HomeMy Public PortalAbout9426 LEMON AVE_Electrical__ 1�w/ C 'tk *
,76A663-oES06 3-64 APPLICATION FOR ELECTRICAL PER1VlIT �L,I
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING j�
BUILDING AND SAFETY DIVISION ADDRESS Z ,r / O
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT eZ 3 TOTAL NO EACH FEE
/Z
OUTLETS FIRST 20 $.20 $ OWNER �� Ll1 C'O
IVS
LIGHT C' b
SWITCH OVER 2D Z .10 �, ADDRESS 2—Z
LIGHTING 1r TOTAL F}RST 20�Z .20 Z G7 CITYS:gN (61Q61Q'9/?/5TEL. NO. Z Zcr
FIXTURES 1 ADD'L 1O ELECTRICIAN
OVFR 20
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS �i' oc �^
GARB.DISP. STA.COOK CIT_-_-fE TEL NO. (?
DISHWASH. AUTO.-WASH. •� STATE
�c� /
SPACE HTRS. STA.APP.(yi H.P.MAX.) .50 �' �! LICENSE NO. � �/ 10
MOTORS, OVER NOT OVER H.P. DISTRIT GROUP ZON ESSED BY
(9
O 1 1.00 '
1 s 1.50 / /--INSPECTION ,f ECORD �AA
e B 2.00 h17Y / nDl'�+2 �Ctevl� OU
8 15 2.50 O
15 50 3.00 ` a
W
so 100 500 G f• h
SIGNS. NO.TRANS
NO.LAMPS
SERVICE 0.600V-Nor OVER 201DA - 1.00 �+v'_y1tq
SERVICE 0.60OV•CVER 200 A. 2.00 v
SERVICE OVER SOOV 5.00
MISC.
PERMIT ISSUING FEE 200 Z
,SUPPLEMENTAgY PERMIT ISSUING FEE 1.00
TOTAL FEE $1.3
1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AB REQUIRED BY LOB ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL- OPERTY. POWER
SIGNATURE 0 E UTILITY CO.NOTIFIED
OF PERMITT
FINAL
0LIDATION ARTHUR C. VEIT�-
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
L
97. 75 MAR 22 2 n 13.80N a
WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
hereby affirm that I have a certificate of consent to self Insure, 76A663 ,
or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy thereof(Sec 38000 Lab C)
W`IV-U r1:6 pony ��C� G FOR APPLICANT TO FILL IN JOB
POIICy NO
❑ ADDRESS LG E7 �t?LYLQ
Certified copy is hereby furnishedNew Residential Bldgs &,Pools NO EACH FEE
$ $ LOCALITYe t L $U
❑ Certified copy is filed with the county building Inspection. 1 &2-Family,Sq FI _ NEAREST
department Multi-family Sq Ft CROSS ST �
Date Applicant Residential Swimming Pools ASSESSOR S - AGE Oft/ PARCEL
MAP BOOK 037
CERTIFICATE OF EXEMPTION FROM WORKERS' .-NE
R OR /
COMPENSATION INSURANCE Outlets Recoo Light S" p FIRM NAME
FIfSt 20 O Q MAIL
(This(This section need not be completed if the work involved by the Total No Additional ADDRESS
n E
permit is for one hundred dollars($100)or less) �p
I certify that In the performance of the work'for which this permit _ CITY [, Tel No Ci'tS_s 27
is Issued, I shall not employ any'person in any manner so as to PLAN CHECK
become,subject to the Workers,Compensation Laws Lighting Fixtures - First 20 APPLICANT
Total No Additional
ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICE TO APPLICANT If, after.•making this Certificate of CITY Tel No -
Exemption,you,should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP
rovisions of'the Labor Code, you must forthwith comply with such PERMIT
p p y e A
Apparatus&Large APPLICANT
provisions or this permit'shall'be deemed revoked Power App "
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS ZZ E1 Z 6-
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl
(commencing with Section 7000) of Division 3 of the Business and CITY -fit Tel No75-vS
Professions Code,and my license Is in full force and effect Over 10 to 50 Incl }
LICENSE OR �� Class a
Over 50 t0 100 InCI REG NUMBER r
7� —/ `"O �— Over 100 DISTRICT NO PROCESS O
License Number Lc Class Q U
Services,Swbd,MCC&Panelboards ®V
Contractor 0-399 Amp Under 600 V DATE FINAL O
400-1000 Amp Under 600 V �� ` U
❑ I am VALIDATION exempt under Sec W
Over 1000 Amp Or-Over 600 V FINAL EI
B&P C-for this reason BRANCH CIRCUIT FEES BY f)
Date 15A,or 20A, 120V,Lighting or Recept Z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Cucuds 2
❑ 41 Or More Branch Clrcwts — �.� -e e
Exemption for Reg Maint Elect 15A,20A,208V To 277V Lighting Br Circuits
SINGLE FAMILY Temp Power Pole&Appurtenances 31707 33.2"1
HOME OWNER-BUILDER DECLARATION' Sign with One Branch Circuit ���
I hereby affirm that I am exempt from the Contractors License Law
for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits TOTAL -O—"—�
Code) IAL =
❑ I, as owner of the property,will do the work and the structure Misc Conduits&Conductors CHECK 33.25
Is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ® �'HANGE ,011
and Professions Code)
CONSTRUCTION LENDING AGENCY i
I hereby affirm that there is a construction lending agency for the 0000-0001 5/17/93
perfoFinance of the work for which this permit Is issued (Sec 3097, PERMIT FEE (Sub-Total)
CIV C) - 9745 1" Ali 9.14
PLAN CHECKING FEE _ -- -
Lender's Name
PERMIT ISSUING FEE a
Lender's Address ? y
I certify that I have read this application and under penalty of purjury state TOTAL FEE V `j
that the above Information is correct I agree to comply with all County
ordinances and State laws regulating Electrical wiring,and hereby authorize
represe tatives of this Coun to enter upon the above-mentioned property
for s c rp es SEE REVERSE FOR EXPLANATORY LANGUAGE
92-
SIGNATURE O ERMITTEE DATE '
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0703280039
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT-
LEGAL ID FEES PAID BUILDING ADDRESS
1 ON FILE 9426 LEMON AV
IFEE DESCRIPTION QUANTITY: UOM. AMOUNT TEMP CA 917801302
ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET.
15382-014-037 1A1 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID J1 LOCALITY: TEMPLE CITY, Cl
IF1 120V, 15/20A BR CKTS 2 00 BR 34 50
TENANT- ILB 200 AMP PANELS, MCC 1 00 PAN 38 85 JISSUED ON PROCESSED BY PLAN BY. EXPIRES ON-
TOTAL FEES 101 10 103/28/07 JK 09/24/07 1
(OWNER: TEL. NO 1FINALTE FI CODE:
IPARK EDWARD I,ESTHER Y TRS PARK TRU (626) 445-5272-
19426 LEMON AV I I
ITEMP 917801302 1 IDESCRIPTION OF WORK
1 1 IRESTORE ELECT SERVICE + UPGRADE ELECTRICAL PANEL TO 200 AMP 1
1APPLICANT TEL. NO I I
1JAMES FIELDS (818) 303-4333- I 1
11408 ROCK GLEN AVE 1 ISPECIAL CONDITIONS 1
IGLENDALE CA 91205 1 I 1
1CONTRACTOR: TEL. NO 1 1APPROVALS DATE INSPECTOR SIGNATURE 1
IBLUE FIELDS ELECTRIC (818) 303-4333- 1 1 I
11408 ROCK GLEN AVE LIC. NO 1 ITEMPORARY POWER POLE I I I
IGLENDALE, CA 91205 843309 C10 1 1 1-1 I
I 1 (UNDERGROUND CONDUIT I I I
1 I I I I I
(ARCHITECT OR ENGINEER TEL NO: 1 1U D ,� I
1 LIC. NO: I IROUGH CONDUIT I I I
I I IROUGH WIRING I I I
t
1 1 IMAIN WATER LINE I I
I I IPLASTIC Y/N METAL Y/N 1 I I
1UTILITY COMPANY NOTIFIED( ,1i1
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IREPORT ID DPR265 ROUTE TO: BS0508 I I I 1
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