HomeMy Public PortalAbout10233 GREEN ST_Electrical__ 7"GUI-CEIOe 10-62 APPLICATION FOR ELECTRI L PERMIT ,-
COUNTY OR LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER HUILDING
BUILDING AND SAFETY DIVISION A.DDR1r/1
OR APPLICANY To FILjN
JOHN A. LAMBIE, CouNTY ENGINEER
Z.4.Z�,-3-Y Z le6-:y, 1*1-7
WILLIAM A.JELNLiEN, BUF'T of QUILDINO LOCALITY
NEAREDT
REcZrT. TOTAL M
OU FIRST 20
LIGHT •20 • OWNER
4 NAIL
swlrcH. o cn 20 .f0 ADDRiis
TOTAL CITY TML NO.
LIGHTING � FIRST 20 .20
FIXTURES ADD'L
Ov[R 20 .10 ELECTRICIAN
RANOMS CL.O.DPrfl" WTR.HTR/. 1.00 ADDRK"
4A".DISr. STA.COOK
CITY To._No.
DISKWASH. AUTO..MASH. STATS
SPA,=HTR[. STA.APP.(Y.Hr.161A1L) ,50 LICKNSE NO.
MOTORS' ovoe [MOT oVWt Hr DIST CTS,N G P Z P ES B
0 1 t.00 (%
1 a 1.50 INSPECTION R C RD
a a 2.00
a 15 2.50
10 50 3.00
5o 100 5.00
SIGNS, Mo.TRAHI.
NO.LAMPS
QERVICE 0-e00V.NoT ovER 200A 1.00
S(ZRVICI 0.60OV-Ovot 200 A. 2.00
5K?VICE OVER 600V 5.00
MIBC.
PERMIT ISSUING FKK 2.00
SUPPLEMENTARY PiAMFT 1RSUING Flit 1.00
TOTAL FEE ; 66,
1 HERIIY ACXMOWLmGX THAT I I-AVI READ THIS APFUCAT'ION APPRQYALf DATE
AND STAT[ THAT THE AIOVI 10 CORRKCT Alm AaRa TO COMPLY CONDUIT
WTTH ALL COUNTY ORDINANCES AND STAT[ LAW RIQULATING
ILICTRICAL W XCL WIRING
1 HEMMY CRAT'IFY THAT I AM PROPO[L.Y Howl AND/OR
LICDIIDJ AS MQUIRID EY LAS ANG&[-KS COU AND STAT[ OF FIXr-U Rg3
CALJFORNLA OR THAT 1 AM THE LEGAL O OF THE AIOVI
DtlOiTSiD RES rLeOr[ItTY. POYr[R
SIGNATURE UTILrry co,NOTIFIFD
OF PKRMII
FINAL
VALIDATiOAkTHUR C. VEIT
CK MQ 5H SUP[RVISING ELltcTRl ENGINwKR
r ,
L
WORKERS' COMPENSATION DECLARATION, � 1081 APPLICATION FOR ELECTRICAL PERMIT
I Rereby alflrm that I have a certificate of consent to self
Insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C.) 3
Policy No. Company FOR A"UCANT TO FILL IN A�DORESS
Certified copy Is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE _
❑ Certified copy Is filed with the county building Inspec- 18 2-Family, Sq. Ft. s — S LOCALITY G7
tion department. Multi-family Sq. Ft. — NEAREST
L+
Residential Swimming Pools CROSS ST. 4
Date Applicant OWNEFIROR
RM NAAhE l
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Reclght Sw.
COMPENSATION INSURANCE DR VF
Flnit 20 ESS
(This section need not be completed If the work Involved by Total No— Additional CITY Tel. No.
the permit Is for one hundred dollars (=100)or leas.) VIV
I certify that In the performance of the work for which this RAN CHEOC
permit Is Jawed, I shall not employ any person In any manner APPLICANT
so as to become subject to the Workers'Compensatlon Lows. Lighting Fixtures First 20 ADDRESS
Total No. Additional
CITY Tel. No.
Date Applicant Fixed Appliances Not Over 1 HP pE
NOTICE TO APPLICANT: If, after making this Certificate of PERMrtT
Exemption, you should become subject to the Worker' 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 beTop FAU —W.H. —
deemed revoked. Top
_ Fan _Other_ CITY Tel. No.
LICENSES CONTRACTORS DECLARATION DI _ Room Air Cond. LICENSE OR
hereby affirm that I am licensed under provisloru of Chapter 9 sP' REG. NUMBHt Class.
(commencing with Section 7000) of Dlvlslon 3 of the Business
and Professions Code,and my license is In full force and effect. DISTRICT NO.
Power Apparatus 8 Large Appliances 6 BY`
Size 8 Type HP, KW, KVA, or KVAR' D `
License Number_ I Ic. C1 ass Up to 1 Incl. FINAL Inc:
Over 1 to 10 Incl. DATE VALIDATION
Contractor Date Over 10 to 50 Incl. FI
❑ I am exempt under Sec. Over 50 to 100 Inc.
Over 100 N
B.BP.C, for this reason Z
Services, Swbd., MCC b Ponelboards U
Dat°' 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. �� y..,�
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 Contractors License Additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and
Professions Code):
I, as owner of the property, Misc. Conduits 8 Conductors
p perty, will do the work and the Complete Fee Schedule Com lSee Other ,
structure Is not Intended orff
oered for sale (Section ( P )—
7044, Buslneu and Professions Code). 5 6 7.3 A
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for # o e o 0,0 2
the performance of the work for which this permit Is Issued PERMIT FEE (Sub-Total) o,0 4 Q 5 0
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE o 0 o 4 Q 5 0.r-1Lender's Name
Lender's AddressL v
;`8 6
_ PERMIT ISSUING FEE I Q,1 6
I certify that I have read this application and state that the TOTAL FEE
above Information Ls 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
t e rt}entloned property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Slgnat o I ee Data
-COUNTY OF LOS-ANGELES - TEMPLE CITY 0508
DEP/RTMEXT OK" LI0JJORKS 9071 LAS TUNAS.
PJJILOIING AND SAFETY / LAND'DEVELOPMENTTEMPLE.CITY G
}1 PHONE: (818)'285-,O4N' EXT:AID
,
ON FILE 1 -
FEE-DESCRIPTION: - OUAfTI7Y:. LEM: - AMOUNT: TEMP GA 9
NATION NUMBER: NEAREST rRM-SPEET: GLICNOM,
8585-095-022: Al PERMIT ISSUANCE FEE 27.75' - j THOMAS PAGE: 597' GRID: B4. '.;OCJ,LITY.: TEMPLf'C111.::
j G1 OUTLETS,LGTSW RECD 12.00.OUT- 23.40
. G2 LIGHTING FIkFAES 3.00 LGT_ 5.85 iggo� ON: PROCESSED BY: PLAN BY: EXPIOES ON:
97 RES EXHAUST;FAMS 1.00'-b(. .10.80 07/09/97 - •. TC 0
TOTAL.FEES'-. 67.80
EN VIRGINIA,G TRUSTEE (626) -7W-
10233 GREEN ST. i s f' 'L�=� ► .. . . -
TEMP 917803337DESCRIPTION OF WDRK
ELECTAICAL.FOR TYD EXISTING.BE'Wh",AMS NEW LK'IN CLO$ET'
W- - -: • - .
MISSION BUILDERS (760) 244-4442- -
CCVD IT IONS:
' ♦ V O DATE INSPECTOR !IGKATO;ff
-
MISSION BUILDERS (619)"244-4;42-r �.
17537 MAIN ST. LIC. NO
HESPERIA, G 92345 - 197673OUT
ARCHITECT
IOR MINEER I TEL.
VO- UPERIGROCKD
LIC. N0:
. . - - - -
ROL16H WIRING
L.I
PUSUC WORKKINJ WATER LINE
PLASTIC Y/M METAL T/M
�40 � , T`
1 REPORT ID: DPR265 WE TO. BSO508