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HomeMy Public PortalAbout4502 FIESTA AVE_Electrical__ 76A663CE-80616/78) APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN JOB ADDRESS �(��� �, New Residential Bldgs.&Pools EACH NO. FEE 1 &2-Family,Sq. Ft, $ .025 — $ LOCALITY AIL b r- icd Multi-family Sq. Ft. .02 — NEAREST Residential Swimming Pools 25.00 CROSS ST. A OWNER OR r FIRM NAME Outlets: Rec Light - Sw. AMAIL DDRESS D ^� First 20 .50 Total No. Additional 30 CITY, Tel. No. PLAN CHECK APPLICANT Lighting Fixtures First 20 .50 ADDRESS Additional .30 Total No. CITY Tel. No. Fixed Appliances Not Over 1 HP PERMIT .n Range_Heater_D.W. _ - APPLICANT ADDRESS Oven—Dryer_ W.M.— Top _FAU — W.H. _ CITY Tel. N „-;?!jcQ Hood_Fan _Other_ LICENSE OR > Disp.—Room Air Cond. 2'50 REG.NUMBER � Closs.r"_/'O IHEREBY ACKNOWLEDGE,THAT I HAVE READ THIS APPLICA- Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO Type HP, KW, KVA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS Size&T Yp REGULATING ELECTRICAL WIRING. a Up to 1 Inc. 2'50 0 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF Over 10 to 50 Incl. 12.50 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE 0 Over 50 to 100 Inc. 25.00 DESCRIBED RESIDENILAIL PROPERTY. p Over 100 40.00 PERMITEE SIGNATUR Services DISTRICT NO. OCE ED BY 0-200 Amp.Under 600 V 12.50 �T1 �j 201-1000 Amp. Under 600 V 25.00 Over 1000 Amp.or Over 600 V 50.00 Z O Temp, Power Pole&Appurtenances 10.00 Q Sign with One Branch Circuit 10.00 Additional Sign Branch Circuits 2'00 INSPECTION INFORMATIONbe Misc.Conduits&Conductors 10'00 ON REVERSE z Other(See Complete Fee Schedule) SIDE u J � o o o o 0 2 PERMIT FEE (Sub-Total) 2 0 0 19.50 Z PLAN CHECKING FEE (One-Fourth Permit Fee) O •0 0 0 1 q5oij PERMIT ISSUING FEE $7.00 c 12 2 7'-7 3 J TOTAL FEE / 571 > INSPECTION FINALED o�c W date: ��r�� 8y 'WORKERS' tOMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT 'rfi"hereb;°" firn?'that I have a certificate of consent to self insure, CE-806G 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.f/� �Compan � FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS $ LOCALITY Ft S il F � amy, q. . $ —Certified copy is filed with the county building inspection 1 & 2- — department. y��y�, CROSS ST.Multi-family Sq.Ft. NEAREST Date ���� applicant � �C^� Residential Swimming Pools OWNER OR NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Sw. MAIL `�— COMPENSATION INSURANCE Light % © ADDRESS 47 J � f 6- (This section need not be completed if the work involved by the First 20 l CITY;;,-- I.No �� � permit is for one hundred dollars($100) or less.) Total No: Additional 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'Compensation Laws. Lighting Fixtures First 20 L ADDRESS 16 dE'g c_. �� Total No. Additional CITY'�WY/ Tel.N� g Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT ",� t/ Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top — FAU _ W.H. LICENSED CONTRACTORS DECLARATION Hood Fan Other CITY c,-,ti/ Tel.No. _ I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR ! Class. (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESS BY � Size& Type HP,KW,KVA,or KVAR 0 License Number " Lic.Class / Up to 1 Incl. FINAL o 0 0 0'o V j� �j Over 1 to 10 Incl. DATE ,i fes' Contractor/ � ���`'� Dat '� / J / LIDATION � ❑ Over 10 to 50 Incl. FINAL ° 0 J 150 UI am exempt under Sec. Over 50 to 100 Inc. BY �11f o 0 o S(�5 Q U d B.&P.C. for this reason Over 100 Services,Swbd.,MCC& Panelboards Z Date: 0- 200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V OS12-88 . ❑ 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 I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits for the following reason (Section 7031.5, Business and Professions Code): ❑ Misc.Conduits & Conductors I,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 , and Professions Code). CONSTRUCTION LENDING AGENCY 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.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address Q J I certify that hatIhave 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 Si nature of Permi ee Date ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL,LO508 0012120011 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 12998 LT: 30 4502 FIESTA AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804209 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 8592-001-045 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY HA FAU LESS 3HP 1.00 FAU 10.95 TENANT: JB AC UNITS +3-10HP 1.00 AC 19.65 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 58.35 12/12/00 UT 06/11/01 OWNER: TEL. NO: FINAL DATE FIX: CODE: MELOHN;VIVIAN (626) 444-9243- 4502 FIESTA AV g TEMP 917804209 DESCRIPTION OF WORK ELECTRICAL FOR NEW HEAT AND COOLING SYSTEM APPLICANT: TEL. NO: AIR-TRO, INC. (626) 357-5311- 1630 S. MYRTLE AVE. SPECIAL. CONDITIONS: MONROVIA, CA 91016 r CONTRACTOR: TEL. NO: �J; APPROVALS DATE INSPECTOR SIGNATURE AIR-TRO INC. (626) 357-5311- 111 1630 S. MYRTLE AVE. LIC. NO TEMPORARY POWER POLE MONROVIA, CA 91016 258228 C20 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508