HomeMy Public PortalAbout5624 / 5628 GLICKMAN AVE_Electrical__ 05UNTY OF LDS ANGRLEB TEMPLE CITY 0508 ELECTRICAL PERMIT
DEPARTMWT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0904300010
BUL DING AND SAFETY / LAND DEVELOPFzFr TEMPLE C2'TY CA 91780
PHONE: (626) 285-0488 ETT:
LEGAL ID: FEES PAID BUILDING ADDRE88:
ON FITS 5624 GLICK?AN AV
FES DESCRIPlrION: QUANLTi'Y: VON: AMOUNT: TEMP CA 917802710
ASSESSOR INFORMATION NUMBER: NEAR ST CROSS STREET: LEVE OAK
8586-016-003 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B3 LDCALITY: TEMPLE CITY, C
Fl 120V, 15/20A BR CLTS 15.00 BR 245.85
TENANT: F2 208, 277V LGL' BR CKT 4.00 BR 109.20 ISSUED ON: PROC&BSF.D BY: PLAN BY: EXPIRES ON:
G1 OUTLETS-LOT,SW,RECP 40.00 OUT 66.00 04/30/09 SR 10/27/09
G2 LIGH TRiO FIXTURES 20.00 LOT 39.00
OWNER: TEL. NO: H1 RES ELIC OVEN LT 3HP 1.00 OVE 10.95 FINAL BY: CODE:
WANG, GEORGE/AMY (626) 823-7968- H2 RFS CR13G DISP LT 3HP 1.00 DIS 10.95 v\y
5624 GLIC124AN AV H3 RES DISHWA.SHR LT 3HP 1.00 DIS 10.95
TEMP 917802710 H4 RES RANGE HDS LT 3HP 1.00 "DO 10.95 DFLSC7RTPTION kF WORK
H5 RES WASH MACH LT 3HP 1.00 WAS 10.95 =CTRICAL FOR ADDITION, EL REWIRE WHOLE HOUSE AND
H7 RES EXHAUST FANS 3.00 EX 32.85 UPGRADE SERVICE PANEL TO 200 AMP
APPLICANT: TEL. NO: JA HEAT PUMPS +3-10HP 1.00 HT 19.65
K K (626) 705-7998- JB AC UNITS +3-10HP 1.00 AC 19.65
9080 TALSTAR AVE LB 200 AMP PANELS, MCC 1.00 PAN 38.85 SPECIAL CONDITIONS:
RL MONTE, CA 91731 TOTAL FEES 653.55
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
AMY S. WANG (626) 823-7968-
P.O. BOX 99 LSC. NO TEXPORARY POSER POLE
WALNUT, CA 91788-0099 NONE
UlqDE5b9ROUXD CONDUTT
ARC-IITECT OR ENGINSSF.: TEL. NO: UFER GROUND
T AND W CONSULTING ENGINEERS (626) 288-0708- r
1168 N. SAN GABRM BLVD. #N LSC. NO: ROUGH COND=
ROSEMEAD, CA 91770 35693
ROUGH WIRIIX3
MAIN WATER T-
PLASTIC YIN METAL YIN
UTrr.rry COMPANY N(Y=13D
REPORT ID: DPR265 ROUTE TO: B80508
WORKERS'COMPENSATIONpECLARATION 76A683
(2-80)CE� APPLICATION FOR ELECTRICAL PERMIT
•
I hereby affirm that I have a certificate of conseht to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
Insure, or a certificate of Workers'Compensation Insurance;or
a certified c 3800, b.C.)
Trc*
(�
EMP, OF WAUSAU FOR APPLICANT TO FILL IN JOB`S GLICKMAN
Policy No. mpany ADDRESS'
New Residential Bldgt.&Pools EACH INO. EE
0. Certified copy is hereby furnished. 1 &2-Famlly,Sq. Ft. i — i LOCALITY LE CTIY
[21Certified copy is filed with the county building inspection Multi-family Sq.
Ft CROSS ST'
department. Residential Svvimming'Pools OWNER OR
��// FIRM NAME
Date1—�—Y7 Applicant — Outlets: Rec.TLlght SW. MAIL SAME
�Irst 20 ADDRESS
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY TEMPLE CITYT@1 INo. 445-1892
COMPENSATION INSURANCE PLAN CHECK
(This Rection need not be Completed if the work Involved APPLICANT n
lay the permit Is for one hundred dollars (5100) or less.) Lighting Fixtures .. Firrt 20 ADDRESS 8
Total No. Additional
I certify that In the performance of the work for which thisCITY Tal No. O
permit is.issued, I ahall not employ any person in any manner . Fixed AppllAnces Not Over 1 HP
PERMIT
so as to become tubject to the Workers' Compensation Laws. Range_ Heater D.W. APPLICANT, n pµ1
Overt —.Dryer_W.M._ ADDRESS 203 N. PECK PD, fn
Date. ^Applicant Top _ FAU LEL-W.H. ?
Hood _ Fan _Other— CITY S . EL. MONTE Tel N°- 579-1982
NOTICE TO APPLICANT: If, after making this Certificate of Dlsp. _-Room Air Cond` 2 5 C R
Exemption, you should become subject to the Workers' ,- REO, NUMBER Clea
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PR SSED B
with comply with such provfsiom or this permit shall be O�
deemed revoked. Size&Type HP,KW, KVA,qr-KVA
Up to 1 Incl.
FINAL
LICENSED CONTRACTORS DECLARATION TfiP. Over.1 to 10 Incl. DATEOver 10 to 60 Incl.
I herebyaffirm That I am'licenaed under pINAL'
provisions. Chapter Over 60 to 100 Inc.IDC
9L (commencing with Sectlon 7000) of Dtiislon 3 of the Buss- over 10.0 BY
neu and Professions.Code, and my license is In full force and
effect. yieft
License Number 26509Ac•Paas C—] Q 1-201 Amp.Under 800 V .12
L
201-1000 Amp. Under 600 V
Contractor TRANENC:['Date Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractgr's Sign with One Branch ClrcuIt
Licenie Law for the following reason (Section 7031.5, Buri- Additional Sign Branch Circults
near and Professions Code):
Misc.Conduits&Conductor
D I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)=
structure Is not intended or offered for rale .(Section 25 55 A
7044, Buainess and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that them Is ■ construction lending agency 4 o -..o o 0 2
for the performance of'the work for which this permit is PERMIT FEE (Sub Total) 20 2 0 - 27,0 0
Wued (Sec. 3047,Civ.C.).
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) '010 0 27.006
Lender's Address PERMIT ISSUING FEE 7 0
G09-80
I certify that I have read this application and state that the TOTAL FEE 27 10q
nbore Information Is correct.I agree to comply with ail County.
ordinances and State laws r Electrical wiring, and
hereby thorize reprman.tati this County to enter upon
the ve-mentionad pro pectlon purposes. S>;E'REVERSE FOR EXPLANATORY LANGUAGE
Signature of Parpttee Date