HomeMy Public PortalAbout10721 GRAND AVE_Electrical__ GOU1PfY OF LOS ANGELEB APPLICATION FOR PE33M
Of ELECTRIC 1
ineer
DIVISION OF BIIIL.DINCi� & SAFETY
WILLIAM J. FOX, Oeooty Eillur
FOR APPLI If YFILL IN DI BTR ICTI�/,N0. GROUP ZONE PERMIT NO.
ELECTRICIAN (,0-73
R10][IVED fY READY FOR DATE ISSUED
ADDRESS FIRST INSPECTION
CITY L NO
OOUKTY LICENSE NO. SMIR111111611,101 ■UILDIN13
P RMT , ADDR�
NUMBER EACH F![ LOCALE
LIGHT OUTLETS NEAREST
RECEPTADLEJ! ROSS ST.
WALL 13WITCHES WNER L t.
TOTAL Ou-rLrm 60 MAIL
[LIC- RANGES IU ADDRESS
[LEO. HEATERS 28 CITY TIEL. NO.
FIXTURp ■
I H[RISY ADKNOYVL[DG[ THAT 1 HAVE READ THIN
MISD. APPLICATION AND NTAT1t THAT THE AaOVE 10 CORRECT
NUMN[R OF LIGHT OIROUITE AND AGREE TO COMPLY WITH ALL COUNTY ORDINAND[■
NUMOER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT 1 POSSESO THE ASOV[ VALID LOW
Nummm HORSEPOWER FEE AN=i" COUNTY UOENM OR 1 AM THE LEGAL OWNER
HIM MVD. HP DVu IMO. [ADN OF THE RESIDENTIAL PROPERT7DESC IS[D ASDVE.
i Llai .aN 01614ATURc or
a .60 P[RMI -
a s 1.00 INSPECTION RECORD
6 1N 1.60
1S so 2.6O
60 200 I,OO
Zoo 600 10.00
J
600 1000 16.00 Q
Z
OVER IODO 2O.m 0
M.G. ■[T FR CHANGER-HP
WIELDKR81A3-KVA O
G[N[RATORS - KW
TRANEFORMER9 - KVA
TEMP. MOTORo 76 or oRli.
MOVED MOTDRE (75or ORiia
IND.
BIONB
Nd
NO.TRANS.
L,M� APPRovArS
FOR [ADH P[RMITI DA INSP[OTOR'N NAM[
WIRING 411.00 41 CONDUIT
FIXTURES 1.00 WIRING AOP — �s
U [ [ RY FIXTURES
POWER
TOTAL FEE 1� �+� LRIuTYCo.NCTIFI[D
FINAL
1EAM3 DBB#U 4-63
WORKERS'COMPENSATION DECLARATION 76A663
'
CE8080 (2-80) APPLICATION ' FOR ELECTRICAL PERMIT
�
I hereby affirm that I have a certificate of consont to self COUNTY OF LOS ANGELES WILDING AND SAFETY
inure, or L cerdfIcate Of Workers'Compensation Insurance,or
certifled copy thereof(Sec. 3800,Lab.C.)
Policy NomptnyP �J/V
T&TI51
T ?te FOR APPLICANT TO FILL IN JOB
'
New Assidentltjl Bldgs.&Pools EACH NO. FEE ADDREBS Q
Certified copy Is hereby furnished. 1 &2-Famlly,Sq. Ft. $ — : LOCALITY
EK�'r� Multi-famlly Sq. Ft. ��
Certified copy is filedwlth the county building inspection CR ST
.d`/epartm�ent.. Realdentlal'Swimming Pool$ OWNE FI OR
Dat0�1 AppUcant Fev�u , rill z , FIRM NAME
Outlets: Rec.K-Light Sw. AIL
--Tint 20 ADDURESS
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No._� AdditionalCITY Tal N
}
COMPENSATJON INSURANCE
PLAN CHECK L�
(11hi$ section need not be oompI4ted tf the work farotyed APPLICANT 8
by the pmWt b for ono-hundred dollars ($100) or Im&) Lighting Fixtures First 20 ADDRESS
Additional
Total No. 0
I certify that in th&performance of the work for which this Fixed`AppllencesNot Over 1 HP CITY Tel No.
permit Y issued, I shall not employ any 15erson 1n any manner PERMIT t
to is to become subject to the Workers) Compensation Laws. Range_ Heater D.W. APPLICANT A D NVA)
Oven — Dryer—W.M. ADDRESS D DL{ Z
Date Applicant Top _ FAU _W.H.
Hood _ Fan _0-ther— CITY Tel
NOTICE TO APPLICANT: If, after making this Certificate of Map. _ Room Air Gond` Q
r Exemption, you should become subject to the `Yorkers' REG.NUMBER &Q�
Compen$atlon.provlsign of the Labor Code,you must forth- power•Appargws& Large Appliances D18TRICT NO. PROCE ED BY -
with comply wlth such. provkfons or .this pergrtf $hall be Size&Type HP,K`W, KVA,or KVA
deemed revoked.
Up to 1 Incl.
Over 1 to 10.incl. F AL
LICENSED CONTRACTORS DECLARATION DATE �O _ g VALIDATION
Over 10 to�6Q Incl.
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100•Inc. FINAL
9 (commencing with Section 7000) of Divisiop 3 of the Busi- (?ver 100 BY `f` as
nes and Prof6sdom.Code, and my license b in full force and - '
effect. /� 7� Services �,
License Number , DAy Lig.Class -� 1 0 x200 p. Under 600 V ;
y 201.1000 Amp. Under 600 V
Contractor te, Over 100Q Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Tafnp,Power Pole&Apportbnerx--w
I hereby affirm that I am'exempt from the Contractor'sSlgn with One Brooch Circuit
License Law for the followths reason (Section'7031.5, 13usi- Additlottal Sign Branch Clrcylts 1 5 7'a 4 A
neo and Profaslons Code): f$ o.a a o'o 2
Mlsc.Conduits&Conductors i
I, as owner of the pr4petty. Will do the work and the Other (See Complete Fee Schedt le)—
structure Is not'Intended or offered for sale (Section 2Fo 029.75
7044, Busineas and Profession Code) "
CONSTRUCTION LENDING AOENCY.
I hergb,y affirm that there is a gonrtrugtion lending agency °i° ° 2 9,7 5 2i
for the performance of the w6rk for wtd6h this permit is PERMIT FEE (Sub-Totel)
issued (Sec. 3097,Ctv.C.). r Q 0 3 L 8 3
Lender's Name PLAN CHECKING FE=E (One-Fourth Permit Fee)'
Lender's Andrea PERMIT ISSUING FEE
I certify that I have read this application and nate that the TOTAL �1 -
above information is correct.I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and -
hereby authorize representadvea'of this Co(rnty to enter upon
rile above mentioned perry for inpectloa purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY 1 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0410010018
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 DUPLICATE
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PATT BUILDING ADDRESS:
TR: 17867 LT: 58 10721 GRAND AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TBP CA 917803408
ASSE-q= INFORMATION Ni ER: NEAREST CROSS STREET: EL MONTE
8574-002-034 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, C
G1 OUTLETS-LGT,SY RECD 18.00 OUT 35.10
TENANT: G2 LIGHTING FIXiaES 5.00 LGT 9.75 ISSUM ON:-PRWESSED BY: PLAN BY: EXPIRES ON:
HA FAU LESS 3HP 1.00 FAU 10.95 10/08/04 JK 04/06/05
H5 RES WASH MACH LT 3HP 1.00 WAS 10.95
H7 RES EXHAUST FANS 1.00 EX 10.95 •
CAMPBELL PAUL D;MARY E (818) 579-3827- TOTAL FEES 105.45
10721 GRAND AV /-/o
TEMP 917803408 DESLRTPTION OF WORK
ELECTRICAL FOR 3/4 BATH AND LAUNDRY ROOM
APPLICANT: TEL. NO:
O'LEARY (626) 287-0927-
5823 AGNE8 SPECIAL CNUMM:
TEMPLE CITY CA 91780
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SMUT79-
O'LEARY TOM (626) 287-0927-
5823 AGNES AVE LIC. NO TEMPORARY POWER P(XE
TEMPLE CITY, CA 91780 NONE
ARCHITECT TEL. NO: LIFER GROUND
LIC. NO: ROM CONDUIl
ROUGH WIRING
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
REPORT ID: DPR265 ROUTE TO: BS0508