HomeMy Public PortalAbout9416 LOWER AZUSA RD_Electrical__ 76AS63 DBS SA 2SM SETS 11-48 . I APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES 1
WILLIAM J. FOX. CHIEF ENGINEER
7UP Z1Z13E PERMIT O.
FOR APPLICANT TO FILL IN DISTRICT NO._ 5 I hJ
ELECTRICIAN r _X eQ l al 790 h/a�A (. RECEIVE 1 B`Y READY FOR DATE ISBU D
ADDRESS ®® l.4AA-fie ��` FIRST INSPECTION /+v 2 7 ✓�c
CITY-,Z,.-.,.fin-. 11i�rt�y8., TEL N°.I gg r'\ �q 7 J
LICENSE NO. EXPIRES 'JQb ® ADDREBUI SS
® 4�Fc°
DESCRIPTION OF WORK.
FEES LOCALITY
NUMBER OUTLETS EACH
.CROSS
LIGHTS 5c !$ gy STREET .A_ e
RECEPTACLES s to,
FIXTURES 5 OWNER _
MAIL ( o
WALL SWITCHES 5 ADDRESS
ELEC. RANGES 25
ELEC. HEATERS 25 �� CITY TEL. NO.
MISC. 1 CERTIFY THAT 1 12088E36 THE ROVE VALID LOS
NUMBER OF CIRCUITS INSTALLED: ANGELES COUNTY LICENSE.
LIGHTS c( RECEPTACLES
MOTORS o '�"
ELECTRICIAN. �f
NUMBER HORSEPOWER FEE (\Jf
NEw MVD. HP OVER INC. EACH I AM THE LEGAL OWNER OF THE RESIDENTIAL PROP-
I/2 a LESS 8 .25 ERTY DESCRIBED ABOVE.
%2 2 .5O
2 5 1.00 1 OWNER.
5 Is 1 1.50INSPECTION RECORD
7s so 2.501
5O 200 5.00
200 Sao 10.00
500 I 1000 15.00 J
OVER 1131313 20.00
_Z
M.G. BET/FREQ. CHANGER-HP
Q'
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS.- KVA
TEMP. MOTORS (75% OF ORIG.)
MOVED MOTORB (75% DF DRIG.)
MISC.
SIGNS
TYPE: NO.TRANS.
TYPE: NO. LAMPS APPROVALS
PERMIT FEE DATE INSPECTORPS NAME
FOR ISSUING PERMIT: CONDUIT
WITHOUT FIXTURES $1.00 I WIRING 9 .2 0 �v A/S
WITH FIXTURES 1.25 FIXTURES
SUPPLEMENTARY .50
® POWER �
TOTAL FEE ° UTILITY CO.NOTIFIED /q
FINAL
WORKER'S COMPENSATION DECLARATION 20.0019 .D. (12-91) APPLICATION FOR ELECTRICAL PERMIT
I 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
�(Seci338000 Lab.,C.)
Policy NoA `1 -Company " v FOR APPLICANT TO FILL IN JOB ( ,, p
El Certified
copy is hereby furnished. New Residential Bldgs.i£Pools NO. EACH FEE ADDRESS 6 W
LOCALITY ��1r,A..e
E Certified copy is filed with the c ty bud g i. p ctlon 14 2-Family,Sq.Ft. _ $ $ olw
NEAREST .���/•'
department. "" Mufti-family Sq.Ft. CROSS ST. wu N( �`'
Date ��Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL.
CERTIFICATE OF EXEMPTION FROM.WORKERS' M1 OWNER OR
COMPENSATION INSURANCE Outlets:Rec. Light Sw. 'J 6O p DD FIRM NAME
First 20 �G a Q MAIL
(This section need not be completed If the work involved by the Total No. Additional ADDRESS 610641V.V
permit is for one hundred dollars(5100)or less.)
I certify that'in the performance bf the work,for which this permit CITY Tel.No.
is Issued, I shall not employ any person in any manner so as to PLAN CHECK VX
become subject to the Workers'Compensation Laws, lighting Fixtures First 20 APPUCAN7
Total No. Additional ADDRESS-7Vr
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after.making this Certificate of CITY L� Tel.Na
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of.the Labor Code.,you must forthwith comply with such PERMIT
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT
LICENSED CONTRACTORSDECLARATION Size,&.Type HP,KW,KVA,or KVAR ADDRESS
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 Tel.No:
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR
I Over 50 to 100 Incl. REO.NUMBER Class. d
�
License Numb e /r�
�sZI Lim Class 'Over 100 DISTRICT NO. P SED BY O
� (,)
too-AMC
Services,Swbd.,MCC&ppppan boards .s/• O�
Contractor Date 0-3897�mp.Undo DATE
❑ 400-1000 Amp.Under 600 V3p^�3 VALIDATION V
I am exempt under Sec. Over 1000 Amp.or Over 600 V d
FINAL.
B.&P.C,for this reason BRANCH CIRCUIT FEES BY
Date- 15A,or 20A.]20V.Lighting or Rsee pt: Z_
I i0 an Circuits
Signature . 11 To 40 Branch Circuits
❑ 41 Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 2
SINGLE FAMILY Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION A4'C—T
Sign with One Brahch Circuit
I hereby affirm that I am exempt from the Contractor's License Law ••• '�;;I' 13112.511.
for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits +-
Code): I
1 ITEKS
❑ 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) T071 AL-' L-9�°P��
and Professions Code).. CHECK 1U■50
CONSTRUCTION LENDING AGENCY }� c .00I'hereby.affirm that there is a construction lending agency for the -
CHANGE
performance of the work for which this permit is issued(Sec.3087, PERMIT FEE (Sub Total) ♦/p
Civ.C.)' i "
PLAN CHECKING FEE. 2I 4I9-'
Lender's Name 1
PERMIT ISSUING FEE 8036 1 ffill■-41
Lender's Address
I certify that I have read this application:and under penalty of purjury state TOTAL FEE . D
that the above Information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring,.and hereby authorize
representIves of t Con to enter pon the above mentioned property
for spa i n purp 2 SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF PERM DATE
f COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
• DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 9912030032
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID ;BU I G-ADDRESS:
TR: 12998 LT: 1 BL: .001 9416 LOWER AZUSA RD
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804219
ASSESSOR INFORMATION NUMBER: 'NEAREST CROSS STREET: CLOVERLY
8592-003-023 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY
_ HA FAU LESS 3HP 1.00 FAU 10.95
TENANT: JB AC UNITS +3-10HP i.GU AC 19.65 ISS ED U7 N:PROCESSED BY: PLA BY.—EXPIRESFION:
TOTAL FEES 58.35 12/03/99 UT 05/"O
OWNER: _ TEL. NO: FINAL nATE FINAL BY: CODE:
BLAKEY NORMAN R;BELETHA J (626) 444-0442- +�
9416 LOWER AZUSA RD 0�
TEMP 9178042/9 DESCRIPTION OF WORK
IELECTP.ICAL FOR NEWHVAC SYSTEM
APPLICANT: TEL. N0:
SAME AS OWNER -
SPECIAL CONDITIONS:
COYTRArTOR: TEL. NO: `j �/� Ar-?ROVALS DRTE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO fff-F(P—op-ARY POWER POLE i
UNDERGROUND CONnUIT
ARCHITECT OR FHGINEER: TEL. NO: IUFER GROUND
LIC. NO 1111111 ROUGH CONDUIT
ROUGH WIRING
Fl: U n D L�C ���O�n/J 3 MAIN WATER LINE
LIF",'a 1u�`� PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
o aj.
c 9eriflce That
REPORT ID: DPR265 ROUTE TO: BS05O8