HomeMy Public PortalAbout6123 LOMA AVE_Electrical__ i
C89064 APPLICAMN F® ELECTRICAL PERMIT
COUNTY OF LOS ANGELES ri a-
DEPARTMENT OF COUNTY ENGINEER i BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A.LAMBIE, COUNTY ENGINEER g
WILLIAM A. JENSEN. SUP'TOF BUILDING LOCALITY
f FOR APPLICANT TO FILL IN CROSS sT
PERMIT FEES
OWNER
1 T E M NUMBERI EACH FEE MAIL
` OUTLETS $ $ ADDRESS
` LIGHTS RECEPT. SW. ,10
LIGHTING FIXTURES CITY TE NO '
.10
ELEC.RANGES CLO. DRYERS _ ELECTRICIAN
WATER H EATERS .50 Q ADDRESS
ELEC.SPACE HTRS. DISHWASHERS CITY - TEL.NO.
4
SGARBAGE DISPOSERS AUTO,. STATE
LICENSE NO.
WASHERS STA. COOKING UNITS .25 m y o
a MOTORS: OVER INC. H.P. DISTRI T G P E P E�D B
0 — I/2 .25 k rQ/
+12 2 .50 INSPECTION RECORD -
2 5 1.00 a
b
s — 15 1.50 _ O
is — 50 2.50 v 0 , 4'
O
50 — 200 5.00
D E127 7U w
SIGNS: NO TRANS. a %. CL
NO. LAMPS L F Sf //LCL' I/Y�IB Z
SERVICE 0.600V
i° SERVICE OVER 600V
5.00
MISC.
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00
'A SUPPLEMENTARY PERMIT sp /IT bra 1W-
TOTAL
FTOTAL FEE $ �(� ��Y�Jl/lr�i? fONl�i(� �/✓ 5
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY '
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING U CONDUIT
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR _
LICENSED AS REQUIRED BY LOB A GELES COUNTY AND STATE OF ? FIXTURES
° CALIFORNIA OR THA M THE EGAL NEB OF THE ABOVE
DESCRIBED REST P OP Y. POWER
SIGNATURE UTILITY CO. NOTIFIED
OF PERMITTE
o 1�. FINA -A. l
IDATION ARTHUR C.VETT.
C MO CASH SUPERVISING ELECTRICAL ENGINEER
LACG 1 3 5 0 ,!hPa 2 0 2 D 2.5 0
WORKERS' COMPENSATION DECLARATION 96A663 10/81 p PPL ICA° N F�k Ep ECTMI�, n PERNT
I hPr'eby affirm that I have a certificate of consent to self CN806G 6'� f)e I1 CJ L� [Ig 1 1L�
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES ' BUILDING AND SAFETY
or a certified copy thereof (Sec 3800, Lab C )
P❑ol cy No Company' FOR APPLICANT TO FILL•IN JOB
Certified copy is hereby furnished New Residential Bldgs & PoIs� EACH NO FEE ADDRESS
1 & 2-Famil S Ft---`� $. — $ LOCALITY >� j� 5
' Certified copy is filed with`the county building inspec- Y. 9 — / l
TE—
tion department Multi-family Scl Ft NEAREST
1Residential SA%immmg Pools CROSS ST
Date Applicant OWNER OR
PP FIRM NAME
CERTIFICATE OF EXEMPTION TROM WORKERS' Outlets Rec _3Light�S Sw MAIL � /
COMPENSATION INSURANCE ADDRESS ��j ! V
(This section need not be completed if the work involved by' ', 'First 20 �-
the permit is for one hundred dollars ($100)or,less.) Total No Additioncdl `� Tel No
I`certifY in that the performance of the'work for which this PLAN CHE
�
permit is issued, I shall not employ any person in any manner APPLICANT
so as to ensa
ect to the Workers
b bec me su 'Compensation Laws Lighting Fixtures First'20 ADDRESS
I P Additional
�� / Total No� CITY `t Tel No
Dare Applica" �Fr�—u/ Fixed Appliances Not Over 1 HP`' PERMIT /
NOTI TO APPLICANT If, fter ma ting this Certificate of
C Exemption, you should become subject',to the Workers' Range_ Heater,_D W •� APPLICANT
II 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
deemed revoked CITY Tel No
LICENSED CONTRACTORS DECLARATION. Hood Fan _ Other_
Disp —'•Room Air Cond LICENSE �' 2- ,' Class
•I Hereby affirm that I am licensed under provisions of Chapter 9 - ,-
REG NUMBER
(commencing with Section-7000) of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO PROC D BY
,and Professions Code, and my license is in full force and effect �. `,
ry� �j Size &Type HP, KW,' KVA, or K,VAR J L 0 -
License Number 0� ` ;7__ Class ✓ / O
Up to 1 Incl FINAL
1,11A
, Over 1 to 10 Incl DATE _ �-y�
Contractor /% [!J/ iDate 0
Over 10 to 50 IndZJ VALID ION O
❑ FINAL U
I am'exempt under Sec Over 50 to 100 Inc BY" W
Over 100 IL
B &P C for this reason N
-
Date I L Services,Swbd , MCC & Ponelboards - - Z
` 7
i 0 -200 Amp Under 600 V
Signature ��' 201 - 1000 Amp Under 600 V ) 2 1 0Z 3 A
❑ Over 1000 Amp or Over 600 V
Exemption for Reg Mamt Elect #'o,o•° 0,0 2
SINGLE FAMILY v Temp -Power Pole-&Appurtenances, ° ° 4 2 5 `
HOME OWNER-BUILDER DECLARATION, a
Sign with One Branch Circuit
Thereby affirm that I am exempt from the Contractor's License ° ° ° 4 2 5�
Law for the following'reason (Section 7031 5, Business and Additional•Sign Branch Circuits ,
Profess ions"Code) A Q 8 8 4,
❑ j, as owner ofthe 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-t) 1
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-mentioned p p ty for ins coon pur osesi
t / SEE REVERSE FOR.EXPLANATORY LANGUAGE
Signature of Permittee D e
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LQ TUNAS EL 0508 0009010016
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL D: FEES PAID ---TUILDING ADDRESS:
TR: 5904 LT: 255 BL: .001 6123 LOMA AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801633
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: TEMPLE CITY BLVD
5384-010-021 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY
LA 100 AMP PANELS, MCC 1.00 PAN 38.85
TENANT: TOTAL FEES 66.60 ISSUED PROCESSED BY: LAN R ON:
09/01/00 UT 03/0 01
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
HU;SHEAN-CHENG (626) 291-2343-
6123 LOMA AV
TEMPLE CITY SCRIPTI F WORK
UPGRADE AND LOCATION CHANGE OF ELECT ICAL PANEL
APPLICANT: TEL. O:
SAME AS OWNER
SPECIAL CONDITIONS:
GELES CO
CONTRACTOR: TEL. NO: OCJ U/�j�, APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO TEMPORARY POWER POLE
UNDERGROUND CONDUIT
ARCHITECT OVENOTWEDE TEL. NO: / UFER GROUND
LIC. N0: 1111111 ROUGH CONDUIT
ROUGH, WIRING
ULOR)LC WORKS
MAIN WATER LINE
4L1.- \I�JiI��Jfl 161�U IC71��� PLASTIC Y/N METAL Y/N
_ s
UTI[rTTCOMPANY NOTIFIED ��e
o -
b,�c service
i
1
REPORT ID: DPR265 ROUTE TO: BS0508