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HomeMy Public PortalAbout9551 LA ROSA DR_Electrical__ 1569 5-A 12-4! ' APPLICATION FOR PERMIT DEPARTMENT, OF BUILDING AND SAFETY lUf1 COUNTY OF LOS ANGELES ELECTRIC WM J. FOX CHIEF ENGINEER NAM DISTRICT NO. GROUP ZONE PERMIT NO. U ADDRESS l S / �E�.. WDY FOR CITY L / I TEL.NO. Q �� /R/E_1EIVED By, FIRST INSPECTION DATEISSUED -1 COUNTY W CERT.NO. EXPIR � APPLICANT FILL FIEAVILY OUTLINED PORTION ONLY JOB DESCRIPTION OF WORK ADDRESS/l/ et., O'i"-+ NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST LIGHT OUTLETS JSW.I PLUGSFlZT CROSS ST. CIRCUIT A B C D E F G H X NAME Z MAIL 3 ADDRESS ' O CITY TEL.NO. 1 AM THE LEGAL POSSES OR OF THE ABOVE LOS ANG COUNTY CERT ICI F,QUALIE CATION.. ELECTRICIAN. I AM THE"GAI OWN F THE PROPERTY DESCRIBED ABOVE OWNER. CORRECTIONS z 9 0 TOTAL NO: OF OUTLETS $ U APPROVALS I NO. OF FIXTURES ® $ O DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT '4- o � NO. OF SIGN'S _ TRANS. $ WIRING NO. OF RANGES OR HEATERS $ FIXTURES MISCELLANEOUS $ POWER PERMIT FEE \� $ UTILITVCO.NOTIFIED TOTAL FEE ` FINAL L GELES CO PUBLIC WORKS APPLICATION 'OR ELECTRICAL PERMIT ��s n .ma` ApkicAFION r ©�r L.:. :. : LO6 BS PLEASE FILL OUT THE FOLLOWING INFORMATION JOB ADDRESS: QI�� ( LA (?-OSA UNIT NO. : CITY/LOCALITY: CROSS-ST: -CE*-APIE CdT`{ '6LV9_ ASSESSOR INFORMATION NO.: S ? `� o -d 4- TENANT: (LAST NAME/BUSINESS NAME) (FIRST) (MI) OWNER'S NAME: GtA l tJ LE-u 06, _ OWNER/BUILDER: YES_ NO_✓ (LAST NAMEBUSINESS NAME) (FIRST) (MI) ADDRESS: 'q 95 1 t-a (Lo c A -TEMgLe- GAT-( GA I I-(go PHONE:(62-6) Zg EXT: APPLICANT: Cir (LAST NAME) (FIRST) (MI) ADDRESS: A,217E- Astu-LN-A8Qfi. (:�A. 9 IS o'3 PHONE:( 6 2.4) fl- I t-I-1 EXT: CONTRACTOR: K!.1 G' ST�IL'Tt o ��- _ LIC. NO.: 1 6o-11b4 CLASS: Fg> (LAST NAMEIBUSINESS NAME) (FIRST) (MI) ADDRESS: 3t2,5�I tJokW k"A Aog-L- PHONE:(!L7 ) 5Zk-OS--3 EXT' ARCH/ENG: LIC. NO.: CLASS: (LAST NAME/BUSINESS NAME) (FIRST) (MI) ADDRESS: PHONE:( ) EXT: WORK DESCRIPTION: t6. : 10/96 (PLEASE FILL OUT THE REVERSE SIDE) WORKERS' COMPENSATION•DECLARATION - 76-663 10/81 ����������� ��� ��ECTRICAPERMIT ' - CE-806G Il , I herebyaffirm'that I have a certificate^of consent to self•insu're, - r : 'or"a certificate of.Workers',Compensation Insurance`,'or,a certified COUNTY OF LOS ANGELES BUILDING:AND SAFETY copy thereof`(Sec 3800,Lab,C,) i Pollcy'No" -,f,�-e` - +' ,Company' _ t - S - •FOR APPLICANT•Y04FILL IN",:: - r� ° -" •i, .JOB - ❑;A�''ertified,copy,is,hereby furnished,r },_ ' EACH NO .FEE *-DDRESS''� S' t r y ;�•,, New Rdsidential•Bldgs &'Pools ' ❑- "r 1 &'2-Family,Sq Ft t $ — $ LOCALIT• ~^ Certified'•copy'is filed with'tlhed county"building inspection department. ?a ,;' Multi-family Sq Ft - _ CROSS ST- ✓ „f; I✓._ Applicant-' r'O Residential Swimmm Pools"'' ,Date - :. _�� t +i' •Z,.. - g- ,3, OWNER OR'-r. _ ., i• - •ia.�. a .- 'n� _ .. ..-•��' ., , ,�:,•, t:4• _ .- rFIRM NAME` - CERTIFICATE OF..EXEMPTION FROM WORKERS' COMPENSATION INSURANCE, . 'outlets,Req— LightSw 's•( MAIL { -�• •;: ." ,.. _ S 'r, '."_r;,l' ' .9 .i 'S,Yn ...r.. -r :i ADDRESS.° •Q' '"'(This section'need not'be'complete If_the work involved by the ��, 'F!rst;20- ." CITY �7 Tel o �� 3 r " permit is for.:one hundred.dollars ($100) or less:) Total No Additonal ,'�r hi - �� rl ` y ,:• . . ,.". '�. a .���" .� ••yr, ;ti ,� PLAN;CHECK - n �• _ .cgrtify;that' the+performance!f f,the,.work'for which this, 'nmit- .'$'.F` � `.r-, --¢:" - is issued,'I.shall,not 6,m to 'an ersoAPPLItANT n in.'an mann4.'so as to Y+;• ' beco ne subfect'to`the,Workers:Compensation Laws': "'' Lightfng-Fixtures� -First 20 ;r r- ^ ::M:�k ' ' ADDRESS d ., Additional' 1- i Total No r" r�. CITY' Tel No f/ Date " gpPhcant- i �C, NOTICE TO�'APPLICANT .;If,;hafter�, making this`.Certificate of;, Fixed Appliances No. .1e '1 HP, PERMIT = ..'Range Heater= D W. APPLICANT' '- ,,Exemption:,you should become subject to the Workers'Compensation g -. provisions of the;Labor Code,you must forthwith comply with such Oven'_ Dryer= ••''- WM + , ADDRESS { prov ns%o f this,permit'shall'be dee Hedy evoked^ ,? _To FAU' —°W H ° " F p` _ LICENSED-CONTRACTORS DECLARATIQN , , t CITY" i ' Tel No', uHood, Fan, Oth"ec_ ul'hereby,affirm Shat I,'am licensed,under, provisions of:Chapter'9 Disp Room -Gond' j , r LICENSE OR ;- Class (commencing with'Section 7000]of Division 3 of,tlie'.Busmess`and; w , , REG NUMBER Professions Code;and'my,Ilcensels'm'full force.and'effect. r 'DISTRICT NO ESSED-Bv.' ft- Power,Apparatus& Large,ApplianceS11 Size&.T` e'HP�KW=KVA,`or°KVAR` A i - �00,'e•` _ j _ License Number r-O-Lic,' Class -"y - - FINAL' �w, V „? Up ao 1-Incl'; ' DATE �. Contractor r "Over 1 to•10 Incl 'b _ '-VALIDATION- 0- " _' :`Date s" Over'1 O,to 50 Incl r ; ( n FINAL V ❑ I am ezempt.uhder Secs ,- Oyer•50 to•.1-00 Ina_.;, ;�r BY B&P C. for this reason �T s 'Over•100 ' ti =f Services, Swbd;MCC& Panelboar ; < �" Z Cn Date VA O �' r-s '0-.200 Amp Under•606 V Signature -•201 -'1000-Amp Under,600 V s J{ " 1 Over 1000'Amp.,or Over 600.V ❑ Exemption for Reg Maint:Elect '.SINGLE FAMILY f '" " '', 'Temp.'Power Pole.& Appurtenances a - `' t` �rl a4 HOMEOWNER=BUILDER DECLARATION ; Sign wdh One Branch Circuit I hereby affirm fhatltam exe'mpt.from the;Coritractor's License'Law „� :: K, '• r,„' e' for the following reason.(Section. Business'and'f rofess6s Additional'SigrnBranch,'Cl�cuits ;;, _ 65060 .. „ a 3303,,,',' t- 'i'p 'ter:': r _l. '• -,- ,. TTEp� r :^ Mi'C Conduits''& Conductors Mf I,as owner,ofahe property,will do the'work and,the structure �' ''`:.r- snot intend ' .or."offered for sale'(Section.7044 ,Business; _ 'Other;(See Complete Fee Schedule) •. ,�' fTgTAL." -:and Professions,Code ) CF{EGO�''',-; 65 0 60 . 'CONST.RUCTION LENDING*AGENCY, /+�/�,� r �; GE I hereby`affirm,thattthere is a construction;lendmg agency.,for the � , h' ''� �w.- :f ;performance of,the work,.for which this permit is issued+(Sec?3097 PERMIT-FEE"N. •- ��.? '(Sub Total)'.' �,� I.- �'- `;�";�- Y'. ,.d Civ C^) 3' e t P-L'AN CHECKING.EEE .,r,'ti I. _ �t;� ;';ww;bwl.'` 7/31/9,5 l enders.Naine�e e: y` z r' p, ' 1623, > �� �1 PCi 56-07 .. ; PERMITJSSUING',FEE' "Lender's Address ;n?-.1 f' ,. .�� , r- s• ,n r !.` I certrfy that 1-have read this application and•state that the above TOTAL FEES �` information is correct I agree to'comply,with all County ordinances_ and State laws'regulating Electrical:.wirmg; and hereby authorize a- representatives"ofrt ounty jor`enter upon the above-mentioned,i, property..or rasp p poses. _SEE.REVERSE;F-OR EXPLANATORY_LANGUAGE ' ure of Permittee Date. COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0104020025 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: -LEGAL EES PAID BUILDINGADDRESS: TR: 13620 LT: 21 9551 LA ROSA DR FEE DESCRIPTION:, QUANTITY: UOM: AMOUNT: TEMP CA 917803827 ASSESSOR ON NEAREST CROSS STREET: TEMPLE CITY BLVD 8590-014-009 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 22.00 OUT 41.70 TE G2 LIGHTING FIXTURES 6.00 LGT 11.70 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: JB AC UNITS +3-10HP 1.00 AC 19.65 04/02/01 JK 09/29/01 TOTAL FEES 100.80 OWNER: TEL. NO: FINAL DA FINAL BY: CODE: CHIN KON LEUNG;CHUN LAN - IZ ZQ� 9551 LA ROSA DR TEMP 917803827 DESCRIPTION OF WORK ELECTRICAL FOR ADDITION, C/O HVAC SYSTEM APPLICANT: TEL. DERRICK NG (626) 524-0803- 3129 NORWICH AVE SPECIAL CONDITIONS: ALHAMBRA, CA 91803 CONTRACTOR: TEL. N0: s Cc APPROVALS DATE INSPECTOR SIGNATURE K N D CONSTRUCTION CO. (626) 524-0803- 3129 NORWICH AVENUE LIC. NO TEMPORARY POWER POLE ALHAMBRA, CA 91803 760784,B UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: / UPER GROUND LIC. NO: I� 1111111 ROUGH CONDUIT ROUGH WIR ( r MAIN WATER LINE PLASTIC Y/N METAL Y/N 11 L1 L 'AlJJ '03)UUU LLL111U UTILITY COMPANY NOTIFIED O 0 D 0 Li a LJ � REPORT ID: DPR265 ROUTE TO: BS0508