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HomeMy Public PortalAbout5203 MCCLINTOCK AVE_Electrical__ 78A889C= CEBif'8B fE/7S APPLICATION OR ELECTRICAL PERMIT . BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN ,JOB N ]� New Residential Bldgs.&Po Is EACH NO. FEE ADDRESS r7 1 &2 Finaily Sq. Ft. $ — $ LOCALITY L Multi-family Sq.Ft. — NEAREST Residential Swimming Pools CROSS ST.OWNER OR FIRM NAME Outlets: Light,Switch&ReceptacleMAIL 7.S' First 20 � � ADDRE Additional ° J CITY ,M Tel. No, 4t. P AN CK Lighting Fixtures A PLIC NT ZqaL First 20 Q AD ESS Additional CITTel.No. PE• M Fixed Appliances Not Over 1 HP APPLII ANT Range_ Heater D.W. ADDRESS '<y Oven _ Dryer W.M. Top _ FAU W.H. CITY Tel.No. Hood Fan' LICENSE OR d Disp. A.C. ', �Q REG. NUMBER class. C7 1HEREBY'ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY Power Apparatus.& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS. REGULATING 0 S Size&Type HP,KW,KVA,or KVAR ELECTRICAL WIRING, q Up to 1 Incl. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Z 'Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES'COUNTY AND STATE OF CALIFORNIA OR TTI AT I AM THE LEGAL OWNER OF THE ABOVE Over 10 to 50 Incl. DESCRIBED•RESIO iT1A,L.PROPE Y Over 50 to 100 Incl. - PERMITEE Over 100 SIGNATOR Services DISTRICT NO. Q P OCE ED BY 0-200 Amp. Under 600 V ✓ 201 -1000 Amp.Under 600 V APPROVALS WE INSPECTOR'S Over 1000 Amp.or Over 600 V SIGNATURE TEMP.POWER POLE Temp. Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit Additional Sign Branch Circuits ROUGH CONDUIT (Other) k S UTHORIZED PERMIT FEE (Sub-Total) O.NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee)PERMIT ISSUING FEE v .dl) W iAt.04i APAebs" ilixo— m" TOTALFEE Fv— /lr lkl� Si J G.yPLAN CHECK VALIDATION CK. M.O. CMIT VALIDATION CK. M.O. CASH 3 1 9 oV 25 2 3 4.1 5 a:.tl WORKERS'COMPENSATION DECLARATION 7Ivorw3ie7 p APPLICATION FOR ELECTRICAL PERMIT O I hereby affirm that'I have a certificate of consent to self CE-806Ginsure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof(Sec. 3800, Lab. C.) ,PolicyNa3 Company - FOR APPLICANT TO FILL IN JOB �� ��G��t H Oli k ' CADDRESS `� ertified copy is hereby furnished.. New Residential Bldgs. &Pools EACH NO. FEE ll Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST �v C � Residential Swimming Pools - CROS ST. Date Applicant CROSS NAME OR 10V%ek CERTIFICATE OF EXEMPTION FROM WORKERS' 3, IMAIL Outlets: Rec Light�Sw.___' I Q ADDRESS !`�3 V '-C COMPENSATION INSURANCE � First 20 P (This section need not be completed if the work involved by ; Total No.� Additional CITY ewl 9 f �� Tel. No.'14.3W-f659 the permit is for one hundred dollars($100)or less.) 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 Work ' Lighting Fixtures First 20 ADDRESS e.sC pensation Laws. g g Additional Date 151-20-2) A licant Total No._ _ CITY Tel. No. PP � Fixed Appliances Not Over 1 HP PERMIT — ' NOTICE TO APPLICANT: If, after making this Certi Cate of APPLICATION "t'1 PY' COy� .rut 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 !) W i-f-vIe with comply with such provisions or this permit shall be o Top — FAU —W.H. deemed revoked. CITY Vn o Hood —.Fan, _Other— V�• ✓tIrD00k Tel. No:'YJ�-3`7g-�66' LICENSED CONTRACTORS DECLARATION LICENSE OR ` Disp. _ Room Air Cond. — C Class. I hereby affirm that I am licensed under provisions of Chapter 9• REG. NUMBER 79- -3 3 (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY >_ and Professions Code,and my license is in full force and effect. 0- I - Size&Type HP, KW, KVA, or KVAR O License Number S. 3 -Lic. Class Up to 1 Incl. FINAL U Contractort'F'te'ny L-�y`� 'd 5`V -91 Over 1 to 10 Incl. DATE ��j VALIDATION I ate Over 10 to 50 Incl. FINAL U I am exempt under Sec. Over.50 to 100 Inc. BY W B.&P.C. for this reason 1ork a ebn8k4 ee Over 100 Services, Swbd.,,MCC&Panelboards CO Date: I' 'gr Z 0'-200 Amp. Under.600 V Signature . 201 - 1000 Amp. Under 600 V I Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. E1 t. SINGLE FAMILY Temp. Power Pole&Appurtenances I HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit AU( °F I hereby affirm that I am exempt.from the Contractor's License Law for the following,reason (Section 7031.5, Business and Additional Sign Branch Circuits •S-SE iii°41 Professions Code): _ 0 I, as owner of the property;will do the work and the Misc. Conduits&Conductors I i EMS structure is not intended or offered for sale(Section 7044, iOther(See Complete Fee Scheduled , I�l i#iL 36- 40. Business and Professions Code). L_- + I CONSTRUCTION LENDING AGENCY ' '-�'� .rte° �` i I hereby affirm that there is a construction lending agency for +,-14ANGE °06 the performance of.the work for which-this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097,Civ. C.). PLAN CHECKING FEE 110011-0001 5128 Lender's Name Lender's Address PERMIT ISSUING FEE 7113-1 8:413 3 6 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 laws regulating EI'ectrical wiring, and hereb authorize representatives of this County to enter upon thea ve- nti ed property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ®s $I ature of Permitte Date n WORKERS'COMPENSATION DECLARATION 76MO DPW 3/W APPLICATION FOR ELECTRICAL PERMIT O I hereby affirm that I have a certificate of consent to self cE-eo�c insure, or a Certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ora certified copy thereof(Sec. 3800, Lab. C. c �,gjI /'/ 1 I Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS S�o� !/YdG C+/I d1TBLr e� ❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE r ❑Certified co is filed with the count building p 1 &2-Family, Ft. $ = $ LOCALITY re ,�Ie C_ copy � y gins ec- Y� Sq• tion department. Multi-.family Sq. Ft. NEAREST Residential Swimming Pools CROSS ST. Foe>aw Date A plicant oo CERTIFICATE OF EXEMPTION FROM WORKERS' FMAIL IRM NAME Id✓ B 7 d Lw1 COMPENSATION INSURANCE Outlets: Rec�Light 3 First 20 Sw.5 Oe rri ADDRESS r7��3 p�►'1: r eye f'o L E' / 00 (This section need not be completed if the work Involved by Total No. 1 Additional / CITY �n C Tel. Now?�ryn_(dS the permit is for one hundred dollars($100)or less.) PLAN CHECK 1 certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws. 1 y� Additional e T Total No. d— CITY Tel. No. Date _ !� -21-Applicant �►bhe'rS/ bah S NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—D.W. APPLICATION fes• ���� Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. CITY yl V•p 1/�tI C;� Tel. No-pe-3--79-466;? Hood — Fan —Other— LICENSED CONTRACTORS DECLARATION Disp. — Room Air Cond. — LICENSE OR 695 -363 Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG.NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PMS SED BY 0} and Professions Code,and my license is in full force and effect. Size&Type HP, KW, KVA, or KVAR J,O � d O License Number S 95 3 6 3 Lic. Class Up to 1 Incl. FINAL U DATE _ cc p Over 1 to 10 Incl. ` VALIDATION Contractor 1` C6 115 'Date 7+19^`1 Over 10 to 50 Incl. FINAL F- lo lo I am exempt under Sec. r Over 50 to 100 Inc. BY LLI 0 B.&P.C. for this reason O�dG 1-wigg I`13�� 4'e Over 100 Dafe: Services, Swbd., MCC&Ponelboards ® Z 0-200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V F-1Exemption 1000 Amp. or Over 600 V Exemption for Reg. Moint. EI t. SINGLE FAMILY Temp. Power Pole&Appurtenances i HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit i-I::• °e Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): ID1,I, as owner of the property, will do the work and the 'Conduits&Conductors _.., .�, structure is not intended or offered for sale(Section 7044, Other,(See Complete Fee Schedule)— ,L IAL Vis; a 30— Business and Professions Code). f.•. - --, CONSTRUCTION LENDING AGENCY 3, �•tk ` °`F� I hereby affirm that there is a construction lending agency for 'moi-IF1ifi:� .03the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Hilil:l—;l ? i•}JI _ Lender's Name 1 _ PERMIT ISSUING FEE ✓ r a ' LI.rJv 1 Arl .2 134 Lender's Address � I certify that I have read this application and state that the TOTAL.jFEE � %. CZ. above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby puthorige representatives of this County to enter upon the ab ve- tion d property for inspection purposes. 0 y SEE REVERSE FOR EXPLANATORY LANGUAGE I ®: Sig Lure of Permittee Date i COUNTY OF LOS ANGELES ! TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0112070016 BUILDING AND SAFETY / LAND DEVELOPMENT I TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL 10: FEES PAID BUILDING ADDRESS: TR: 13384 LT: 22 5203 MCCLINTOCK AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803559 ASSESSOR0 0 U NEAREST CROSS STREET: GRAND 8574-004-007 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY LB 200 AMP PANELS, MCC 1.00 PAN 38.85 TENANT: TOTAL FEES 66.60 ISSUED 0 PROCESSED 5 . 12/07/01 JK 06/05/02 OWNER: TEL. NO. FINAL DATE FIN CODE: BLANKA;THOMAS (626) 840-5256- 5203 MCCLINTOCK AV TEMP 917803559 05SCRIPTI-01 OF WORK NEW ELECTRICAL PANEL APPLICANT: E O: EXPRESS ELECTRICAL SERVICE (818) 762-0845- 11225 PEACHGROVE101 SPECIAL CONDITIONS: N. HOLLYWOOD 91601 CONTRACTOR: TEL. N0: �©CJ APPROVALS DATE INSPECTOR SIGNATURE EXPRESS ELECTRICAL SERVICE (818) 762-0845- 11225 PEACH GROVE APT 101 LIC. NO TEMPORARY POWER 0 N. HOLLYWOOD, CA 41601 R.H.E. B/L * \ UNDERGROUND-CONDUIT ARCHITECT OR EG NE R: TEL. NO: - \ R GROUND LIC. NO• /- 1111111 ROUGH CONDUIT LROUGH WIRING L� K U C W �R 5MAI ATE/ LINE IIS u PLASTIC Y/N METAL Y/N oc �. _ UTILITY COMPANY OT I D c Service i ADDITIONAL DATA ON FILE i �tEPORT ID: DPR265 ROUTE TO: BS0508 I�