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HomeMy Public PortalAbout5033 GLICKMAN AVE_Electrical__ DBS 5A 25NI SETS 1-48 DEPARTIIIENT OF BIJILDIN6 SAND SAFETY AI'P ATION FOR PERMIT COUNTY OF LOS ANGELES ELECTRIC CTRIC ' M. J. R a NAM DISTRICT NO. GROUP ZONE PERMIT NO. U ADDRESS U CITY B1. NO RECEIVED BY READY FOR DATEISSUED FIRST INSPECTION ,.I COUNTY W CERT.NO. IIMPIRIM G APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB DESCRIPTION OF WORK. ADDRESSP,004 NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST LIGHT OUTLETS JSW. PLUGS FUCT CROSS ST CIRCUIT A B C D E F If W NAME Z .MAIL ADDRESS O CITY TEL.NO. 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGRLES COUNTY CERTIF TE OF QUALIFIC TION.. 00-1 EL EC C I AM THE LEGAL OW OF THE PROPEJ D SCRIBED ABOVE OWNER. CORRECTIONS J a I _Z E9 O TOTAL NO. OF OUTLETS $ APPROVALS NO. OF FIXTURES $ DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS TRANS. $ WIRING NO. OF RANGES OR HEATERS $ FIXTURES M U $ POWER $ UTILITY CO.NOTIFIED FINAIL, Y S 76A663 DBS 5A 11-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ELECTRIC 1 COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. ELECTRICIAN RECEIVED BY READY FOR DATE ISSUED ADDRESS JKFIRST INSPECTION p CITY TEL. NO. 'T� ( C ;J G' COUNTY LICENSE NO. 6LL`/ EXPIREpr BUILDING PERMIT FEES ADDRESS FEE NUMBER EACH LOCALITY LIGHT OUTLETS NEAREST RECEPTACLES CROSS ST. jo _ WALL SWITCHES OWNER TOTAL OUTLETS 5C $ MAIL ELEC. RANGES 25 '• ADDRESS ELEC. HEATERS 25 CITY TEL. NO. FIXTURES g 1 HEREBY ACKNOWLEDGE THAT I 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 ELECTRICAL WIRING. MOTORS 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER NEW MVD. HP OVER I INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. 1/2&LESS $ .25 SIGNATURE OF I/2 2 50 PERMITTEE 2 5 1.00 INSPECTION RECORD 5 15 1.50 15 50 2.50 50 200 5.00 I 200 500 10.00 ..1 500 1000 15.00 yQ Z OVER 1000 20.00 M. G. SET/FREQ. CHANGER-HP WELDERS: AC-KVA L O GENERATORS-KW TRANSFORMERS-KVA TEMP. MOTORS (75%OF ORIG.) MOVED MOTORS (75%OF ORIG.) MISC. SIGNS NO. NO. TRANS. APPROVALS NO. NO. LAMPS FOR EACH PERMIT: CONDUIT DATE INSPECTOR'S NAME WIRING $1.00 WIRING FIXTURES $1.00 SUPPLEMENTARY .50 I FIXTURES / POWER TOTAL FEE $ / `� UTILITYCO. NOTIFIED I op / I FINAL ! � 76A663 DSS SA 25M SETS „-48 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ELECTRIC i COUNTY OF LOS ANGELES WILLIAM J. FOX. CHIEF ENGINEER DISTRICT NO. GROUP ZONE PERMIT NO. FOR APPLICANT T❑ FILL IN �t ELECTRICIAN 3Sd�/A�A.O htiL� C`d RECEIVED BY READY FOR DATE ISSUED ADDRESS t©.3 / FIRST INSPECTION CITY TEL. N / BUILDING LICENSE NO. EXPIRES Q d ADDRESS ,41c7 DESCRrPTION OF WORK _ O NUMBER I OUTLETS EACH FEES LOCALITY •/J7• CROSS J, LIGHTS Sa $ STREET v RECEPTACLES 5 6316FIXTURES 5 OWNER WALL SWITCHES 5 I MAIL ADDRESS ELEC. RANGES 25 ELEC. HEATERS 25 CITY TEL. N MISC. I CERTIFY THAT 1 PO E H V V L D L09 NUMBER OF CIRCUITS INSTALLED: ANGELES COUNTY LICEN ' LIGHTS RECEPTACLES MOTORS ELECTRICIAN. NL,MSER HORSEPOWER FEE NEW MVD. HPI OVER INC- EACH 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PROP- 1�2 6 LESS $ .25 ERTY DESCRIBED ABOVE. %2 2 .50 2 5 1.00 OWNER- S 15 1.50INSPECTION RECORD is 50 2.50 50 200 5.00 200 500 10.00 Boo loco 15.00 J Q OVER 1000 20.00 Z M.G. SET/FREQ. CHANGER-HP 17 WELDERS:AC-KVA 0 �{ GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF DRIG•) 1 MOVED MOTORS (75% OF aRt G.) MISC. SIGNS TYPE: NO.TRANS. TYPE: NO. LAMPS APPROVALS PERMIT FEE DATE INSPECTOR'S NAME FOR ISSUING PERMIT: CONDUIT WITHOUT FIXTURES WIRING WITH FIXTURES 1.25 FIXTURES SUPPLEMENTARY .50 POWER TOTAL FEE $ UTILITY CO.NOTIFIED ; FINAL WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, 76A663 or a certificate of W&ker's Com pensati n In once, or p certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy,jhere �38<4,,�ab. C.) �15HU4td _P_� /-� /) / Policy No. 1 /Ldd `.�aj Company FOR APPLICANT TO FILL IN JOB ADDRESS ' ❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALIT r 1 &2-Family,Sq.Ft. — $ $ C� Ceyt ed co y is filed with the co my ilding inspection _ NEAREST Multi-family Sq.Ft. CROSS ST. Date r Applicant Residential Swimming Pools MAPEBOOOK r PAGE PARCEL CERTIFICATE OF WNER OR EXEMPTION FROM RKERS' Outlets:Rec._Light Sw. FFIIRM NAME COMPENSATION INSURANCE First 20 MAIL (This section need not be completed if the work involved by the Total No. Additional ADDRESS ) permit is for one hundred dollars(S100)or less.) I certify that in the performance of the work for which this permit CITY o. ��- 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 First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESID NT AL APOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation O 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT P Y P Y APPLICA provisions or this permit shall be deemed revoked. Powe Apparatus&Large Appliances LICENSED CONTRACTORS DECLARATION SJ&TypeP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 J Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY . o. Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR L3, (i�a j /�� Over 50 t0 100 Incl. REG.NUMBER `I{• t/,i,�"• fl// Over 100 DISTRICT NO. PR •EBBED BY U License Number Lic.Class Services,Swbd.,MCC&Panelboards Contractor Date 0-399 Amp.Under 600 V FINAL DATE //� ! I— ❑ s 400-1000 Amp.Under 600 V �-2fGJ`gam VALIDATION W I am exempt under Sec. W Over 1000 Amp.or Over 600 V FINAL 0_ B.&P.C.for this reason BRANCH CIRCUIT FEES BY (� Date: 15A,or 20A,120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits `: SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuiti+10 for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits t � Code): ❑ 1, as owner of the property, will do the work and the structure Misc.Conduits&Conductors (_•j, (.)�. y_s r; is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ 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) /Y I h,i i—::_i s ? •j;m Civ. C.) PLAN CHECKING FEE sI' Lender's Name / PERMIT ISSUING FEE � (� 7D Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE A_ _/ that the above in � tion is correct. I agree to comply with all County ordinances and to la s regulating Electrical wiri g,and hereby authorize representative of t is ounty to enter upon t ab we-mentioned pr party for inspecti SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF PERMITTEE L� ATE WORKERS'COMPENSATION DECLARATION CE- to/si APPLICATION FOR ELECTRICAL PERMIT {� � I hereby affirm that I have a certificate of.consent to self insure, CE-806G u or a cerfificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab. C.) Policyolli N'0.Company FOR APPLICANT TO FILL IN JOB -� Certified copy is hereby furnished. EACH NO. FEE ADDRESS 03 New Residential Bldgs.&Pools ❑ 1 &2-Family,Sq.Ft. $ _ $ LOCALITY Certified copy is filed with the county building inspection department. Multi-family Sq.Ft. NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec �/ - FIRM NAME aLi1��sd Sw. MAIL ght . ? COMPENSATION INSURANCE ® ADDRESS ,50- �4Cr_Mu � This section need not be completed if the work involved b the First 20 `• ( p y Total No. 23 Additional 1� CIT I� Nor oi�1 Tel.No.40- f� permit is for one hundred dollars ($100)or less.) that in the performance of the work for which this permit PLAN CHECK I certify P APPLICANT is issued, I shall not employ any person in A manner so as become subject to the Workers'Compensa• a Lighting Fixtures First 20 ADDRESS Additional �1 L/AV Total No. CITY Tel.No. Date, �s� ! Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after maki this ertificate of APPLICANT Exemption,you should become subject to th orkers'Compensation Range_ Heater_ D.W. Jo 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 OtherCITY Tel.No. � _ I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. 1000 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. PROCE D BY d Size&Type HP,KW,KVA,or KVAR ® W License Number Lic.Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE VALIDATION Contractor Date Over 10 to 50 Incl. - V FINAL? ❑ I am exempt under Sec. Over 50 to 100 Inc. BY Ci �' -Over 100 W I B.&P.C.for this reason � N Services,Swbd.,MCC& Panelboards 1 / Z Date: 0-200 Amp.Under 600 V �. Signature 201 - 1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole& Appurtenances - 7';DYI HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit `�`� f I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits 1 ITEMS Code): TOTAL 4 AL �"0 o 70 [{ I,as owner of the property,will do the work and the structure Mise.Conduits&Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) CHECK "70.70��°f!� and Professions Code). , CHANGE 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) 0;000-01301 7/�5/01IZ Civ.C.). q PLAN CHECKING FEE 2047 1 i^lrl 4' Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the above TOTAL FEE -7 W information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives this At ent upon the above-mentioned property for' s c' n p ,pos SEE REVERSE FOR EXPLANATORY LANGUAGE A`0 ign ture rmittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0309260006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 10821 LT: 6 BL: C 5033 GLICKMAN AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804023 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 8585-013-019 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 20.00 OUT 39.00 TENANT: G2 LIGHTING FIXTURES 4.00 LGT 7.80 ISSUED ON: PROCESSED BY: PAN BY: EXPIRES ON: HA FAU LESS 3HP 1.00 FAU 10.95 09/26/03 JK 03/24/04 JB AC UNITS +3-10HP 1.00 AC 19.65 OWNER: TEL. NO: TOTAL FEES 105.15 FINAL DA jEINAL BY: CODE: LIN; SUSAN (626) 825-9398- /_,;z 5033 GLICKMAN AV TEMP 917804023 DESCRIPTION OF WORK ELECTRICAL FOR ADDITION APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: -,t UFER GROUND LIC. NOd ----JJ — ROUGH CONDUIT _. _- --- ROUGH WIRING 0 MAIN WATER LINE PLASTIC Y/N METAL Y/N - UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508