HomeMy Public PortalAbout5732 GOLDEN WEST AVE_Electrical__ y ,
Worm tIh t I have
a certificate
DECLARATIONS f CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT
hereby affirm that I have a certificate of consent to self CE-8066
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
ADDRESS 6 3V
Certified copy is hereby furnished -New Residential Bldgs &•Pools EACH NO FEE- I `
1 & 2-Famil S Ft $ — $ LOCALITY
❑ ' Certified copy is filed with the county building inspec- Y q —
'NEAREST
tion department Multi-family Sq Ft 1� CROSS ST Q �.I
Residential Swimming Pools OWNER T
Date Applicant FIRM NAME G J
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Recl�Light OR
�Sw MAIL
COMPENSATION INSURANCE ADDRESS 73a
57
This section"need not be completed if the work involved b" First 20 _
( P Y Total No CITY-' Tel •No
the permit is for one hundred dollars ($100)or less.) Additional -fin � � E _ `•- 6 396
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 Worker 'Compensation ws Lighting Fixtures First 20 ADDRESS Q
Total No� Additional
Date Applicant CITY iY1, c�`� Tel No
NOTICE TO APPLICANT If, after �aking this Certifi to of Fixed Appliances Not Over 1 HP PERMIT
—,t.
Exemption, you should become subject to the Workers' Range_ Heater_D W — APPLICANT G 1 t G C.
Compensation provisions of the Labor Code, you-must forth- Oven _ Dryer, —W M — ADDRESS (yyla comply with such provisions or this-permit shall be Top _ FAU --_W H —
'-deemed revoked CITY-rep J C/ Tel N.,;297 393
LICENSED CONTRACTORS DECLARATION Hood _ Fan� _Other_ -
Disp Room Air Cond 'LICENSE OR _y 71 Class F3-
I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER (O
(commencing with Section 7000) of Division,3 of the,Business DISTRICT NOPRO SED BY
and Professions Code, and my license is in full force and effect Power Apparatus& Large Appliances
7 6 1-67� Size &Type HP, KW, KVA, or KVAR License Number Lic 'Class Up to 1 Incl FINAL V
_'1 ��4' Over 1 to 10 Incl DATE 2`�i- VALIDATION 0
Contractor ate d / Over 10 to 50 Incl FINAL U
❑ I am exempt under Sec Over 50 to 100 Inc BY
B&P C for this reason Over 100
Date Se�rvices,'Swbd , MCC& Panelboards Poo,
� Under 600 V
Signature 201 - 1000 Amp Under 600 V
EJJOver 1000 Amp or Over,600 V
Exemption for Reg Maint Elect
SINGLE FAMILY Temp Power Pole &Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that'I am exempt from the Contractor's License Additional Sin Branch Circuitsn, /I
Law for the'following-reatiga
son (Section 7031 5, Business and
Profess ions"Code)
❑ Mi Conduits&Conductors 2 0,0 4 5 2� 5
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 Schedule)_ a
7044, Business and Professions Code) ► owo o a 5.215:E5
CONSTRUCTION LENDING AGENCY -
1 hereby affirm that there is a constructiondending agency for
the performance of the work for which this permit isissued PERMIT FEE (Sub-Total)
(Sec 3097, Gv C )
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE- -
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
hereby authorize representatives of this County to enter upon
the ab a-menti ned pr ty fob inspection purposes _ SEE REVERSE FOR EXPLANATORY LANGUAGE
ature of Permittee � '77^/Date� -
1
COUNTY OF IAS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1102020040
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ITR: 6561 LT 456 5732 GOLDEN WEST AV
I IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917802503
ASSESSOR INFORMATION NUMBER II NEAREST CROSS STREET-
8587-028-018 IA1 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 597 GRID A3 LOCALITY TEMPLE CITY, Cl
F1 120V, 15/20A BR CKTS 1 00 BR 17 30
TENANT- 1F2 208, 277V LGT BR CKT 2 00 BR 54 60 JISSUED ON PROCESSED BY PLAN BY
JHA FAU LESS 3HP 1 00 FAU 10 90 102/02/11 SR
IJB AC UNITS +3-10HP 2-00 AC 39 40 I I
(OWNER TEL NO I TOTAL FEES 150 00 (FINAL DATE FqIBY CODE
ICAMPOS, RICARDO (626) 286-3915- I I 1
15732 GOLDEN WEST AV 1 1
ITEMP 917802503 DESCRIPTION OF WORK I
1 I 1ELECTRICAL FOR HVAC SYSTEM
I
(APPLICANT TEL NO I
ICORZO, ANDREW (951) 538-1595- 1 1
15027 WYCHE CT i ISPECIAL CONDITIONS
SAN BERNARDINO 92407 11
1 I I I
ICONTRACTOR TEL NO- I (APPROVALS DATE INSPECTOR SIGNATURE 1
NORTON AIR HEATING AND A, C - (951) 538-1595-
15027 WYCHE ST LIC NO 1 '��,.. yi Y ITEMPORARY POWER POLE
I 1
ISAN BERNARDINO, CA 92407 819746 C20 1
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(UNDERGROUND CONDUIT
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(ARCHITECT OR ENGINEER TEL NOI - IUFER GROUND I I I
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I LIC NO- i IROUGH CONDUIT I I 1
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1 IROUGH WIRING 1 1
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I IMAIN WATER LINE I
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IPLASTIC Y/N METAL Y/N
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1 1UTILITY COMPANY NOTIFIEDI I 1
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1 IREPORT ID DPR265 ROUTE TO BS0508
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