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HomeMy Public PortalAbout10116 OLIVE ST_Electrical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0011020028 ,BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 • PHONE: (626) 285-0488 EXT: LEGAL D: FEES PAID BUILDING ADDRESS: TR: 10558 LT: 21 10116 OLIVE ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803344 ASSESSOR I FORNA ION NUMBER: NEAREST CROSS STREET: GLICKMAN 8585-002-011 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 8.00 OUT 15.60 TENANT: G2 LIGHTING FIXTURES 1.00 LGT 1.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 45.30 11/02/00 UT 05/0 /01 IN OWNER: TEL. NO: FAL DATE FINAL BY• CODE: WANG;DAVID 11 10116 OLIVE ST TEMP 917803344 DESCRIPTION OF-WORK ELECTRICAL FOR BEDROOM EXTENTI APPLICAN . NO: STEVE C. Y. WU (626) 912-3289- 18403 VILLA CLARA ST SPECIAL CONDITIONS: ROWLAND HEIGHTS, CA LES C® CONTRACTOR: TEL. NO: APPROVALS��/r� APPROVALS DATE INSPECTOR SIGNATURE KONGEA CONSTRUCTION CO. (626) 912-3289- 18403 VILLA CLARA STREET LIC. NO TEMPORARY POWER OLE ROWLAND HEIGHTS, CA 91748 731678 B UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. N0: - UFER GROUND LIC. NO 1111111 ROUGH CONDUIT ROUGH---WIRING C n /1 0 K 3MAIN WATER LI\w//\w�/ uu PLASTIC Y/N METAL Y/N TILI Y COMPANY OTIFIED t a o O ❑ � I O ❑ ��I�_ O ❑ Yr., El 46��0 E 0 Service'that REPORT ID: DPR265 ROUTE TO: BS0508 DEC WORKERS' I have cerci cafe of consent I ,DAB, - APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that 'I have a certificate of consent to self �'B�' insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof(Sec. 3800, Lab. C.) I Policy No. Company FOR APPLICANT TO FILL IN JOB Certified co is hereby furnished. EACH NO. FEE ADDRESS PY Y New Residential Bldgs. 8 Pools r_1 Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST Residential Swimming Pools CROSS ST. to Lo Date Applicant • OWNER OR � FIRM NAME L. Rif YJ2A,&J AC CERTIFICATE OF EXEMPTION FROM WORKERS' IL Outlets: RecLightSw.Z COMPENSATION INSURANCE r ADDRESS1011.6 �• �+ V tThis section need not be completed if the work involved b First 20 1 he permit Is for one hundred dollars($100)or less.) )r Total No.� Additional CITY Tel. No. 8 that in the performance of the work for which this PLAN CHECK I certify P APPLICANT permit is issued,I shall not employ any person in any mann'er so as to become subject to the Workers'Compens ion Laws. Lighting Fixtures First 20 ADDRESS ��uu Total No. Additional Date —.�-3-8 ppl!cant 'ry CITY Tel. No. NOTICE TO APPLICANT.: If, after making this C rtificate Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range_ Heater_D.W. _ APPLICANT Compensation provisions of the Labor Code, you must forth- Oven —Dryer _W.M.— ADDRESS with comply with such provisions or this permit shall be Top _ FAU —W.H. — deemed.revoked. Hood Fan _OtherCITY Tel iVo. LICENSED CONTRACTORS _ _ DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room-Air Cond. REG.NUMBER Class. (commencing with Section 7000)df Division 3 of the Business DISTRICT NO. PROCES D BY and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances y. Size 8 Type HP, KW, KVA, or KVAR' i(> O License Number Lic. ClassU LJp to 1 Incl. FINAL Contractor Date Over 1 to 10 Incl. DATE "� VALIDATION- 0 ❑ Over 10 to 50 Incl. � FINAL � I am exempt under Sec. T Over 50 to 100 Inc. BY U1 B.$P.C. for this reason Over 100PA Services, Swbd.,.MCC&Panelboards pop. Date: 0 -200 Amp. Under 600 V ` Si nature 201•- 1000 Am Under 600 V 9 P• ! ❑ Over 1000 Amp, or Over 600 V Exemption for Reg. Maint. Elect. 4t f SINGLE FAMILY Temp: Power'Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit r v'a o u 2 I hereby affirm that I am.exempt from the Contractors License Additional Sign Branch Circuits Law for the following reason (Section 7031.51 Business and a a ? L Professions Code): ' ❑ 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)_ ► _ [4 ' 7.044, Business and Professions Code). — CONSTRUCTION LENDING AGENCY I hereby affirm.that•there is a constructionlending 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 J 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 the above-mention .property for inspection:purposes. SEE.REVERSE.FOR EXPLANATORY LANGUAGE ignatu o r ittee Date • WORKER'S COMPENSATION DECLARATION 76A883 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT ' I hereby affirm that I have a certificate of consent to self Insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.,C.) Policy No. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE ADDRESS' © �0iqe $ $ LOCALITY Certified copy is filed with the county building Inspection 1 &2-Family,Sq.Ft. NEAREST department. Multi-family Sq.Ft. CROSS S Date Applicant Residential Swimming Pools MAP SSOOk PAGE.WZ PARCEL bit CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. LigO owNER OR. ht Sw. IRM NAME t/ COMPENSATION INSURANCE First 20 eiwj MAIL l� (This section need not be-completed If the work Involved by the Total Ne Additional ' O ADDRESS ` permit is for one hundred dollars($100)or less.) XT_ I certify that in the performance of the work for which this permit CITY Tel.No. is issued, I shall not.employ any person int)Lmaor so as to PLAN CHECK become subject to the Workers'CompensatioLighting Fixtures First 20 APPLICANT Total No.� Additional ADDRESS Date - •Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If., after making this Certificate of 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 forthwitli comply with such PERMIT p y Power Apparatus&Large Appliances APPLICANT provisions or this permit shall be deemed revoked. 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 Professions Code,and my license is in full force.and effect.. Over 10 to 50 Incl.. _ LICENSE OR 1' Class.. Over 50 to-100 Incl. REG.NUMBERBER i� 0 License Number ✓ '� — 1 LIC.Class _ Over 100 DISTRICT NO. p PD BY ROCE EU Services wlsd-M6C.&Pane s ` �J Contractor ,t ate 399'Amp.'Und (® DATE Q O El I am exempt under S 400-1000 Amp.Under 800 V. 3`2 l VALIDATION W Over 1000 Amp.or Over 000 V ' FINAL /� )y BRANCH CIRCUIT FEES, B.&P.C.for this reason BY Z Date :15A,or 20 120V,Lighting or Recept. _ 1 To 10 Branch Circuits. Signature 11 To 40 Branch Circuits 41 Or More.Branch Circuits ❑ Exemption for Reg.Maint.Elect. 15A,20A,20 VV To 277V Lighting Br.Circuits 2 s SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER.BUILDER DECLARATION ACCTe4 I hereby affirm that I am exempt from the Contractor's License Law Sign with One Brants Circuit _ t[i� ❑ for the following reason(Section 703'1..5,•Business and Professions Additional Sign Branch Circuits ,31307 19 a 7.3 Code): ' r, El 1,as owner of the property,will do the work and the structure Misc.Conduits&Conductors i ITEM;3 is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) TOTAL -199-95 and.Professions Code). CHECK ��// y p 4i7G�r4 1�T a 95 CONSTRUCTION LENDING AGENCY � CHANGE a� I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is'issued(Sec. 3097, PERMIT FEE (Sub-Total) a Civ.C.) PLAN CHECKING FEE _ j�QG — i 1./ 9!93,1 Lender's.Name PERMIT ISSUING FEE 914 A11��� Lender's`Address TOTAL FEE aI certify that I have.read this.application and under penalty of purjury state that the above information is correct: I agree to comply with all County ordinances and State laws regulating Electrical wiring,and hereby authorise representatives of this County to enter upon the above-mentioned property for 1%,Iion.Irpos s. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGN URE OF PERMrrrEE. DATE I�'