HomeMy Public PortalAbout5635 HELEO AVE_Electrical__ 78A°N.QEB"3
•09
APPLICAON F0Fj ELECTRIC *RMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEE / BUILDING
BUILDING AND SAFETY DIVISION AODRESs
JOHN A. LAMBIE, COUNTY ENGINEER J
CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
MIi
PERT FEES
ITEM NUMBEq EACH FEE OWNER
OUTLE / _ $ $ MAIL
LIGHTS RECEPT 6W. 1O ADDRESS
LIGHTING FIXTURES 10 / CITY J TEL. . 7/
ELEC.RANGES CLO.DRYERS ELECTRICIAN
WATER HEATERS .50 / ADDRESS
ELEC.SPACE HTRS. DISHWASHERS �[ CITY - L. N
GARBAGE DISPOSERS / AUTO.- -
/j {' STATE
WASHERS STA.COOKING UNITS) '/ .2$ [J� LICENSE ND. 116
MOTORS' OVER INC. HP.. 1� DISTRICTNO, GROE UP ZON , CESSE /BY
^O— 1/z .25 S 0 1 --/ 14 -
v=- 2 .50 INSPECTION RECORD
2— 5 1.00
5— 15 LBO
15— 50 2.50
50-200 5.00
SIGNS: NO.TRANS.
NO.LAMPS
SERVICE O-SOOV 1.00
SERVICE OVER 600V 5.00
MISC.
WIRINGPERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50
TOTAL FEE S
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPE EOR'6 SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR WIRING
LICENSED AS REQUIRED BY�L 5 ANGELES _UNLY AND STATE OF FIXTURES
CALIFORNIA OR THAT I M THE LEGAL OWN OF T E ABOVE
DESCRIBED RESIDENTIAL R P POWER
SIGNATURE UTILITY CO.NOTIFIED ul.
OFPERMITTELFINA
®n /VAIJDATION ARTHUR C.VEIT,
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
L>ACO7 2 5 5 2 vM 4 2 A 1 1.1 5
Vm that I'have a certificate
DECLARATION 76A6690PW 9/89 APPLICATION FOR ELECTRICAL PERMIT
0-001
I hereby affirm that I have a certificate of consent to self insure,
or a cmificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 Lab.C.)
Policy Not 1 348528ompany CNA FOR APPLICANT TO FILL IN JOB 5635 Heleo Ave.
El
ADDRESS
�l ,Certified copy is hereby furnished. New Residential Bldgs.8 Pools $EACH NO. $ FEE LOCALITY Temple City
Hd Certified copy is filed with the county building i speclion 1 8 2-Family,Sq.Ft.
departmen. _ Multifamily Sq.Ft. CROSS 9T.
Date Applican
Residential Swimming Pools ASSESSOR
MAP BOOK PAGE I PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light_Sw._ F�AMENAME Wm. Roberts
COMPENSATION INSURANCE First 20
(This section need not be completed if the work involved by the Mall
Total No. Additional ADDRESS 5635 Heletid^Ave.
permit is for one hundred dollars(4700)or leas.)
I certify that in the performance of the work for which this permit CITY Temple City T.LNn.291-5632
is issued, I shall not employ any person In any manner se a5 t0 PLAN CHECK
became subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional
ADDRESS
Data Applicant 15 OR 20A120V BRANCH CIRCUITS
,
NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel,No.
Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH
provisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMIT
P PY
provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACHAPPUcANTGeneral Heating & A.0
LICENSED CONTRACTORS DECLARATION ADDRESS 1310 S. Myrtle a.
I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 2TIV LIGHTING EACH
(commencing with Section 7000) of Division 3 of the Business and CITY Monrovia, _ T.I.TeI.N35 B-0022 0
Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE ORQ
e^ Power Apparatus 8 Large Appliances REG.NUMBER 469166 Ciao. C O
License Number 469166 Lic.Class C Size 8 Type HP,KW,KVA,or KVAR ISTRICT rv0. P E BV F'•
Up to 3 Incl. l _ 5-0b r W
GeneralHeating & Air ConditioningOer3to,omcl. FINAL
Contractor Date Over 10 to 50 Incl. DATE
❑ / VALIDATION _
I am exempt under Sec. Over 50 to 100 Incl.
100 FINAL
8.8P.C.for this reason Over BY
Services,Swbd.,MCC 8 Panelboards
Date: 0.200 Amp,Under 600 V
ElSignature 201-1000 Amp.Under 600 V 00
Over 1000 Amp.or Over 600 V 3'9
Exemption for Reg.Mainz.Elect.
SINGLE FAMILY Temp.Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION i
h Ci
B
h One ne rancCircuit
I hereby affirm that I am exempt from the Contractor's License Law Sign wACCT.F
tar the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits
Code): L'AI]d 451.151
❑ I,as owner of the property,will do the work and the structure Misc.Conduits 8 Conductors 1 HEM'
is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule)
and Professions Code). OTAL 45- 15
HECK c c
CONSTRUCTION LENDING AGENCY Q-'.tJ
I hereby affirm that there is a construction lending agency for the CHANGE ,til Of
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total)
Civ. C.)
PLAN CHECKING FEE
Lender's Name JUCIU-LSJUi r/12f �
Lender's thatAddI
PERMIT ISSUING FEE `�)`i 1 I;m ILI k I
s
I certify that have read this application and state that the above TOTAL FEE S
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 above-mentioned
rty for inspecti n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
/ TE
SIGNATURE 05-APPLICANT OR AGENT DATE