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HomeMy Public PortalAbout5337 GLICKMAN AVE_Electrical__ 76A663-CE806 10/74 APPLICATION FOR ELECTR "AL PERMIT r COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB BUILDING AND SAFETY DIVISION ADDRESS Af-1k LOCALITY 1 —4 NEAREST FOR APPLICANT TO FILL IN CROSS ST, OUTLETS NO. EACH FEE OWNER OR tFIRM NAME RECEPT.! $ $ MAIL ADDRESS FIRST 20 LIGHT - TOTAL .25 CITY C t EL. NO. �3 f SWITCH OVER 20 .10 PLAN HECK TOTAL LIGHTING 1 FIRST 20 25 � APPLICANT )} L OVER 20 ADDRESS FIXTURES .10 RESIDENTIAL APPLIANCES CITY TEL. N0, PERMIT RANGE DRYER_WTR. HTR._ APPLICANT STA. COOK DISP. F.A.U. ADDRESS SPACE HTR. AIR COND. CITY w TEL, NO. CLOTHES WASH. DISHWASH, LICENSE OR REG. NUMBER CLASS. FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. SIZE IN TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABO 1 - 10 3.00 DESCRIPED R7ESS PERTY. O U 10 - 50 5.00 PERMITEE SIGNATURE O F-- 50 - 100 10.00 C-') DISTRICT NO. PROCE SED BY W 100 - 500 15.00 J G SIGN, GAS [SIGN ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOeS SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVI CENOTOVER 600 VOLTS OR 200 AMP 3.00 UNDERSLAB WORK SERVICEOVER600VOLTS OR200AMP 10.00 ROUGH CONDUIT TEMPSERVICE,POLE, &APPURTENANCES 5.DO WIRING - 1 TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED /ZVI FINAL PERMIT FEE (SUB TOTAL) NOTES: c PLAN CHECK FEE PERMIT ISSUING FEE 3.00 i) TOTAL FEE Q(� PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION(,_, CK. M.O. CASH 5 13 r JUL 16 2 U 4.0 0 ,&=)o SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE `v" A. DBS S-A 12-44 DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT -"�• COUNTY OF LOS ANGELES ELECTRIC WM. J. FOX CHIEF ENGINEER NAME DISTRICT NO. GROUP ZONE PERMIT NO. U ADDRESS 1 RECEIVED BY READY FOR DATE ISSUED U CITY TEL.NO. FIRST INSPECTION —1COUNTY w CERT.NO. '�� EXPIRES APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB DESCRIPTION OF FORK ADDRESS NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST LIGHT OUTLETS 1SW, PLUGS FIXT CROSS ST. CIRCUIT A B C I D E F G H 0: NAME - - w - - �..s 3 MAIL ADDRESS O _ CITY TEL.NO. IAM THE LEGAL POSSESSOR—OF THE ABOVE LOS ANGELES COUNTY CERTIFICAT O QUALIFICATION.. ELECTRICIAN. I AM THE LEGAL OWNER OF THS PROPERTY DESCRISED ABOVE OWNER. CORRECTIONS J a --- z E3 Ix D TOTAL ! / NO. OF OUTLETS $ `3 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 E LLANEOUS $ POWERT FEE $ UTILITY CO.NOTIFIED FEE FINAL �� WORKERS' COMP NSATjQN DECLARATION 76A663 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT I h.ereb -,w#irm tKatd hovo"'dFcertificcie of consent td self CE806G Y O insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or o,certified copy thereo# (Sec. 3800, Lab. C.) '4 a� fr Policy No. rst 1-0 Y0 Company �%/%Tf6ti`�h Ir�r �0 FOR APPLICANT TO FILL IN JOB ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS ❑Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. _ $ LOCALITY �� .'&C C,i'y tion department. Multi-family Sq. Ft. NEAREST CROSS ST. Date A licant Residential Swimming Pools OWNER OR �z f PP FIRM NAME 4J FIR ✓ f CERTIFICATE OF EXEMPTION FROM WORKERS' � MAIL ; COMPENSATION INSURANCE Outlets: RecLight Sw._ ADDRESS v �� .�_1.) First 20 (This section need not be completed if the work involved by Total No.� Additional CITY L� mil Tel. No. the permit is for one hundred dollars ($100)or less.) PLAN CHE K I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws. Additional Total No. � CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION Rlo Z� ,. (,'QL Exemption, you should become subject to the Workers' Range— Heater—D.W. — _ Compensation 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. LICENSED CONTRACTORS DECLARATION LICENSE OR f u �r_yl Disp. — Room Air Cond. — Class. 1 hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PR SSED B and Professions Code,and my license is in full force and effect. Size &Type HP, KW, KVA, or KVAR L� O License Number J Lic, Class Up to 1 Incl. FINALDATE 0 p(� �a �4 '�(�it i Over 1 to 10 Incl. VALIDATION O Contractor % Date Over 10 to 50 Incl. FINAL 1 U ❑ I am exempt under Sec. Over 50 to 100 Inc. BY LU B.&P.C. for this reason Over 100 i IL Services, Swbd.; MCC& Ponelboards U) Date: ® ( Z � 0-200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole &Appurtenances 3 .. ia CIn ~ 5 i HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit i N EMS'd Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): ITAL 26 m 50 ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors �'JIL3_ -=r(- structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ f Business and Professions Code). ® HANIGE Ti 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) 011]001•-E�(�r1 =f 1/Q01 (Sec. 3097, Civ. C.). ti;4 AN -s a PLAN CHECKING FEE " Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and state that the I TOTAL FEE a .®' 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 Ath, bove-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ture of Permittee Date ©s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1202060017 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: I FEES PAID I BUILDING ADDRESS: ITR: 10558 UN: .004 5337 GLICKMAN AV 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917803330 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LANDSEER 18585-002-019 1A1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, Cl I - IF1 120V, 15/20A BR CKTS 2.00 BR 34.60 1 1 ITENANT: IF2 208, 277V LGT BR CKT 1.00 BR 27.30 (ISSUED ON: PROCESSED BY: PLAN BY: 1 1 IG1 OUTLETS-LGT,SW,RECP 15.00 OUT 29.10 102/06/12 SR 1 1 1G2 LIGHTING FIXTURES 16.00 LGT 31.00 1 1 (OWNER: TEL. NO: 1H2 RES GREG DISP IT 3HP 1.00 DIS 10.90 IF AL DATE FINAL BY: CODE: 1 IAL, ADRIAN (626) 476-5999- • 1H3 RES DISHWASHR IT 3HP 1.00 DIS 10.90 1 \ 1 15337 GLICKMAN AVE. 1H4 RES RANGE HDS IT 3HP 1.00 HOO 10.90 1 ) ITEMPLE CITY CA 91780 I TOTAL FEES 182.50 IDESCR PTION OF WORK 1 I 1ELECTRICAL FOR ADDITION AND REMODEL (APPLICANT: TEL. NO: 1 I ILIU, MICHAEL (213) 928-7746- I 12550 W. MAIN STREET I ISPECIAL CONDITIONS: I 1ALHAMBRA CA 91801 I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I IPALACE CONSTRUCTION INC. (626) 552-1655- 1 1 1 117078 COLIMA ROAD #317 LIC. NO 1 ITEMPORARY POWER POLE I I 1 IHACIENDA HEIGHTS, CA 91745 383572B 1 1 1 1 I 1UNDERGROUND CONDUIT I I I 1ARCHITECT OR ENGINEER: TEL. NO: 1 IUFER GROUND I I I ILAM, GARY (626) 588-8615- 1 1 1 1 1 12550 W. MAIN ST., #211 LIC. NO: 1 IROUGH CONDUIT I I 1ALHAMBRA, CA 91801 NONE II 1 1 I TROUGH WIRING / 1 1 I IMAIN WATER LINE 1 1 1 1 IPLASTIC YIN METAL YIN 1 1UTILITY COMPANY NOTIFIED( I 1 1 I I I I I 1 I I I I I 1 I I I I I I I I I I I I I I I I I I I I I I I 1 I I I I I I* ADDITIONAL DATA ON FILE I I I I 1 IREPORT ID: DPR265 ROUTE TO: BSO508 1 1 1 1 1 I I I I I