HomeMy Public PortalAbout9073 HERMOSA DR_Electrical__ 7
OBA.SARR3 9.55 APPLICATION FOR ELECTRIC PERMIT �.
DIVISION OF BUILDING AND SAFETY
Department of County Engineer OEM
County of Loa Angeles BUTLDI
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OE BUILDING
LOCALITY - , GL-_ '7
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS ST.
NUMBER EACH FEE /y,
LIGHT OUTLETS OWNER TCY
RECEPTACLES - MAIL
ADDRESS
WALLSWITCHES .
TOTAL OUTLETS _ 5¢ $ CiT / 1LJ" f �'J TEL. NO. /
ELEC. RANGES 25 �/ ELECTRICIAN L 'L /.V
_ELEC. HEATERS 25 ADDRES<S J
KW EA CITY�-�/J?A TEL NO.
FIXTURES 5 .LICENSE NO. I:// �641
NUMBER OF LIGHT CIRC UITS - DISTRICT NO. I GROUP I(�ZONE READY FOR INSPECTION
CIRCUITS
NUMBER OF RECEPTACLE CI
MOTORS ' � l
NUMBERHORSEPOWER FEE •� y INSPECTION RECORD
NEW V. HE OVER INC. I EACH '���L�!� D K TO AFS n rpfc oMr,c'f_R
1 &LESS S .25
/2 2 50
_ 2 5 1.00
5 15 1.50
15 50 2.50
50 200 5.00
MISC.
NO.SIGNS NO.TRANS.-
NO.SIGNS NO. LAMPS
FOR EACH PERMIT'
WIRING $1.001 /
FIXTURES $1.00
.SUPPLEMENTARY .50 / APPROVALS
TOTAL FEE $ / DATE INSPECTOR'S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING �(J
ELECTRICAL WIRING,
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENT] PROPERTY.
SIGNATURE UTILITY CO. NOTIFIED
OF PEI FINAL
WILLIAM J. FOX.COUNTY ENGINEER VALIDATION A. C.VEIT.CHIEF ELECT. INSPECTOR
r U'I. NOV25 2 1 .25
WORKER'S COMPENSATION DECLARATION 260019 DPW 9/89
6A663 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure, ..
or acertificate 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.),'.- L - - .
Policy No. Company FOR APPLICANT TO FILL IN JOADDB RESS : ^
❑ �x—
,
Certified copy is hereby furnished: New Residential eltlgs.8 Pools 'EACH NO. FEE .
❑ $ — $ LOCALITY 121.0— Iry
Certified copy is tiled with the county building inspection - I&2-Family.Sg.Ft.
department Multi-family$ Ft. — NEAREST
9 _ CROSS ST.
Date_" Applicant Residential Swimming Pools ASSESSOR
MAP BOOK I PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' � OWNER OR
Outlets:Rec.ii� Light SW. FIRM NAME q
COMPENSATION INSURANCE � 2 +' 3GP- � `
(Thissectionneed not be completed if the work•involved by the 7 First20 ".MAIL
permit is for one hundred dollars($100)or less.).. Total No, L Additional ' DDRESB Q (1 f
I certify that in the performance of the work for which this permit CITY _L Tel.No.
is issued, I shall not employ any person in any manner so as to
became subject to the Workers'Com ensati i Laws. - Lighting Fixtures First 20 I V� PLAN CHECK. .
1 P q 9 9 APPLICANT
Total No. Additional �'
L ADDRESS
Da f i Appl1, r ^ 15 OR 20A,120V BRANCH CIRCUITS'
NOTI E TO A PLICA T: If, after making ih s erlificate f CITU T.I.No.
Exemption, yppu��sshould b come subject to the' r ers' Compens on 1 TO 10 INCLUSIVE EACH
provisions of'Ehe Labor Code, you must forthwl comply with,such 11 TO 40 INCLUSIVEEACH -"PERM." . -
APPLICANT
provisions or,this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH }
LICENSED CONTRACTORS DECLARATION - - ADDRESS - d.
I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,20BV TO 277V LIGHTING EACH O
(commencing with Section 7000) of Division 3 of the Business and _ CITY Tel No. V
Professions Code, and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO SHP LICENSE OR ir
Power Apparatus&Large Appliances . - REG.NUMBER Blass' O
Size&Type HP,KW,KVA,or KVAR DISTRICT NO. PROC BY L
License Number Lic.Class 0
Up to 3 Incl W
Over 3 to 10 Incl. FINAL a.Contractor - Date - - -- DATE - fn
Over 10 to 50 Incl. I` vy Z
❑ I am exempt under Sec. Over 50 to 10_0 Incl. _ 4 "l VALIDATION
B.&P.C.for this reason Over 100 FINAL- ,L,
BY
Services,Swbd., MCC&Panelboar
Date:
1-200 Amp.Under 600 V
Signature 201 -1000 Amp.Under 600 V
❑. Over 1000 Amp.or Over 600 V
Exemption for Reg.Mainz.Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances _
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason (Section 7031.5, Business and Professions .Additional Sign Branch Circuits
Code):
I,as owner of the property, will do the work and the structure Misc.-Conduits&Conductors -
is not intended ar offered for sale (Section 7044, Business Other(See Complete Fee Schedule)
and Professions Code). - -- - ® - 2
CONSTRUCTION LENDING AGENCY - ." ._ _ - ."7+..i Lis
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE _ (Sub-Total) I V
Civ. C.) - n Ts'K
PLAN CHECKING FEE
Lender's Name i�I;ai._
PERMIT ISSUING FEE
2. s CHECK. if: j
Lender's Address
.
I certify that I have read this application and state that the above TOTAL FEE
information is correct. I agree to comply with all County ortlinances '
and State laws regulating Electrical wiring, and hereby authorize
representatives of this County to enter upon the above-mentioned
s
rbpert f r inspect, purposes ( LIriE I PJI1, i f 7,/V`?
// Al
_ SEE REVERSE FOR EXPLANATORY LANGUAGE
R IAPPLIC NT OR Are OA
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0909210008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: - FEES PAID BUILDING ADDRESS:
ITR: 5904 LT: 334 9073 HERMOSA DR
IEEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917801917
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: HART
15384-015-032 IA1 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl
I IG1 OUTLETS-LGT,SW,RECP 8.00 OUT 15.60
TENANT: IH2 RES GRBG DISP LT 3HP 1.00 DIS 10.95 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
I - IH3 RES DISHWASHR LT 3HP 1.00 DIS 10.95 109/21/09 SR 09/21/10
1 JH4 RES RANGE HDE LT'3HP 1.00 HOD 10.95 1
TOWNER: TEL. NO: TOTAL FEES 76.20 IFINAL DATE FINAL BY: CODE:
ITRAN, TAM T 1626J 602-6 us- (/} s�o� l.�,l�
19073 HERMOSA DR 1 U'� K I
ITEMP 917801917 IDnSCRIPTION OF WORK
(ELECTRICAL FOR KITCHEN AND BATHROOM REMODEL
APPLICANT: TEL. N0:
(SAME AS OWNER -
SPECIAL CONDITIONS:
-II
CONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE
(SAME AS OWNER -
LIC. NO (TEMPORARY POWER POLE
(UNDERGROUND CONDUIT
(ARCHITECT OR ENGINEER: TEL. N0: UFER GROUND
I I I II I II
LIC. NO: IRQDGB CONDUIT
I (ROUGH WIRING
(MAIN WATER LINE
(PLASTIC YIN METAL YIN
I (UTILITY COMPANY NOTIFIED( I I
I II I I I I
I I 111 III III I
II I I II II I
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VIII
II I I I I I
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(REPORT ID: DPR265 ROUTE TO: BS0508
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