HomeMy Public PortalAbout6204 GOLDEN WEST AVE_Electrical__ I16A663-CE80610-61 APPLICATION F R ELECTRICAL PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER C
WILLIAM A. JENSEN, SUP'7 OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. 1
1 T E M NO. EACH FEE
OUTLETS: FIRST 20) $20 $ OWNER
LIGHTS RECEPT. !Z— SW. MAIL
OUTLET (ADD'L UNITS) .f0 ADDRESS
LIGHTS RECEPT. SW.
LIGHTING FIXTURES: (FIRST 20) .20CITY TEL O.
J
LIGHTING FIXTURES: (ADDITIONAL) .10 ELECTRICIAN /Jj�
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS ✓ V R
GARB.DISP. STA.COOK
CITY L.NO.
DISHWASH. AUTO.-WASH. STAT
SPACE HTRS. STA.APP.('/s H.P.MAX.) .50 LICENSE NO.
MOTORS: ovER NOT OVER H.P. DIST ICT NO. GROUP 7,ONE P CESSED Bx
O 1 1.00
1 3 1.50 j INSPECTION RECORD
_ a
3 3 2.00 / p
U
8 Is 2.50
Im
15 50 13.00 1
W
50 100 5.00
IL.
SIGNS: NO.TRANS' %
NO.LAMPS Z
SERVICE 0.600V-NOT OVER 200A 1.00
SERVICE 0.60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2.00 474
SUPPLEMENTARY PERMIT ISSUING FEE 11.001 1
TOTAL FEE $ 1,144
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING.
WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR `
LICENSED AS REQUIREDBY LOS GELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM T LEGAL OWN" F THE ABOVE
DESCRIBED RESIDENTIAL Fj0O RTY. " POWER -
SIGNATURE � - UTILITY CO.NOTIFIED
OF PERMITTEE
FINAL
LI ARTHUR C. VEIT
C MOO CAS CASH SUPERVISING ELECTRICAL ENGINEER
L654 ( 15 : c 4 .2
, 1
WORKERS'COMPENSATION DECLARATION CE 806G (2-80) APPLICATION FOR ELECTR-ICAL PERMIT
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, ori
a certified copy_thereof(Sec 3800,Lab C) r
FOR APPLICANT TO FILL IN, SOB'
Policy'No Company EACH NO FEE ADDRESS - a aLDC/� l✓L�S7
New Residential-Bldgs &Pools r
Certified copy is hereby,furmshed. 1 &2-Family,Sq. Ft $ — $ LOCALITY
Multi-family Sq Ft - 1 — NEAREST /_.7-,,, T
Certified copy_is Bled with the county building inspection I CROSS ST'
department Residential Swimming Pools - OWNER OR
FIRM NAME
Date` I Applicant ,Outlets Rec_Li ht Sw MAIL
1' g First 20 ADDRESS � '� �
CERTIFICATE OF EXEMPTION FROM WORKERS' r
COMPENSATION INSURANCE Total No Additional• CITY`���7�Lr �7t- Tel N.-.4
PLAN CHECK d
APPLICANT O
(This section need not be completed if the work involved U
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures Flirst,20 ADDRESS
Total No Additioiial cr
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP \ i CITY I TelNo0
,permit is issued, I shall not employ any person in any manner PERMIT ��Q W
so as to.become subject to''the Workers' Compensation Laws Range Heater_D W APPLICANT a
' Oven Dryer_W M. ADDRESS
Date_/3 1'^Apphc��Gn Top _ FAU _W H - Z
Hood Fan _Other_ 1 CITY Tel No
r 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 Class
-Compensation provisions of the Labor Code,.you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY
wi kcomply with such provisions or this_perm>t shall] be
- -,- --Size-&-Type<HP_;KW;KVA;or-KVAR.- —_-
deemed revoked T p
Up to 1 Incl
, FINAL Over 1 to 10 Incl DA E
LICENSED CONTRACTORS DECLARATION (Fr VALIDATION
Over 10 to 50 Incl
I hereby affirm that I am licensed under provisions of Chapter Over 50 tor100 Inc. FINAL
BY
9 (commencing with Section 7000) of Division 3 of the Busi- Over 100
ness and Professions Code, and my license is in full force and
effect Services 3
License Number Lic Class ' 0-200 Amp Under 600 V I
L 201-1000 Amp Under 600 V'
Contractor Date Over/1000 Amp or Over 600 V
HOME.OWNER-BUILDER DECLARATION Temp Power Pole'&Appurtenances ,
-� Sign with One Branch Circuit
I.'hereby, affirm that I_am exempt from the Contractor's Additional Sign Branch Circuits
License Law for the following,reason (Section 7031 5, Busi-
ness and Professions Code). ' 4 0 rJ 6 a ,
Misc Conduits&Conductors
I, as, owner of the property, will do the work and the Other (See Complete Fee Schedule)-- J
struture is 'not intended or offered for sale (Section # o'o o o o 2
7044, Business and Professions,Code)
CONSTRUCTION LENDING AGENCY 2'o'o i2 2,0 0
I hereby affirm that there,is a construction lending agency 11
for the ,performance of the work for which this permit is 0 0 =
issued (Sec' 3097,•Civ C). PERMIT FEE .(Sub-Total) o 2 2 0 0 v
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) 2 1 TJ-18 11
Lender's Address PERMIT•ISSUING FEE BO t
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 4
the above-mentioned pro ty for inspection purposes --SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee 1 Date -
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 jELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EO 0508 9806150014
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
LEGAL D: FEES AID BUILDING DRESS:
ON FILE 6204-GOLDEN-WEST AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA-917801704
ASSESSOR ITrUMM9 NUMBER: NEAREST CROSS STREET: FLAHERTY
5385-025-019 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CTIY
F1 120V, 15/20A BR CKTS 1.00 BR 17.40
TENANT: G1 OUTLETS-LGT,SW,RECP 16.00 OUT 31.20 ISS N: PROCESSED BY: EXPIRES .
G2 LIGHTING FIXTURES 6.00 LGT 11.70 06/15/98 UT 06/15/99
HA FAU LESS 3HP 1.00 FAU 10.80
OWNER: TEL. NO: H2 RES GRBG DISP LT 3HP 1.00 DIS 10.80 FINAL DATE FINAL BY: CODE:
GROHS, AGNES (626) 447-4716- H3 RES DISHWASHR LT 3HP 1.00 DIS 10.80
6204 GOLDEN WEST JB AC UNITS +3-10HP 1.00 AC 19.65-
TEMP 91870 LA 100 AMP PANELS, MCC 1.00 PAN 38.85 D SCRIP.T•10 -OF`WOR
TOTAL FEES 178.95 ' ELECTRICAL_F.OR REMODEL AND-NEW HEAT/AC-SYSTEM---
APPLICANT:
-APP I NT: TEL. NO:
SAME AS OWNER
-- -_ SPECIAL CONDITIONS:
CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO TE OWER POLE
UNDERGROUND CONDUIT
ARCHITECT ORE TEL. NO: �� Ij �, VUFER GROUND
i
LIC. N0: ROUGH CONDUIT
ROUGHWIRING
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
�� --- --- -- ___ UTILITY COMPANY NOTIFIED
REPORT ID: DPR265 ROUTE TO: BS0508