HomeMy Public PortalAbout4914 PERSIMMON AVE_Electrical__ 76A663 DBS 5A 7-51 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES �� C���C
r� WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT N. GROUP I ZONE PERMIT NO.
ELECTRICIAN Walton isleotriC CO• RECEIVED BY READY FOR DATE ISSUED
ADDRESS 2454 IVs Rosemead Blvd*, FIRST INSPECTION r� - / `�J /
CITY Pjl Monte TEL NO. FO 8556 99 1AIA. 6 sem}
COUNTY LICENSE NO. 1104EXPIRES BUILDING �� �rS'��1✓l0�7
PERMIT FEES ADDRESS
NUMBER EACH FEE LOCALITY Temple City
LIGHT OUTLETS 7 NEAREST
RECEPTACLES 13 CROSS ST.
WALL SWITCHES 7 OWNER Celeste Const. Co.
TOTAL OUTLETS 27 5c S 1 35 MAIL
ELEC. RANGES a5 ADDRESS
ELEC. HEATERS 25 CITY TEL NO.
ry
FIXTURES ` 5 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS 9 D AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWERFEE ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER
New MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
1/2 s LEBB $ .25 SIGNATURE OF
%2 2 .50 PERMITTE
a 5 1.00 INSPECTION RECORD
5 15 1.50
15 5O 2.50
50 200 SAID
200 500 i O.00 J
500 1000 15.00 Z
OVER 1000 20.00 L9
M.G. BET/FREQ. CHANGER-HP rz
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF OR101.)
MOVED MOTORS (75% OF CRIB.)
MISC.
SIGNS
NO. NO.TRANS. I APPROVALS
-
NO. NO.LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 1 OO CONDUIT
FIXTURES $1.00 00
WIRING yj
SUPPLEMENTARY .50 FIXTURES
3 70 POWER r
TOTAL FEE $ UTILITY CO.NOTIFIED (�
FINAL 15 —
k'
W,.
S'COMPENSATION DECLARATION , 20.0019 DPW 3/87 { n jJ �� O\`
that 1••rtiva@ c�•certificate of consent to self 76'0'3 APPUCATO V LI('011e EL TICU ' CALF PERN'Th'ficate of Workers'Com ensation Insurance, cE-eoe�
1Pr-a_.Certified copy Hereof (Sec. 3800, Lob. C.) COUNTY OF LOS.A(11Q'sELIES I ®APV. OF PUBLIC WORKS �y
61l-,policy No." �1! Company. FOR APPLICANT TO FILL IN ADDRESS G� t
❑ [New,, Certified'c'op'y is hereby furnished. I Residential Bldgs. &Pools EACH NO. FEE
$ _ ,LOCALITY
❑Certified copy is,filed with the county building inspec- ' 1 &2-:Family, Sq. Ft. $ NEAREST I e
tion department. Multi-family Sq. Ft.
Residential Swimming-Pools CROSS ST. /.o
Date Applicant ; OWNER M i!
CERTIFICATE OF EXEMPTION FROM WORKERS' �` FMAIL
IRM NAME
COMPENSATION INSURANCE Outlets: Rec Light' Sw.0 0A - I'ADDRESS � C-
(This section need not be completed if the work involved by Total No. �"`� Addii First tional CITY T_el. a
the permit is for one hundred dollars($100)or less.) PLAN CHECK (�
I certify that in the performance of the work for which thisAPPLICANTHE
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers'Compensation Pws. Lighting Fixtures First 20 ADDRESS
Additional
Dote Applicant II Total No. CITY Te
NOTICE TO APPLICANT: If, after m king thi Certifi ate of l Fixed Appliances Not Over 1 HP PERMIT
Exemption, you should become subject to the Workers' I Range— Heater—yy D.W. — APPLICATION.
Compensation provisions of the Labor Code, you must forth- Oven — Dryer -l�--W.M.— ADDRESS
with comply with such provisions or this permit shall be I Top — FAU —W.H. —
deemed revoked. Hood — Fan —Other— CITY Tel No.
LICENSED CONTRACTORS DECLARATION I / LICENSE OR
Disp. — Room Air.Gond. -iL- REG. NUMBER Class.
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business ' Power Apparatus&Large Appliances DISTRICT NOr PROCESSE, Y a
and Professions Code,and my license is in full force and effect. I /)
Size&Type HP, KW, KVA, or KVAR I 0( (J O
License Number Lic. Class Up to 1 Incl. FINAL
Contractor Date Over 1 to 10 Incl. DATE `� VALID ON cc
AtAg O
❑ b Over 10 to 50 Incl. j I U
I am exempt under Sec. Over 50 to 100 Inc. FF LV
B.&P.C. for this reason Over 100
U)
Services, Swbd., MCC& Pa lbP
ds Z
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 I
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits
Professions Code): I ;9Q 3 7,0 A
E] 1, as owner of the property, will do the work and the Misc. Conduits&Conductors
structure is not intended or offered for sale(Section 7044,, Other (See Complete Fee Scheduled D # o o 0 0 0'2
Business and Professions Code).
CONSTRUCTION LENDING AGENCY I ( 6525
I hereby affirm that there is a construction lending agency for 0 0 j
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) ; 0 6rj 2'5=
v
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE 1a05-8 8
I
Lender's Name j PERMIT ISSUING FEE
i
Lender's Address o ��
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 1.
hereby authorize representatives of this County to enter upon
t above-mentioned p operty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE i
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 I' ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0310270003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LE S AI
TR: 4902 LT: 7 BL: E
� 4914 PERSIMMON AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804114
ASSESSOR INFORMATION NUM R: NEAREST CROSS STREET: LOWER AZUSA
8574-024-011 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY
LB 200 AMP PANELS, MCC 1.00 PAN 38.85
TENANT: TOTAL FEES 66.60 ISSUED 0N: PROCESSED Y: PLA XP RES .
10/27/03 JK 04/24/04 .
OWNER: TEL. NO: W_IN_AAJTAMT FI AL BY: CODE:
DIEP KAREN4914 PERSIMMON AV
TEMPLE CITY 91780 N OF WOR
ELECTRICAL PANEL TD 200AMP
APPLICANT: TEL. NO:
THAI T TRAN (626) 215-3919-
2204 CHARLOTTE AVE SPECIAL CONDITIONS:
ROSEMEAD 91770
i
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
U S CONSTRUCTION (626) 215-3919-
2204 CHARLOTTE AVE LIC. NO TEMPORARY POWER POLE
ROSEMEAD CA 91770 661037 C10 }
UNDERGROUND CONDUIT
ARCHITECT OR ENG N ER: TEL. NO: UFER GROUND
LIC. NO: ROUGH CONDUIT
ROUGH-WIRING
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY N TIF rEu
REPORT ID: DPR265 ROUTE TO: RS0508