HomeMy Public PortalAbout9534 FLAHERTY ST_Electrical__ 76A663 DBS SA 11-30 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND•SAFETY
COUNTY OF LOS ANGELES C �ic i
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN $. FWalton
.
REC VED BY READY FOR DATEISSUED�
ADDRESS 5134 N. Acacia' St. •FIRST INSPECTION n
CITY Sall: Gab, TEL. NO.AT 68583 / vYl�
COUNTY LICENSE NO. 11 EXPIRES BUILDING `
PERMIT FEES ADDRESS 9534 Flahert 'Street
NUMBER EACH FEE LOCALITY Temple City
LIGHT OUTLETS 15 �NEAREST
RECEPTACLES 24 CROSS ST.
Meeker
WALL SWITCHES 19 OWNER
TOTAL OUTLETS 58 Sc S 2 90 MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 1 25' 25 '
FIXTURES 15aJ
_ 5 7G CITY TEL. NO.
1 HEREBY. ACKNOWLEDGE' THAT 1 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 FaLECTRICAL WIRING.
MOTORS I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
.HORSEPOWER - ANGELES COUNTY. LICENSE, OR 1 'AM THE LEGAL OWNER
NUMBER
FEE OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
NEW MVD. HP OVER I INC. EACH
4 1/2 &LESS $ .25 25 SIGNATURE OF
�- 1/2 2
PERMITTEE
50
2 5 1.00 INSPECTION RECORD
5 15 1.50
15 50
50 200 5.00
200 SOO 10.00
500 1000 15.00 '' •Q
Z
OVER 1000 20.00 -.o
M. G. SET/FREQ. CHANGER-HP O
WELDERS: AC-KVA
GENERATORS-KW
TRANSFORMERS-KVA C _
TEMP. MOTORS (75%OF ORIG.)
MOVED MOTORS•(75%OF ORIG.). '
MISC.
SIGNS
No. No. TRANS. - APPROVALS
NO. NO. LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT: 6
_ CONDUIT A
WIRING $1.00 1 00
FIXTURES $1.00
F-1
00 WIRING
SUPPLEMENTARY ..50 FIXTURES
a.
V
C 5 POWER
TOTAL FEE I $ UTILITY CO. NOTIFIEDI
® FINAL
f
WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
� 76A663
I hereby.affirin diet I have a certificate of consent to Self insure,
or a certificate 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.)
Poll y No .� Company I Y v` FOR APPLICANT TO FILL IN ' JOB J? '
ADDRESS
Certified copy is hereby furnishedNew Residential Bldgs.&Pools NO EACH FEE
$ $ LOCALITY
❑• .Certified copy is filed with the county building inspection• 1 &2-Family,Sq Ft
department• Multi-family Sq.Ft. CRossSST S
Date �Q `'! Applicant b(Com?l eir5 kP1C Residential Swimming Pools ASSESSOR �jr p `�
- AP BOOK 30 J PAGE O PAROF
M
CERTIFICATE OF EXEMPTION FROM WORKERS' L Sw FIPM NAME
OWNER OR
.... Outlets:Rec Light
COMPENSATION INSURANCE First 20 •'S6 _
(This ADDRES
section need not be completed if the work involved by the MAIL
Total No._L Additional S]
permit is for one hundred dollars($100)or less.)' 7
I certify that"'in the performance`of the�work for which this permit CITY(,^' •P�r G�� Tel.No28 _.,! (f
is issued, I shall not-employ any person'in'any manner so as to PLAN'CHECK �
become subject to the Workers' Compensation Laws Lighting Fixtures Q First 20 / APPLICANT �, GOtvS?.
Total No J Additional
ADDRESS k l ocD 1 -91U e
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE,TO. APPLICANT. If, after making this Certificate of CITY U R 1( S Tel.N(-61o0�3 R/
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3-HP vl
provisions of the Labor Code, you must forthwith comply with such PERMIT Power Apparatus&Large Appliances APPLICANT'
provisions or this permit shall be deemed revoked. -
"' LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS
I hereby affirm that I am'licensed under provisions-of Chapter 9 'Over 3 to 10 Ind
(commencing with Section 7000) of Division 3 of th'e'Business and CITY Tel No
Professions Code, and my license is in full force and effect Over 10 to 50 Incl:
LICENSE OR /L �/ Class $ }
Over 50 t0 100 Incl. REG NUMBER Z' '7
Over 100
License Number � �/ LIC.Class
✓ DISTRICT NO P O SSED BY O
_
' Services,Swbd.,MCC P elby�ards .. -
Contractor_ ..
�' s (' Date 0-399 Artfp. eer 60OlV / FINAL
DATE 0
❑` I am exempt under Sec. 400-1000 Amp.Under 600 V. _Q 0VU VALIDATION
Over 1000 Amp.or Over 600 V FINAL W
'B.&P-C.for this reason BRANCH CIRCUIT FEES BY d
Date: 15A,or 20A, 120V,.Lighting or Recept Z_-
1 To 10 Branch Circus s
Signature 11 To 40 Branch Circuits "
41 Or'More Branch Circuds 5 i
Exemption for Reg'Maint.Elect. 15A,20A,208V To 277V Lighting Br Circuits
SINGLE FAMILY Temp.Power Pole&Appurtenances - ACC °H O
HOME OWNER-BUILDER DECLARATION 90.15
I hereby affirm that I am exempt from the Contractor's License Law
Sign with One Branch Circwt CJI I,j 71�
for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits ii T�
Code) 1 I i�i
i t�
_ .
ElI,as owner of the property, will do the work and the structure Misc Conduits&Conductors .......... TOTAL go _ —a
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) Li t, i('oii}
and Professions Code) CHECK _
CONSTRUCTION LENDING AGENCY _ CHANGE 0I
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.) Oi►-u��11 /27/93
PLAN CHECKING FEE '04 Ci I • .. i f '01
Lender's Name
PERMIT ISSUING FEE
Lender's Address D ,
I certify that I have read this application and under penalty ofpurjury state TOTAL FEE 7
that the above information is correct I agree to comply with all County
ordinances and State laws regulating Electrical wiring,and hereby authorize
representativeoff,,,Coutyto enter upon the above-mentioned property SEE REVERSE FOR EXPLANATORY LANGUAGE
ti a_/ 8
A F PERMITTEE+ , DATE -
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1103070009
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE. (626) 285-0488 EXT:
ILEGAL ID: FEES PAID I BUILDING ADDRESS. 1
ITR: 17179 LT: 7 9534 FLAHERTY ST 1
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917801643
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: PRIMROSE
15385-008-007 IAL PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl
I IG1 OUTLETS-LGT,SW,RECP 24.00 OUT 44.30 1 1
(TENANT: 1G2 LIGHTING FIXTURES 14.00 LGT 27.20 (ISSUED ON: PROCESSED BY: PLAN BY: 1
I IHA FAU LESS 3HP 1.00 FAU 10.90 103/07/11 SR 1
1 1H5 RES WASH MACH LT 3HP 1.00 WAS 10 90 1 I
(OWNER: TEL. NO: 1JB AC UNITS +3-10HP 1.00 AC 19.70 (FINAL DATE FT AL BY: CODE:
IJELINEK, SANDRA (626) 287-5452- 1 TOTAL FEES 140.80 r / —vS//1
19534 FLAHERTY ST 1 �1�j I
(TEMP 917801643 I (DESCRIPTION OF WORK 141
1 _1 ELECTRICAL ADDITION AND REMODEL
I
I
(APPLICANT: TEL NO 1
ICASAREZ, LARRY (951) 233-0399-
11433 DEERFOOT DRIVE I ISPECIAL CONDITIONS:
IDIAMOND BAR 91765
I
I I I 1
ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE
IJELINEK, LAWRENCE JAMES (626) 287-5452- 1 1
ISANDRA LYNN JELINEX LIC. NO 1 ITEMPORARY POWER POLE I I I
19534 FLAHERTY STREET NONE I 1 1 1
(TEMPLE CITY, CA 91780-1643 1 1UNDERGROUND CONDUIT 1 1 1
1ARCHITECT OR ENGINEER: TEL. NO: 1 IUFER GROUND
1KMN STRUCTURAL ENGINEERING (714) 937-9060- 1 1 —1-1 1
1321 N RAMPART ST LIC. NO: IROUGH CONDUIT
(SUITE 145 2668 1
1
1ORANGE CA 92868 1 (ROUGH WIRING 1 In 1
1 1 (MAIN WATER LINE 1
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1 1PLT.STIC YIN METAL YIN
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1UTILITY COMPANY NOTIFIED( I
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1 IREPORT ID: DPR265 ROUTE TO: BS0508 1 1