HomeMy Public PortalAbout9160 GARIBALDI AVE_Electrical__ 76A663-GE806 8/63 APPLICATION FOR ELECTRICAL PERMIT ' 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER _ y
WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY
NEAREST '> '
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT, 67 TOTALNO. EACH FEE �, y
OU ETS FIRST 20 ffi 20 S OWNER INY
LIGHT a Uz� MAIL
ADD'L ADDRESS
SWITCH./if OVER 20 •1O V
TOTAL CITY TEL.NO
LIGHTING LFIRST 201 20 .2 (..'7">
FIXTURES ADD'L 10 ELECTRICIAN .
V R 20
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS
GARB.DISP. STA.COOK
CITY TEL.NO.
DISHWABH AUTO.-WASH.
j A _{; STATE
SPACE HTRS. .IBTA.APP.(1/2H.P.MAX.), .may .SO �' LICENSE NO.
MOTORS: OVER NOT OVER H.P. DISTRICT NO. GROUP ZONE PROCE� E f BY
O 1 1.00 _ -?. A r/ .
1 s 1.50 INSPECTION RECORD
3 8 2.00
O
8 15 2.50
15 50 3.00
O
50 100 5.00 V
W
SIGNS: NO.TRANS d
NO.LAMPS N
Z
SERVICE 0-600V.NoT OVER 200A 1.00
SERVICE 0.60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
Lj
ISSUING FEE 2.00
MENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE s
REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI TION APPROVALS DATE INBPECTOR'S SIGNATURE
TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ICAL WIRING. WIRING
REBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
ED AB REQUIRED BY LOS ANGELES COUNTYAND STATE OF FIXTURESRNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
BED RESIDENTIA PROPERTY. POWER
ATURE UTILITY CO.NOTIFIED
RMITTE
FINAL
LIDATION ARTHUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
V
WORKERS'COMPENSATION DECLARATION 7&4.66q°°"�m APPLICATION FOR ELECTRICAL PERMIT O
I hereby affirm that I have a certlflcat6 of nt to self C�
Insure, or a certificate of Workers' mpe on n urance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or a certlfJQ/�c[op�y thergof (Sec. C_
p'r�,���cy�N �� Com *`� FOR APPJ)CAM TO FlL IN JOB
rtgLertlfled copy is hereby furnished. New Residential ElIdgs. & Pools EACH NO. FEE
llll���❑----'"'C�Ifled copy Is filed with the un bulldl Inspec- 1 &2-Family, Sq. Ft. $ — $ LOCAL
tion department. Multl-family Sq. Ft. — NEAREST
/_��Q l Residential Swimming Pools
Dat Applicant
FIRM NAME ?
CERTIFICATE OF EXEMPTION FROM WORKERS' ML
COMPENSATION INSURANCE Outlets: R Light Sw. AIADDRESS
Irst 20
(This recMon need not be completed if the work Involved Ery Total No. Additional CrrY el. No.
the permit Is for one hundred dollars (;100)or less.)
I certify that In the performance,of the work for which this PLAN,ql��
permit Is Issued, I shall not employ any person In any manner
sous to become subject to The Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Additional
Date Applicant Total No I
CITY Tel. No.
PERMrF
t40T10E TO APPLICANT: If,-after making this Certificate of Fixed Appliances Not Over 1 HP APPLiC
Exemption, you should become subject fo the Workers' Range— Heater—D.W. — Al'PLICATKxJ `�/
Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS 12(Y6
with comply with such provisions or this permit shall be Top — FAU —W.H. —
deemed revoked. Hold — Fan —Other— CITY q7_ Tel. No., _may-
LICENSED CONTRACTORS DECLARATION Disp. — Room Air Cond. — LICENSEM�8E3t Class.
1 hereby affirm that I am licensed under provisions of Chapter 9
(commenci with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. d
and Profess) Code,and my license Is In full force-S14 effect. C1
Size&Type HP, KW, KVA, or KVAR v O
Ir
License Num r J LIc. Class r"' Up to 1 Incl. FINAL- U
Contract / e 3 d f Over 1 to 10 Incl. DATE V DAT10N
F-1 Over 10 to 50 Incl. FINAL ~
I am exempt under Sec. Over 50 to 100 Inc. gY U
W
B.&P.C. for this reason Over 100
Services, Swbd., MCC& Panelboards , z
Z
Dat°' 0-200 Amp. Under 600 V
Signature 201 - 10Q0 Amp. Under 600 V
❑ Exemption for Reg. Malnt. Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY Temp. Power Pole&Appurtenances a
HOME OWNER-BUILDER DECLARATION r
Sign with One Branch Clrcult WCT.
��r�,
1 hereby affirm that I am exempt from the Contractor's Llcense Additional SI n Branch Circuits tJV7 19.al
Low for the following reason (Section 7031.5, Buslnan and g
Professions Code): 1 ITM
❑ I, as owner of theoperty will do the work and the Misc. Conduits&Conductors
structure Is not Intended or offered for sale(Section 70", Other (See Complete Fee Schedule)_ TOTAL 19 . 30
Business and Professions Code). C'IEf . 19.37
CONSTRUCTION LENDING AGENCY .((I
I hereby affirm that there Is a construction lending agency for
the performance of the work for which this permlt Is Issued PERMIT FEE (Sub-Total)
(Sec. 3097, Clv. C.).
PLAN CHECKING FEE l7M'01IM11 JI 9/917
Lender's Name {�4 22 1 O.rr
PERMIT ISSUING FEE 8• _
Lender's Address
I certify that I have read this application and 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 outhorize repr ntatives of this County to enter upon
thea e- tion pr rty or nmpact7 pu
SEE REVERSE FOR EXPLANATORY LANGUAGE
Slgrwture of Permittee t ms
`"O "EPS have
a c SI1l ate of mvmATION � '0'81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I haus a oertfnoate or corteerrt tv eeff atsUe, �-
or a oerURoete of wbrkere' Compensation Ineurnnoe, or a eerd d COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thered(3sa 3800,L&L C.)
Pofdcy No 9 9 357 c.. R erw b I i c Ind. rpt,+rp�To Fu iN roe
❑
Cart]-fled ooPy Is hey furnished• New RealderrtSel Bidge S Pada EACH NO. FEE _ .916Q Qadbal.di
$ — $ LOOALlTY
® Ceritfded oo�'y Is fled
11-0-bon 1 8 2-Fam�y,S4 Ft — NFAFF�
Temple City
department Y S4 Ft CA088 8T.
Date- .4/11Z90 �ent� vPo* owrnoa
�IAWMr, MF�jja
-
CERTMATE OF EXE_
FROM. O — Light —gv• '""�' 91bQ Garibaldi
r INSLIF MICE First 20 Atm
O'hls section need not be oorVkA d tf the work kwofwd by tr» Tome No Additional Cay Te le Cit Cit'X1780
pem-0%for orw hundred doWrn($100)or We&) •
373
1 certfy that:In'the Perionnarioo,of the wont for wh h,thts permit 'pp ,wr
is J $hall root employ airy person In arty•manner so as to
become subject to the.Mrkere'Compeneeficn.Laws., Lighttrp FbBraee F-W 20, ADDLES$
Ell, Trial iJo Addttiortal , CfTY Tei N4 '
t Ioent Fixed Apoaroea Not Q,.w 1 HP -
KMCE TO APPLICANT4 ff, attar making thb.,CertHioete Bryant ant I-It & A/C
Exemptlon,.you ehoufd beoomte sub}eat to the Worirerq'0unpensatbn Range_ "96bmT b W. :�
.prwblons of the Labor Co*you menet brtrffth com* with suoh oven Dryer W.M.—• ANXESS 1350 E. L:aS'Tunas'Drive
provielore.or this perq*shall be deerrred retidced Top FAU W.FL —; 1
LiGEN,Wq COWrP.WTORS DECLARAT}QNiyocd , — aTM San Gabriel 'CA TN:Na 286-1141
I hereby,gfftrm that I em fioeneed under govlebne d Chapter 8 _ 1 5 -25 UCENSE OR
(oomrnanctng with Sedbn 7000) of Dlvbloq 3 q lite Buelneea and t?iap — Room Air Gond R>=G:Nukccro •22175 a G*2�
Profeeslons Code.and my Were is In hal force and affect. Power Apperat 3 Large APpflenoee v - EIY
3tre d Type,Hli,BCW,KNIk,or KVAR 0
Ucenee 2 1751' Z-74mi4n—
e C=20 Up t6 1 tnd FINAL
Over 1'to '10. lr c�. DATE b
c«,tra�t« O4W 10 to so t4. ALMATIQ
FINAL ]
ElI unryer ower.6o,to,100iPp. BY _
BSP.C.Jot thb rdeson Over-100,
8erv6^3wbd,MCG d Psnfboe
srde Z
m
0-200 Ap.Under 600 V _.
Sigruture 291,- 1000 Ani Under 600 1Y
_ Oyer 1000 Amp,or Over 800 v
❑ for Req.Mak tL Elect - .. .
SINOLE'FAMILY Tbrnp•'Power Polo d Appraterranoeq
HOME OWNER-BUILDER DECLARATION Sign whh One Branch Ctnxlt Fi1,41 .
I N"by affirm teat I am exempt from the Contractors Lloenee Law
for the following reason(Seddon 7031.6Buenas and Protepalcm Additional Sign Brandi Ctroufts ,'�]7-__. yr+ .
,Code): I ITEFS-'— -
❑ I,ae owner d the property,w01 do the work and the wuoft" M}sc.'Condufts a Conductors _'}TIAL~- �0 ..75
Is not.Intended or ofWad for sale (Section 7044. Business- ott"I (See Complete Fee 3d")
and Pro(am."ts Code): 77 DEC,• 30o75 .
ANCE
CONSTRLY-' o LENDING AGENCY - .10
I hereby aMrm that there is a construction Iardbig agency for the
performanpe d the work for which this permk Is lasued(Sea 3087, PERW FEE (Serb-Total) --
Ctv.a). . ODOO-b D 1 4/16/90
L.endWa N&rM PLAN Cl EC#(1NG FEE 01.'4 1 AM10:.54
PERMrr.ss NG FEE Lad
LendWa Address
I oerttfy that I have reed this application and state that the sboyp - TOU4L FEE
tJormatloni is correot I agree to oou#y with all County ordVances
and State kr" rogulatft Electrical wlrIrQ and hereby authortze _
b enter upon the aboy&-rnentlonbd
for
SEE REVERSE FOR EM- NdOW LANdUAGE
ON P&ffLffbge Date
Y
COUNTY OF LOS ANGELES TEMPLE CITY 050.8 I ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0012200001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 5904 LT: 375 BL: .001 UN: .002 9160 GARIBALDI AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801623
ASSESSOR INFORMATION NUM ER: NEAREST CROSS STREET: LOIWENCINITA
5384-013-014 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY
LB 200 AMP PANELS, MCC 1.00 PAN 38.85
TOTAL FEES 66.60 1 MED
. PROCESSED BY: PLAN BY: EXPIRES ON:
12/20/00UT 06/19/01
OWNER: TEL. NO: FINJL D4TE CODE:
MEJIA JUANITO;JOSIE R (626) 285-2939- D/
9160 GARIBALDI AV `-
rul-
TEMP 917801623
UPGRADE El ECTRI SERV/NA EL TO 200 AMPS
APPLICANT: TEL. NO:
SAME AS OWNER -
SPEC14
R. Vim:DATE INSPECTOR SIGNATURE
CONTRACTOR: TEL. NO:
l Gvwr -�
SAME AS OWNER
LIC. NO T E]KPOW Y POWER POLE
LIFER GROUND
ARCHITECT OR ENGINEER: TEL. NO:
LIC. NOrf/f; r_ I 111111 ROUGH�'{
ROUGH WIRING
UTFVTRPLASTIC Y/N METAL Y/N
LIT I L I TY ANY NOTIFIED
= _ q_
REPORT ID: DPR265 ROUTE TO: BS0508