Loading...
HomeMy Public PortalAbout9518 LA ROSA DR_Electrical__ 78AG63-CEB06-10-68 APPLICATION FO R ELECTRIC PERMIT BUILDING AND SAFETY DIVISION Department of County Engineer aB U I LD Iss 951f SA R O SA DR County of Los Angeles. JOHN A. LAMBIE; COUNTY ENGINEER TEMPLE CITY CASSATT D. GRIFFIN. SUPT OF BUILDING' LOCALITY NEAREST TEMPLE CITY BLVD. FOR APPLICANT TO FILL IN CROSS$T; PERM FEES OWNER A J SAVING • LIGHTS RECEPTACLES SWITCHES NUMBER I T E M EACH FEE MAIL Q S S ADDRESS -9-IM OTAL OUTLETS - .10 3 ELEC. RANGES, WATER HEATERS, 1 C/1 CITY TEL. NO. CLOTHES DRYERS ,50 ilV 'ELECTRICIAN ' ELEC. SPACE HEATERS, STAT-Y. COOK- - 1 ING UNITS, GARBAGE DISPOSERS, 2g ,ADDRESS 1403 MA'.RDINA ST AUTO WASHERS, DISHWASHER .25 ,1 14 LIGHTING FIXTURES ,10 CITY, ES•Lrt1 'CO COVINA TEL. NJD9885:x MOTORSSTATE 89638 LICENSE NO. HORSEPOWER _ DISTRICT NO. GROUP ZONE READY FOR INSPECTION N.P. OVER INC, 1� 1 raj 1 — I/x IN LESS .25 p +.?sr� Ib — 2 •50 INSPECTION RECORD 2 gl5d 1.00 5 1.5015 2.5050 5.00 -MISC. - ray) rnwl.-/--��7 SIGNS NO.TRANS NO.LAMPS - ( -+T-C`��-�L+�,•k"1 ., SERVICE O-'600V 1.00 SERVICE OVER 600V 5.00• WIRING PERMIT -1.00 Uc FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 APPROVALS TOTAL FEE $ DATE •- INSPECTOR'S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION L TE THAT .THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT L COUNTY ORDINANCES AND STATE LAWS REGULATINGAL WIRING. WIRING tBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES AS REQUIRED BY LOS NG COUNTY AND STATE OFIA ORTHATI L OWNER F THE ABOVE POWERD RESIDENTIALURE UTILITY CO. NOTIFIEDMITTEE FINAL JOHN A. LAMBIE, xALIDATION ARTHUR C.VEIT, COUNTY ENGINEER cK Mo CASH SUPERVISING ELECTRICAL ENGINEER L&IL 4 s 2 FF-824 2 .A 1 1 .5',0 M WORKERS'COMPENSATION DECLARATION CE 806G (2-80) APPLICATION FOR ELECTRICAL PERMIT : I hereby affirm that I have a certificate of consent to selfi _ COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or / a certified-copy thereof(Sec. 380 FOR APPLICANT TO FILL IN SOB Policy No. Compan ADDRESS New Residential Bldgs.&Pools EACH NO. FEE Certified copy is hereby furnished. 1 &2-Family,Sq: Ft. $ — $ LOCALITY Multi-family Sq. Ft. — NEAREST — Certified'copy is filed with the county tLuilding inspection CROSS ST de'pprtrrfent. Residential Swimming Pools OWNER OR ' FIRM NAME Date Applic Outlets Rec.—Light—Sw. MAIL First 20 ADDRJESS CERTIFICATE OF EXE ION FROM WOR S' Total No Additional ' r CIT L Tel No. COMPENSATION INSURANCE } PLAN CHE 0. (This,section need n6t be completed if the work involved; APPLICAN O by, the permit is for one hundred dollars (5100) or less.) Lighting Fixture's First 20 ADDRESS Additional Cc O Total No. CITY Tel No. I certify that in the performance of the work for'which this Fixed Appliances Not Over 1 HP ' ♦— permit is issued, I shall not employ any'person in any manner PERMIT U so'as to become subject to the Workers' Compensation Laws. Range_.Heater_D.W. APPLICANT ' W CL Oven _ Dryer_•W.M. ADDRESS / U) ' Date Applicant Top _ FAU _W.H. _ Z Hood _ Fan _Other_ CITY Tel No. 'C/' �� NOTICE TO APPLICANT: If,after making this Certificate of Disp. _ Room Air Cond.— LICENSE OR Exemption, .you should become'•subject to the Workers' REG.NUMBE O% Class Compensation*provisions of the Labor Code, you must forth- Power Apparatus&-Large Appliances DISTRICT NO. P5iVtEAED BY �vwith comply with such provisions or this. permit shall be, Size&Type HP, KW, KVA,or KVAR deemed revoked. Up to•1 Incl. t • � • Over.1 to 10 Incl. FINALDATE �v� LICENSED CONTR-ACTORS DECLARATION �ti' ®`r 0 VALIDATION, Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc.. FINAL BY 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 �� , ness and Professions Code, and my license is in full force and effect. (� I Services License Numbers Lia /�Class v 0-200 Amp. Under.600 V• 201-1000 Amp. Under 600 V Contractor Date �� Over 1000 Amp'or Over 600 V HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances Sign with One,Branch Circuit 4 0 1.3 A I.hereby affirm that I am exempt from the Contractor's; Additional Sign Branch Circuits- 'License Law for the following reason (Section 7031.5, Busi- o;0 0 0 0 2 ness and Professions Code): Misc.Conduits&Conductors 2'0:- 2 3 5 0 Other (See Complete Fee Schedulel— I, as owner of the property, will do the work'and the structure is not intended or offered for sale (Section• o o o 2-3.5 0 ' 7044, Business and Professions Code). - CONSTRUCTION LENDING AGENCY 05 1 4'—8 2 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT-FEE (Sub-Total) issued (Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE ; I certify that I have read this application' and state 'that the TOTAL FEE a� 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 i ie above-mentioned operty for inspection purp ses. SEE REVERSE FOR EXPLANATORY LANGUAGE - - can r� ature of Permittee ate r. WORKERS'COMPENSATION DECLARATION 76Ao19oPws a7 APPLICATION FOR ELECTRICAL PERMIT O til hereby aifficm t I hcfLe a certificate of consent to self .CE°'� insure, or a,Nlliticote of Workers' Compensation insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ansacy certified copy thereof (Sec. 3800, b C ) Po No. Company FOR APPLICANT TO FILL IN JOB aCe ed copy is hereby furnished. ( New Residential Bldgs & Pools EACH NO; FEE ADDRESS LOCALITY C• Certified copy is filed with the county building inspec- yI & 2-Family, Sq. Ft. $ — $ G ' _ tion department Multi-family Sq. Ft — NEAREST �– CROSS ST Date� 39� Applicant Residential,SwimmmgPools OWNER OR //�� FIRM NAME C CERTIFICATE OF EXEMPTIO ROM WORKERS' Outlets- RecL&Light ' Sw.� MAIL COMPENSATION`I SURANCE D ADDRESS fj First 20 '(This section need not be completed if the work Involved by Total No. Additional i CITY Tel No the.permit is for one hundred dollars ($100)or less.) PLAN CHECKOn I certify that in the performance of•the,work for which this APPLICANT - permit is issued,�l_sholl not employ any person in any manner so as to become subject to the Workers'Compensation•Laws Lighting Fixtures� First 20 ADDRES 4 Additional Total No. CITY/44,,—,e �_ Tel N Date Applicant It NOTICE TO APPLICANT- If, after making thil Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION Compensation provisions of the Labor Code, you most forth- Oven Dryer —W M _ ADDRESS with,comply with such provisions or this-permit shall be Top FAU W.H. — deemed revoked. Hood — Fan CITY Tel. No. Other— LICENSED CONTRACTORS DECLARATION D Disp. Room Air Cond _ LICENSE OR ✓ Q I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER ��V Class. .d r (commencing with"Section.7000)of Division 3 of the.Business Power Apparatus & Large Appliances DISTRICT NO PRO ED BY Y and Professions Code,and my license is in full force and effect r , - f0 0- Size &-Type.HP,KW,'KVA, or KVAR Q '75License Numbe Lic Class U Up to 1 Incl. FINAL, Contracto `�` Date l �� Over 1 to 10 Incl. DATE VALIDATION Over 10 to 50 Incl. FINAL ~ ❑ "I am exempt under Sec. Over 50 to 100 Inc BY aW B.&P C. for this reason Over 100 AI ® Date. Services, Swbd., MCC& Ponelboards, Z Z 0-200 Amp Under 600 V Signature 201 - 1000 Amp. Under 600 V El Over 1000 Amp. or Over 600 V Exem ion for eg. Maint. Eject.. SINGLE FAMILY Temp. Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Ir I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit k ay 3'y Law for the following reason '(Section 7031 5, Business and Additional Sign Branch Circuits _7•,z_ c- Professions Code)• �.FS` ❑ I, as owner of the property, will do thework and the Misc. Conduits&Conductors structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— i —_ 0Business and Professions Code) ^'r m CONSTRUCTION LENDING AGENCY. a CHECK 'o;(. I hereby affirm that there is a construction lending agency for `�Y CHANGE a lil the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) Q (Sec, 3097, Civ. C ). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE 2 Lender's Address 7a .6 � 1 f lN r7,".:'_ 1 certify that I have read this application and state that the TOTAL FEE �o � 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 ove-mentioned pro erty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Si ture o P m,tee Dae l ©s t � COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0911250011 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID FEES PAID I BUILDING ADDRESS- I ITR: 13329 LT: 49 BL: .001 UN- .002 I 9518 LA ROSA DR I I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917803826 1 (ASSESSOR INFORMATION NUMBER- I I NEAREST CROSS STREET: TEMPLE CITY I 18590-019-008 1A1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY, Cl I ILB 200 AMP PANELS, MCC 1.00 PAN 38.85 I I (TENANT: I TOTAL FEES 66.60 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1 I 111/25/09 SR 11/25/10 I (OWNER: TEL. NO: IFINAL DAT FINAL BY: CODE- I ICHOI SOON K (626) 287-4813- 19518 LA ROSA DR ITEMP 917803826 I IDESCRIPTIOIN OF WORK 1 I (UPGRADE SERVICE PANEL TO 200 AMP (APPLICANT: TEL. NO: 1 I I ISAME AS OWNER I I ISPECIAL CONDITIONS: 1 I I I 1 ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE I ISAME AS OWNER - 1 I I I LIC. NO 1 - ITEMPORARY POWER POLE I I I I (UNDERGROUND CONDUIT I _ (ARCHITECT OR ENGINEER: TEL. NO: 1 IUFER GROUND I I a• - LIC. NO: IROUGH CONDUIT 2A- LIC. � 1 I IROUGH WIRING 1 I 1 IMAIN WATER LINE I 1 I PLASTIC YIN METAL YIN I 1 1UTILITY COMPANY NOTIFIE 11 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 I I I I I I I I