HomeMy Public PortalAbout9555 PENTLAND ST_Electrical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1311250014
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
]LEGAL ID: I FEES PAID BUILDING ADDRESS: I
ITR: 14572 IT: 24 ] ] 9555 PENTLAND ST ]
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:] TEMP CA 917803845 ]
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I
8590-007-013 ]Al PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY I
ILA 100 AMP PANELS, MCC 1.00 PAN 38.90 ! 1
TENANT: TOTAL FEES 66.70 ISSUED ON: PROCESSED BY: PLAN BY: 1
11/25/13 SR
1
OWNER: TEL. NO: I (FINAL DAT FINAL BY: CODE:
ICHANG, ANDY -
19555 PENTLAND ST �� ]
ITEMP 917803845 I32EFCRIPTIPN OF RK 1
1 1 i EINSTATE EXISTING ELECTRS METER-
(APPLICANT: TEL. NO:
IMCWONG HOLDING CO 626 57099 -69 1-
1809 S. ATLANTIC BLVD V
CONDITIONS:
#201 MONTEREY PARK, 1 1SPEGTnr•
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ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE ]
IMCWONG HOLDING CO
LIC. NO ]TEMPORARY POWER POLE ] I I
NONE
]UNDERGROUND CONDUIT I I I
I � ]
]ARCHITECT OR ENGINEER: TEL. NO: II 1UFEA GROUND I ]
LIC. NO: II [ROUGH CONDIIIT I
v IROUGH WIRING I 1 ]
� ] I
' I MAIN WATER LINE I I I
I.PLAS"IC TAL Y/N
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II j I 2TY NOTIFIED] ]
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I I I I I
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REPORT ID: DPR265 ROUTE TO: BS0508 I ] ]
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WORKERS'COMPENSATION DECLARATION CEE-BoeG '0'81 APPLICATION FOR ELECTRICAL PERMIT '
I'hereby affirm that I have a certificate of consent to self insure, ,
or a-certificate of Workers' Compensation Insurance;or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.,C,) I
Policy No. Company i FOR APPLICANT TO FILL'IN ; JOB _/_.
Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE #IN
DDRESS u Pel) T
1 &2-Family,Sq:Ft. $ — $ OCALITY
Certified cop is-filed with the -c t building inspection _ EAREST
p
rt
I. Multi-family Sq.Ft. I CROSS ST.'
fX� Residential Swimming Pools OWNER OR
Date �v Applicant' 1 + FIB NAME , S
ERTIFICATE OF EXEMPTION FROM WORKERS' I `� ,MAIL
COMPENSATION INSURANCE Outlets:Rec Light_Sw. 1 ADDRESS
First 20
(This section need not be completed if the work Involved by the I CITY �. Tel.No. .
permit Is for one hundred dollars($100)or less:) y Total No: Additional
.I certify that in the performance:of the work for which this permit 1 PLAN CHECK
I APPLICANT
is issued, I shall riot employ any person in any manner so as to
become subject to the Workers'Compensation Laws., Lighting Fixtures First 20 ADDRESS
Total No. Additional CITY- Tel..No;
Date Applicant Fixed Appliances Not Over 1 HP
NOTICE TO APPLICANT: If, after making this Certificate of PERMIT
E yemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLICP NT e
provisions of.the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS
provisions or this permit shall be deemed revoked.
' Top FAU W.H. _ � ' CITY Tel.No��
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_
',I hereby affirm th..at I am licensed under provisions of 'Chapter 9 Disp, _ Room.Air Cond. _ j LICENSE OR Class IC
(commencing with Section 7000)•of Division'3 of the Business and REG.NUMBER
Professions Code,and my license is in full force and effect. y s DISTRICT Ng— _r PROC ED BY, ,
+ Power.Apparatus&Large Appliances 1 GJ-' /V1 �
�/"'7 ; 1 Size.$Type HP.,KW,KVA,or KVAR. p
License Number—. •/ Lic.Class Up.to 1 Incl: FINAL C3
Over 1 to 10 Incl. DATE C/
i C/ VALIDATION Q
Contractor 1 I Over 10 to 50 Incl. ) FINA �j
0 I am exempt under Sec Over 50 to'100.Inc. BY W '
B.&P.C.for this reason Over 100 ). N
Services,Swbd.,MCC&Panelboards O I , - Z
Date: 0-200 Amp.Under 600 V 81. A
Signature 201 - 1000 Amp.Under 600 V f
ElExemption for Reg:Maint.Elect.' Over 1000 Amp.or Over 600 V # 0 0 0 o 0 2
SINGLE FAMILY Temp.Pow_er Pole&Appurtenances (.
HOME.OWNER-BUILDER''DECL'ARATION 1 o o 2.],
1 hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit 0
for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits
Code): '
❑ 1 0 0 o 2 Z 0 0 5 I,as owner of the property,will do the work and the structure Misc.-Conduits&Conductors• •
is not intended or,offered for sale (Section 7044,-Business I: Other(See Complete Fee Schedule)
and Professions Code). ► �J $.8
CONSTRUCTION LENDING AGENCY i Q 0
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) �•
Civ.C.). ti
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEEID
'
Lender's Address yy�
I certify that I have read this application and state that the above TOTAL FEE �V
information is correct.I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
YSIgnae
r upon the above-meet' ned
sec ur es. SEE REVERSE FOR EXPLANATORY LANGUAGE
turof Permittee Da ( '