HomeMy Public PortalAbout4847 GOLDEN WEST AVE_Electrical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0304250015
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 5342 LT: 6 4847 FRONT GOLDEN WEST AV NONCONFORM
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803936
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA
8589-019-007 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY
LA 100 AMP PANELS, MCC 1.00 PAN 38.85
TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
04/25/03 JK 10/22/03
It
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
CHENG•PETER (626) 292-6826-
4847 GOLDEN WEST AV -�
TEMP 917803936 DESCRIPTION OF WORK
RELOCATE ELECTRICAL METER
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: UFER GROUND
LIC. NO: ROUGH CONDUIT
ROUGH WIRING
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
REPORT ID: DPR265 ROUTE TO: BS0508
ph WO?KERS'COMPENSATION DECLARATION 76A663 to/Bt APPLICATION FOR ELECTRICAL PERMIT
J y affirm that I have a certificate of consent to self CE-806G
I
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB , L
Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS
E] Certifiedcopy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY
tion department. Multi-family Sq. Ft. — NEAREST
CROSS ST.
Residential Swimming Pools
Date Applicant OWNER OR jy
FIRM NAMEj�_
MAIL
CERTIFICATE OF EXEMPTION FROM WORKERS'
Outlets: Rec Light Sw.
COMPENSATION INSURANCE ADDRESS.
This section need not be completedFirst 20 - r�f _•
( if the work involved b Y Total No. Additional CITY Tel. No.
the permit is for one hundred dollars ($100)or less.)
PLAN CHECK
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
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
i�/
Total No. Additional
CITY „ Tel. No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT
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. No.
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER Class.
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESS BY
and Professions Code, and my license is in full force and effect. Power Apparatus & Large Appliances
Size&Type HP, KW, KVA, or KVAR' (
License Number Lic. Class Up to 1 Incl. FINAL U
Over 1 to 10 Incl. DATEof
J_9S VALIDATION
Contractor Date Over 10 to 50 Incl.
FI NA / l �J
❑ I am exempt under Sec. Over 50 to 100 Inc. BY Lu
B.&P.C. for this reason. Over 100
Date: Services, Swbd., MCC& Ponelboards
0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V G 1 4 2 5 R
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect. �'• ° m ° ® 2
SINGLE FAMILY Temp. Power Pole&Appurtenances s - 25.50
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's LicenseAdditional Sign Branch Circuits am
Law for the following reason (Section 7031.5, Business and
Professions Code):
Misc. Conduits&Conductors 01.28785
� I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section Other (See Complete Fee ScheduI )_ y
7044, Business 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 PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.). _
PLAN CHECKING FEE L1
Lender's Name
PERMIT ISSUING FEES
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
he'"reby authorize representatives of this County to enter upon
th" above entioned property for inspection purposes.
v � SEE REVERSE FOR EXPLANATORY LANGUAGE
Sig ature a Permittee Date