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HomeMy Public PortalAbout5405 GOLDEN WEST AVE_Electrical__ 76A663CE-806(6/78) APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN JOB FAppliances sidential Bldgs.&Pools EACH NO FEE ADDRESS ,S -Family,Sq. Ft. $ .025 — $ LOCALITY i�family$q. Ft. 02 — NEAREST 25.00 CROSS ST. ential Swimming Pools OWNER OR FIRM NAME Rec Light Sw. MAIL First 20 .50 ADDRESS No. Additional .30 CITY Tel. No. PLAN CHECK APPLICANT Fixtures First 20 .50 ADDRESS Additional 30 No. CITY Tel. No. ppliances Not Over 1 HP PERMIT e_Heater_D.W. APPLICANT _Dryer_W.M.— ADDRESS Top _FAU — W.H. _ CITY Tel. No. Hood—Fan _Other_ LICENSE OR Disp._Room Air Cond. 2.50 REG.NUMBER Class. IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA- Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO d Size&Type HP, KW, KVA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS G REGULATING ELECTRICAL WIRING. Up to 1 Incl. 2.50.00 L_j5I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF U.Over 10 to 50 Incl. 1250 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE U. Over 50 to 1 00 Inc. 25.00 DESCRIBED RESIDENTIAL PROPERTY. OG Over 100 40.00 PERMITEE SIGNATURE O Services DISTRICT NO. PROCESSED BY 0-200 Amp. Under 600 V 12.50 y� 201-1000 Amp. Under 600 V 25.00 ~ Over 1000 Amp.or Over 600 V 50.00 Z O Temp. Power Pole&Appurtenances 10.00 Q Sign with One Branch Circuit 10.00 Additional Sign Branch Circuits 2'00 INSPECTION > INFORMATION Misc.Conduits&Conductors 10.00 ON REVERSE z Other(See Complete Fee Schedule) SIDE v Z Q J d 4 S m K PERMIT FEE (Sub-Totali Z' PLAN CHECKING FEE IOne-Fourth Permit Feel O s m PERMIT ISSUING FEE $7.00 0 J TOTAL FEE > j t= INSPECTION FINALED ode date: B C�rjA, a WORKER S'COMPENSATION DECLARATION 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 / ` 11 rtiu yGhef pf(Sec.'3800, Lab.C.) ^� l{l =�\A �` FOR APPLICANT TO FILL IN JOB — Po N Company . 22V EACH NO. FEE ADORES 4_ New Residential Bldgs. &Pools Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — Is LOCALITY 'S Multi-family Sq. Ft. NEAREST Certified co R copy is filed with the county bui inspection CROSS ST L9 ar nt. Residential Swimming Pools OWNER OR FIRM NAME Date Applicant�c Outlets: Rec.—Light— Sw. MAIL First 20 A D D R CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel No. y COMPENSATION INSURANCE' d PLANHEC 0 (This section need not be completed if the work involved APPLICANT V by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS Additional Total No. O I certify that in the performance of the work for which.this CITY Te Fixed Appliances Not Over 1 HP 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 0. N Oven _ Dryer_W.M._ ADDRESS Z Date.Applicant Top _ FAU _W.H. Hood _ Fan _Other_ CITY Tel No. NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond.. LICENSE OR 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. PROCE ED BV with comply with such provisions or this permit shall be deemed revoked. Size&Type HP,KW, KVA,or KVAR C Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE VALIDATION LICENSED CONTRACTORS DECLARATION // Over 10 to 50 Incl. /' ® — I hereby affirm that l 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 U effect. Services 0-200 Amp. Under 600 V �� License Numb ic.Clas 201-1000 Amp. Under 600 V Contra 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 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): rrJ� �,2 R Misc.Conduits&Conductors E] 1, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— ;,t o 0 0 0 0 2 structure is not intended or offered for sale (Section 7044, Business and Professions Code). 2 0'0 3 2 0 0 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 0 0 ` 3 2 0 0 issued (Sec. 3097,Civ.C.). PERMIT FEE (Sub-Total) c Lender's Name Q 3-8 1 PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE I certify that I have read this application and state that the TOTAL FEE above information is correct. 1 agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon bove-73ned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ignature'bWermittee Date WORKERS'COMPENSATIONDECLARATION CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that .I have a certificate of consent to self COUNTY OF LOS ANGELES insure, or a certificate of Workers'Compensation Insurance,or ,--/'/5 BUILDING AND SAFETY C ati4ZWW-� of(Sec. 3800,L b.C. 77 ,Gf/� FOR APPLICANT TO FILL IN 3OB /I, rompan EACH NO. FEE ADDRESS Q 4c;e0 J f,� �/ New Residential Bldgs.&Pools Certified copy is hereby furnishe ✓ 1 &2-Family,Sq. Ft. $ — $ LOCALITY Multi-family Sq. Ft. NEAREST Certified copy is filed with the c ty bu' Ing inspect' n CROSS ST depar a Residential Swimming Pools OWNER OR /�'� FIRM NAME Applicant Outlets: Rec.—Light Sw:� �(� MAIL First 20 CERTIFICATE OF EXEMPTION FROM W ERS' Total No. Additional CITY Tel No COMPENSATION INSURANCE }. PLAN CHECK �- (This section need not be completed if the work involved APPLICANT O by the permit is for one hundred dollars Fixtures First 20 s ($100) or less.) ADDRESS Additional (1' Total No. 0 1 certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. 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 d Oven _ Dryer_W.M._ ADDRESS Date Applicant Top — FAU _W.H.. Hood _ Fan _Other_ CITYSI Tel N NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond,_ LICENSE OR lf��,/� Exemption, you should become subject to the Workers' REG. NUMBER �T�/ Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PR PR E EDB with comply with such provisions or this permit shall be / deemed revoked. Size&Type HP,KW, KVA,or KVAR �✓ c e� Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE LICENSED CONTRACTORS DECLARATION VALIDATION Over 10 to 50 Incl. FINAL I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. 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 ���� 0-200 Amp. Under 600 V License Numbe Lia Class 201-1000 Amp. Under 600 V t Contractor 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 Contractor's Sign with'One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits 92'5 2 0 A ness and Professions Code): # o`0 0 0'0 2 Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— 2 0 40 0 9, 0 structure is not intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 0,0 0 0 9, 1 0 v I hereby affirm that there is a construction lending.agency I " for the performance of the work for which this permit is PERMIT FEE (Sub-Total) 0 1.0 5'-8A issued(Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE 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 d State Taws regulating Electrical wiring, and hereby h ize rep sentatives of this County to enter upon fie a v do roperty for ins ction purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE Signature o Permittee Date 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 Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec. 3800 Lab. C. ADDRESS 5 V-5 Policy No./ / 'Company ���-/c`- �t//j ` FOR APPLICANT TO FILL IN JOB r-1 ' ^ Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE $ $ LOCALITY ❑ Certified co is filed with the count bui din Ins 1&2-Family,Sq.Ft. PY Y 9 P department. Multi-family Sq. Ft. NEAREST ST. —2 Hyl, Residential Swimming Pools ASSESSOR �r�.- Date .000'Applicant MAP BOOK PAGE © PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS', OWNER OR T AL1 �rul COMPENSATION INSURANCE Outlets:Rec. Light Sw. FIRM NAME V f r First 20 MAIL (This,section need not be completed if the work involved by the ADDRESS permit is for one hundred dollars($100)or less.) Total No. Additional I certify that in the performance of the work for which this permit CITY Tel.No. 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 RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT: If, after .making this Certificate of . CITY Tel.No. Exemption, you should become,subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such PERMIT /.s �� provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT f! LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am*licensed under provisions of Chapter 9 Over 3 to 10 Incl. (commencing with Section 7000) of Division 3 of the Business and CITY Tel. Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR i� ///// 7.tl Class./t g Over 50 to 100 Incl. REG.NUMBER f� / y 7 / [! ([ y S�7 G �- Over 100 DISTRICT NO. PROCES?BY Q License Number / Lia Class /C/ V Services,Swbd.,MCC&Panelboards T_ Contractor Date o-399 Amp. Under 600 V FINAL V DATE 0 ❑ exempt under Sec. 400-1000 Amp.Under 600 V I­_I am VALIDATION V Over 1000 Amp.or Over 600 V FINAL BY d L0 B.&P.C.for this reason BRANCH CIRCUIT FEES Date: 15A,or 20A, 120V,Lighting or Recept. Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits El 41 Or More Branch Circuits Exemption for Reg.Maint. Elect. 15A,20A,208V To.277V Lighting Br.Circuits f SINGLE FAMILY Temp. Power Pole&Appurtenances - s HOME OWNER-BUILDER DECLARATION ACCTf =U I hereby affirm that I am exempt from the Contractor's License Law. Sign with One Branch Circuit 77 FMr}�- for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits ` - Code): ❑ I,as owner of.the property, will do the work and the structure Misc.Conduits&Conductors T77 sws5 f fTAL a is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) / and Professions Code). }_;i"�ECK r r s•-'17, •• CONSTRUCTION LENDING AGENCY (M-41`E a J ) 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) Q Civ. C.) '{I{-k �� `[�t "(e- PLAN CHECKING FEE Lender's Namef PERMIT ISSUING FEE L9 46 Lender's Address I certify that I have read this applibation and under penalty of purjury state TOTAL FEE that the a,�o,7e information is correct. I agree to comply with all County ordinances and State laws regulating Electri al wiring,and hereby authorize representatives thi County to enter o e ab -mentioned property for inspecti ses. SEE REVERSE FOR EXPLANATORY LANGUAGE lG' - 7 P �f SIG E bf PERMITTF DATE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1103280029 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I ITR: 35012 LT: 2 I I 5405 GOLDEN WEST AV 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917803219 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I 18588-020-023 1A1 PERMIT ISSUANCE FEE 27.80 1 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl 1 IF1 120V, 15/20A BR CKTS 1.00 BR 17.30 1 - 1 (TENANT: I TOTAL FEES 45.10 (ISSUED ON: .PROCESSED BY: PLAN BY: I 103/28/11 SR (OWNER: TEL. NO: 1 IF NAL'D TE FIN CODE: I IEVANS JAMES R;ROBIN B (626) 285-3470- 1\ 15405 GOLDEN WEST AV (DESCRIPTION OF WORK 1 ITEMP 917803219 (INSTALL 40 AMP CIRCUIT FOR ELECTRIC VEHICLE CHARGING STATION( I 1 (APPLICANT: TEL. NO: I 1 1 IFONTANILLA, MICHAEL (626) 241-6442- 1 I I 1222 E. HUNTINGTON DR ISPECIAL CONDITIONS: IMONROVIA, CA 91016 I I I ICONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE 1AEROVIRONMENT INC. (626) 357-9983- I 1181 W. HUNTINGTON DR. LIC. NO 1 (TEMPORARY POWER POLE 1 1 (MONROVIA, CA 91016 946935 C10 I 1 (UNDERGROUND CONDUIT 1 I I I I (ARCHITECT OR ENGINEER: TEL. NO: i JUFER GROUND I I LIC. NO: I IROUGt; CONDUIT I 1 I (ROUGH WIRING 1� 1 (MAIN WATER LINE IPLASTIC YIN METAL YIN I 1UTILITY COMPANY NOTIFIED( 1 1 I I I I i I I I I I I I I I 1 I I I I I I I I I I 1 i I I I I I I I I I I I I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 I I I I I I I I