HomeMy Public PortalAbout10130 OLIVE ST_Electrical__ %•9WORKERS'COMPENSATION DECLARATION 78-883 10/81 APPLICA ON FOR ELECTRICAL PERMIT
I hereby affirm that 1 have a certificate of consent.to self Insure, CE-8o8G 1
or a certificate of Workers' Compensation Insurance, or a certified # COUNTY OF LOS ANGELES I BUILDING AND SAFETY
copy thereof(Sea 3600,Lab.C.)
Policy No. Company '' FOR APPLICANT TO FILL IN JOB �� ^
❑ Certified copy is hereby furnished.'. i, New Residential Bldgs.&Pools EACH NO. FEE ADDRESS
Ft.
LOCALITY 6 +'
❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq. $ _ $ ,
department. Multi-family Sq.Ft. NEAREST
CROSS ST.
Date Applicant Residential Swimming Pools OWNER OR 7
FIRM NAME C/
CERTIFICATE OF EXEMPTION FROM.WORKERS' e� Light�Sw. MAIL_
COMPENSATION INSURANCE , 'ADDRESS
Outlets:R
(This-section need not be completed If the work involved by the First 20
Total No CITY Tel.No.'
permit is for one hundred dollars($100)or less.) � Additional , ,
I certifythat in the performance of the•work.for which this permit
' PLAN CHECK
P APPLICANT
is issued, I shall not employ any perso..n in any manner so as to' ,
become subject to the Workers'Compensation Laws. -( Lighting.Fixtures• First.20 Q ADDRESS: '
Additional ie
3 ,i Total No. - CITY Tel.'No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT
Exemption,you should become subject'to the Workers'Compensation, ' . Range—'Heater DW
provisions 6f the Labor Code;.you must,forthwith comply with such' Oven, Dryer W.M._i ADDRESS , e
1 1 , /{mss ..%••�� .
provisions.or this permit shall be deemed revoked. Top FAU W.H. - - CITY r. I:,Nb..
LICENSED CONTRACTORS DECLARATION Hood''_. Fan Other_
,LICENSE OR
y .'
I hereby'affirm that.f am Licensed'under proirisions' of Chapter 9 'Disp. Room Air Cond: REG.NUMBER Clas.4•-- 1
(commencing with Section.7000)of Division 3 of the Business and ;
Professions Code,,and my license is,in.'full force and effect. ; Power Apparatus&Large Appliances DISTRICT NO. PROC D BY..
U i, Size&Type HP,KW,KVA,or KVAR. • d Q
License,Number�r 0 7 Lis..Class� �'• Up to 1 Incl. FINN `+
Over 1 to 10 Incl: DATE �..
VALIDATION
ContCLEI f��']Ate J Over 10,to 50 Incl, FINAL t
I am exempt under Sec. Over 50'to`100'Inc. BY '' W
B,BP.C,for this reasoq' Over 100 d� '
r Services;Swbd.,MCC&Panelboards:
0-200 Amp.Under 600 V
Signature 201 -1000 Amp:Under 600 V: ,
i Over 1000 Amp.or Over 600 V
❑ Exemption-for Reg:Maint.Elect. -
SINGLE FAMILY Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ~
I hereby affirm that I am exempt from the ontractor's'License law • I r•�. ,
for the following reason(Section 7031.5,Business and Professions 'Additional Sign Branch Circuits
Code): -
°❑ , Misc.Conduits&Conductors
I,as owner of the property,will'do the'work and the structure Other(See Complete Fee Schedule)
is not intended or offered for sale (Section 7044, Business ( -'
and Professions'Code). {:
7 pop
CONSTRUCTION LENDING AGENCY 4.
ti+ _ ,S.,
I hereby'affirm that there•is a construction lending agencjr for the 01
S
performance of.the Work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total)
I
Civ:C.). ,
.i PLAN QHECKING'FEE•
Lender's Name
PERMIT ISSUIN...G,FEE
Lender's Address , --
I 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
representative f th' County to enter u the above-mentioned J
property p o
SEE REVERSE'FOR EXPLANATORY LANGUAGE
Signatu f Permittee ~Date j '
'BA663CE-86616/78) APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL.IN JOB q a/� /
EACH NO. FEE 9—, O/
New Residential Bldgs. /
H ADDRESS 9 0!&Pools
l e-
1 &2-Family,Sq.Ft. LOCALITY$ .025 — $_ _11114 .e 61
Multi-family Sq,Ft. `02 NEAREST
EAR ST . '
Residential Swimming Pools 25.00 CROSOWNER OR
FIRM NAME Dj 6`d'1/1 C A .
Outlets:Rec Light Sw. ' MAIL ��ryry
First 20 •50 ADDRESS 0 1✓/�
Total No. Additional •50 CITY Tel.No. y[yr-aGb�
PLAN CHECK
APPLICANT
Lighting Fixtures First 20 •50 ADDRESS
Additional .30
Total No: CITY Tel.No.
Fixed Appliances Not Over 1 HP PERMIT. Ay/O�� .4 /`,
Range_Heater_D.W.
APPLICANT �T( I
Oven—Dryer_W.M.— ADDRESS 34 j5 S1 V.Vj - 1,..-
Top _FAU —:W.H. CITYTel,No.
Hood_Fan _Other_ _e X (I
2.50 LICENSE OR Class.
Disp._Room Air Cond. REG.NUMBER
'I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA-
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Size&Type HP,KW,KVA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
2 50 -REGULATING ELECTRICAL WIRING.
Up to 1 Incl. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
Over 1 to 10 Incl.. 5.00 LICENSED AS.REQUIRED BY LOS ANGELES COUNTY AND STATE OF 40
Over 10 to 5.0 Incl. 12.50 CALIFORNIA OR THAT I AM THE LEGAL ER OF THE ABOVE.
25.00 DESCRIBED RESIDENTIAL PROP RTY.
Over 60 to 100 Inc. PERMITEE
Over 1.00 40.00 �J
SIGNATURE.
Services DISTRICT NO.. P D BY,
0-200 Amp.Under 600 V 12.50 �0 0
201-1000 Amp.Under 600 V 25.00 '
Over 1000 Amp.or Over 600 V 50.00 Z
O
'Temp.Power Pole&Appurtenances 10.00 a
Sign with One Branch Circuit 10.00
Additional Sign Branch Circuits 2'00 INSPECTION
Misr.Conduits&Conductors
10.00 INFORMATION W
ON REVERSE s
Other ISee'Complete Fee Schedule) ' SIDE g @2360A
d... # o o o 0 0 2
PERMIT FEE (Sub-Totat) 2 - - 24,50
PLAN CHECKING FEE (One-Fourth Permit Feel p o 0 0 2 k 5 0 C5
PERMIT ISSUING FEE $7.00, , 0122-79
TOTAL FEE
INSPECTION FINALEDIL
ode
date: ,� B A
COUNTY'OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1404020014
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAID I BUILDING ADDRESS:
TR: 10558 IT: 23 1 1 10130 OLIVE ST
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT-.1 TEMP CA 917803344
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: BALDWIN
18585-002-013 IA1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY CAI
IF1 120V, 15/20A BR CKTS 16.00 BR 260.30 1 I
ITENANT: ILB 200 AMP PANELS, MCC 1.00 PAN 38.90 ISSUED ON: PROCESSED BY: PLAN BY: ]
ILN OTHER PNL 0-399 AMPS 1.00 PAN 38.90 104/02/14 SR
I TOTAL FEES 365.90 1 I
OWNER: TEL. NO: 0/74-)
F BY: CODE:
1JANKLY JOHN B;ROSA (626) 442-2862- 1
110130 OLIVE ST 1
ITEMP 917803344 1 JDWCRtPfIO4 OF WORK I
I I (UPGRADE 200 AMP SERVICE, S -PANEL 60 AMP ON GARAGE, REWIRE ]
I I IHOUSE, SMOKE ALARMS AND 16 NEW BRANCH CIRCUITS ]
]APPLICANT: TEL. NO: I I
1ALCANTAR, FRANCISCO (818) 631-7767- 1 I
11401 FAIRFIELD ST [ ]SPECIAL CONDITIONS: I
1GLENDALE CA 91201 I I I
[CONTRACTOR: TEL. NO: [ [APPROVALS DATE INSPECTOR SIGNATURE ]
IALCANTAR ELECTRICAL SERVICES (818) 631-7767- I 1 ]
11401 FAIRFIELD STREET LIC. NO I TEMPORARY POWER POLE I I I
GLENDALE CA 91201 874055 1 1 I I I
I (UNDERGROUND CONDUIT I I I
(ARCHITECT OR ENGINEER: TEL. NO: 1 1UFER GROUND I I I
] LIC. NO: I IROUGH CONDUIT I I [
L �
TROUGH WIRING r I
I I IMAIN WATER LINE I I
[ I (PLASTIC Y/N METAL Y/N ] I I
I I ]UTILITY COMPANY NOTIFIED I
I I I ] I
I I 1 I 1
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IREPORT ID: DPR265 ROUTE TO: BS0508 1 ] I [