HomeMy Public PortalAbout6327 GOLDEN WEST AVE_Electrical__ DSS 5-A 12-44 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ��������
COUNTY OF LOS ANGELES
WM. J. FOX CHIEF ENGINEER
NAME DISTRICT NO. GROUP ZONE PERMIT NO.
U ADDRESS
RECEIVED BY READY FOR DATE ISSUED
U CITY t.. TEL.NO. FIRST INSPECTION
.I COUNTY } - -
W CERT.NO. EXPIRES
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
DESCRIPTION OF WORK ADDRESS 1;2-1
NUMBER OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS NEARES�El' _
LIGHT OUTLETS SW. PLUGS FIXT CROSS S
CIRCUIT A B C D E F G H W NA
Z MAIL
3 ADDRESS /
0
CITY.,.-� TEL.NO. f+
1 AM THE L90AL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION-
ELECTRICIAN.
UALIFICATION..
ELECTRICIAN.'
1 AM THE"GAL OWNER OF THE PROPFRTY DESCRIBED
ABOVE
' OWNER.
CORRECTIONS
J
Q
— Z
C7
O
TOTAL
NO. OF OUTLETS $ APPROVALS _
NO. OF FIXTURES $ DATE INSPECTOR'S NAME
NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. $ WIRING
NO. OF RANGES $ FIXTURES
MISCELLANEOUS $ POWER
PERMIT FEE $ I ; UTILITY 6ol D
TOTAL FEE FINAL "��
, c
Wfirm th'CI h6ve a cerci DECLARATION C� 10/81 APPLICATION FOR ELECTRICAL PERMIT
I her gfflrm thpt I have a certificate of consent to self CE-8'06G
•dnsufe, a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C.)
r
Policy No. Company FOR APPLICANT TO FILL IN JOB
New Residential
Certlfled copy Is hereby furnished. Bldgs. 8 Pools EACH NO. FEE ADDRESS
❑ s —
Certified copy Is filed with the county building Inspec- 1 8 2-Family, Sq. Ft. s LOCALITYfTYNEARESTtion department. Multi-famlly Sq. Ft.
Date A llcant Residential Swimming Pools CROSS OR
PP FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL
COMPENSATION INSURANCE ADDRESS
(This section need not be corrrpleted If the work Imrohred by Flat 20
Total No Additional CITY Tel. No.
fhe PermitIs for one hundred dollar (6100)or loss.)
PLAN CHIE(Y
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' tion Laws. Lighting Fixtures First 20 ADDRESS
Total No. Additional
CITY No.
Date'R`� 7 ATv,llcant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, aking t Is Certificate ofRJ
Exemption, you should become subject to the Workers' Range_Heater_D.W.
CANT 4N
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. CITY Tel. No.
LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_
hereby affirm that I am Ilcerued under provisions of ChapDlsp. _ Room Air Cond. LICENSE OR
Chapter 9 REG. NUMBER Claw
(commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. U((� 11Yand Professions Code,and my license Is In full force and effect. 5 UX
Size 8 Type HP, KW, KVA, or KVAR' �
License Number- I Ic. Class Up to 1 Incl. FINAL
Confractw pate Over 1 to 10 Incl. DATEi yAL4"
Cher 10 to 50 Incl. FINAL
❑ am exempt under Sec. Over 50 to 100 Inc. BY
DAP.C_ for this reason Over 100
z
DOT°' Services, Swbd., MCC 8 Panelboards r d ►
0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Malnt. Elect.
SINGLE FAMILY Temp. Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Clrcult
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and
Professions Cade): S 6 5 9.3 A
I, aerty
s owner of the prop , will do the work and the Mlsc. Conduits 8 Conductors
structure Is not Intended or offered for saie (Section Other (See Complete Fee Schedule)_ , # o o o o e 2
7044, Business and Professions Code}. ( o o 2 a 5 0
CONSTRUCTION LENDING AGENCY 0 0 0 2 5 5 0
I hereby affirm that there Is a constructloh lending agency for
the performance of the work for which this permit Is Issued PERMIT FEE (Sub-Total) 02-27-87
(Sec. 3097, Clv. C.).
PLAN CHECKING FEE
Lenders Name
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and state that the TOTAL FEE p2Sr
above Informatlon 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 above property for Inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sqre of Permlttee Date
~ COUNTY OF LOS ANGELES TEMPLE CITY �• 0508 CEL CT ERMII{I
• DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 50>�97042
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-DM EXT:
LEGAL ID: FEES PAID ---lW
ON FILE LDIM-ADDRESPi(04DN �AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 7f 1
ASSESSOR N NEAREST CROSS STREET:
5383-019- Al PERMIT ISSUANCE FEE 27_75 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY
G1 OUTLETS-LGT-SW RECD 25.00 OUT 45.75
G2 LIGHTING FIXTaES 5.00 LGT . . 9.75 .
IA N-RES EX FANS LT 31+P 1.00 EX 15.45 04/24/97 TC 04/24/98
TOTAL FEES 98.70
OWNER: TEL. NO: FIWAL DATE.- FT .
LEU SHIM-HWA•MOU LI-MIM (818)- 287-5868-
6327 GOLDEN NEST AV
TEMP 917801421 -
'U17TION UF WORK
ELECTRICAL FOR NEW 458.SQ. FT. ITION
APPLICANT: TEL. NO.
SAME:AS OWERSPECIAL CONDITIONS:
SANE AS OWER
LIC. NO "'�iTOMMY
0�q`
ARCHITECT OR TEL. NO:
LIC. Mtn:
nin
C ®OS MAIN WATER
PLASTIC MAI METAL Y/N
d r^ .
° D
REPORT LD: DPR265 ROUTE TO: BS0508