HomeMy Public PortalAbout9434 LEMON AVE_Electrical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0701300028
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT.
LEGAL ID FEES PAID BUILDING ADDRESS.
ON FILE 9434 LEMON AV
1 IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917801302
ASSESSOR INFORMATION NUMBER. I NEAREST CROSS STREET TEMPLE CITY
15382-014-024 1A1 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID J1 LOCALITY: TEMPLE CITY, Cl
ILB 200 AMP PANELS, MCC 1.00 PAN 38 85
ITENANT I TOTAL FEES 66 60 11SSUED ON- PROCESSED BY PLAN BY. EXPIRES ON 1
I I 101/30/07 JK 07/29/07 1
1OWNER: TEL NO 1 IFINAL DATE FINCODE 1
IFUENTES, RUDOLPH (626) 446-5313- 1 1 .i 1
19434 LEMON AVE 1 1 1
ITEMPLE CITY CA 91780 1 IDESCRIPTION OF WORK 1
I I IRELOCATE ELECTRICAL PANEL U GRADE TO 200 AMP 1
1APPLICANT TEL NO I I I
SAME AS OWNER
1 ISPECIAL CONDITIONS 1
ICONTRACTOR TEL NO 1 1APPROVALS DATE INSPECTOR SIGNATURE 1
ISAME AS OWNER - 1 I 1
LIC NO i (TEMPORARY POWER POLE 1-1 I
I JUNDERGROUND CONDUIT I 1 1
ARCHITECT OR ENGINEER TEL NO , 1UFER GROUND I I I
1 LIC. NO 1 IROUGH CONDUIT 1 I 1
1 1 IROUGH WIRING 1 1
1 1 IMAIN WATER LINE 1 1 1
1 I 1PLASTIC Y/N METAL Y/N 1 I
1 1 1UTILITY COMPANY NOTIFIEDI I 1
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 1 1 1 1
WJRKERS'COMPENSATION DECLARATION 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby'aTfiibi that I have a certificate of consent to self CE-806G
insure, or a cert?ficate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec 3800, Lab C )
Policy No Company FOR APPLICANT TO FILL IN JOB
Certified co is hereby furnished EACH NO FEE ADDRESS
PY Y New Residential Bldgs & Pools
❑ 1 & 2-Family, S Ft $ — $ LOCALITY 7-
Certified copy is filed with the county building mspec- Y. 9
tion department Multi-family Sci Ft NEAREST
CROSS ST
Residential Swimming Pools OWNER OR
Date Applicant FIRM NAM
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw— MAIL nn�� ''II
COMPENSATION INSURANCE ADDRESS-23 � (7
s section neenot completed if the work involved b First 20
(Thitid t b
p y CITY Additional �d Tel No-30*v3��
the permit is for one hundred dollars ($100)or less.) Total No 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
Total No Additional
CITY Tel No
Date Applicant Fixed Appliances Not Over 1 HP PERMIT �"
NOTICE TO APPLICANT If,•"after making this Certificate of APPLICA Gysv7�/��/�— L'
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 !�jq , 6
with comply with such provisions or this permit shall be Top _ FAU —W H —
deemed revoked CITY � Tel Nc,&4/��
LICENSED CONTRACTORS DECLARATION Hood Fan _Other— �y�
D sp _ Room Air Cond _ LICENSE OR /� Class v/Q
O /�
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO PROCESSED
and Professions Code, and my license is in full force and effect Power Apparatus & Large Appliances y
�/f) Size 8 Type HP, KW, KVA, or KVAR L ��
License Number/C��/ Lic Classes Up to 1 Incl FINAL V
Contract �r�� Date Over lrto 101ncl DATE —/ — VALIDATION �
❑ Over 10 to 50 Incl ! U
FINAL
1 am exempt under Sec Over 50 to 100 Inc BY 0.
B &P C for this reason Over 100 ` \9.5
of
Serve s, Swbd , MCC& Ponelboards f� $0 9,5 A
Date 0 -200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V # o 0 o o io,2
❑ Exemption for Reg Moint Eject Over 1000 Amp or Over 600 V o 0 25.50
SINGLE FAMILY Temp Power Pole & Appurtenances o;o e 2 5 5 0 6
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's LicenseAdditional Sign Branch Circuits 2,`8 7
Law for the following reason (Section 7031 5, Business and
Professions Code)
❑ 1, as owner of the property, will do the work and the Misc"Conduits &Conductors
structures 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 jaws regulating Electrical wiring, and
hereby authorize representatives of this County to ente on
the ov -me ion property for i pection os � SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee ate