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HomeMy Public PortalAbout6004 HART AVE_Electrical__ , 76A663 CE-806(6/78) AnPL5��.:Jf/"'�1T V Duk �E(� C (��CAL PERn/��1Y COUNTY '"'OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN. JOB' New Residential Bldgs.&Pools EACH NO. FEE ADDRESS S 1 &2-.Family,Sq. Ft. $ .025 — $. LOCALITY Multi-family Sq. Ft. .02 — NEAREST Residential SwimmingPool25.00 CROSS ST. /f s OWNER OR r' FIRM NAME Outlets: Rec Light Sw. MAIL `, First 20 50 ADDRESS' Total No.— Additional .30 CITY Tel, No. PLAN CHECK J � ` APPLICANT L 14 Lighting Fixtures first 20 .50 ADDRESS Additional 30 Total No, CITYI. No. Fixed Appliances Not Over-1'HP PERMIT Range_Heater_ D.W.._ APPLICANT Oven—Dryer'_W.M. ADDRESS "• /�• Top _FAU W.H._, 'CITY ' No. Hood_Fan . _Other_ LICENSE OR Disq-.—Room Air Cond. 2'50 REG..NUMBER (y / /'� O Class' A0 I'HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA- Power Apparatus&Large Appl iances TION AND STATE THAT-THE ABOVE,IS CORRECT AND,AGREE TO Size&T or KVAR COMPLY,WITH ALL-;COUNTY ORDINANCES AND STATE LAWS YPe-HP, KW, KVA, REGULATING ELECTRICAL WIRING. Up to 1 Incl. 2..50 I HEREBY CERTIFY THAT I AM PRO ERL•Y REGISTERED AND/OR Over 1 to 10 Incl. 5.00- LICENSED AS;. IRED BY LOS COUNTY AND STATE OF Over 10 to 50 Incl. 12.50 CALIFORNI R T AT I AM T LE -OWNER OF THE ABOVE Over 50 to 100 Inc. 25.00 I _DESGRIBE ESIDE Tl7(L`.PROPE Y. Over 100. 40.00,;-` j PERMIT _ J b. SIONA URE .Services. DISTRICT'NO�I �71D BY 0-40 Amp.Under 600 V 12.50 201-1000 Amp. Under 600 V - 25.00 Over'] 50.00 000 Amp.or Over 600 V Z Temp. Power Pole&Appurtenances 10.00 Q . 'Sign with One Branch Circuit 10.00 - Additional Sign Branch Circuits 2'00 INSPECTION > Misc.Conduits&Conductors 10,00 INFORMATION � ;2.5'2 2'7 A" - - i Other(See Complete Fee Schedule) ( ON REVERSE u # 0'010 0'0 2 SIDE, � CL 2oo1.950 PERMIT FEE , (Sub-Total) ° ° 1' 9.5 d v PLAN CHECKING FEE (One-Fourth Permit Feel O 7 `'7 9 II' PERMIT ISSUING FEE $7.00O .1 71 J TOTAL FEE �'� > t INSPECTION FINALED W date"77 By �ave.,� '! WORKERS'COMPENSATION DECLF.4fA.Co `J 76-40b tr/B; /,a PP C /,p YMN FOR (�R ECTROC D n FERN T CE-t30S�. p !�lf"IT L� jr�1 II V (lei 15 L�15 ll [lam ClL 0 V II ' 1 hereby affirm' that I have q certificate of ..onsent�sse9f y� , 0psy;re, or a certificate of Workers' CompensQtior, Insurance, 'COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN,• JOB Certified copy is hereby furnished. New Residential.Bldgs. & Pools. EACH NO. FEE ADDRESS 1 & 2-Famil q. $ — $ LOCALITY 7,--- F-1 t� `Certified copy is filed,with the county building inspec- y, S Ft. — ,--- Multi-famil S Fi. NEAREST tion department. Y q CROSS,ST. q E(4Is1}R 0/ Date A IicanT { Residential Swimming Pools OWNER OR •-�/ PP Fl M. //-f�vkn—s 4 ,fvleGFCZCC�P J"1 CERTIFICATE OF EXEMPTION FROM WORKERS' i Outlets: Rec Light5w. MAIL s COMPENSATION INSURANCE First 20 � ADDRESS Lf J,(. t4q A-;7 1 (This section need not be completed if the work involved by Total No. CITY'' the permit is for one hundred dollars ($100)or less.) Additionalr CC, Tel,No �3 Z I certify that in the performanceof the work for which this PLAN CHECK permit is•issued;I shall not employ-any persomin any manner 3 APPLICANT so as to become subject to the Workers"Com pensation.Laws. Lighting Fixtures, � First 20 Q� ADDRESS Total No. Additional Date Applicant CITY _ Tel. No. NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT • . Exemption, you should become subject to 'the- Workers' Range_ Heater=D.W..` APPLICANT Compensation provisions of the Labor.Code, you must forth- Oven Dryer W.M.1_- e 'ADDRESS with comply with such provisions, or this permit shall be I Top _.FAU —W.H. deemed'riavoked. CITY' Tel. No. LICENSED CONTRACTORS DECLARATION' .. Hood _ Fan _ Other_ Disp. Room Air Cond. LICENSE OR I hereby affirm that-I am licensed"under provisions of Chapter 9 REG. NUMBER Class. (commencing with Section 7000) of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO. PROCES D BY and Professions Code,and my license is in full force and effect. Size & Type HP;KW;KVA, or KVAR' License'Number. Lic. Class Up to 1 Incl. FINAL u Over 1 to 10 Incl. DATE //_� VALIDATION Contractor DateO Over 10 to 50 Incl FINAL b I am exempt under Sec.' Over 50 to 100 Inc. BY " B.&P.C. for this reason Over 100 B' �. . ' Date: (Services, Swbd., MCC&_Panelboards' ,#'� � 4.9.4�� 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V o 0 0 0 0 Over 1000 Amp. or Over © -.4.3,50 Exemption for Reg. Maint. Elect. - _ ; ' h.4A,4: i2ea 0.0 SINGLE FAMILY Temp Power Pole&Appurtenances V� 43,509 HOME OWNER-BUILDER DECLARATION /nu . ..(Sign with One Branch Circuit I hereby affirm that I am exempt.from'the Contractor's License Additional Sign Branch Circuits 0 7 8.5 Law for the following reason (Section 7031.5, Business and P fessions Code): 1, as owner of the property; will do the work and the Misc Conduits 8 Conductors structure is not intended or offered for sale (Section ther (See Complete Fee Schedule)_ D 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for j the performance of the work for which this permit is issued ?ERMIT FEE (Sub-Total) _ (Sec. 3097, Civ. C.). (LAN CHECKING FEE Lender's-Name 11 "ERMIT ISSUING FEE 0" Lender's Address I certify that I have read this application and"state that the OTAL FEE Jrs above information is correct. I agree to comply with all County , l ordinances and State laws.regulating Electrical wiring, and, herebyfauthorize representatives of this County to enter upon the ve-mentioned pr ert or in ection purpo es. ' � SEE REVERSE FOR EXPLANATORY LANGUAGE S'•gnatu�e of Permittee Date } COUNTY OF LOS ANGELES TEMPLE CITY # 0508 .-ELECTRICAL-PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ',,EL-0508 9802230009 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: TR: 5904 LT: 339 UN: .002 6004 HART AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP-CA-917801914 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: HERMOSA 5384-014-008 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 28.00 OUT 49.80 TENANT: G2 LIGHTING FIXTURES 9.00 LGT 17.55 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: H7 RES EXHAUST FANS 1.00 EX 10.80 02/23/98 UT 02/23/99 TOTAL FEES 105.90 OWNER: TEL. NO: FINAL DATBY: CODE: HART THOMAS D (626) 285-6081- 6004 HART AVE. TEMP 917800514 DESCRIPTION OF WORK 'ELECTRTCAL FOR-GARAGNE 'AND-ADDITION APPLICANT: TEL. NO: SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: d �V�� APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER fy LIC. NO TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. N0: UFER GROUND LIC. NO ri ��11�1111� ���» ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N - - - - - - UTILITY COMPANY NOTIFIED t � REPORT ID: DPR265 ROUTE TO: BS0508