DESCRIBED RES]DEN�71_PROPERTY POWER / n / /� A /
SIGNATURE / r UTILITY CO NOTIFIED 7 i
OF PERMITTEE
r FINAL
�
LIDATION ARTHUR C VETT
SUPERVISING ELECTRICAL ENGINEER
CK MO CASH
L410,o 6'9'2QI --JUM25 2- D 620cQ
—
WORKERS COMPENSATION DECLAE2ATlON . 76A663 10,81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure CE-806G
or a certificate of Workers Compensation IAurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof (Sec 3800 Lab C) _ffift
Policy No Company FOR APPLICANT TO FILL IN JOB
❑ Certified copy is hereby furnishedNew Residential Bldgs & Pools EACH NO FEE ADDRESS
❑ Certified}copy is filed with the county building inspection 1 & 2-Family Sq Ft $ — $ LOCALITY
department , I i I Multi-family Sq Ft — NEAREST
CROSS ST
Date Applicant Residential Swimming Pools OWNER OR i
• } FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERSOutlets Rec Light Sw MAIL
— _
COMPENSATION INSURANCE � ADDRESS
/J
(This section need not be completedFirst 20 If the work Involved by the Total No Additional t �� 41 1 CITY1' Tel No`7h
permit Is for one hundred dollars ($100)or Tess) I otn63 Liz
I certify that in the performance of the work for which this permit ! , l j ' ^, � r
PLAN CHE K
is issued I shall not employ any person in any manner so as to 7{ ` APPLICANT
become subject to the Workers,Compensation Laws Lighting Fixtures First 20 + + ` ' ADDRESS
v Total No Additional � ' 1
Date -Z6 ,16 Applicant�G' CITY Tel No
NOTIC TO APPLICANT If after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT
Exemption you should become subject to the Workers Compensation Range_ Heater_ DW _
APPLICANT �(,J PSA
provisions of the Labor Code you must,forthwith comply with such Oven _ Dryer _ W M _ ADDRESS I pt
provisions or this permit shall be deemed revoked Top __FAU
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ - CITY ,' Tel o ft Z�
I hereby affirm that I am licensed under provisions of Chapter 9 Disp<— Room Air Cond LICENSE OR
(commencing with Section 7000) of Division 3 of the Business and REG NUMBER/�Q J.t p3 Class "
4 Professions Code and my license is in full force and effect DISTRICT NO ROCESS BY
� Power Apparatus& Large Appliances
�/ A Size& Type HP KW KVA or KVAR - 0
License Number ��7' 0. Lic Class 4 Up to 1 Incl - __ FINAL ? V
Over 1 to 10 Incl DATE � n A") VALIDATION X'
Contractor Date Over 10 to 50 Incl FINAL O
❑ I'am exempt under Sec _ Over 50 to 100 Inc BY C.1
B&PC for this reason Over 100 1 0-
Services Swbd MCC & Panelboards °p L N
Date ,0-200 Amp Under 600 V d �� Poo. ng Z
Signature 201 - 1000 Amp Under 600 V 1307 ;f'1010
Over 1000 Amp or Over 600 V
❑ Exemption for Reg Maint Elect 1 ITEM
SINGLE FAMILY - Temp Power Pole& Appurtenances TOTAL 3: 00
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit i
I hereby affirm that I am exempt from the Contractors License Law C HECK ,' -1,
for the following reason(Section 7031-5 Business and Professions Additional Sign Branch Circuits--- _ _ 3�oL-I
Code) CHANGE o UU
❑ I as owner,of the property will do the work and the structure Misc Conduits& Conductors
is not intended or offered for sale (Section 7044 Business Other`(See Complete Fee Schedule)
and Professions Code) 5J27/9fl
CONSTRUCTION LENDING AGENCY ,
3143 A AM 9:117
1 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 '
Lenders Name
PERMIT ISSUING FEE
Lenders Address
I certify that 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 for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
r� .
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0711150048
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ITR 4902 LT 3 BL 001 10766 FAIRVIEW AV
1 1FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917804101 1
ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET 1
18574-022-010 lAl PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID D4 LOCALITY TEMPLE CITY, Cl
1G1 OUTLETS-LGT,SW,RECP 20 00 OUT 39 00 1
TENANT 1G2 LIGHTING FIXTURES 5 00 LGT 9 75 JISSUED ON PROCESSED BY PLAN BY EXPIRES ON
1H1 RES ELEC OVEN LT 3HP 1 00 OVE 10 95 111/15/07 SR 05/13/08
1H2 RES GRBG DISP LT 3HP 1 00 DIS 10 95 1
OWNER TEL NO IH4 RES RANGE HDS LT 3HP 1 00 HOO 10 95 IFINAL DATE FIN BY CODE
1CAOILI JOSE,LEONILA (626) 279-7878- IH5 RES WASH MACH LT 3HP 1 00 WAS 10 95
110766 FAIRVIEW AV 1H7 RES EXHAUST FANS 1 00 EX 10 95 1 ! 1
1TEMP 917804101 1 TOTAL FEES 131 25 1D SCRIPTION OF WORK 1
1 1 (ELECTRICAL FOR ADDITION
(APPLICANT TEL NO 1
1 I
1GORDON (323) 816-2544- I
120310 CARON CIR 1 1
1CARSON, CA 90746 1 1SPECIAL CONDITIONS 1
1 1
I I 1
ICONTRACTOR TEL NO 1 (APPROVALS DATE INSPECTOR SIGNATURE 1
1LOUIS GORDON (323) 816-2544- 1
1GORDON'S NEIGHBORHOOD HARDWARE LIC NO 1 1TEMPORARY POWER POLE I I I
120310 CARON CIR 705289 B 1
1CARSON, CA 90746 1 (UNDERGROUND CONDUIT
I I I
1ARCHITECT OR ENGINEER TEL NO 1 IUFER GROUND I I I
1 I I
1 LIC NO 1 1ROUGH CONDUIT 1 1
1 1 1ROUGH WIRING
1 1 1MAIN WATER LINE I 1 1
1 1 1PLASTIC YIN METAL YIN 1 1 1
1 1UTILITY COMPANY NOTIFIED( 1
I I I I I I
1 1 I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
1 I I I I I
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1 1REPORT ID DPR265 ROUTE TO BS0508 1 1 1 1
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