HomeMy Public PortalAbout6013 KAUFFMAN AVE_Electrical__ Vrm that I COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure, CE-806G � .
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec. 3800,1-ab. C.) .
�.
Policy No. Company FOR APPLICANT TO FILL IN JOB
❑ Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRESS
❑ Certified co y g p 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY .y/�t 1. Z 0 j '✓ !a
copy is filed with the count building inspection
NEAREST _
department. Multi-family Sq.Ft.
CROSS ST. wt7 L) - V%^
-� ,' Applicant si O, //f', Residential Swimming Pools NAME /-��.L/-
FIRM Z�:
\� Date' �3/- y� �^ 9 OWNER OR
CERTIFICATE OF EXEMPTION FRO WORKERS' Outlets:Rec Light _ Sw. — MAIL _
COMPENSATION INSURANCE First 20 ADDRESS
�y
(This section need not be completed if the work involved by the Total No. Additional CITY d�/=�y/�J��_ i j Tel. No.,$
permit is for one hundred dollars($100) or less.)
PLAN
I certify that in the performance of the work for which this permit APPLICANT CHECK
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. CITY Tel.No.
Date Applicant Additional
Fixed Appliances Not Over 1 HP
NOTICE TO APPLICANT: If, after making this Certificate of PERMIT
APPLICANT
Exemption,you should become subject to the Workers'Compensation Range_ HeaterD.W.
_
provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS
provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _ CITY Tel.No.
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR
(commencing with Section 7000) of Division 3 of the Business and REG.NUMBER Class.
Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT No. PRO17/1
Y
1 ! 4 Size& Type HP,KW,KVA,or KVAR ti0
License Number Lic.Class Up to 1 Incl. FINAL VU
Over 1 to 10 Incl. DATE a.
Contractor Date VA DATION 0
El
10 to 50 Incl. FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY 0
B.&P.C. for this reason Over 100 d
Services,Swbd., MCC & Panelboards �) N
Date: Z
0- 200 Amp.Under 600 V ® >;- a E--
Signature 201 - 1000 Amp. Under 600 V _
❑ Over 1000 Amp. or Over 600 V 7ti{77 ljl, l t(!
Exemption for Reg.Maint.Elect. _
SINGLE FAMILY Temp.Power Pole& Appurtenances SS
HOME OWNER-BUILDER DECLARATION33
I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit �4_Ij =h+� _00
�-+"�-i
for the following reason Section 7031.5, Business and Professions Additional Sign Branch Circuits CC
;y
Code): k.-HEt•�'`I- �'°=-
❑ Misc.Conduits & Conductors fG €i�ls� ,031I,as owner of the property,will do the work and the structure
is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule)
and Professions Code). �q
CONSTRUCTION LENDING AGENCY tJ_I00 0001 /3"
t
I hereby affirm that there is a construction lending agency for the b 1021 ' j NM 6i`9?
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total)
Civ. C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE G
Lender's Address ,may
I certify that I have read this application and state that the above TOTAL FEEW
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
property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
yd
` Signature oJj ermittee Date
�. COUNTY OF LOS ANGELES - TEMPLE CITY #'O508 ELECTRICAL PERMIT
. DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0510110014
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 6561 LT: 116 6013 KAUFFMAN AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801742
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
5385-018-011 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, C
G1 OUTLETS-LGT,SW,RECP 23.00 OUT 43.05
TENANT: G2 LIGHTING FIXTURES 6.00 LGT 11.70 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
LB 200 AMP PANELS, MCC 1.00 PAN 38.85 10/11/05 JK 04/09/06
TOTAL FEES - 121.35
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
HILLER PETER J;ANN E (626) 286-5109-
6013 KAUFFMAN AV
TEMP 917801742 DESCRIPTION OF WORK
ELECTRICAL FOR ADDITION AND UPGRADE SERVICE PANEL 200 AMP
APPLICANT: TEL. NO:
ADVANCED ELECTRICAL (818) 952-1811-
2222 FOOTHILL BLVD. SPECIAL CONDITIONS:
LA CANADA, CA 91011
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
ADVANCED ELECTRICAL (818) 952-1811- _
2222 FOOTHILL # H LIC. NO TEMPORARY POWER POLE
LA CANADA, CA 91011 719719CIO
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND
RICHARD DIRADOURIAN (818) 249-1888-
3786 LA CRESENTA AVE LIC. NO: ROUGH CONDUIT
GLENDALE CA 91208 C10336
ROUGH WIRING
MAIN WATER LINE /
PLASTIC YIN METAL YIN
UTILITY COMPANY NOTIFIED / �)
* ADDITIONAL DATA ON FILE
REPORT ID: DPR265 ROUTE TO: BS0508