HomeMy Public PortalAbout9508 LIVE OAK AVE_Electrical__ 76AGGS
DBS-5A
11-SS APPLICATION FOR ELECTRIC PERMIT
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DIVISION OF BUILDING AND SAFETY ��yy �p
Depostznent Of County Engineer BUILDING uy �( T ^
County of Los Angeles ADDRESS / U
JOHN A. LAMBIE, COUNTY ENGINEER �a
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST (7
PERMIT FEES CROSS ST.
NUMBER OWNER ,
LIGHT OUTLETS MAIL
RECEPTACLES ADDRESS
WALL SWITCHES FEE CITY TEL. NO.
TOTAL OUTLETS @ s¢ $ ELECTRICIAN
ELEC. RANGES 25 56
ADDRESS
ELEC. HEATERS 25
KW EA CITY EL.NO.
STATE
FIXTURES g LICENSE NO. 1 (9
MOTORS DISTRICT NO. GROUP ZONE READY FOR INSPECTION
NUMBER HORSEPOWER FEE Z-1N MVD. HP OVER INC. EACH44
1�$LESS $ zs INSPECTION ORD
Yz 2 .50
2 s 1.00
5 is 1.50
15 50 2.50
50 200 5.00
MISC.
NO. SIGNS NO.TRANS.
NO. SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING $1.00
FIXTURES $1.00
SUPPLEMENTARY .50 APPROVALS
TOTAL FEE $ U DATE INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT t
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGl�
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF A
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER n t �A
DESCRIBED RESIDENTI OPE TY,
SIGNATURE UTILITY CO.NOTIFIED
� � _
OF PERMITTEE FINAL -2z
m
JOHN A.LAMBIE.COUNTY ENGIN R ATION ARTHUR C.VEIT.CHIEF ELECT. INSPECTOR
CK MO CABH
A06 1 5 0-, �R 18 2 8.8 cC �
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t�ORKER'S COMPENSATION DECLARATION 20-0019 DPW 9/89
76A663 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self Insure,
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 3800 Lab C) ' r ffir_�
POIICy NO9�`--Company-,cY \_/K/K!-� FOR APPLICANT TO FILL IN _ JOB
❑ - ADDRESS
Certified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEEx
LOCALITY
❑ Certified co is filed with nt bwldin in ctlon 1 &2-Family,Sq Ft $ — $
PY Y 9 — NEAREST `
department --5y � r Multi-family Sq Ft CROSS ST
Date /rApplicant Residential Swimming Pools ASSESSOR
y MAP BOOK PAGE �,1 OPARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec _'Light Sw FlRWNEROR M NAME QC�n�(T
COMPENSATION INSURANCE First 20
(This section need not be completed if the work Involved by the ADDRESS 1e
permit is for one hundred dollars($100)or less.) Total No Additional
I certify that in the performance of the work for which this permit CITY 71 No
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 15 OR 20A,120V BRANCH CIRCUITS `
NOTICE TO APPLICANT If, after making this Certificate of CITY Tel No
Exemption,ycu'should become subject to the Workers"Compensation 1 TO 10 INCLUSIVE EACH
IT
provisions of the Labor Code, you must forthwith complyswith such 11 TO 40 INCLUSIVE EACH APPLICANT
provisions or this permit shall be deemed revoked 41 OR MORE BRANCH CIRCUITS EACH
LICENSED CONTRACTORS DECLARATION ADDRESS15 OR 20A,208V TO 277V LIGHTING EACH a
I hereby.affirm that I am licensed under provisionsof Chapter 9 � I -
O
(commencing with Section 7000) of Division 3 of the Business and CI Y Tel No -19V40
Professions Code,and my license is in full force and effect RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR ! /a O
PoMER
wer Apparatus&Large Appliances _ REG NUBClass
License Number Lic Class Size&Type HP,KW,KVA,or KVAR DISTRICT NO PROCE SED BY v e
Up to 3 Incl - UJ
Over 3 to 10 Incl r FINAL d
CoDtraC -/ -- DATE - Z
❑ Over 10 to 50 Incl = 1 /b-9 Z
I am exempt under Sec Over 50 to 100 Incl FINAL Over 100 VALIDATION
B&P C for this reason
ServicPOO
MCC&Panelboards Aep Under 600 V �Signature mp Under 600 V
❑ Over 1000 Amp or Over 600 V
Exemption for Reg Maint Elect
SINGLE FAMILY Temp Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION
herebyaffirm that 1 am exempt from the Contractor's License Law Sign with One Branch Circuit
P
for the following reason,(Section 7031 5, Business and Professions Addttional.Slgn Branch Circuits
Code) i LitC.
❑ I,as owner of the property,will do the work and the structure Misc-Conduits&Conductors
Is not Intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) !)-`t 77
and,Professions Code) I ,
CONSTRUCTION LENDING AGENCY _- _ r L; ,i:--L-
performance
`� a y I(
I hereby affirm that there is a construction lending agency for the _
performance of the work for which this permit Is issued (Sec 3097, PERMIT FEE (Sub-Total) ��-
Civ C) �i-
-PLAN-GHEG1 04GGFEE
Lender's Name
PERMIT ISSUING FEE �••�
I, Lender's Address
I certify that I have read this application and state that the above TOTAL FEE
Information is correct 1 agree to comply with all County ordinances
and State laws regulating Electrical winnA and hereby authorize
.representatives of this County to enter po the above-mentioned
gro�ipectionpose SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF APPLICANT OR AGENT DATE -
I
COUNTY OF LOS'ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUgLIC WORKS 9701 LAS TUNAS EL 0508 0011160053
BUILDING AND SAS ETY'/ LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE 9508 LIVE OAK AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802513
ASSESSOR INFO NEAREST CROSS STREET: CLOVERLY
8588-006-008 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY
G1 OUTLETS-LGT,SW,RECP 1.00 OUT 1.95
TENANT: TOTAL FEES 29.70 ISSUED 0 PROCESSED BY: PLAN EXPIRES ON:
11/16/00 UT 05/16/01
OWNER: TEL. NO: FIN AT FINAL BY: CODE:
WU;PEIYAO (626) 287-9918- v�/IJ
9508 LIVE OAK AV
TEMP 917802513 59sc ION OF WORK
MOVEV LAUNDRY TO OUTSIDE OF RESIDENCE
ELECTRICAL FOR MOVING LAUNDRY TO OUTSIDE OF RESIDENCE
APPLICAN .
SAME AS OWNER
SPECIAL CONDITIONS:
LES co
of-
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO TEMPORARY POWER POLE
d UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND
LIC. N0: / 1111111 ROUGH CONDUIT
L ROUGH I G
Gln (� D n C � /1 /701 f1�/ 3 MAIN WATER LINE
J U ILIA \1VI1\11 J1/ IL1�U< IL1K� PLASTIC Y/N METAL Y/N
Y COMPANT 0 D
` 0
O 0
D ® ®5
REPORT ID: DPR265 ROUTE TO: BS0508