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HomeMy Public PortalAbout4929 MCCLINTOCK AVE_Electrical__ -o COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0610170001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 ERT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 4902 LT: 11 BL: .001 4929 MCCLINTOCK AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804104 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GRAND 6574-024-025 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE. 597 GRID: D4 LOCALITY: TEMPLE CITY, C LB 200 AMP PANELS, MCC 1.00 PAN 38.85 TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 10/17/06 JK 04/15/07 OWNER: TEL. NO: FINAL DAT FINAL BY: CODE: VALVERDE, ARTHUR/LISA (626) 442-4768- - 4929 MCCLINTOCK AVE TEMPLE CITY CA 91780 DESCRIPTION OF WORK CHANGE OUT 60 AMP EXISTING SERVICE WITH NEW 200 AMP METER MAIN APPLICANT: TEL. NO: VALDERDE (626) 442-4768- 4929 MCCLINTOCK AVE SPECIAL CONDITIONS: TEMPLE CITY CA 91780 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE ARTHUR/LISA VALVERDE (626) 442-4768- 4929 MCCLINTOCK AVE LIC. NO TEMPORARY POWER POLE TEMPLE CITY, CA 91780 NONE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 IGA663 DBS--SA 55 8•95 APPLICATION C ION Il ®R ELEC ■ RIC ■ ERMIT DIVISION OF BUILDING AND SAFETY Department of County Engineer County Of LOS Angeles AUILDING DDRESS WM.J.FOX COUNTY ENGINEER _ CASSATT D.GRIFFIN.SUPT OF BUILDING 4 r j LOCALITY FOR APPLICANT TO FILL IN NEAREST y PERMIT FEES CROSS ST. NUMBER EACH FEE e OWNER LIGHT OUTLETS MAIL RECEPTACLES ADDRESS WALL SW ITCHES TOTAL OUTLETS 59 S CITY EL.NO. ma ELEC.RANGES 25 ELECTRICIAN r 8_ELEC.HEATERS 25 ADDRESS rP a ' KW EA CITY /.c� TEL.NOI'1— r AIC FIXTURES 5 LICENSE NO. (LUMBER OF LIGHT CIRCUITS w - D)STRICTNO. IGROUPI .ZONF— READY FOR INSPECTION _,v NUMBER OF RECEPTACLE CIRCUITS MOTORS NUMBER HORSEPOWER FEE INSPECTION RECORD NEW MVD. HP OVER INC. EACH IIh a LESS S .25 lb`r 2 .50 2 5 1.00 5 15 1.50 15 50 2.50 50 200 5.00 MISC. j NO.SIGNS NO.TRANS. NO.SIGNS NO.LAMPS FOR EACH PERMIT, WIRING S1.00 4 FIXTURES $1.00 SUPPLEMENTARY .50 APPROVALS " TOTAL FEE I g /.'U DATE INSPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY q� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES o LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE L GAL OWNER OF THE ABOVE POWER DESCRIBED RESIDEN 1 L PROPERTi/ SIGNATURE UTILITY CO.NOTIFIED h � OF PERMITTEE 1 ' FINAL WILLIAM J.FOX.COUNTY ENGINEER VALIDATION A.C.VEIT.CHIEF ELECT.INSPECTOR _ 0 3 3 3 1 FE8 21 2 1.0 0 WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) 1 hereby•affirm that I have a certificate of consent to self insure, 76A663 APPLICATION FOR ELECTRICAL PERMIT 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.) Policy NO. Comp FOR APPLICANT TO FILL IN jOB ADDRESS % �+ •+ ❑ Certified co Is hereby furnished. NO. EACH FEE PY Y New Residential.Bldgs.&Pools LOCALITY 1 &2-Family,Sq.Ft. _ $ $ Certified copy is filed with the county b ding inspection NEAREST d rtme It C; ♦ Multi-family Sq.Ft. CROSS ST Date +`—' Applicapt Residential Swimming Pools MAP BOOK PAGE PARCEL NER OR 00"OF Z47 1 CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Ree. Light—/—Sw. /� FIRM NAME COMPENSATION INSURANCE First 20 MAIL /L9 r) (This section need not be completed if the work involved by the Total No. Additional ADDRESS i OS permit Is for one hundred dollars($100)or less.) I certify that in the performance of 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 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 P P y provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT Ci LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVARADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. �G (commencin.g with Section 7000)of Division 3 of the Business and CI Tel.No. e✓ra;O Professions Code,and my,license is in full force and effect. Over 10 to 50 Incl. LICENSE OR } /y Over 50 to 100 Incl. REO.NUMBER v . k'f Class G O �/ 1 / `7© Over 100 DISTRICT NO. P 0 ED BY c. V License Numb g55 ! Lic.Class C� h D� / Services,Swbd.,MCC&Panelboards cc Contr p / 0-399 Amp.Under 600 V DATE O ❑I am exempt under Sec. 400-1000 Amp.Under 60.0 V '(ems VALIDATION V Over 1000 Amp.or Over 600 V FINAL Over 1Z B.&P.C.for this reasonBRANCH CIRCUIT FEES BY CO Z Date: 15A,or 20A,120V,Lighting or Recept. — 1 To 10 BranchCircuits 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 P I hereby affirm that.1 am exempt from the Contractor's License Law Sign with One Branch Circuit for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits _ Code): ❑ 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) and Professions Code). , t`+��.I% CONSTRUCTION LENDING AGENCY '_("1A.GE 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) a Civ.C.) PLAN CHECKING FEE Lender's Name I i i Ari , 5_` PERMIT ISSUING FEE Lender's Addresa. p 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 1 representatives of this County to enter upon the above- ntioned property for ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE .SIGNATUREW PERMITTEE IATE