HomeMy Public PortalAbout9808 MILOANN ST_Electrical__ WORKER'S COMPENSATION DECLARATION 7BAS68 DPW(72-91) APPLICATION FOR ELECTRICAL PERMIT ll
I here.bj a9tirrg..that I have a certificate of consent To self insure, 76A868
dr a certifica,S'Xo6%rrei's Compensation Insurance, or a certified COUNTY OF LOS ANGELES -v ., ,. DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 Lab.C.)
Policy No. Company . FOR APPLICANT TO FILL IN ADDRESS e .
NO. EACH FEE
Certified copy is hereby furnished. New Residential Bldgs.&Pools COCALI, d
❑ 1 &2-Family,Sq.Ft. — $ $
Certified copy is filed with the county building Inspection I. _ 'NEAREST.
department. Multi-family Sq.Ft. CRoss ST.
Date Applicant Residential Swimming Pools ASSESSUK
MAP BOO PAGE PARCEL
CERTIFICATE OF EXEMPTION.FROM-WORKERS' Outlets:Rec._Light Sw. FIRM NAME
COMPENSATION INSURANCE
I First'20 MAIL
(This section need-not be completed if the work Involved by the ADDRESS `
permit is for one hundred dollars($100)or less.) Total No. Additional Q.
T.I.; N . it
I certify that in the performance of the work for which this permit 1 Cl Fj� Q
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
r l Total No. Additional ADDRESS
Date Applicant I
NOTICE TO APPLICANT:.If, after making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP. 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 suchPERMIT I
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 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 Class.
Over 50 to 100 Incl. REG.NUMBER d
License Number
Over 100 DISTRICT NO. P C SED BY V
Lid.Class p
Services bd.,MC. &Pane ards ? -�p
Amp. P4
e 600 V
Contractor Date / 0.�� DAT L I U
.400-1000 Amp.Under 600'V �'��✓ � VALIDATION ~
I am exempt under Sec. 4 Over 1000 Amp.or Over 600 V FINAL 11
B.&P.C.for this reason BY IL
BRANCH CIRCUIT:FEES
Date: 15A,or 20A,120V,Lighting or Recept. I Z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits-
41.Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,20A,.20BV To 277V Lighting Br.Circuitslie
SINGLE FAMILY Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACCT=''e'
I hereby affirm that I am exempt from the Contractor's License Law
for the following.reason.(Section 7031.5, Business and Professions Additional Sign Branch Circuits 3303 65.60
Code): , M
I,as owner of the property,will do the work and the structure �--y
1 ITEMS
Misc.Conduits&Conductors
Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) , TOTAL 455.,450
and Professions Code). CHECK
beb�
CONSTRUCTION LENDING AGENCY CHS o60
I hereby affirm that there is a construction lending agency for the p
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) a
Civ.C.)
PLAN CHECKING FEE I 0000--0001 4/29/96
Lender's Name PERMIT ISSUING FEE o?/ 10981 �M c° {
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
ordina ces and State laws regulating Electrical wiring,and hereby authorize
repro tatives of this County to enter upon the above-mentioned property
for insp ction purposes, SEE REVERSE FOR EXPLANATORY LANGUAGE
for
OF PE ITT -DATE
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECT 11 M PERMIT_
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0-5-0"6TTT300
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
i
LEGAL ID: FEES P IDpJLDIi G-ADB
TR: 12830 LT: 31 �lt0 Mil(]ANNRgT��
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TAMP CA 917803925
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
8589-008-022 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY
G1 OUTLETS-LGT,SW,RECP 1.00 OUT 1.95
E HA FAU LESS 3HP 1.00 FAU 10.80 SS EDti0 : PROCESSED B LAN BY: EXPIRES ON:
JB AC UNITS +3-10HP 1.00 AC 19.65 11/13/96 TC 11/13/97
TOTAL FEES 60.15
OWNER: TEL. NO: FINAL D TE FINAL BY: CODE:
TINSLEY DANIEL P;SHALOM J - O Icy 7
9808 MILOANN ST V // V
TEMP 917803925 DESC PTION OF WORK
NEW HEATING AND A/C SYSTEM IN RESIDENCE
PLI 0:
SAME AS OWNER
LE C SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: ® APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER . LIC. NO Cb
�® TEMPORARY POWER POLE
cUNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: 0:
UFER GROUND
LIC. NO: �y,� ROUGH CONDUIT
RO WIRING
PU L C W 0 Vl K Sj- MAIN WATER LINE
PLASTIC Y/N METAL Y/N
co UTILITYCOMPANY NOTIFIED
69r o
REPORT ID: DPR265 ROUTE TO: BS0508
i
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9708060019
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
I
- LEGALS PAID BUILDING SS:
TR: 12830 LT: 31 9808 MILOANN ST
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TAMP CA 917803925
ASSESSOR INFORMAT0N NUMBER: NEAREST CROSS STREET:
8589-008-022 Al PERMIT ISSUANCE FEE 27.75 TjIONAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY
LN OTHER PNL 0-399 AMPS 1.00 PAN 38.85 I
TOTAL FEES 66.60 issuhu ON: PROCESSED BY: PLA RES ON:
08/06/97 TC 08/06/98
OWNER: , TEL. 6- FIN D TE NAL BY: CODE:
TINSLEY DANIEL P•SHALOM J (626) 286-2696-
9808 MILOANN ST
TEMP 917803925 CRI 0 F R
NEW SUB PANEL IN GARAGE 50 AMP
APPLICANT: E 0:
SAME AS OWNER -
SPECIALiCONDITIONS:
CONTRACTOR: TEL. N0: ` `�3"'. -_-- y''• a', APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO a r: ` . k TEMPORARY POWER POLE
":� r` '• r !'=� ;'~ ^' UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. 0: 5 t:E; , _ FER GROUND
' I
LIC. N0: ROUGH CONDUIT
ROUGH RING
14AIN WATER LINE
PLASTIC;Y/N METAL Y/N
UTILITY C P Y OTI D
i
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I
I '
i
I
I
REPORT ID: DPR265 ROUTE TO: BS0508
I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0807140019
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: 1
ITR: 12830 LT: 31 I [ 9808 MILOANN ST [
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ TEMP CA 917803925 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1
18589-008-022 IAl PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl
I IG1 OUTLETS-LGT,SW,RECP 3.00 OUT 5.85 1 .1
TENANT: 02 LIGHTING FIXTURES 6.00 LGT 11.70 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
H2 RES GRBG DISP LT 3HP 1.00 DIS 10.95 107/14/08 SR 01/10/09
1H3 RES DISHWASHR LT 3HP 1.00 DIS 10.95 1 1
[OWNER: TEL. N0: [ TOTAL FEES 67.20 IFINAL DATE- /JP
pp BY: CODE: 1
19808 MY DAN (626) 705-1930- i i IL-If I'oil
19808 MILOANN ST IILLIIWJII
ITEMP 917803925 [ IDESCRIPTION OF WORK
[ 13 OUTLETS, 6 LIFHT FIXTURES, GARBAGE DISPOSAL AND DISHWASHER
(APPLICANT: TEL. NO:
SAME AS OWNER
1 1 ISPECIAL CONDITIONS:
I
I I I I
ICONTRACTOR: TEL. NO: [ [APPROVALS DATE INSPECTOR SIGNATURE [
ISAME AS OWNER - I I 1
LIC. NO i (TEMPORARY POWER POLE I I I
I I [UNDERGROUND CONDUIT
I I I
[ARCHITECT OR ENGINEER: TEL. NO: 1 1UFER GROUND I I I
_ I I I
LIC. NO: [ [ROUGH CONDUIT 1 I 1
TROUGH WIRING [ 1
[ I IMAIN WATER LINE
[ I IPLASTIC Y/N METAL Y/N
1
I I I
[ I [UTILITY COMPANY NOTIFIE51 I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I
I I I 1
I I I
I I I I I I
[ IREPORT ID: DPR265 ROUTE TO: B80508 [ I 1 I
I I I I I I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 iELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS 'EL 0508 9904280007'
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
r " PHONE: (626) 285-0488 EXT:
LEGA ID: FEES PAID --B _ LDI G-A DR SS:
TR: 12830 LT: 31 9808 MILOANN ST
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803925
ASSESSOR-INFORMATION NUMER: NEAREST CROSS STREET: GOLDEN WEST
8589-008-022 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY
G1 OUTLETS-LGT,SW,RECP 10.00 OUT 19.50
TENANT: G2 LIGHTING FIXTURES 5.00 LGT 9.75 ISS ON: PROCESS BY: EXPIRES 0 :
H7 RES EXHAUST FANS 2.00 EX 21.60 04/28/99 UT 10/25/99
TOTAL FEES 78.60
OWNER: TEL. NO: FINAL DATEFI BY: CODE:
TINSLEY DANIEL P;SHALOM J (626) 286-2696-
9808 MILOANN ST
TEMP 917803925 SC IP ON OF OR
ELECTRICAL FOR BATH ADDITION
APPLICANT: . NO:
SAME AS OWNER -
SPECIAL CONDITIONS:
P�GElill Es C®
CONTRACTOR: TEL. NO: SCS �/�/Ay APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO TEMPORARY POWER POLE
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: �� 0: - ER GROUND
LIC. NO / 1111111 ROUGH CONDUIT
� O G I G
n/1� I llKS MAIN ATE/ LINE � �J
�v�v PLASTIC Y/N METAL Y/N
UTILITY COMPANY OTIF ED
0 ❑ �I
f�rrli +.
El
Q ty
El
46��C Service
REPORT ID: DPR265 ROUTE TO: BS0508