HomeMy Public PortalAbout9862 LEMON AVE_Electrical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL,PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0008210049
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
GAL FEES PAID BUILDING-ADDRESS:
ON FILE 9862 LEMON AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917800000
ASSESSOR INfORMATION NUMBER: NEAREST CROSS STREET: ROWLAND
5383-025-029 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY
G1 OUTLETS-LGT,SW,RECP 14.00 OUT 27.30
TENANT: G2 LIGHTING FIXTURES 5.00 LGT 9.75 ISSUED PROCESSED BY: PLAN Y: EXPIRES ON:
H7 RES EXHAUST FANS 1.00 EX 10.95 08/21/00 UT 02/18/01
LB 200 AMP PANELS, MCC 1.00 PAN 38.85
OWNER: TEL. NO: TOTAL FEES 114.60 FINAL DATE FINAL BY: CODE:
DEE GREGORY;CECILIA
9862 LEMON AV
TEMP 917800000 DESCRIPTION OF WORK
ELECTRICAL FOR ADDITION AND REMODELING
PPLIC
A-1 CONSTRUCTION AND GENERAL CONT. (626) 458-8677-
511 S. FIRST AVE. SPECIAL CONDITIONS:
ARCADIA, CA
G, E L� C�
CONTRACTOR: TEL. NO: /� APPROVALS DATE INSPECTOR SIGNATURE
J
A-1 CONSTRUCTION AND GENERAL (626) 458-8677-
CONTRACTING LIC. NO TEMPORARY POWER POLE
511 S. FIRST AVE. #289 630600 B
ARCADIA, CA 91006 UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. ER GROUND
LIC. L NO 1111111 ROUGH CONDUIT
ROUGH RING
U
'LogLn /1 / IRDMAIN WATER L[NE
\\U/�\\VI/ �u�((� PLASTIC Y/N METAL Y/N
_ UTILITY COMPANY NOTIFIED
01-
0 ® d ®5
0 V 0
Service
REPORT ID: DPR265 ROUTE TO: BSO508
WORKERS' COMPENSATION DECLARATION CE-806G 10/8
1
APPLICATION ION FOR ELECTRICAL itICAL PERMI 1
I hereby affirm that I have a certificate of consent to self j
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lob. C.)
a cy No^, i CompanyF` FOR APPLICANT TO FILL IN JOB
Certified co is hereby furnished. EACH NO. FEE ADDRESS
PY Y New Residential Bldgs. & Pools
ED
S —
Certified copy is filed with...the.county building inspec- 1 & 2-Family, q� Ft. $ $ LOCALITY—
tion department. ! Multi-family Sq. Ft. NEARESTCROSS T.
_ »� t Residential Swimming Pools OWNER OR
Date ! Applicant FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec; LightSw.�_ MAIL
COMPENSATION INSURANCE s-,
ADDRESS
First 20 .-
� �
(This section need not be completed if the work involved by Total No. Additional CITY Tel. No.
the permit is for one hundred dollars ($100)or less.) PLAN CHECK
I certify that in the performance of the work for which this APPLICANT
permit 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
Additional
Total No. CITY Tel. No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT ,
Exemption, you should become subject to the Workers' Range_ Heater—D.W. —
Compensation provisions of the Labor Code, you must forth- Oven — Dryer — W.M.— ADDRESS
with comply with such provisions or this permit shall be Top _ FAU —W.H. CITY Tel. No.
deemed revoked. Hood — Fan — Other_
LICENSED CONTRACTORS DECLARATION r' LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. .p.4 Room Air Cond. REG. NUMBER Class.
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO PROCESSED BY d
and Professions Code, and my license is in full force and effect. Power Apparatus& Large Appliances O
_ Size &Type HP, KW, KVA, or KVAR F _ U
License Number Lic. Class Up to 1 Incl. FINAL ' e LU
Over 1 to 10 Incl. DATE
VALIDATION
Contractor Date >_
❑ Over 10 to 50 Incl. FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY Q
B.&P.C. for this reason Over 100 0
Date:
Services, Swbd., MCC & Panelboards ► CL
0 - 200 Amp. Under 600 VLU
Signature 201 - 1000 Amp. Under 600 V F'
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect.
SINGLE FAMILY
HTemp. Power Pole & Appurtenances
HOME OWNER-BUILDER DECLARATION
Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and
Professions Code):
❑ I, as owner of the property, will do the work and the Misc. Conduits& Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— ,
7044, Business and Professions Code).',
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) !
(Sec. 3097, Civ. C.). _
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address
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
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the above-mentiohed property'for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date