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Home My Public Portal About9653 LOWER AZUSA RD_Electrical__ ' TEMPLE Ol°l'Y 76A663-CES" 8-62 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING to�- BUILDING AND SAFETY DIVISION ADDRESS JOHN A LAMBIE. COUNTY ENGINEER A WILLIAM A JENSEN,SUP T OF BUILDING LOCALITY RIEAR8ST FOR APPLICANT O FIL IN CROSS ST RECEPT TOTAL NO EACH FEE / OUTLETS FIRST 20 S 20 S OWNER LIGHT MAIL 00, SWITCH ADD'L 10 ADDRESS OVER 20 LIGHTING TOTAL FIRST 20 20 r_d CI w TEL NO a VF:R 2O 1-1 FIXTURES OV R 210 ELECTRICIAN RANGES CLO DRYERS WTR HTRB 100 ADDRESS GARB DIBP STA COOK CITY TEL NO DISHWABH AUTO-WASH STATE SPACE HTRS STA APP (Vj H P MAX> 60 LICENSE NO MOTORS. _OVER NOT OVER H P DISTRICT NO GROUP ZONE PROCESSED BY 0 1 100 1 s ISO INSPECTION R CORD 8 8 200 8 18 280 is so 300 so 100 500 0 SIGNS NO TRANS Im NO LAMPS O SERVICE O SOOV•NOT OVER 200A 100j SERVICE 0.600V OVER 200 A 200 N SERVICE OVER 600V s 00 Z MISC PERMIT ISSUING FEE 200 Q SUPPLEMENTA13Y PERMIT ISSUING FEE 100 TOTAL FEE L'olFR BY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPRO DATE IN OR' SIGNATURE TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT LL COUNTY ORDINANCES AND STATE LAWS REGULATING CAL WIRING WIRING BY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF I'IXTURES NIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ED REgt I PROPERTY POWER URE UTILITY CO NOTIFIED OE MI FINAL 0 LIDATION A H C. VEIT CK MO CASH SUPERVISING ELECTRICAL ENGINEER W4,6651 RAY 14 2 D 2.40~ c - WORKER'S COMPENSATION DECLARATION 20.0019 DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT I hereby af�irm that I have a certiYlcate of consent to self insure, 78A883 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) / `_' Pohcy No Company FOR APPLICANT TO FILL IN DRESS (o� I_o�y e V_ s ❑ Certified copy is hereby furnished New Residential Bldgs &Pools NO EACH FEE LOCALITY ❑ Certified copy is filed with the county budding Inspection 1&2 Family,Sq Ft — $ $ NEAREST department Mufti4amdy Sq Ft CROSS ST Residential Swimming Pools ASSESSOR Date Applicant MAP BOOK PAGE I PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw Q Fl M NAME - rI COMPENSATION INSURANCE First 20 '< / �( r` - r r (This section need not be completed If the work Involved by the Total No Additional �' MAI KESS C( &Vej &M 'EST permit is for one hundred dollars($100)or less) 1 G I certify that in the performance of the work for which this permit , CITY W G Tel 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 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 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 Aftlwzv LICENSED CONTRACTORS DECLARATION 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 Over 50 to 1 DO Incl LICENSE OR Class } REG NUMBER _ a Over 100 DISTRICT NO PR D BY V License Number Lic Class �f Se V m n er V FINAL O Contractor Date DATE ❑ I am exempt under Sec 400 1000 Amp Under 600 V Over 1000 Amp or Over 60O V FINAL NAL V ATI d B&P C for this reason BRANCH CIRCUIT FEES N Date 15A,or 20A,120V,Lighting or Recept Z 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits .4 ❑ 41 Or More Branch CircuitsT Exemption for Reg Maint Elect 15A,20A,208V To 277V ng Br Orcults AC CT.s SINGLE FAMILY Temp Power Pole&Appurtenances 34M 65.29. HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law 1 ITM for the following reason (Section 7031 5, Business and Professions Additional Sign Branch Circuits Code) TOTAL 26,5 I,as owner of the property,will do the work and the structure Misc Conduits&Conductors CHECK is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) and Professions Code) CHAW 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(Sec 3097, PERMIT FEE (Sub-Total) VVLiV 1 10/ SM Civ C) PLAN CHECKING FEE 2070 1 AM10 m.95 Lender's Name PERMIT ISSUING FEE Lender's Address I certify that I have read this application and under penalty of purjury state TOTAL FEE that the 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 property -/for Inslaoron purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Y � SIGNATURE OF PERMrllll.EE, DA a COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1406120027 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID FEES PAIDBUILDING ADDRESS TR 14467 IT 52 9653 LOWER AZUSA RD FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917804228 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET 8589-016-001 Al PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 597 GRID A5 LOCALITY TEMPLE CITY CA HA FAU LESS 3HP 1 00 FAU 11 00 4TENANT JB AC UNITS +3-10HP 1 00 AC 19 70 ISSUED ON PROCESSED BY PLAN BY TOTAL FEES 58 50 06/12/14 SR TOWNER TEL NO � F TE F CODE IGROMAN, RUSS (626) 864-3514- 9653 LOWER AZUSA RD TEMPLE CITY CA 91780 jq!EsdRIPTI6N OF WORK IELECTRICAL FOR FAU AND A/C UNITS 14931 TEL NO COPLICJAM�, CARRA (6266) 286-3157-N ENCINITA AVE 1SPECrnr• CONDITIONS TEMPLE CITY CA 91780I :rTwRmaj- I I CONTRACTOR TEL NO I JAP OV DATE INS C ICONNOR AIR CONDITIONING AND (626) 286-3157- _ 1REFRIGERATION INC LIC NO TEMPORARY POWER POLE 4931 N ENCINITA AVENUE 403735 * 1 TEMPLE CITY CA 91780 UNDERGROUND CONDUIT (ARCHITECT OR ENGINEER TEL NO - 1 IUFER GROUND LIC NO ROUGH CONDUIT 1 ROUGH WIRING MAIN WATER LINE I PLASTIC YIN METAL YIN 1 UTILITY COMPANY NOTIFIED ! I 1 j 1 1 i 1 I I 1 I I• ADDITIONAL DATA ON FILE I i (REPORT ID DPR265 ROUTE TO BS0508 I I