HomeMy Public PortalAbout9112 OLEMA ST_Electrical__ 76A663-CE806 1-68•,4 APPLICATION FOR ELECTRICAL/PERMIT '
COUNTY OF LOS ANGELES 11.JI
'DEPARTMDIENT OF COUNTY ENGINEER BUILDING
BUILNG AND SAFETY DIVISION ADDRESS 9112 Es Olema St
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS; SUPERINTENDENT OF BUILDING LOCALITY Temple Cit
FOR APPLICANT TO FILL IN NEAREST Encinita & Livia
CROSS ST.
NO.
EACH FE.E
RECEPT.
$ $ OWNER Dale L. Kna
MAIL
LIGHT-/-Z— TOTAL FIRST 20 .20 ADDRESS 9112 Es O ema Sts
SWITCH OVER 20 .10 CITY Temple City TEL. NO.286-8220
PLAN CHECK
LIGHTING JTOTALI FIRST 20 .20 APPLICANT
FIXTURES OVER 20 .10 ADDRESS
RANGE—DRYER—WTR.HTR.— CITY TEL. NO.
r
STA.COOK_DIS P.—F.A.U._ CONTRACTOR
A mm-
SPACE HTR. AIR COND. ADDRESS:
CLOTHES WASH.Jk-LDISHWASH._ CITY TEL. NO.
FAN—OTHER 1.00 MQ LICENSE NO.. CLASS.
MOTORS,TRANSFORMERS RATING
IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATI-N6
ELECTRICAL WIRING.
0 — 1 1.00
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
1 — 10 3.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFOIRNA OR THAT 1 AM THE.LEGAL OWNER OF, AND INTEND TO O.ff
10 — 50 5.00 RESIDE N, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. O
50 – 100 10.00 SIGNATURE V
OF PERMITTEE
ad
100 – 500 15.00
DIS IC NO-1139-041P tNE I P
SIGN,GAS SIGN AND ONE CIRCUIT 3.00 +� W
TUBE, OR O.
_
MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: Z
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT G
PERMIT FEE (SUB TOTAL) WIRING
FIXTURES
PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED
PERMIT ISSUING FEE 2.00 'a UTILITY.CO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL
TOTAL FEE JOSEPH C. ROOHAN
SUPERVISING ELECTRICALEN
PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDATION CK. M.O. CASH
6 9 3 7,1 OCT21 ' 2 0 3.6 ON q
fE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
WORKERS'COMPENSATION DECLARATION 20.0019 DPW 3187 O
I hereby affirm that I hawe.a cWtificate of consent to self cAPPLICATION FOR ELECTRICAL PERMIT
CE-806G i
insure, or a certificate of Workers Compensation Insurance, COUNTY OF LOS ANGELES I DEPT. OF PUBLIC WORKS
or a certified copy thereof(Sec. 3800, Lab. C.)
Policy No. Company I FOR APPLICANT TO FILL IN JOB
❑Certified copy is hereby furnished. f New Residential Bldgs. &Pools EACH NO. FEE ADDRESS
❑Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ i LOCALITY
tion department. Multi-family Sq. Ft. i NEAREST
Date Applicant
Residential Swimming Pools CROSS ST /o� a G/
FIRM NAME /(INAl /I✓ G�
CERTIFICATE OF EXEMPTION FROM WORKERS' I Outlets: Rec Light Sw.____ AMAIL
DDRESS
COMPENSATION INSURANCE First 20
(This section need not be completed if the work involved byTotal No. CITY Tel. No.
the permit is for one hundred dollars($100)or less.) Additional � f PLAN CHECK
I certify that in the performance of the work for which this ` I 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. ,
/ Additional '
Date B� Applicant �r Total No. CITY Tel. No.
NOTICE TO APPLICANT: If, after ma ng this Certificate of Fixed Appliances Not Over 1 HP I PERMIT _
Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION
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. I Hood — Fan —Other— I CITY Tel. No.3a
LICENSED CONTRACTORS DECLARATION I LICENSE OR
I Disp. — Room Air Cond. — Class.
I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER �r
DISTRICT NO. P O ESSED BY a
(commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances I
and Professions Code,and my license is in full force and effect.
O
��; Size&Type HP, KW, KVA, or KVAR ar,. 6
License Number Lic. Class_ Up to 1 Incl. I FINAL V
M��e J 64 E& �/I/ Over 1 to 10 Incl. ; DATE VALIDATION 0
Contractor 5Q[�— o ^te , FINAL
T Over 10 to 50 Incl. U
I am-exempt under Sec. Over 50 to 100 Inc. BY LLI
Over 100 d
B.&P.C. for this reason
Services, Swbd., MCC&Panelboards ® Z
CD
Date: Z
I 0-200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY I Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License ' Sign with One Branch Circuit %Kl :+ +7 --
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuitsj'
Professions Code):
Misc. :s`
Conduits&Conductors
❑ i, as owner of the property, will do the work and the —a
structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)— f is 1 HL 3�_ 00
Business and Professions Code). polo
.E3�l.�:i
CONSTRUCTION LENDING AGENCY i
I hereby affirm that there is a construction lending agency for j -1-'
GhfiN
the performance of the work for which this permit is issued I PERMIT FEE (Sub-Total) /z --- -
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name I _
PERMIT ISSUING FEE t 1 OIL
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 i
hereby authorize representatives of this County to enter upon
the above-mentioned property for inspections purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Amn!4's ato, 0S
SVgncgre of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1203290017
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID
NG ADDRESS:
TR: 12115 IT: 35 9112 O
9112 OLEMA ST
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT.1TEMP CA 917801339
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
15382-023-027 Al PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl
I LA 100 AMP PANELS, MCC 1.00 PAN 38.90 I I
TENANT: TOTAL FEES 66.70 ISSUED ON: PROCESSED BY: PLAN BY:
103/29/12 SR
OWNER: TEL. NO: IF TE (02..,e FI B CODE:
LIEN, THANH -
19112 OLEMA ST
TEMP 917801339 SCRIPTION OF WORK
[REPLACE THE EXISTING ELECTRI METER 100 AMP
APPLICANT: TEL. NO:
JASON, THAI (626) 641-3815-
I4830 HALLOWELL AVE I SPECIAL CONDITIONS:
TEMPLE CITY CA 91780
CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE
JASON THAI ELECTRICAL CONTRACTOR (626) 641-3815- I I
14830 HALLOWELL AVENUE LIC. NO ITEMPORARY POWER POLE I I I
TEMPLE CITY, CA 91780 731603010 I I I I
I [UNDERGROUND CONDUIT
[ARCHITECT OR ENGINEER: TEL. NO: - i JUFER GROUND
LIC. NO: I IROUGH CONDUIT i I
TROUGH WIRING
IMAIN WATER LINE
[PLASTIC YIN METAL YIN I•
(UTILITY COMPANY NOTIFIED
I I I I40I
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
I I I
[REPORT ID: DPR265 ROUTE TO: BS0508