HomeMy Public PortalAbout4819 HELEO AVE_Electrical__ • G:' TION CE-806 10/81 APUCAMN FOR ELECUMCad pCG°3(nU T
I hereb at„ -„to of consent to self CE-806G
insure, 8r o cera,,_, .. "Compensation 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. 8 Pools EACH NO. FEE ADDRESS
I 8 2-Family, S FL $ — $
LOCALITY—
CertifiedC
Certified copy is filed with the county building inspec y• q
dZ
tion department. Multi-family Sq. Ft. — NnARESTT `
Residential Swimming Pools �ciie n A
Date Applicant OWNER OR
-FIR NAM B
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec�Light�Sw. 3 MAIL
COMPENSATION INSURANCE 20 ADDRESS �• y/ � e__—
s section neenot completed if the work involved b First t
(Thitid t b
p Y Total No. Additional CITYl e Tel. No. —�
the permit is for one hundred dollars ($100)or less.)
I certif that in the performance of the work for which this PLAN CHET
Y e P APPLICANT
permit is issued, I shall not employ any person in any manner
so as.to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Total No. Additional
CITY i,,o.
Date =3 e8 Applicant Fixed Appliances Not ver 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Cer' ' _�yfr w
Exemption, you should become' subject to the r ers' Range_ Heat r D.W. — APPLICANT r -
Compensation provisions of the Labor Code, you must forth- Oven _ DrWA_ W.M.— ADDRESS
with comply with.such provisions or this permit shall be Top — FAU —W.H: r `
deemed revoked. Hood Fan Other— CITY Tel..No."
LICENSED CONTRACTORS DECLARATIONQ LICENSE OR \'•: `.
I.hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER .. 1 -Class. }
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. -PRO D BY'' fl.'
and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances
Size &Type HP, KW, KVA, or KVAR' ` C
License Number Lic. Class U to 1 Incl FINAL CC
Over 1 to 10 Incl. DATE V IDATION
Contractor Date
Over 10 to 50 Incl. FI Ld
I am exempt under Sec. Over 50 to 100 Inc. �!
} B.BP.C. for this reason Over 100 Z.4
Date: Services, Swbd., MCC& Panelboards
0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect. `
SINGLE FAMILY Temp. Power Pole&Appurtenances. 93 o-62 A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit .
I hereby affirm that I am exempt from the Contractor's License # o•o:o'o o 2
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits
Professions Code): I o o31,75
as owner of the property, will do the work and the Misc. Conduits 8 Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ D o 0 0 3 1,7 5
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY 003 $5
I hereby affirm that there is a construction lending agency for '
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name Q
PERMIT ISSUING FEE V
Lender's Address
I certify that I have read this application and state that the TOTAL FEE /
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 a ve-mentioned ioperty for ins�p—ec�t n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
gnature of Permittee Date
' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0811100006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: 1
ITR: 13329 LT: 19 I 4819 HELEO AV 1
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917803821
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LOWER AZUSA 1
18590-024-022 1A1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY, Cl
I IG1 OUTLETS-LGT,SW,RECP 2.00 OUT 3.90 1 1
(TENANT: IG2 LIGHTING FIXTURES 1.00 LGT 1.95 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1
TOTAL FEES 33.60 111/10/08 SR 05/09/09
(OWNER: TEL. NO: IFINAL DATE FINAL BY: CODE: 1
ICHUA, CHERRY ( 1 1 I
14819 HELEO AV I 1I yI
ITEMP 917803821 1 IDESCRIPTION F WORK
(ELECTRICAL FOR BATHROOM REM DEL
(APPLICANT: TEL. NO: I _ I
(WALKER (805) 857-0866- 1
12163 PALOS CT. IISPECIAL CONDITIONS:
INEWBURY PARK 91320 I 1 I
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1CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I
IWALKER BUILT GENERAL CONTRACTOR (805) 857-0866- I 1
12163 PALOS CT LIC. NO ITEMPORARY POWER POLE I I
INEWBURY PARK, CA 91320 916231 B 1 I I I I
I 1UNDERGROUND CONDUIT
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(ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND I
1 1 1 I
LIC. NO: i IROUGH CONDUIT 1
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1 I IROUGH WIRING I1 I
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I 1MAIN WATER LINE Val
I 1PLASTIC Y/N METAL Y/N
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I 1 (UTILITY COMPANY NOTIFIEDI I I
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IREPORT ID: DPR265 ROUTE TO: BS0508 I I I
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