HomeMy Public PortalAbout10938 FREER ST_Electrical__ '°"°°3,CX8" 4-615
APPLICATION FOR ELECTRICAL ERMIT
COUNTY OF LOS ANGELES
DEPARTMtNT OF COUNTY ENGINEERFAR7
BUILDING AND SAFETY DIVISION JOHN A. LAMBIE,.COUNTY ENGINEER
COLEMAN.W. JENKINS. SUPT. of BUILDING
FRECACLKCLE, OTAL NO. EACH Fa
JI} UTL¢T6 FIRST 20 *.10 OWNER
�y ADDMAIL
(f O� �/ .10 �-� ADDREfJiTOTAL FIRST 20 .10 CITYTEL. NO.
G l FIXTURES
S OVER 20 .10 CONTRACTOR CLO.DRYER( WTR.HTR(. 1.00 ADDRESS y. A.COOKCITY T�NO.
.-WiuH. STATE
l. .50 L L I C E N eE NO.
woroRe' avlR H.P. DISTRICT NO. I GROUP ZQNE I PRgOESSED
L' 0 1 1.00
t a 1.150 INSPECTION RECORD
a 8 2.00
S 1S 1.50
13 SO 1.00
So 100 5.00
SIGNS. NO.TRAM.
NO.LAJAM I�
SERVICE O-SOOV-NoT ova(200A 1.00 N
SERVICE O-SOOV-OVER 100 A. 1.00
SERVICE OVER SOOV 5.00 .
OTHER (SEE COi(FLrM FEE SCHEDULE)
PERMIT ISSUING FEE 1.00
SUPPLEMQITAQY PERMIT IS§UFNa FEE 1.00
TOTAL FEE APEROY DATE I
IHERIDY ACKNOWLi [Da[THAT I HAVR.AD THIS AFF KATION UNDERSLAB WORK
AN
HI I
D STATE TAT THASOVIS COBRA=AND AGREE TO COMPLY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCKS AND STATE LAW REGULATING
ELECTRICAL WIRING. WIRING
1 HERY CiRTIFM t=O Y THAT 1 APROPERLY RI61ITI1AND�OR FIXTURES ,
LI EICENSmAS REgU1RIH
D ■Y LOS ANGELES COUNTY AD STATE OF
CALIFORNIA OR THAT 1 AM TH LEGAL OWNER OF, INTEND TO SER
RH
RESIDE IN,THE ASOV ED RISIDEN IAL
SIGNATURE UTILITY co-,NQTIFIKD
OF PIK RMITTE
FINAL
(DATION JOSEPH C. ROOHAN
SUFI<RVISINa ELECTRICAL ENa1NQR
CK w0 CAGH
[ACo6 6 3 O 3 XT2 0 2 B 1 9.00- q
COUNTY'OF LOS ANGELES TEMPLE CITY 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9704140002
,BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
LEGAL ID: FEES RT5 BUILDING ADDRESS:
TR: 11497 LT: 2 BL: .001 10938 FREER ST
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803542
ASS 3OR INFORMATION NLMER: NEAREST CROSS STREET: SANTA ANITA
8574-009-065 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY
G1 OUTLETS-LGT SW RECP 20.00 OUR 39.00
G2 LIGHTING FIkTIIRES 8.00 LGT 15.60 ISSUS ON: PROCES:SED BY: PLAN BY: EXPIRES ON:
LB 200 AFP PANELS, MCC 1.00 PAN 38.85 04/14/97 LC 04/14/98
OWNER: TEL. NO TOTAL FEES 121.20 FINAL DATE FINAL
DECEMVIRALE SUSIE - !
10938 FREER ST
TEMP 917803542 DESCRIPTION OF WORK
��� � � E�LOEC�CAL FOR 2ND STORY ADDITION. MAIM SERVICE UP-GRADE
APPLICANT: TEL70--
�� �
MODAY ELECTRICAL SERVICE, INC. (818) 500-7307- 1,
.� `•� SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: Lys s 1 i]f El
li . ;;.!
MODAY ELECTRICAL SERVICE, INC. (818) 500-7307- 4 �•• 1T „ ,
1345 CARLTON DR LIC. NO ! a1 � ,' _ ii �`�i, mwwiRy POWER POLE
GLENDALE CA 91205 413155 C10 =
.?l � h- uTsFmvxxF-
LIC. NO: ii` - I--�-- fj ROUGH ONDUIT
ow
MAIN UATER LINE
//j ROUGH WIRINGPLASTIC Y/N METAL Y/N
UTILITY COMPARY
\� 1
717Z`
REPORT ID: DPR265 ROUTE TO: 830508
WORKER'8 COM PENSATKJN DECLARATION 20-0019 DP%(12-91)
Ihereby'sf},llm that I have a oertlfloata of convent to self.lnsura, :76A683 APPLICATION FOR ELECTRICAL PERMIT Ll
or abartlflcatev Worker's Compensation Insurance, or a certIIIad OOUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
gopy thereof(Seo.3800 Lab.C.)
PoIcy No. -A Company F4DR APPUCANT ro FELL W X88
Certfiled copy Is hereby hrnfahed. Naw Po. Bilges S Pools NO. EACH FEE
LOCALITY 10
C Cf
❑ Cardfled oopy Is filed i th the oourrty bulidng Inspection 1 S 2 femlfy,8q.Ft _ NEAREST
departrnent- Multi-farrdly Sq.Ft CF4088 8T. n nl G
Dete APPI� Rseidantlal Swimming Pools ASSESSOR
MAP BOOK �5/ pM1E e 7 Pia !j
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlet Rao Light Sw. �
IP Lt CCM 1/1r4 A
COMPENSATION IN8URAN CE
First 20 ""`
! 9
(This asoUon need not be completed K the work Invoived by the Total No. Additional ADORED Q c-1 J
permit is for one hundred dollars(8100)or lase.)
I oertlfy that In the performanoa of the work for which this permit CITY T.L N°-
le Issued, I shall not employ any person In any manner so as to PLAN CHECK Ir
become subject to the Workers'Compeneatlon Laws. meting First 20 �� O APPUCANT
Total No. Addrdcrgd
ADDRESS
Defe Applloam RESIDENTIAL APPLIANCES NOT OVER 3 H.P.
NOTICE TO APPLICANT: If, after making this Cortlfloate of CrrY Tel.No-
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
PENM R
provisions of the Labor Code, you must forthwith comply with suoh Poww APPS✓k L"Appllancss APPLICLANr
provisions or this permit shall be deemed revoked.
LICENSED CONTRACTORS DECLARATION Stne a Type HP,KW,KVA,or KVAR ADDRESS
I hereby affirm that I am licensed under provlelone of Chapter 9 Over 3 to 10 Ind.
(oommencing with Section 7000) of Division 3 of the Business and CITY TeL NO'
Profeeslons Code,and my license Is In full force and effect. Over 10 to 60 Ind.
UCENSE OR
Over 60 to 100 Ind. RE(i P"BBER Com- 0-
Over 100 DISTRICT NO. BY
Lk�nae Number Lb.CUM �{ v
Servbee,Swbd.,MCC a Panelboerds
Contnotor DMe 0-396 Amp.under 900 VDATE FlINAL O
00
❑ 4 -1000 Amp.Under 600 V W
Ova 1000 Amp.or Over 800 V R NAL VALIDATION
I am exempt under Sec
B.SP.C.for this reason BRANCH CIRCUIT FEES BY Z
Date: ISA,or 20A,12OV,Lighting or Roospti
1 To 10 Brenoh Clrculte
Suture 11 To 40 Branch Ctcufb
41 Or Yore Branch C1nly
❑ Exemption for Rag.Malnt Etat. 16A,2Q&200V To 277V Br.Chxts 2
SINGLE FAMILY Temp.Po~Pole&Appurtenances HOME HOME OWNERUILDER DECLARATION ACCT■i
I hereby affirm that I am exempt from the Contractor's Lloenss Law Sign with One Branch Circuit
for the following reason (8ectlon 70,31.6, Business and Professions Additional Sign Branch Clrouits 303 69.30
i T EM
I,u erty
owner o}the prop ,will do the work and the structureMlao.Conduits S Conductors 1 iT[J i,7
structure w1
Is not Intended or offered for sale (Section 7044, Buslnesa Other(See Complete Fee Schedule) , TOTAL 69
v 30
and Profaealons Cods). CHECK 69.30
CONSTRUCTION LENDING AGENCY
I hereby affirm that there la a construction lending agency for the
performsnoe of the work for whloh this permit is Issued (Seo. 3097, PERMff FEE (Sub-Tota
CIV. C.)
PLAN CHEC*UNG FEE �' 'WO1 7/ 8/96
Lenders Name 7295 1 PM 3;35
' PERMff ISSUING FEE
Lenders Addrees
I oeriffy that I have read this appflcn on and under penalty of p^ry mate TOTAL FEE G 9 A
that the above Information is correct. I agree to comply with all County
orcitrw coo and State laws regulating Electioel wiring,and hereby autfxchm
represectwNve of this County to enter upon tfw above-mentioned property
forInepecdon P-21 - SEE REVERSE FOR EXPLANATORY LANGUAGE
✓NOWTURE OF FEPJATTEE DATE
I