HomeMy Public PortalAbout5304 GLICKMAN AVE_Electrical__ 76A 663-CE306 3-69
q
,. APPLICATION FOR ELECTRIC PERMIT
COUNTY OF LOS ANGELES
• • ' DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEARLE
,� �!
�
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING
y�
FOR APPLICANT TO FILL IN CROSS ST. N� {L
NO. EACH FEE
Z.3;
$ S OWNER P C• i
RECEIPT._ MAIL 5304-
�C` N
LIGHT i91� TOTAL FIRST 20 v ,20 op ADDRESS
I/
SWITCHL OVER 20 10 O CITY ei TEL.NO. y�s�3�tf
PLAN CHECK
LIGHTING TOTAJ FIRST 20 ,20 APPLICANT
FIXTURES }RT 1 OVER 20 ,10 ADDRESS
RANGE DRYER WTR. HTR. CITY TEL.NO.
STA. COOKDISP._F.A.U. CONTRACTOR
SPACE HTR_ AIR COND. � / ADDRESS
CLOTHES WASH._DISHWASH. CITY TEL.NO.
FAN_OTHER 1.00 LICENSE NO. CLASS.
MOTORS,TRANSFORMERS RATING (/✓ I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
IND. HEATERS, ETC. HP. KW. KVA. ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
SIZE TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING.
0 - 1 1'00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATEOF }
1 - 10 3.00 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN, THE ABOVCRIBED RESIDENTIAL PROPERTY. O
10 - 50 5.00 �y U
SIGNATURE 7J
50 - 100 10A0 OF PERMITTEE ,/ O
100 - 500 15.00 DISTRIf,T NO. GRO�}T ZON PR C SE V
L, l W
SIGN,GAS SIGN AND ONE CIRCUIT 3.00 v O r� N
TUBE, OR Z
MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES:
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00
SERVICE OVER 600 VOLTS OR 200 AMP 5.00 `
TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
WIRING v w`lo
PERMIT FEE (SUB TOTAL) FIXTURES
1i1
PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED t
PERMIT ISSUING FEE 2.00 UTILITY CO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL
TOTAL FEE J isEPH C. ROOHAN
IC +�
SUPERVISING ELECTRAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
pr� 6 1 7 fic-_ huIj
' 5 2 D 17.3 0-
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
WORKERS'COMPENSATIONDECLARATION
CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT
CE-806
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or
rtifed co th reof Sec. 3800, b.C.)
10�1
���— jFOR APPLICANT TO FILL IN SOB
cy No. o pany
New Residential Bldgs.&Pools EACH NO. FEE ADDRES
ertifiedcopy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY
Multi-family Sq. Ft. — NEAREST.
Certified copy is filed with the county building inspection fir• CROSS ST
L * ,Residential Swimming Pools N- OWNER OR
11 ^� FIRM NAME
Date Applicant L—_` Outlets: Rec.—Light_Sw. MAIL
First 20 ADDRESS
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No.
COMPENSATION INSURANCE PLAN CHECK C-
(This section need not be completed if the work involved APPLICANT
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS
Total No. Additional tr
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel
permit is issued, I shall not employ any person in any manner PERMIT W
so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT ®.
Oven _ Dryer_W.M._ ADDRESS rn
D e Applicant \L�/�C� Top _ FAU _W.H.,_
Hood _ Fan _Other_ CITY Tel
NOTICE TO APPLICANT: If, after making this Certificate of Disp. — Room Air Cond. LICENSE OR y
Exemption, you should become subject to the Workers' REG.NUMBER lass
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY
with comply with such provisions or this permit shall be
deemed revoked. Size&Type HP,KW,KVA,or KVAR ��
Up to 1 Incl.
FINAL
Over 1 to 10 Incl. DATE yam' .-
' 1
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. z.-- VALIDATION
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY
ness and Professions.Code, and my license is in full force and
effect. Services
License Numberkic.Cla �_� 0-200 Amp. Under 600 V
r 201-1000 Amp. Under 600 V
Contractoe �� Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit
License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits
ness and Professions Code): 1 3 1 3 A
Misc.Conduits&Conductors
I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— i,o v o c
structure is not intended or offered for sale (Section �,
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY _ 2 0 - 3200
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is ° ° ° 3 2 0 C, 6
issued(Sec. 3097,Civ.C.). PERMIT FEE (Sub-Total) 09,23
�,` 3 s`' 1
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE -
Lj-
I certify that I have read this application and state that the TOTAL FEE f
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
ebove ntioned property for inspection p Vrposes. SEE-REVERSE FOR EXPLANATORY LANGUAGE
Signatu a of Permittee t Date 111
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0804290021
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID I BUILDING ADDRESS:
1TR: 10558 LT: 31 5304 GLICKMAN AV
1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803328
ASSESSOR INFORMATION NUMBER: 1 1 NEAREST CROSS STREET: OLIVE
18585-004-023 lAl PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, Cl
1G1 OUTLETS-LGT,SW,RECP 1.00 OUT 1.95 I 1
1TENANT: 1G2 LIGHTING FIXTURES 2.00 LGT 3.90 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1
TOTAL FEES 33.60 104/29/08 SR 10/26/06 1
I I
(OWNER: TEL. NO: 1 (FINAL DA FINAL BY: CODE: 1
1THOMAS DARYL G (626) 579-9065-
15304 GLICKMAN AV 1 1
ITEMP 917803328 1 DESCRliPTIOOF WORK 1
11 SWITCH AND 2 LIGHT FIXTU S 1
1 I
(APPLICANT: TEL. NO: I 1
1WU (626) 912-3289- 1 1 1
118403 VILLA CLARA ST 1 1SPECIAL CONDITIONS: 1
ROWLAND HEIGHTS 1
I I
1CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE
THAMAS SURACHAI (626) 579-9065- 1 1 1
15305 GLICKMAN AVENUE LIC. NO 1TEMPORARY POWER POLE 1
1TEMPLE CITY, CA 91780 NONE 1 1 1
1UNDERGROUND CONDUIT I I
(ARCHITECT OR ENGINEER: TEL. NO: 1 IUFER GROUND 1 1
1WU, STEVE C Y (626) 912-3289- I 11 1 1
118403 VILLA CLARA ST. LIC. NO: 1 1ROUGH CONDUIT
1ROWLAND HEIGHTS, CA 91748 26073 C 1 1 1 1 1
TROUGH WIRING
1MAIN WATER LINE 1
IPLASTIC YIN METAL YIN 1
1 1 I I I
(UTILITY COMPANY NOTIFIED( I
I I I I
I I I I I
1 1 I I I I
1 1 I I I I
1 1 I I I I
1 1 I I I I
1 I I I I I
1REPORT ID: DPR265 ROUTE TO: BS0508
1 I I I I I