HomeMy Public PortalAbout5638 GRACEWOOD AVE_Electrical__ S SA
DBDEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PE11-46 RMIT 1
COUNTY OF LOS ANGELES ELECTRIC
WM. J. FOX CHIEF ENGINEER
Z_ NAME DISTJWT NO. GROUP ZONE l PERMIT NO.
U ADDRESS
f
E
W CITY TEL.NO: REGI ED BY READY FOR L]qT SSUE
FIRST INSPECTION
J COUNTY
W CERT.NO. EXPIRES
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
DESCRIPTION OF WORK
JOB
NUMBER OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS NEAREST
LIGHT OUTLETS ISW. PLUGS FACT CROSS ST.
CIRCUIT A B C D E F G 1H IZ NAME
3 ADDRESS
O
CITY TEL.NO.
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION..
ELECTRICIAN.
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE
OWNER.
CORRECTIONS
— a
z
c�
«�. Ei
0
TOTAL
No. OF OUTLETS $ ' APPROVALS
NO. OF FIXTURES $ t 1 DATE IN TOR'S NAME
NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. $ WIRING
-L : #
NO. OF RANGES OR HEATERS $ FIXTURES
MISCELLANEOUS $ POWER
PERMIT FEE $ y'. U7ILITYCO.NOTIFIED
TOTAL FEEy - FINAL
76AS63 DBS SA 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUIZDING AND SAFETY ELECTRIC
�����'
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRINO. GROUP ZONE PERMIT NO.
ELECTRICIAN
RECEIVq BY READY FOR DATE IB ED
ADDRESS � FCST SPECTION
° -
CITYo�'U
COUNTY LICENSE N0. EXPIRES 0 —ADDRESS I
��'IR � DD
PERMIT FEES
FEE LOCALITY / /�,/► L (.� T Y
NUMBER EACH
LIGHT OUTLETS NEAREST
CROSS ST.
RECEPTACLES
WALL SWITCHES OWNER
TOTAL OUTLETS 5C $ r'L� MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25 CITY TEL. NO.
FIXTURES 5
1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS
MISC. ,APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS SAND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
I FEE
NEW Mvo. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
6 LESS $ .25 SIGNATURE Or - ✓
1/2 2 .50 PERMITTE --
2 s 1.00 INSPECTION CORD
5 is 1.50
1s so 2.50
_ 50 200 5.00 _
200 500 10.00 ..1
Q
1000 15.00 Z
OVER 1000 20.00 I9
M.G. SET/FREQ. CHANGER-HP --- Q'
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS X75% or ORIG.)
MOVED MOTORS (75% Or DRIB.)
MISC.
SIGNS
NO. NO.TRANS.
APPROVALS
NO. NO. LAMPS
DATE INSPECTOR'S NAME
FOR EACH PERMIT:
WIRING $1.00 CONDUIT
FIXTURES $1.00
WIRING
SUPPLEMENTARY .50FIXTURES r,f._ 7--
POWER
TOTAL FEE S _UTILITY CO. NOTIFIED _
FINAL
vdORKER3 COMPENSATioN DEa ARAT1oN 7EAe$9 1oie1 APPLICATION FOR ELECTRICAL PERMIT
I Y'aVft that I# CE-8,06B Aave e owffioafe.'of coneerd to self Ymre,
-or a oK flcs ofYVbfkerp' Comperrsptbn Irt«ranoe, or s certified COUNTY OF LOS ANGELES BUILDING"'AND SAFETY .
obey thereof(Sec.3800,L.eb.C•)• }
PoBvy No. +y Poa APPCx.1NT To PLL iN JPB
Q' Germs copy 6.herby furnler,ed. New Reelderrtfal s,dgs d Poolh �t NO• FEE S
• Cerrttted oopy le' fled with tha county NAdfrig kv$Wtfon 1 a 2-FarnRY,S%Ft. $ _ a Y
departnri-t.-• I Mtfl-farnDy Sq,Ft a-r -
Date Reekierrtiel swlmmtrrp Poote CYO EA OR
OF'EXEMPTION FROM WORKEPS' MAL
SATION ItJSlh3AN(E Outtehs Rao Ll�rt Sw. ADDFIW
'
(Tt►b�icfiorr nwd not be computed If tiro work trrvofved by the �L�/ ddftiFirst 2Q.� TT& '
permR M'Tor ohs hurKr}d0oltan,{=iQ0)or kw&- ,,. Totsl No-,; �. Agnel' Crit_ -
i certify than�n the perforn,enoe of the work fpr which tills permit �,wT
b bayed„l: (t-nd,aTrpby ary person In any manner so as tb
bsoorne subject to the VrbrkKs'Comperieatloh(awe afro Futures Bret 20' ADDRESS' -
Totel Na_ Additbnel, _ CrFY Tbh Na
.Applbefit Flied Appflanoea Not Ovbr 1 HP PEFUT
NOT)bE.•TO APPUCAW: A. after rnaking ttils •Gertfl'bAe .of
E-owtfon,Youshould•beco(netsub}ecii9-the Workers'Cpenaatfo
onn - RVQe•_ Heater_ D.W.._ . ' ,
proVfa m of Spe Labor Godo. You mu$t iorttwith corn*•with such Oven Dryer _ W.M._ ADDRESS
'
proyWons or U*pw#*sisal be deemed reyo ed - . Top ._ FAU W H. -
UC-NSED.Cpf1T LACTOR'S DECLARATION., , Food Fan Other_ . / ary . ter.Na'
I 'he-m6y,affirm Yhet I'e.M Godnaed, rpder p «m of. Uwptw 9 Dip Room Air Gond. / 10 trl1�e�EJt
(corrrnenoing wail Sertbn'7000) d DNfebn 3'Qt the amtmws and
Profsesfpne Oode,and hry%arae is In fu)1 force and effeot Power Apparatus.&L-W Apolarx e- Dr9TFOCT No.
8tze d type HP,KW,KNP or Ku4A 4 �� � -�"� 8
LbWw Number Lir.Gess Up to 1 IiwL FINALDATE
U
_ Date ever 1 tp ]Q Ir". G-2 f`�- ur inerw_iN- p
Over 10 to 60 Ind. FiNAL
.I exempt under Sec ' - Over 60 to 1AQ ino '. BY W
B.BP.C.for thie reason Over 100 to
_ - Det« sw bee,Sw*(. MCC& P"Oosids _ Z.
0-200 Amp.Under 800-V
04e 201 - 1000 Amp.Und)(666 V - - -
- _ Over 10Q0 Amp.or Ov .600 v
F�aernptbn for Reg,Matnt Elect _. er _
t` SINGLE FAMILY Tarnp.Powpf Pole d Apptrrtehencee
HOME OWNER-BULDER DECLARAT}ON 8lgn with One BrenSoh Ctrorft ACCT■
I hereby afRrm that I am exw#,from tt-od,Contractors L,benee Law
for the.fofbwing�ge;pon 4SectJoo.a031.5,Business and Protpaebrts Additional Slari l3renoh arcuhe _. 84■00
Mi60:C-04 rte & C0dXk Qn5 -
LDl I,aa•owrrer of ttie prpperty,W1 dott,a worfr Qnd me afn,ohre � (See Complete Foe 9ohechAe) - TOTAL
is not.htarrded of 4" for sale•(Sectlon 7044, Busbose ,Code)
ap.Eq; 4'►■00
and Proteaelorn
C.ONSTRUCTION'L- NDWO AGENCY..' []�
I hWeby affirm tf,at there b a oonsLvcHon briding agency for the
•
perfrxmance of the work for wtrloh this permit Is blued(Seo.3097, PERMIT FEE (Sub-Total) '
PLAN CHECKING FEE 000 ` l 12/ 1/95
LeWs.Name 3525 1 AMlb.'04
PERMfT ISSUiN(i�EE o�
Landers Address
I certify Urst I have rued thb appdostlon•and state that the above TO-OIL FEE
trfornmWon Is oorlBct I agree to oompy'with ell County ordharme
and Statehaw�th�B
Eled7foal whtig, and hereby autt"tze
nty to entar upon•the merttbrr@d
fa PU {/ SEE FtEVER$E FOR EXPLANATORY•LANGUA13E ;
WORKER'S COMPENSAT10N DECLARATION 2040,6 DPW(+2-01) APPLICATION FOR ELECTRICAL PERMIT
7eAee3
I hereby affirm that I have a certificate of consent to self Insure,
or a certifloate 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.)
FOR APPt1CANT TO Pal IN A�pp�-88 � ` ;(�
❑ NO. Company N ti J
Certltied copy is hereby tumtshed. New Raeiderttlal Bldgs.S Pooh NO. EACH FEE
LOCAL"
❑ 1 d 2-Farr0y,Sq.Ft
Certi}1ed Dopy to filled with the county bulldtr g Inapeorion _ NEAREST
dspartn»nt. Muttl-famRy Sq.R. CFKM ST.
ReakWntlal Swimming Pooh A38E8S0r1
Date APpRos-nt MAP BOOK J�fG FAKE PARCEL dL>
CERT1RlCATE OF EXEMPTION FROM WORKERS' Off:Roc._LIQht Sw. ��NAME S ^�
COMPENSATION INSURANCE
(Thls section need not be oomplsted if the work Involved by the Fleet MNADORE88
permit is for one hundred dollars(i100)or less.) Total No. Addltbrtal
I certify that In the performance of the work for which thle permit CITY sL N-
is issued, I shall not employ any person In any manner so as to PLAN CHECK
become subject to the Workers' Compensation Laws. Ughtirg Rbduree FIrst 20 APQucANT
Total No. Addhlonal
ADDRESS
Date APPDosn-d RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITY TOL No.
Exemption,you should become subject to the Workers' Compeneatlon OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Cade, you must forthwith comply with such Power Apparatus S Large AppllartceejC VtT
provisions or this perntlt shall be deemed revoked.
LFCENSED CONTRACTORS DECLARATION Size 8 Type HP,KW,KVA,or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 8 Over 3 to 10 Ind.
(oommencing with Section 7000) of Dlvlelon 3 of the Business and CffY TOL NO
Professions Code, and my Iloense Is In full force and effect. Over 10 to 60 Ind. LKIN.E OR Cisme
Over 60 to 100 Ina. RE&NLAASEA O
Over 100 ort;rwcT No. t3Y
Uoenee Number Lb.Class V
Swbd
//•• FINALContr&dor Deis gyp ' . n, DATE
❑ I am exempt under Sea 400-1000 Amp.Under e00 V /-Z
Over 1Q00 Amp.or Over 800 V Fw,L VALlDATFON W
CL
B.SP.C.for this reason BRANCH CIRCUIT FEES EFY Z
Data. 15A,or 20A,120V,Llghting or Recept
1 To 10 Branch CtrcuIts
SIgnahire 11 To 40 Branch Circuits
41Or More Branch Circulfs
❑ Exemption for Reg.Matnt Elect. 16A,20A,2OBV To 277V Br.Ctaib
SINGLE FAMILY Temp.Power Pole S Appurtenances 7
HOME I hereby affirm that I am exxeemBptifrom theLIDER D Contr'actor's Lloense Law SigACCT■T
Sign with One Branch Circuit
for the following reason (Section 70L31.6, Buelneas and Professions Additional Sign Branch Clroults 65.60
I,as owner of the property,will do the work and the structure Mlao.Conducts S Conductors 1 I r M
Is not Intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedub) , 'VITAL 65 -60
and Professions Code). GEC 65.60
CONSTRUCTION LENDING AGENCY /•�.��,�t�•�
I hereby afflrm that there Is a construction lending agency for the t+t2flM1S .tiV
performance of the work for which this permit Is Issued (Seo. 3087, PERMrT FEE (Sub-Total)
Civ.C.)
PLAN CHECKING FEE 00*-O 01 12/26/95
Lenders Name PERMIT ISSUING FEE 6-933 1 PM 6:42
Lender's Address
I certify that I have read this app6oatkm and under penalty of purjury state TOTAL FEE Z 0
that the above to I &gree to corN*with a➢ County
ordinances and State regulating
Electrical wtri ng,and hereby authortre
01 th my to enter upon the aboy&-mention
ed
'-76ct-'-p n SEE REVERSE FOR EXPLANATORY LANGUAGE
,ver oP DATE /tJ
X-C
TION
'WORKERS'COMPENSATION cafe of corse CE-906 10,81 APPLICATION FOR ELECTRICAL PERMIT
I�hefen at I have a certificate of consent to self CE-906G
Infure, br a certicnte of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a ceFtlfled co y thereof (Sec. 3800, Lob. C.)
Policy No. Company FOR A"UCANT TO RLL IN ^/
Certified copy Is hereby fumished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS
✓ v
❑ 1 3 2-Family, Ft. s — $ LOCALITY
Certified copy Is filed with the county building Inspec- Y- Sq•
tion department. Multi-famlly Sq. Ft. — NEAREST t
CROSS ST.
Residential Swimming Pools OWNER OR
Date Applicant FIRM NAW
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Re�LI ht S �' L
COMPENSATION INSURANCE g w.T— �> y ADDRESS
Total No— First
(This section need not be completed If the work Imrohred by AddIt�IL',bnal CITY Tel. No73 cJ378
the permM V for one hundred dollars ($100)or less.)
I certify that In the performance of the work for which this A-sN CHECK ANT
APPLICANT
permit Is Issued, I shall not employ any person In any manner
to as to become subject to the rkers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Total No. Additional
CITY Tel. No.
Date 'f -Applicant Fixed Appliances Not Over 1 HP PT
NO TO APPLICANT: If, after making this Certlfl -of APPLICANTExemption, 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 CITY Tel. No.
Hood _ Fan _Oter_ U�'SE
LICENSED CONTRACTORS DECLARATION Room Air Conk — OR Claes
I hereby affirm that I am licensed under provisions of Chapter 9DisREG. NUM ER
(commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. r BY
and Professions Code,and my license Is In full force and effect. O
Size&Type HP, KW, KVA, or KVAR' c (J
License Number I Ic. Claes Up to 1 Incl. FINAL
Cher 1 to 10 Incl. DATE VALIO
DATN
Contractor Date Over 10 to 50 Incl. FINAL
❑ I am exempt under Sec. Over 50 to 100 Inc. BY p'
8.8P.C. for this reason Over 100 �
Date:
Services, Swbd., MCC 8 Panelboards ►
0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Rep. Malnt. Elect.
SINGLE FAMILY Temp. Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's Ucense Additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and
Professions Code): '
Misc. Conduits 8 Conductors
as owner of the property, will do the work and the
s Other See Complete Fee Schedule)—
structure Is not Intended or offered for sale (Section ( P , �5�2� A
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY # o 0 0 0 0 2
I hereby affirm that there is a construction lending agency for 1 0 0 1 2 7 5
the performance of the work for which this permit Is Issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C_).
PLAN CHECKING FEE e.° ° 1 2756
Lender's Name 09.1 1 -86
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and state that the TOTAL FEE x
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 abovementloned property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Sl`grailure of Permittee Date
y COUNTY OF LOS ANGELES I TEMPLE CITY 4,0508 . ELtCTRI PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508-,9710020043
SUILDINQ AND SAFETY / LAUD DEVELOPMENT TEMPLE CITY G
PHONE: (818) 285-0488 EXT:
ON FILE 5638 GRACE61DM AV
FEE D EYCR I PT I OIL: QUAN T I TY:. U OR: AMOUlli T: ARCD G 910078411
ASSESSOR N NEAREST CROSS STREET:
8586-014 Al PERMIT ISSUANCE FHE 2 .75 THOMAS PAGE: 597 GRID: R3 LOCAL ITY. TEMPLE CITY '
G1 OUTLETS-LGT SLI RECD 3.00 .85
G2 LIGHTING FIki:UtES 1_00 LG7 1.95 .
TOTAL FEES 35.55 10/02/97 UT 10/02/96 .
TANG FRANCIS, C;GRACE M (118),447-1686- `�
1115.H000 REID DR . .
ARCO 910076163 CRK
ELECTRICAL FOR NEW PATIO
APPLICANT: TEL. NO:
SAME AS OWNER -
SPECIAL CON ITIONS:
9
SAME AS OWNER - - Off.
- LIC. NO � � TEMPOlZARY POWER POLE
ARCHITECT OR ENGINEER: TEL. NO-
LIC, NO / -
US L i C WORKS PLASTIC Y/N METAL Y/N T-
G
l
c'
I i
REPORT ID: DPR265 ROUTE TO: RS0508 -
1 I i