HomeMy Public PortalAbout9462 OLIVE ST_Electrical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS' 9701 LAS TUNAS EL 0508 0806300008
BUILDING AND SAFETY / LAND DEVELOPMENT' TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: c I FEES PAID I I BUILDING ADDRESS:
ON FILE9462 OLIVE ST I
IFEE DESCRIPTION: QUANTITY: UOM2 AMOUNT:( TEMP CA 917803130 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: TEMPLE CITY
18590-004-027 IA1 PERMIT ISSUANCE FEE 27.75 I THOMAS. PAGE: 596GRID: J4 LOCALITY: TEMPLE CITY, Cl
I ' IG1 OUTLETS—LGT,SW,RECP 20.00 OUT 39.00 I I
ITENANT: IG2 LIGHTING FIXTURES 6.00 LGT 11.70 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
I TOTAL FEES 78.45 06/30/08 SR 12/27/08
(OWNER: TEL. NO: I IF , • DATE F Y: CODE:
IGONZALEZ„ JOSE/ANA (626) 451-0197— I I (
19462 OLIVE ST I
ITEMP 917803130 I IDESCRIPT,ION OF ;WORK
120 OUTLETS AND 6 LIGHT FIXTURES
(APPLICANT: TEL. NO: I
IHONG (626) 675-6692— 1
11809 MONTEREY ST. I ISPECIAL CONDITIONS:
IALHAMBRA CA 91801 I I I
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I
IHONG A MIU (626) 675-6692— I I
11809 MONTEREY ST. LIC. NO I TEMPORARY POWER POLE I I
IALHAMBRA, CA 91801 755456 B I I ' I I I
(UNDERGROUND CONDUIT I I I
(ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND I I
I - I I
I LIC. NO: I (ROUGH CONDUIT I I I
IROUGH WIRING I
IMAIN WATER LINE
II IPLASTIC YIN METAL Y/N I
(UTILITY COMPANY NOTIFIEDI I I
1 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
IREPORT ID: DPR265 ROUTE TO: BS0508
I I I I
WORKERS'COMPENSATION DECLARATION �?6A663 10/8 — f
hereby affirm that I have a certificate of consent to self ZE-806G APPLICATION FOR ELECTRICAL PERMIT
insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES i BUILDING AND SAFETY
or a certified copy thereof(Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB s
Certified copy is hereby furnished. EACH NO. FEE I ADDRESS
New Residential Bldgs. 8 Pools LOCALITY
F-1Certified copy is filed with the county building inspec- 1 8 2-Family, Sq. Ft. $ — $ l C
tion department. Multi-family Sq. Ft. j NEAREST41
Residential Swimming Pools CROSS ST. d—
Date Applicant FOWNER OR
IRM NAME / O t�
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ I MAIL �y
COMPENSATION INSURANCE ADDRESS /��
(This section need not be completed If the work involved by First 20 ,�
the permit is for one hundred dollars($100)or less.) Total No. Additional CITY ` C` Tel. No.
I certify that in the performance of the work for which this I PLAN CHECK
permit is issued, I shall not employ any person in any manner APPLICANT
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
,�> r " Total No. Additional
Date/0.`,►V� �y�pplican /ir+s CITY Tel. No.
Fixed Appliances Not Over i HR PERMIT
NOTICE TO APPLICANT: If, after making this Certificate air ,.�
Exemption, you should become subject to the Workers' Range_ Heater_D.W. APPLICANT
I Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M. ADDRESS
de
with comply with such provisions or this permit shall be
deemed revoked. Top _ FAU —W.H. — CITY Hood _ Fan _Other_ � 1 � Tel. No --1,7 4!
LICENSED CONTRACTORS DECLARATION
p. _ LICENSE OR
DisRoom Air Cond. I �` Class
I hereby affirm that I am licensed under provisions of Chapter 9 I REG. NUMBER
(commencing with Section 7000)of Division 3 of the Business power Apparatus 8 Large Appliances DISTRICT NO. P
and Professions Code,and my license is in full force and effect.
�fl� G �/� Size 8 Type HP, KW, KVA, or KVAR
License Number Lic. Class Up to 1 Incl. FINAL
DATE -� O
` Over 1 to 10 Incl. VALIDATION
Contracto�y�ff7/.��� �tciC:Ilt�e fC?'"�G'��❑ Over 10 to 50 Incl. INA
FW
I am exempt under Sec. Over 50 to 100 Inc.. BY N
Over 100
8.8P.C. for this reason z
Services, Swbd., MCC 8 Ponelboards a
Date: 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 Temp. Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031:5, Business and
Professions Code):
❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ ,
7044, Business and Professions Code). ;2 5 7 Q 7 A
CONSTRUCTION LENDING AGENCY # o 0 0 0 0 '2
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097,.Civ. C.). 1 - 2550
*,
PLAN CHECKING FEE o .o 0 255053
Lender's Name �
PERMIT ISSUING FEE 1 Q 2 0-8 6
Lender's Address
1 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-mentioned property for inspection purposes. I
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee 0– Date +