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HomeMy Public PortalAbout10158 NADINE ST_Electrical__ 76A••B DBB BA 7 61 APPLICATION FOR siiRli ` DEPARTMENT OF BUILDING AND SAFETY ELECTRIC i COUNTY OF LOS ANGELES WILLIAM J FOX, CHI[r ENGINEER FOR APPLICANT TO FILL IN OIBTRIC�NO GROUP ZONE PERMIT NO ELECTRICIAN O "As S 2 �S 1� R EIVED BY READY ran DATE IBBUED ADDRESS VN `�t/ rIR 1 P C ION CITY TEL.NO COUNTY LICE BE NOlie EXPIRES d BUILDING 4# PERMIT ADDREM (/ . NUMBER EACH rE[ LOCALITY .I LIGHT OUTLETS NEAREST �e CROBB BT G� �� RECEPTACLES WALL SWITCHES OWNER W k1AA1 At WA .ICI TOTAL OUTLETS SC is O MAIL /O,l� L!roC Sr EL[C RANGES g5 ADDRES`J �y Sy CLEO HEATERS SB CITY �Q//� yp?`l TEL NO*/tO /oy/ rIXTUREB s I HEREBY ACKNOWLEDO[ THAT 1 HAVE READ THIS MISO APPLICATION AND STATE THAT THE ABOVE IN CORRECT NUMBER or LIGHT CIROUITS AND ABBE[ TO COMPLY WITH ALL COUNTY ORDINANC[B NUMBER Or RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING MOTORS I C[RTIrY THAT I POM THE ABOVE VALID LOB NUMBER HORSEPOWERr[E ANGELES COUNTY LICENSE OR 1 AM THE LEGAL OWNER NIFW Mw P OVER INC EACH Or THE RESIDENTIAL PR PERTY RIBED 11BOVE. ZroveYn a • LESS 10 Q600, BIGNATUR9 or vs B s0 PERMITTER - B s 100 INSPECTION RECORD s is ISO In so ago so ZOO Sao 200 5130 loco J moo loco 16 CO z Z OVER 1000 00 00 0 M G BET rR[ CHANGER HP WELDERS AC KVA O GENERATORS KW TRANBroRMEINt KVA TEMP MOTORS (76% or ams) MOVED MOTORS (76 Or CRIB) MIsC SIGNS NQ NO TRANS. APPROVALS NO. NO LAMPS ran EACH PERMIT DATE INBPECTOR0B NAM[ WIRING 81 OO CONDUIT rIXTURES 61 OO WIRING Z gr rY ISUIPPLEMENTARY SO rIXTUREB Y POWER TOTAL FEE 6 7. UTILITY 00 NOTIr1ED G rINAL YO G WORKERS COMPENSATION DECLARATION 7 r883 10/81 APPLICATION FOR ELECTRICAL PER IT gq ifl I hereby affirm t I have a certificate of consent to self Insure CE sceG or a certificateof Compensaton Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec 3800 C) Policy No Company FOR APPLICANT TO FILL IN JOB ADDRESS ❑ Certified copy is hereby furnished New Residential Bldgs &Pods EACH NO FEE ❑ Certified copy is filed with the county budding inspection 1 &2 Family Sq Ft $ — $ LOCALITY L ' department Multi fatuity Sq Ft — NNEARE ST Q, Ma I Date Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec—Light_Sw MAIL COMPENSATION INSURANCE ADDRESS O// p & e. -117 (This section need not be completed If the work Involved by the First 20 permit is for one hundred dollars($100)of less) Total No Additional CITY HE Tel No 2 z PLAN CHECK I certify that in the performance of the work for which this permit APPLICANT is Issued I shall not employ any person in any manner so as to become subject to the Workersnation Laws Lighting Fixtures First 20 ADDRESS Additional DataZ,+ � APplican � Total No CITY Tel No NOTICE TO APPLICANT If a making this Certdica of axed Appliances Not Over 1 HP PERMIT Exemption you should become su t to the Workers Compe ation Range r HeateDW _ A��T provisions of the Labor Code yo ust forthwith comply with such Oven _ Dryer_ W M _ ADDRESS 2 provisions or this permit shall be deemed revoked Top _ FAU _ WH 'A LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ CITY ©v �4 14- Tel No 33Z(p Q I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR Disp — Room (commencing with Section 7000)of Division 3 of the Business and A �or�OT REG NUMBER Class Professions Code and my license is in full force and effect Power Apparatus&Large Appliances DISTRICT NO 1!/ PROCE D BY Size&Type HP KW KVA or KVAR r v a License Number Lic Class Up to 1 Incl FINAL Over 1 to 10 Incl DATE p N Contractor Date Over 10 to 50 Incl F I am exempt under Sec Over 50 to 100 Inc B&PC for this reason Over 100 Date Services Swbd MCC&Panelboards 0 200 Amo Under 600 V Signature 201 1 00 Amp Under 600 V Over 1000 Amp or Over 600 V Exemption for Reg Mamt Elect SINGLE FAMILY Temp Power Pole&Appurtenances HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit 8 5 I hOreby affirm that I am exempt from the Contractors License Law 3 A for the following reason(Section 70315 Business and Professions Additional Sign Branch Circuits Code) #I❑ ..3 ie, I as owner of the property will do the work and the structure Misc Conduits&Conductors 0 Other(See Complete Fee Schedule) _ IIS not Intended or offered for sale (Becton 7044 Business ► and Professions Code) % CONSTRUCTION LENDING AGENCY e e -32 5 013 1 hereby affirm that there is a construction lending agency for the 91 performance of the work for which this permit is issued(Sac 3097 PERMIT FEE (Sub Total) 2 0 7-87 CN C) PLAN CHECKING FEE Lenders Name PERMIT ISSUING FEE Lenders Address 1 certify that I have read this application and state that the above TOTAL FEE 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 above mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE r �� ature of Permittee Date � r WORKERS CI have COMPENSATIONDECLARATION of corse 260019 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT Q I hereby affirm that I have a certificate of consent to self �� insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS or)a certified Scrth�r�/p 3800 C) Poli NIM V�f ompany FOR APPLICANT TO FILL IN JOB rtified copy is hereby furnished New Residential Bldgs 8 Pools EACH tV0 FEE ADDRESS Certified copy is Bled with the unty bui mg ins 1 &2 Family Sq Ft $ — $ LOCALITY tion department Multifamily Sq Ft NEAREST CROSS ST .] Date 0— Residential Swimming Poo s OWNER OR d pP FIRM NAME I'm Des CERTIFICATE OF EMPTION FROM WORKERS Outlets Rec Light Sw—_ MAIL COMPENSATION INSURANCE / 'O ) O ADDRESS First 20 (This section need not be completed N the work involved by Total No CITY No the permit Is for one hundred dollars($100)or less) Additional I certify that in he performance of the work for which this APPLICANT CCANT r permit is issued I shall not employ any person in any manner lighting Fixtures First 20 ADDRESS r `! so as to become subject to the Workers Compensation Laws Total No Additional CITY �' Tel No Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If after making this Certificate of APPLICATION 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 REG I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Au Cond _ NUMBER Class Z-Z 7 (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO PROC SED BY >- and Professions Code and my license is in full force and a0 2,7 Size&Type HP KW KVA or KVAR U License NumberUV2 IS Lic Class Up to 1 Incl FINAL r d -y'y Over 1 to 10 Inc[ DATE VALIDATION 0 Contractor to Over 10 to 50 incl U ❑ FINAL I am exempt er Sec Over 50 to 100 Inc BY W B 8P C for t reason Over 100 Date C 1/ Services Swbd MCC&Ponelboards ► Z 0 200 Amp Under 600 V Si tur 201 1000 Amp Under 600 V ❑ Exemption for Reg MaOver 1000 Amp or Over 600 V mt Elect SINGLE FAMILY HOME OWNER BUILDER DECLARATION Temp Power Pole&Appurtenances Sign with One Branch Circuit At-1 r i I hereby affirm that I am exempt from the Contractor s license Low for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits J7 288.�� Professions Code) ❑ I as owner of the property will do the work and the Misc Conduits&Conductors 1 ITEM structure is not intended or offered for sale(Section 7044 Other(See Complete Fee Schedule) ► TUTAL. 2 dry Business and Professions Code) e` ��+� amu.1� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for C WGE OL the performance of the work for which this permit is issued PERMIT FEE (Sub Total) (Sec 3097 Civ C) Lender s Nome PLAN CHECKING FEE I PERMIT ISSUING FEE p� Lenders is" 1 �� I certify at I have read this application and state that the TOTAL FEE - A. above 1 motion i orrect I agree to comply with all County ordm s and St a laws regulating Electrical wiring and her t riz presentatives of this County to enter upon th me ed property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Permittee Date ®' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1001060011 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285 0488 EXT LEGAL ID FEES PAID BUILDING ADDRESS ON FILE 10158 NADINE ST FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917802725 ASSESSOR INFORMATION NUMBER INEAREST CROSS STREET BALDWIN 8586 026 033 jA1 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID B3 LOCALITY TEMPLE CITY Cl IG1 OUTLETS LGT SW RECP 15 00 OUT 29 25 TAT JG2 LIGHTING FIXTURES 4 00 LGT 7 80 JISSUED ON PROCESSED BY PLAN BY EXPIRES ON TOTAL FEES 64 80 01/06/10 SR 01/06/11 OWNER TEL NO i IFINAL-PATE F� Y CODE IHODSON MARCUS BARBARA (626) 443 2389 ��((\\ (` 10158 NADINE ST TEMP 917802725 IDESCRIPTION OF WORK �fiLfiCTRICAL FOR BEDROOM BATHROOM ADDITION (APPLICANT TEL NO CLINTON (626) 786 9336 SPECIAL CONDITIONS CONTRACTOR TEL NO I JAPALS DATE INSPECTOR SIGNATORE IROBERTS CLINTON (626) 786 9336 IP 0 BOX 92261 LIC NO ITEMPORARY POWER POLE PASADENA CA 91109 NONE JUNDERGROUND CONDUIT ARCHITECT OR BNGINSER TEL NO JUFER GROUND JKY ENGINEERING LLC (323) 868 2054 7111 WALNUT STREET STE 212 LIC NO IROUGH CONDUIT PASADENA CA C62778 ROUGH WIRING �U-10: MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID DPR265 ROUTE TO BS0508