HomeMy Public PortalAbout5527 MCCULLOCH AVE_Electrical__ * • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1308010050
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I
ITR: 13613 IT: 106 I 5527 MCCULLOCH AV
1 ,(FEE DESCRIPTION: QIIANTITY: DOM: AMOUNT: TEMP CA 917802940
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: DAINES I
18573-008-005 IA1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY CAI
I IG1 OUTLETS-LGT,SW,RECP 6.00 OUT 12.00 1 1
TENANT: G2 LIGHTING FIXTURES 6.00 LGT 12.00 ISSUED ON: PROCESSED BY: PLAN BY: I
TOTAL FEES 51.80 (08/01/13 SR T
TOWNER: TEL. N0: I (FINAL RA FIiQAL Y: CODE: 1
IMOLINA MARTHA (626) 862-5051- I I
15527 MCCULLOCH AV I I
ITEMP 917802940 I ID CRIPTION OF WORK
I 16 OUTLETS AND 6 LIGHT FIXT S 1
[APPLICANT: TEL. NO: I I
ISAME AS OWNER - [
I I IISPECIAL CONDITIONS: I
ICONTRACTOR: I 1
TEL. N0: 1 (APPROVALS DATE INSPECTOR SIGNATURE
ISAME AS OWNER - I
ILIC. NO I ITEMPORARY POWER POLE I I I
Ii [UNDERGROUND CONDUIT I I I
(ARCHITECT OR ENGINEER: TEL. NO: I
1 - I 1UFER GROUND I I I
LIC. NO: I IROUGH CONDUIT I I
1 I IROUGH WIRING I I 1
IMAIN WATER LINE I I I
1 IPLASTIC Y/N METAL Y/N I I I
JUTILITY COMPANY NOTIFIEDT I I
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I I I I I
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IRSPORT ID: DPR265 ROUTE TO: BS0508
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ri WORKER'S COMPENSATION DECLARATION 7BA663 DPW(12-91)
,l APP'LI'CATION FOR ELECTRICAL PERMIT
hercby.;affirm tKaa
t 1'6ve certificatei of consent to self Insure, s.
or a certificate of VoIter's 6omRensat'ion Insurance,.or a certified : COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thergof(Sec.3800 Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
ADDRESS S✓2 C.6C
Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE$$Ft
S
il
Famy, q. . LOCALITY
— 7�
El .. Certified copy'is filed with the county building inspection 1 &2- - NEAREST
department. Multi-family Sq.Ft.. — CROSS ST. Ll0
Date Applicant Residential Swimming Pools ASSOR ,,�+
MAPESSBOOK �� '� PAGE DO PARCE060
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec..f.Light�Sw. FIRM NAME
COMPENSATION INSURANCE First 20
(This section need not be completed If the work Involved by the MAIL Total No. Additional 8 ADDRESS c5p,r'� G All.
Q�G
permit Is for one hundred dollars($100)or less.)
�!C u
1 certify that in the performance of the work for which this permit CITY ( fi �r rel.No. �-tj'� Q
I's Issued, I shall not employ any person in any manner as to PLAN CHECK
become subject to the Workers'Compensat' ws.� r .Lighting Fixtures First 20 APPLICANT
r Total No. Additional
ADDRESS
Aide
NOTIC TO. PPL CANT: If, of WMAIMOCES NOT OVER 3 HP. CITY Tel.No.
Exemption,.you should become ensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the'Labor Code,you m's forthwit comply with such PERMIT
92
provl'si'ons or this permit shall be deem d revoked. Power Apparatus&Large Appliances APPLICANT19
LICENSED CONTRACTORS DECLARATION iz &.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 Cld
/�, /,p Over 50 f0 100 Incl. REG.NUClaw.
License-Number Lic.Ciass
- Over.100 DISTRICT PROCESSO
. ° U
Services,Swbd.,MCC&Panelboards
Contractor , Date 0-399 Amp.Under 600 V DATE O
❑ I am exempt under Sec.: 400-1000 Amp.Under 600 V VALIDATION W
Over 1000 Amp.or Over 600 V FINAL a
B.&P.C.for this reason �/ BRANCH CIRCUIT FEES BY U)
Dat . '77N 15A,or 20A,120V,Lighting or Recept. _
1 To 10 Branch'Circuits
Signature 11 To 40 Branch Circuits 2
❑ 41 Or More Branch Circuits ` � °;
Exe t- 15A,20A,208V To 277V Lighting Br.Circuits 1,,, •�� q f� -?'i
SINGLE FAMILY Temp,'Power Pole&Appurtenances " " `` 33.107
HOME OWNER-BUILDER DECLARATION , -- f.
I hereby affirm that I am exempt.from the.Contractor's License Law Sign with One Branch Circuit i s1 EWO
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits {• ,. g
'Code): TOTAL 8.11 ®30
❑ 1,as owner of the property,will do the work and the structure Misc.Conduits&Conductors CHECK 81.30
is not Intended or offered for sale(Section 7044, Business .Other(See Complete Fee Schedule) °"If
and Professions Code). CHANGE
I
CONSTRUCTION LENDING.AGENCY ill
I hereby affirm that there is a construction lending agency for the ® I I j�j - } Z ;/r. 294
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Am 4}°'"=i
Civ.C. �°�''
PLAN CHECKING FEE
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 regulati g Electrical wiring,and hereby authorize
rep resentativ's of.this Qoun enter upon the above-mentio d property
for
r insp urpos SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGN T
WORKER'S COMPENSATION DECLARATION 20.0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
I hereby'affL thaE l have a.certificate of consent to self insure, 78A663
or e,certiflost&of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
,06 thereof.,(Sec..3800 Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
S sZ�.
Certified copy is hereby furnished. NO. EACH FEE
New Residential Bldgs.&Pools LOCALITYT� ! f
❑ Certified co Is filed with the county building 1&2-Family,Sq.Ft. — $ $
copy' ty g inspection _ NEAREST A .�.,/
department. Multi-family Sq.Ft. CROSS
ST/
Date Applicant Residential Swimming Pools _ ASSESSOR
MAP BOOK I PAGE PARCEL v
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR
COMPENSATION INSURANCE Outlets:Rec.J_9_� Light :C Sw. OD �� FIRM NAME
First 20 0 -MAIL
(This section need not be completed 1f the �i
work Involved by the Total No. Additional +' ADDRESS �G�L�
permit is for one hundred dollars($100)or less.)
I certify that in the performance of the work for which this permit CITY Tel. SSB
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 dV
ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. •
NOTICE;TO APPLICANT: if; after making this Certificate of RESIDENTIAL Tel.No.
Exemption,you should becomesubject 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 CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9Over 3 to 16 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 Clare
Over 50 to 100 Incl. REG.NUMBER d
Over 100 DISTRICT NO. ESSED BY O
License Number Lic.Class U
Services,SWbd.,MCC&Panelboards � 0
Contractor Date ,!24 n 9C M Amp.Under 600 V DATE / O
❑ I am exempt under Sec. 400- 000 Amp.Under 600 V a'�! VALIDATION (j j
Over 1000 Amp.or Over 600 V FINAL. IL
B.&P.C.for this reason BRANCH CIRCUIT FEES BY Z
Date: 15A,or 20A,120V,Lighting.or Recept. ` _
1 To.10 Branch Circuits
Signature 11 To.40 Branch Circuits
El- 41 Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,20A,208V Td 277V Lighting Br.Circuits
i
SINGLE FAMILY Temp.Power Pdle&Appurtenances
HOME OWNER-BUILDER DECLARATION AMT.
I hereby affirm that I 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 36 129.15
Code): 'Y_t�+
❑ a y'g 1 I`
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) poll. ;,,)'i AL "�-_�9 s x.51
and Professions Code).
• erliCt_i 4 1219.1—.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a.construction lending agency for the CHAIINIG o1-i�l
performance of the work for which this permit Is Issued (Sec. 3097, PERMIT FEE (Sub-Total)
Civ.C.)
PLAN CHECKING FEE
j _jY (ti133r` y
Lender's Name
PERMIT ISSUING FEE 7494 1 Ph 5 9�CS
Lender's Address C 1
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 up n'the above-mentioned property
forn ur SEE'REVERSE FOR EXPLANATORY LANGUAGE
.l s N TUR OFFERMITTEE DTE