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HomeMy Public PortalAbout5514 MCCULLOCH AVE_Electrical_9/23/1985_ 4-'-WORK %RS'COMPENSATION DECLARATION 76AW 10/81 APPLICATION FOR ELECTRICAL PERMIT '4 F e;ebji affirm that I have a certificate of consent to self CE-8066 insure, or a certificate df Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof(Sec. 3800, Lab. C..)•• Policy No. - Company FOR APPLICANT TO FILL IN — $ -JOB e ( C.- �,[ ' 0 C IL Certified copy is hereby furnished. N Residential Bldgs. &Pools EACH NO. FEE ❑ pp $ — LOCALITY Certified copy it.filed with the county building inspec• 'q. Ft. d O tion department. Multi-family Sq. Ft. z NEAREST CROSS ST. Date Applicant Residential Swimming Pdols OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec� �_ .� LightSwMAIL A COMPENSATION INSURANCE 6 ADDRESS First 20 (This section need not be completed If the work involved by Total No.�_ Additional CITY Te -ft Cif Tel. No. 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 Workersmpensation La Lighting Fixtures First 20 ADDRESS Additional Total No.� CITY a o. Date ^ T A�plicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPUdANT 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 with comply with such provisions or this permit shall be Top _ FAU —W.H. ' CITY Tel. No. deemed revoked. Hood _ Fan _Other_ c . LICENSED CONTRACTORS DECLARATION LICENSE OR ' I hereby affirm that I am licensed'under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PRO ES D BY. Power Apparatus&Large Appliances and Professions Code,and my license is in full force and effect. � � Size&Type HP, KW, KVA, or KVAR (/ O License Number Lic. Class Up,to 1 Incl. FINAL Contractor Date Over 1 to 10 Incl. DATE /Z.3� VA ATION ❑ Over.10 to 50 Incl. 'FINAL I� I am exempt under Sec. Over 50 to 100 Inc. BY /�✓ LU B.BP,C. for this reason Over 100 PA Date: Services, Swbd., MCC&Panelboards o -200 Amp. Under 600V A247,7A Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V # 0 0 0 0 0 2 Exemption for Reg. INaint. Elect. SINGLE FAMILY .Temp. Power Pole&Appurtenances i 0 o l a 7 Jr HOME OWNER=BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from The Contractor's License Additional Sign Brandi Circuits ° ° ° 7 5 FI Law for the following reason (Section 7031.5, Business and PFofessions Code): 000-88 Q ❑ I, as owner of the property, will. do the work and the Misc. Conduits&.Conductors structure is not intended or offered for sale (Section- Other(See Complete Fee Schedule)_ 7044, Business and Professions Code). 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 PERMIT FEE (Sub-Total) (Sec. 3097; Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE /0 V Lender's Address 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 Electrical wiring, and hereby authorize representatives of this County to enter upon Xthe ove-mentioned erty for inspection purposes. �r SEE REVERSE FOR EXPLANATORY LANGUAGE 1 ;�� 7 17 —0s30 Signature of Permittee Date ;GAGGS DBS-SA 9•SS APPLICATION FOR ELECTRIC PERMIT 1 8A DIVISION OF BUMMIG AND SAFETY Deportment of County Engineer County of Los Angeles BUILDING WM.J.FOX.COUNTY ENGINEER ADDRESS CASSATT D.GRIFFIN.SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST PERMIT FEES CROSS ST. NUMBER EACH FEE LIGHT.OUTLETS OWNER RECEPTACLES MAIL. ADDRESS WALL SWITCHES TOTAL OUTLETS g¢ $ CITY TEL.NC. ELEC.RANGES 25 ELECTRICIAN ^ ELEC.HEATERS 25 ADDRESS KW EA CITY TEL.NO.. FIXTURES 5 LICENSE NO. Z NUMBER OF LIGHT CIRCUITS — DISTRICT NO. I GROUP I JO NE READY FOR INSFECTIOR NUMBER OF RECEPTACLE CIRCUITS MOTORS J� NUMBER HORSEPOWER FEE INSPECTION RECORD NEW MVD. HP OVER INC. EACH 72&LESS $ .25 — I/z 2 50 r. 2 5 1.00. 5 15 1.50 15 SO 2.50 50 200 'S.00 MISC. e�S • 3 NO.SIGNS . NO.TRANS. NO.SIGNS NO.LAMPS FOR EACH PERMIT: WIRING $1.00 FIXTURES. $1.00 SUPPLEMENTARY .50 APPROVALS . TOTAL FEE16 —a7—_,57-b —DATE _ INSPECTOR'S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES .AND STATE LAWS REGULATING WIRING � ELECTRICAL WIRING. yy i 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGE ES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LE L OWNER. OF THE. ABOVE POWER DESCRIBED RESIDENTIAL.;W906 SIGNATURE UTILITY CO.NOTIFIED T, O OF PERMITTEE FINAL WILLIAM J.FOX.COUNTY ENGINEER VALIDATION A.C.VEIT.CHIEF ELECT.INSPECTOR ,9 7 6 1 AUG30 E. 10 to . 7 A663 DBS-9A 8.99 APPLICATION DIVISION OF BUILDING AND SAFETY Deportment of County Engineer �� , COunty of LOS Angeles ADDRESS a � //�! Apo ;�,4'fi-�' UILDING WM.J.FOX, COUNTY ENGINEER CASSATT D.GRIFFIN.SUPT OF BUILDING LOCALITY c� _F: i t•- - C 1� t L-1, , FOR APPLICANT TO FILL IN NEAREST PERMIT FEES CROSS ST. )4 NUMBER EACH FEE OWNER $_22 Ii2i —��G1 FTOTAL TLETS MAIL LES ADDRESS SWITCHES OUTLETS 5¢ $ CITY ,? TEL.NO. ELEC.RANGES _ 25 ELECTRICIAN �'` + 'yj ,�. !.!',9.. ELEC. _ HEATERS 25 ADDRESS �C.+} /�-y •a ! .f -�� �� �'�� / KW EA CITY ! /�`f�4 / /f/ TEL.N - /-r' i• FIXTURES 5 LICENSE .r•a• NUMBER OF LIGHT CIRCUITS Raw F DISTRIC NO. I GR9.4p I READY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS 0 MOTORS NUMBER HORSEPOWER FEE INSPECTION RECORD NEW MVD. HP OVER INC. EACH Y2&LESS $ .25 2 .50 2 5 1.00 S 15 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 c SUPPLEMENT .50 t APPROVALS T ML E S 3 DATE INSPECTOR'S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT I HAVE R D THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ,s ELECTRICAL WIRING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES r LICENSED AS REQUIRED BY LOS,ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM TIN LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENTIAL I?JOPE[t Y. /,/ f E1[�/l� /�� '" �i �� FINAL UTILITY CO.NOTIFIED a SIGNATURE OF PERMITTEE / ' / `�. WILLIAM J.FOX,COULNTY ENGINEER VALIDATION A.C.VEIT.CHIEF ELECT.INSPECTOR 0 0 1 6 SEP 7 2 .60 o DOS-SA 9-59 A PLICATOON F®_ IR ELECTRIC PERMIT 1 DBS-BA DIVISION OF BIDING AND SAFETY Deportment of Cor'' Engineer County Of Y.O�` Qalso BUILDING �s I WM.J.FO COUl�1ti ENGINEER ADDRESS CAOSATT D.GRIFFIN.Si 'T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST PERMIT FEES CROSSST. NUMBEEREACH FEE OWNER LIGHT OUTLETS MAIL RECEPTACLES ADDRESS WALL SWITCHES TOTAL OUTLETS 5¢ $ CITY TEL:NO. ELEC.RANGES 25 ELECTRICIAN ELEC.HEATERS 1 25 ADDRESS KW EA CITY dea TEL.NO. FIXTURES 5 YQ LICENSE&0. Y NUMBER OF LIGHT CIRCUITS - DISTRICT-W. GI P NE READY FOR INSPECTION I ll,/NUMBER OF RECEPTACLE CIRCUITS { MOTORS NUMBER HORSEPOWER FEE INSPECTION RECORD NEW MVD. HP OVER INC. EACH I/2&LESS $ .25 lh 2 .50 2 5 1.00 5 15 1.50 15 50 2.50 ; 50 200 5.00 MISC. NO.SIGNS NO.TRANS. NO.SIGNS NO.LAMPS FOR EACH PERMIT., WIRING 51.00' FIXTURES $1.00 SUPPLEMENTARY .50 APPROVALS TOTAL FEE $ O DATE INSPECTOR'SSIGNATURE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING fJ•/�(���/ (� f,��++bl.<�e.�.� ELECTRICAL WIRING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LE L. OWNER OF THE. ABOVE POWER DESCRIBED RESIDENTIAL P ER SIGNATURE UTILITY CO.NOTIFIED a OF PERMITTEE FINAL. `��1 Pll WILLIAM J.FOX.COUNTY ENGINEER. VALIDATION A.C.VEIT.CHIEF ELECT.INSPECTOR PIP f c +' WORKERS' I have a certificate of consent CE-806 10/81, APPLICATION FOR ELECTRICAL. PERMIT }••�'I.hereby affirm that I have a certificate of consent toy self, CE-806r, insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof(Sec.3800, Lab. C.)- P❑olicy No. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished, New Residential Bldgs. &Pools EACH NO. FEE ADDRESS C a Certified copy is filed with the county building inspec- 1 &2-Family, q•S Ft.. — S LOCALITY tion department. Multi-family Sq. Ft. — NEAREST y Residential Swimming Pools CROSS ST: A.• I V ©ft_ Date Applicant OWNER OR ) jj FIRM�NAME .., / -All !t I I&-- Y� CERTIFICATE OF EXEMPTION FROM WORKERS' 2 MAIL A COMPENSATION INSURANCE ; Outlets: Rec Light Sw, ADDRESS �7 A4 L r d C First 20"' (This section need not be completed if t6ie work involved by Total No. Additional. CITY . .�WLi_rV Tel. No.�j/'/ /?S"O the-permit is for one hundred dollars(5100)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 Workers'Compensation L ws. Lighting.fixtures First 20 ADDRESS Additional �_ ��•� � � CITY Tel. No . Date opplicorit Total No.Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making chis Certificate of APPLICANT a 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 with comply with such provisions or this permit shall be Top _ FAU _W.H. — deemed revoked. CITY Tel. No. Hood. _ Fan _Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am Licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG.NUMBER Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROC BY per. and Professions Code,and my license is in full force and effbct. Power Apparatus A Large Appliances �` .Size&Type HP; KW, KVA, or KVAR' U License Number• Lic. Class Up to 1 Incl. FINAL n: Contractor Date Over 1 to 10 Incl. DATE � VALID TION a Over 10 to 50 Incl. FIN W- I am exempt under Sec. Over 50-to 100 Inc. B.&P.C.for'this reason Over 1.00 Date: Services,.Swbd.,MCC&Panelboards 0-200 Amp. Under 600 V Signature 20`1 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp.-or Over 600 V M 5 2.Q'2 A SINGLE FAMILY Temp. Power Pole&Appurtenances # o i:o 0 0 0 2 HOME OWNER-BUILDER DECLARATION Sign with..One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits J.° °2,1..E 0 Law for the following reason (Section 7031.5, Business avid Professions Code): 0 0 10 2.1;O UP! ry I, as owner of the property, will do the work and the M;sc. Conduits 8 Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule.)_ , Q a o 7:..8 b 7044, Business and Professions Code). 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address ' I certify that I have read this application and state that the TOTAL FEE e Q 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 b v -mentioned pro r•e y for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date o W9 ; WORKERS'COMPENSATION DECLARATION 70MO10/81 'APPLICATION FOR ,ELECTRICAL PERMIT "I hR'?l'.-Paffirm that I have a certificate of consent to.self CE-8066 ins4re, or a i:ertific6te of Workers.'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or,a certified copy thereof (Sec: 3800, Lab. C.) 1 Policy No. Company FOR APPLICANT TO FILL IN ADDRESS JOB _ I l' .J f G��( I .0 Certified copy is.hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ❑ S _ $ LOCALITY Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. NEAREST tion department. Multi-family Sq. Ft. Residential Swimming Pools OWNER OR t / ©e, A-`� FIRM NAME I/� Date Applicant • /1 P Y CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Li ht Sw._ MAIL COMPENSATION INSURANCE g ADDRESS _Sr S / f 1 L ��D C. First 20 (This section need not beredcompletedif the work involved by Total No. Additional CITY �.Q }jL �e et yclS` �5��7 the permit is for one hundred dollars(;100)or.less.) Tel. No, 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 Workers'Compensation L, s. Lighting Fixtures First 20 ADDRESS Gi Additional Total No. • CITY Tel. No. Date / pplicant _ Fixed Appliances Not Over 1 HP PERMIT NOTICE TO PPLICANT: If, after making this Certificate of APPLICANT 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 with comply with such provisions or this permit shall be Top _ FAU _W.H. — deemed revoked. Hood _ Fan _Other_ CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. — REG. NUMBER Class. (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. P CE ED BY and Professions Code,ons my license is in full force and effect. Power.Apparatus&Large Appliances V Size&Type HP, KW, KVA, or KVAR• ° License Number Lic. Class Up to 1 Incl. FINAL DATE Contractor Date Over 1 to 10 Incl. CCC/// VALIDATION � (~� Over 10 to 50 Incl. FIN. I am exempt under Sec. Over 50 to 100 Inc. BY' 0 �/v B.&P,C. for this reason Over 100 U)Z Date: Services,Swbd.,MCC&Panelboards 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. 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 Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's.license Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): I, as owner of the property, will do the work and the M;sc. Conduits&Conductors structure is not intended or offered for sole (Section Other(See Complete Fee Schedule)_ , 7044, Business and Professions Code). 5 3 9.'3 A CONSTRUCTION LENDING AGENCY # 0000:02 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Tofal) ( °'° 2 5'5 0 (Sec. 3097, Civ. C.). o o o 2 5'5 0.0 PLAN CHECKING FEE Lender's Name 0(199-86 PERMIT ISSUING FEE Lender's Address , 1 certify that I have read this application and state that the H TOTAL FEE 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 ab ve-mentioned roperty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE o Qj _4 Signature of Permittee /DgA ,V-40--' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0406020011 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: GAL ID: FEES PAID BUILDING ADDRESS: BK: 60 PG: 40 PC: 3 5514 MCCULLOCH AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802943 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: DAINES 8573-013-038 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY, C G1 OUTLETS-LGT,SW,RECP 1.00 OUT 1.95 TENANT: G2 LIGHTING FIXTURES 1.00 LGT 1.95 SSUE ON.PROCESSED : PLAN BY: EXPIRES ON: HA FAU LESS 3HP 1.00 FAU 10.95 06/02/04 VG 11/29/04 JB AC UNITS +3-10HP 1.00 AC 19.65 OWNER: TEL. NO: TOTAL FEES 62.25 FI L D T FINAL BY: CODE: SAVARE, YVONNE - 5514 MCCULLOCH AV /� n TEMP 917802943SC P-rIO O�F WORK ELECTRICAL FOR HVAC APPLICANT: TEL. NO: AIR TRO (626) 357-5311- SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE AIR TRO (626) 357-5311- 1630 MYRTLE AVE LIC. NO TEMPORARY POWER POLE MONROVIA CA 91016 258228C10 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER. TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH-WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED * ADDITIONAL DATA ON FILE REPORT ID: DPR265 ROUTE TO: SS0508