HomeMy Public PortalAbout9012 GARIBALDI AVE_Electrical__ �eweesc=eoa.�o.De APPLICATION FOR ELECTRIC PERMIT 1
BUMDING AND SAFETY DIVISION
DUILDING
ADDRRfb
c0cmty of Los Ang*lm
JOHN A. Q. C:gUNrIY HNaINMIR
TT D. aRIFIrIN. •iurPr^rr of BUILDING LOCALITY
11MP.R Mar
FOR APP I1LL IN
OWNER
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aKRV ICM O-COOV 1.00
DILRVICM OVIR COON 5.00
WIRING Pa"I'T S 00 (�
FIXTUR11 PIKRYIT 1.00
SUPPLIIENTARY PMRNIT .DO APPROVALS
TOTALEM 17U DATM IMIIPECTOY s SIG Tu
I RKRIMT ACCKNOWLI>af[ THAT 1 RAyE READ TRIS AP LI T OM
AND eTATM THAT THY ABOVE Ie CORRECT AND AGREK TO COMPLY CONDUIT
CPTH ALL COUNTY OYDI14AACIs AND ITTATS LARD REGULATING
Q.MCTYICAL 1<IYIAO. WIRING
I RERKST CERTIFY THAT I AM PROPERLY REWSTERED AILD/OR FIXTIJITid
LICKR MD AS 1WUIRED BY Lot$ AAGSL[E COUNTY AND STATE OF
CALIFORMIA OR THAT I AM THII LX9AjL OWNIER OF THI A1101E P01N1LR
DRSCRIBMD Mie
SHMATURE UTILITY CO.NOTIFIED
OF ON"r T[t FINAL — —S
OHN A,_T�.1MB� VALIDATION 'i�irrt�vlirr o > rRlawL ENallKsn�
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79Al%"-Cit0i5.10-99 APPLICATION FOR ELECTRIC PERMIT 1
BMMING AND SAFETY DIVISION
De,portmmn!of Conan Enghww BUILDING
County ofLos"ni ffe m .wDRana
JOHN A IE. Coui,T 8Na1NRlQ
CASG TT D. GRIMN.N. Slur-T of■ummms LOCALITY
NlLA!!EDT ,
FOR APPLI__CAN'TTO-FILL IN
LIOHTI Rs0>TT�..I1��' F$$$ twrreH.. OWNER
NUNN" r T K N KACJJ FIi MAIL
S AD D R EDD
TOTAL OUTLET!! � .10
CLIC. a" M WATI■ OIATI&t, _ CITY NO.
DN
CurTrl1 titt ',540 ELECTRICIAN
RI tFACi tTAT'T. COO[.
IIt tt D t s, O AD'?REBD.
ADTO WAIAIIt D ;215
LIGHTING FEMRES Ib U CITY N
MOTORS DTATE 1
CEN I
AORHEPOtf�i
N r. IlrtO. I No. 1,3110up Agn IUDT FOR I!I►[OT 10■
i Litt :D
-- Y 90 INSPE=ON BMCOBD
Y D 1.040
D
1D DO 2.150
DO 200 15.00
AIRND H0.TRAXA
NO.LAMM
ORRVICI O-OGOV 1.00 0
awwlcI OVLR 600V 15.00
WIRING PERMIT 1.00d
FLXTURa FE"M 1.00
SU PPULM ENTAt[Y PXRY TT .00
APPROVALS
TOTAL DATE INbl1<CT0Q f glQR,ATUlW
I AERKBT A oM—K 7F�►T I RAYL READ THIS APPLICATION
AND RATE TRAT THB nUT 1S CORRR= A" AGM TO CORPI,T CONDUIT _SCJ
S/i Al L COUNTY OIDINAACV5 AND STATZ LAWS REGULATING
ELS CAL mr9inG. WIRING 3
I HST CKRTIFT THAT 1 AN FROPERLT RIOLSTtMD AND/OR FLKMPSA
LICLKSED AS REQUIRED BT LOS ARGE1Yh COUNTY AND STATE OF
DRXCISRI RIOR TRAT 1 All THY UGAL OWNER OF TAIL A" POyym
W.
110TTI
iAtIJItS f,J I UTILITY CO. NOTIFIKD -f
OF�t)lY 11TEI nr
FINAL I
'H N A. L'I'm s. VALIDATION ORTM U R C.�a R
LIMY 6IIiS�t ax YQ wN LTrf]IYLt.INa ,CAL III;N"Nmt
WORKERS COMPENSATION have cartI D to (3f consent-
'� '0'e1 ' .APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of convent_to self CE-8066
Insure, or a certificate of Workers' Compensation Inlurance, COUNTY OF LOS ANGELES / r (f, BUILDING AND SAFETY
cr a certified copy thereof (Sec. 3800, Lab. C-)
Policy No. Company IOR APPLICANT TO 141 IN JOB
Certified copy Is hereby furnished. New Residential Bldgs.
8 Pools EACH NO.' LOC
❑ Certified copy Is filed with the county building Irspec- 1 8 2-Famlly, Sq. Ft.� _ = i CK ALffY � '
017
tlon department. Multi-family Sq. Ft. NF RE5T
Resldentlal Swimming Pools QR=ST.
Date Applicant 0YfNER OR
FIRM NAME &W 1r LN
CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL 1
COMPENSATION INSURANCE Outlets: Rec LlghtrLSW. Q / 14 ADDRESS t
First 20 ff�� (Q
(This section rwed not be completed H the work Invah- d by Total No Additional CIN e Tel. No. �–
the permit Is for on*hundred dollars (:100)or less.)
AN CHECK
I certify that In the performance of the work for which this qp
permit Is Issued, I shall not employ any person In any manner
to as to become subject to the Worker'Compensctl ,L ughting Fixtures First 20 ADDRESS
11/ Total No. / Additional CITY Tel. No.
Date J J! Applicant. Fixed Appliances Not Over 1 HP pEPMT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT
Exemption, you should become subject to the Workers' Range_ Heater_D.W. —
Compensaflon provisions of the Labor Code, you must forth- Oven _ Dryer —W.M.— ADDRESS
with comply with such provisions or this permit shall be Top — FAU —W.H. —
deemed revoked. Hood Fan _ Other_ CITY Tel. No.
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am Ilcensed under provisions of Chapter 9 Dhp. _ Room Air Coed. �NUggz Clow
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. BY
and Professions Code, and my license is In full force and effect. Power Apparatus 8 Large Appliances
Size 8 Type HP, KW, KVA, or KVAR' i� /� O
License Number Llc. Class Up to 1 MCI. FINAL r 7 U
Over 1 to 10 Incl.
DATEQX
Lr VALIDATION 0
Contractor Date 50 I
10 tl
Over o nc.
FINAL
❑ I am exempt under Sec Over 50 to 100 Inc. BY WIL
B.BP.0 for this reason Over 100 �r1
Services, Swbd., MCC 8 Panelboards , z
fie' 0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
Over 1000 Amp. or Over 600 V
❑ Exemption for Reg. Malnt. Elect. 2 0 0' 7,'25
SINGLE FAMILY Temp. Power Pole 8 Appurtenances o o.o 1 7,2 5 v
HOME OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Sign with One Branch Circuit 05,31 —8 4
Low for the following reason (Section 7031..5, Business and Additional Sign Branch Circuits
Prpfesslonv Code):
❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors
structure is not Intended or offered for sale (Section Other (See Complete Fee Schedule)— ,
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 PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.). Id
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE Q
Lender's Address
I certify that I have read this application aid state that the TOTAL FEE
above 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
t e bove-mentioned property for inspect purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
•l
gnature of Perm ttee �nDo``tte`r J
COUNTY OF LOS ANGELES TEMPLE CITY 0505 ELECTRLCAL PERP41T
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUiAS EL 0508 0303140007
BUILDING AND SAFETY / LAND DEVELOPMHIT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL FEES PAID SUI�D
TR: 5904• LT: 160 BL: .001 901 GARIBALDI AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUfT: TEMP CA 917801545
ASSESSOR INFORMTION! NUMBER: NEAREST CROSS STREET: ROSEMEAD
5384-016-001 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY
LB 200 AMP PANELS, MCC 1.00 PAN 38.85
TENANT: TOTAL FEES 66.60 ISSUED ON: BY: EXPIRES ON:
03/14/03 JK 09/10/03
CUM MICHAEL. P (626) 287-8117- N /& ,}�`�
9012 GARIBALDI AV
TEMP 917801545
NEW 200 AMP SERVICE PANEL UPGRADE
SAME AS OWNER -
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO:
SAME AS OWNER -
APPROVALS DATE INSPECTOR SIGNATURE
LIC. NOTEKPORARY
Ji
UNDERGR"D CONDUIT
ARCHITECT OR
TEL. NO: UFER GROUND
• LIC. M0: , il. I__ I '• -. � _ ,
ROUGH WIRING
KAIW WATER LINE
PLASTIC Y/N METAL Y/N
_l
I
REPORT ID: DPR265 ROUTE TO: BS0505