HomeMy Public PortalAbout10232 GREEN ST_Electrical__ 768663-CE806 10,72 APPLICATION FOR ELECTRICAL Pf RMIT
COUNTY OF LOS ANGELES 7�3 DEPARTMENT OF COUNTY ENGINEER JOB
ADDRESSBUILDING AND SAFETY DIVISION
LOCALIG�NEARESFOR APPLICANT TO FILL IN 7 CROSS
FFIXTURES
TLETS LO EACH FEE OWNER OR �,� r/
FIRM NAME dam/
$ $ MAIL ,,//
TOTAL ,/�/
FIRST 20 25 �� ADDRESS /OZ3J"
CITY��-n7 L i TEL. NO.'GJ"TY- �/lJ
OVER 20 10
PLAN CHECK
FIRST 20 APPLICANT
TOTAL .25
OVER 20 ADDRESS
.10
SIDENTIAL APPLIANCES CITY TEL. NO.
PERMIT
DRYERWTR. HTR._ APPLICANT
K DISP. F.A.U. ADDRESS
R, AIR COND. CITY TEL. NO.
CLOTHES WASH. 01SHWASH. LICENSE OR CLASS.
REG. NUMBER
FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING.
SIZE & TYPE OVER TO
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 — 1 1.00 LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE
1 — 10 300 OESCRIOED RESI NTIAL PROPERTY.
O
PERMITEE I!.!_C V
10 - 50 5.00 SIGNATUR I=
O
50 - 100 10.00 1.-
DISTRICT N0. PROCES ED BY W
100 - 500 15.00 /5 /1 Z
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS (rte v DATE INSPECTOR' IGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE
SERVICENOTOVER600VOLTS OR200AMP 3.00 UNDERSLAB WORK
SER'VI CE OVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT
TEMP SERVICE,POLE, &APPURTENANCES 5.00 WIRING
TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIED /' �.- %i; •�I �,.
FINAL
PERMIT FEE (SUB TOTAL) NOTES:
PLAN CHECK FEE
PERMIT ISSUING FEE 3.00 (/
TOTAL FEE (J
PLAN CHECK VALIDATION CK. M.O. �cASH PERMIT VALIDATION CK. \ M.O. CASH
4 ilCi 1 2 7.0 0 ♦��
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
WORI¢A'8 COMPEN8ATfON DECLARATION 20-0010 DPW(,z-o,)
711{683 APPLICATION FOR ELECTRICAL PERMIT
1 hsfeby afflrjn that I have a certificate of oonsent to self Insure,
or a cerdfloate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLJC WORKS BUILDING AND SAFETY DIV.
oopy thereof(Sec.3800 Lab. C.)
No. Company FOR APPL.ICAIIT TO RLL IN A✓7DRE88
Certified copy Is hereby ftunlahed. New Residential Bldgs.S Poole NO. EACH FEE
OCALrTY
F1CerlfiW copy Is Mad with the county bulking Inspection 1 S 2 fainly,8q.Ft L
rFlAE9T
depnrtmn Muhi-femBy Sq.Ft. CFKM gr. Ai X
FLeeidentiel Swimming Pooh WAPA BOOKPr[iE�D PIACa
Dais Appl krem
CERTIFICATE OF EXEMPT10N FROM WORKERS' Re0 —IL Rec. —14--Sw. OMER OR
COMPENSATION INSURANCE F9 rat
20 d U RRL NAME
(Thla eectlon need not be oompleted tf the work Involved by the MAIL
permh le for one hundred dollars(1100)or lase.)
Total No., AddFtlonal" A--S t ✓1
1 oerdfy that In the performance of the work for which this permit CiTI T■l.
Is Issued, I shall not employ any person In any manner so as. to
become sifbjact to the Workers'Cpmpensation La L-igh-ting FbdR
uroe rutPLAN
20 PLAN 6HE c �J
T el
ADDRESS
pole Appllcer t O
NOTICE TOAPPLICANT: If, after akinA. CertlTlcate of OVER 3 HP. � T■L Na
Exemption,you should become eubJect to the orkArn'CompenaaUon OTHER APPLIANCES If4bT OVER 3 HP. /�
provisions of the Labor Code, you must forthwith comply with such Power Apparehts S Large Appllanr es. � /G
provlalons or this permft shall be deemed revoked.
LICENSED CONTRACTORS DECLARATION Size&-Type HP,KW,KVA,or KVAR ADDRESS
I hereby affirm that I em licensed under provisions of Chapter 8 Oyer 3 to 10 Ind.
(commenoing with Section 7000) of Division 3 of the Buslness•and CLT' T@LNo.
Professions Code,and my license le In full force and effect. Over 10 to 60 Ind. }
T LNUOver 60 to 100 Ind. FEMp+� (d�
LJoenee Number Over 100 DISTRICT NO. X
LJo.Cleve VV
Services,Swbd.,MCC S Penglbosrds S, iz
0
Contractor Date 0-399 Amp.Under 600 V DATE
El
400-1000 Amp.Under 600 V _ U
I am exem under Sec. YAUDAT}ON UU
Quer 1000 Amp.or Over 800 V FP1AL (L
a
B.BP.C.for this.reason BRANCH CIRCUIT FEES / By Z
Date: or ML,12OV,LJghdng or RecepL
1 To 10 Branch Clrcuhe
S�ruuure 11 To 40 Branoh Circuits
41 Or More Branch Clraulls
❑ Exertlptlon for Req.MaJnt.Elect- 164,20.4.WW To 27N Br.aTxx s ry#�
SINGLE FAMILY Temp.Power Pole&Appurtertanoes H4CT■T
HOME OWNER�UILpEA DECLARATION gIgn wOne with OBranch CtrcuR
I hereby affirm that I am exempt from the Contractor's LJcenae Law _ t rl1
for the following reason (Section 70-31.5. Business and Profeaalons Addhfonal Sign Branch Circuits .3303 119.,N
Code): _ .].7th7 i TT[F�C
I,m owner of the property,will do the work and the structure Mlsc.Condults d Conductors _ w`1 ITEM
M
//���fff s not Intended or offered for sale (Section 7044, Buslneea Other(See Compote Fee Schedule) , TOTAL .. 1 16 -59
and Professions C(>de). �+�t��•-�
116.50
r
CONSTRUCTION LENDING AGENCY CIEC►f - .
1 hereby affirm that there Is a construction lending agency for the 11
performance of the work for which this parmft Ib Issued (Sec. 3097, PERMIT FEE (Sub-Total)
CN.C.)
PLAN CHECKING FEE
Lender's Name
PERMff ISSUING FEE
cart re AddressI TOTAL FEE /
certify that I have reed this epplkxfion and underalt
penalty of perjury stats
that the above Information la correct. I agree to comply with all County
ordlnanose and State laws requladng Beofrioal wf tV,and hereby authorize
�r�apramvtatKwo( y to enter upon the above-merioned P opeRy SEE REV�FOR EXPLANATORY LANGUAGE
COUNTY OF LOS AlKlE ES 'E20PLE CITY 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 IAS TUNAS EL 0508 1001270002
13U=.D]3 G AND SAFETY / LAND DEVEIOPKWr TEMPLE CITY CA 91780
PHONE: (626) 285-0488 RXT:
LEGAL ID: FEES PAID BU=ING ADDRESS:
ON FILE 10232 GREEN 9T
FEE DESCRIPTION: QUANTITY: 0014: AMOUNT: TEKP CA 917803336
ASSESSOR INFORMATION NUMBER: N]MU= CROSS STREET:
8585-006-023 Al PERMIT ISSUAlgCE FEE 27.75 THOF9kL.9 PAGE: 597 GRID: B4 IO(ZLITY: TEMPLE C1T7, C
GI OLTIL0T9-L3T,SW,RECP 1.00 OUT 1.95
TENANT: G2 LIGFTTIMG FIXTURES 1.00 LOT 1.95 ISSUED ON: PROCUSSRD BY: PLAN BY: SZPIRE.9 ON:
TOTAL FEES 31.65 01/27/10 SR 01/27/11
OWNER: TEL. NO: FINAL DATE F12UiL BY: CODE:
BALTIER.RA/VTNCENT, BARBARA (626) 452-0561- �l]�C)
10232 GREEN 9T n
TEMP 917803336 DESCRIPTION OF WORK
1 O=M AND 1 LIGHT FIXTURE
APPLICANT: TEL. NO:
SAME AS OWNER -
SPECIAL CONDITIONS:
CONTRA=: TEL. NO: APPROVALS DATE 32WSPEtTOR SIGAIA`iURE
SAME AS OWSffit -
LIC. 290 TRMPOPARY POWER POLE
UNDERGROUND CONDUIT
ARC-[I= OR RNGINffi2: TEL. NO: UFER GROUND
LIC. NO: ROUGH Can=
ROUGH WIP-12 G
MAIN WATER LIFTS
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
REPORT ID: DPR265 ROUTE TO: BS0508