HomeMy Public PortalAbout4840 KAUFFMAN AVE_Electrical__ TEMPLE CITY
768663-CE+'06 ,D,72. APPUCAMN FOR ELEC IrMC AL PERMH
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER '0B RESS
BUILDING AND SAFETY DIVISION
LOCALITY
NEAREST
FOR. APPLICANT TO FILL IN CROSS ST.
OUTLETS NO. EACH FEE OWNER OR '
$ 5 FIRM NAME
_VpJOpMAt Co.
RECEPT:
FIRST 20 ADDRESS I;C19A Tin
LIGHT�.9 TOTAL .25 '
CITYTEL. INo. 286-2818
SWITCH _]$__ OVER 20 1p Templp City ,
s 70
PLAN CHECK
LIGHTING TOTAL FIRST 20 19— 25 7 60 APPLICANT
FIXTURES
•19 OVER:20 .10 ADDRESS
-
RESIDENTIAL APPLIANCES 'CITY TEL. NO.
PERMIT
RANGE DRYER'- WTR. HTR. APPLICANT "C.n McGee Electric Inc.
STA. COOK DISP. 1 F',A.U. 1 - - ADDRESS P .. 0 • BO.X -'2186
SPACE HTR. AIR COND. CITY Pomona_ TEL. No. 628-122.1
CLOTHES WASH. DISHWASH. LICENSE OR
C REG. NUMBER .5 8. CLASS. _
FAN 1 OTHER- 5,. 1:00 7 50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING.
SIZE & TYPE OVER TO
I HEREBY CERTIFY THAT I AM PRO�ERLY REGISTERED AND/OR
0 — 1 100 LICENSED AS REQUIRED B OS ANGE ES C UNTV AND STATE'OF
CALIFORNIA RTHAI I AM THE LE AL O NER OF,r,THE ABOVE r
1 10 3.00 DESCRIDED RE 5IDENTIAL P OP p
4 50 O
PERMITEE V
10 — 50 5.00 SIGNATURE I
O
50 = 100 10.00 v
DISTRICT NO.� CE SED B
100 — Soo 15.00 "1 GGO
SIGN, GAS, SIGN AND ONE CIRCUIT; 5.00 APPROVALS ..DATE INSP OR'S.SIGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS I.00 TEMP. POWER POLE
SERVICE NOT OVER600VOLTS OR200AMP 1 3.00 41 50• 1 UNDERSLAB WORK - -
SERVICEOVER600 VOLTS OR 200AMP 10.00 ROUGH CONDUIT
07
TEMPSERVICE,POLE, &APPURTENANCES 5.00 WIRING 7• r .7.e(
TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES '
POWER AUTHORIZED
UTILITY CO. NOTIFIED
FINAL
PERMIT FEE (SUB TOTAL) 40 80 NOTES: V '
PLAN CHECK FEE - -
PERMIT ISSUING FEE 3.00 4 50
TOTAL FEE
45-IL—
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIONcK. M.O. CASH
6 3.`8'•: RU,28 2.',D ` Q:o�a
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE / '
WO*KERS'COMPENSATION DECLARATION CE 806G (2-80) APICA N FOR
EL
ECTMICAL PERNU
I hereby affirm that 1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or �._/''// (✓
rtifie Fopy thereof,Sec.lrS3 Lab.,
� / FOR APPLICANT TO FILL IN 3pg
Cd4dnnpany l EACH NO. FEE' ADDRESS
New Residential Bldgs.&Pools
Certified copy"is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY
Multi-family Sq. Ft. NEAREST r J
Certified copy is,filed with the county building inspection CROSS ST
'department. Q Residential Swimming Pools OWNER OR
\� FIRM NAM
Date Applicant� "� Outlets: Rec._LighSw: " . MAIL
irst 20 1 ADDRESS
CERTIFICATE OF,EXEMPTION"FROM WORKERS' Total No. Additional CITY 'Tel No.
COMPENSATION INSURANCE d
PLAN CHECK O
(This section need not be completed if the work involved APPLICANT V
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS
Additional
Total No. O
I certify that in the performance of the work for which this Appliances Not Over 1 HP. CITY T o. U
permit is issued, I shall not employ any person Fixed in any manner PERMIT 0
so as to become subject'to the Workers' Compensation Laws. Range_ Heater_D.W. LU
APPLICANTJ�ap_
Oven Dryer_W.M. ADDRESS Z
- Z
Date Applicant Top _ FAU, —W.H..
Hood _ Fan _Other_ CITY l Tel N
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond.— LICENSE OR
Exemption, you should become subject to they. Workers' REG. NUMBER Class
Compensation provisions of*the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. P CE SED BY
with comply with such provisions or this permit "shall be
deemed,revoked. Size&Type HP,KW, KVA,or KVAR
Upto1 Incl. FINAL
Over 1 to 10 Incl. DATE
LICENSED CONTRACTORS DECLARATIONf��.a VALIDATION
Over l0to.501nc1.
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inca FINAL
9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY
ness and Professions.Code, and my license is in full force and
effect. Services
License Number Lic.Class 0-200 Amp'. Under 600 V
201-1000 Amp. Under 600 V
Contrac r ate. Over 1,000 Amp.or,Over 600 V
,r
HOME OWNER-BUILDER DECLARATION, Temp.Power Pole& Appurtenances
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit
License Law for the following reason (Section'7031.5, Busi- Additional Sign Branch.Circuits
ness and Professions Code):
Misc.Conduits&Conductors
-I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)—
structure is not intended or offered for sale.(Section
7044, Business and Professions Code).
CONSTRUCTION LENDING AOENCY
I hereby affirm that there is a construction lending agency 2 0 2 9 A
for the performance of the work for which this permit is PERMIT FEE (Sub-Total)
issued(Sec. 3097,Civ.C.). # 0 0 o°o o,2
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
.23.2 0 0
Lender's'Address .o 0
PERMIT ISSUING FEE e
- . 'o o e 3200
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 9.0'5-8 0
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
he above-mentioned property for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE
Signature o�ttee Date
COUNTY uF LOS ANGELES 'T EMPLE'CITY x 0508
DEPARTMENT 0; PUSLiC WORKS 9701- LAS TUNAS EL.G � 0409-07,3004
BUILDING AND SAFETY /• L ;dD DEVELOPMENT' TEMPLE CITY C„ Q1780
PHONE: (626) 285--0488 EXT:
LC�/sL IL). -� - FEES PAID BUILDING ADDRESS:----- _ -
T�
31181 LT: 7 II�
! EE DESCRIPTION':- ,;L!c,:TTr.• , I — 4840 KAUFFMAN AV
(c LJM> AMOi s ! _ TEMP CA 917804244
85 9-oi9 'TJFORFIATICIN NUMBER: 1 NEAREST CROSS STREET: LO;lER AZUSA
85 014 059 'A1 P• RNIT ISSUANCE FEE 2'7..5 1 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY
JGi '"UTLETS-LGT,SW RECD 5.00 OUT 9.75 I
!G2 !_IGHTING FIXTURES 2. 00 LGT 3.90' TSSUEDPROCPROCESSED 3Y:-PSA;: 3Y: ''EXPIRES.OR,.
"A r: RES EX FANS LT 3HP 1.00 CX 15.31) !0,9;07/04 JK' 03/06/05 Y
C!•1:J ii— TEL. N0: ! TOTAi, TEES 56.70 - -
WU, Ji OIt I' ( c I. =is<A DA —r : CODE
'TS ISHI/WAIY 6,26) 291 379=
4840 KAUFFMAN AV
;>
TEMP 917804244 � ID .WIPT! PJ OF WORK ---
—i
5 OUTLETS, 2 LIGHT FIXT-RE.S- EXHAUST .FAN
A:IPLJCANT: TEL. NO
S'ME AS OW!JER _ I
j SPECIAL CONDITIONS:
TEL, NO: i 1APPROVALS DATE INSPECTOR GNATiiF
f�A'�F. As U41f.E3
i _
I� LIC. NO j tEAPUl.AFY-^i)WER POLE --
� • UNDERGROUND CONDUIT i t
I.Sh::.ITECT OR ENGIiJEEP,:
CERswGROUND; -I
t -
LIC. NO., - RUL CCvDI;IT
�M,=.iN WATER t.INs '--'
I - PLASTIC Y/N METAL Y/^I
I` 111.1LITY Cu PAN'Y NC7T 'Ica;
REPORT ID: DPR265 ROUTE TO: BS0508