HomeMy Public PortalAbout4929 PERSIMMON AVE_Electrical__ �"'"ea DBS SA 7-s1 APPLICATION FOR PERMIT
, DPARTMENT OF BUILDING AND SAFETY
/ COUNTY OF LOS ANGELES ELECTRIC 1
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NN�Oj.
ELECTRICIAN Walton J( I #3�'5
Electric
RECM'm
D BY READY FOR DATE ISSUED
ADDRESS 2454 N. Rosmead Blvd., FIRST INSPECTION
CITY El Monte TEL NO. FO 85679
COUNTY LICENSE NO. 1104 EXPIRES pDING
DD
PERMIT FEES
NUMBER EACH FEE LOCALITY Temple City
LIGHT OUTLETS 7 NEAREST
' RECEPTACLES 13 CROSS ST.
WALL SWITCHES 7 OWNER Celeste Const. Co.
TOTAL OUTLETS 27 5D 5 1 MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25 CITY TEL NO.
FIXTURES 7 5 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
• NUMBER OF LIGHT CIRCUITS 1 -j 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 1 AM THE LEGAL OWNER
NEw MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
%2 s LEBB $ .25 SIGNATURE OF
I/2 2 .50 PERMITTEE
2 s 1.90 INSPECTION RECORD
5 75 1.50
15 50 2.50
SO 200 5.00
200 BOO 10.00 -1
500 1000 15.00 Q
Z
OVER .1000 20.00.
M.G. SET/FREQ. CHANGER-HP
WELDERS:AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF amm.)
"MOVED MOTORS (75% OF DRIB.) _
MISC.
SIGNS
NO. NO.TRANS.
NO. NO.LAMPS APPROVALS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
r
WIRING $1.00 1 00 CONDUIT �y
FIXTURES $1.00 1 00 WIRING / 4-
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE $ 3 70 UTILITY CO.NOTIFIED
FINAL
WORKER'S COMPENSATION DECLARATION ;sAS63 DPW c:9., , APPLICATION FOR ELECTRICAL PERMIT
I her6by affirm that I have a certificate of consent to self insure,
or a ce&yiticafe 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 A
NOADDRESS `
Certified copy is hereby furnished. New Residential Bldgs.&Pools . EACH FEE LOCALI �-.
❑
1&2-Family,Sq.Ft. — $ $ `�'Certified copy is filed with the county building inspection — NEAREST
department. Multi-family Sq.Ft. CROSS sT. m
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' �-, O.wNER OR r
COMPENSATION INSURANCE Outlets:Rec. Light Sw. d FIRM NAME
First 20 MAIL
(This section need not be completed if the.work Involved by the Total No.G/►�— Additional 0 ADDRESS
permit Is for one hundred dollars(S100)or less.)
I certify that in the performance of the work for which this permit CITY TA.No.
is Issued. I shall not employ any person In any manner so as to PLAN CHECK
become subject.to the Workers'Compensation Laws. 'Lighting Fixtures. ZI
First 20 APPLICANT
Total No. Additional ADDRESS a
t
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT- If, after making this Certificate of CITY `W G Tel.No. -
Exemption,you should become subject to the Workers'Compensation OTHERAPPLIANCES NOT OVER 3 HP.
rovisions of the Labor Code,you must forthwith comply with such PERMIT
P Y P Y APPLICANT
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances0*60
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,•or KVAR ADDRESS
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 Tel..No.
Professions Code,and my'license is in full force and effect. Over 10 to 50 Incl. }
LICENSE• Class: 11
Over 50 to 100 Incl. REG.NUMBB ER
Over 100 DISTRICT N0. 6PG19SSED BY
/� V
License Number Lic.Class C �
Ice Swbd.,MCC&'Panelboards cc
Contractor Date + ��0-399 Amp.Under 600 V I ' S DA7E V
❑ - 400-1000 Amp.Under 600 V
I am exempt under Sec. VALIDATION W
Over 1000 Amp.or Over 600 V FINAL O.
BAP.C.for this reasonBRANCH CIRCUIT FEES BY Cl)
Date: 15A,or 20A,12OV,Lighting or Recept. Z
. 1 TO 10 Branch Circuits
Signature + -11 To 40 Branch Circuits
41 Or More Branch Circuits
❑ Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits
SINGLE FAMILY Temp..Power Pole.&Appurtenancess
HOME OWNER-BUILDER DECLARATION CC j e
I.hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit
for the following reason (Section 7031.5, Business.and Professions Additional.Sign Branch Circuits 3303105.90
3
code ��03105.90
. I,as owner of the property,will do the work and the structure ;Misc.Conduits&Conductors 1 1TEnS
is not Intended or offered for sale(Section 7044, Business +Other(See Complete Fee Schedule) , TOTAL 1105 x€ 01
and Professions Code). '
CONSTRUCTION LENDING AGENCY CHECK: 105.90
I hereby.affirm that there is a construction lending agency for the CHAKE .00
performance of the work for which this permit.is issued(Sec. 3097, PERMIT FEE (Sub-Total)
Civ:C.)
PLAN CHECKING FEE dO/?,r0,/9
Lender's Name - /-
PERMIT ISSUING FEE' 1045 1 PM 4:51
Lender's Address
I certify that I have read tnis•application and under penalty of pur'ury state TOTAL FEE
that'the above information is correct. l.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!nape on r ose i SEE REVERSE FOR EXPLANATORY LANGUAGE
_!a Z&P
SIGNAT.UR OF PERMIT 'DATE
r
A-
COUNTY OF LOS ANGELES TEMPLE CITY i� 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS L'-
0508 0410060016
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
E D: — ES PA:� -- I;�It:G DDRESS:
TR: 4902 LT: 5 BL: .001 4932 PERSIMMON AV
FEE DESCRIPTION: QUANTITY: UOM: 4MOUNT: TEMP C!! Q17+104114
ASSESSOR INFORM;T'IO td 0B R: NEAREST CROSS STREET: GRAND
8574-024-008 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY
Gl OUTLETS-LGT,SW,RECP 68.00 OUT 103.80
TENANT: G2 LIGHTING FIXTURES 30.00 LGT 52.50 ISSUED 0 : ?kOCE SED BY: PLAN BY: EXPIRES ON:
HA FAU LESS 3EP 1.00 FAU 10.95 10/06/04 JK 04/04/05 _
JA HEAT PUMPS T3-10HP 1.00 HT 19.65
OWNER: TEL. NO: TOTAL FEES 2.14.65 FINAL A E _ FINAL BY: —
CLARK;RUSSELL (626) 401-0603-
4932 PERSIMMON rcd
TEMP 917804114 R ' tuNuF l:5.2K
E CTR AL FOR NEW ADDITION
APPLICANT: TEL. NO.
SAME AS OWNER
SPECIAL CGNOi IONS:
CONTRACTOR: TET.. pn: — APPROVALS — DATE ;9SPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO TEMPORARY POVER POLE
1UNDERGRO.1'.
ARCH C' ACL. U. U!a'i)
"T � —GRs —
'LIC. NO: TROUGH CCfdDUI7
i
I 'MAIN WATER ' :NE i
i PLASTIC .. , ••ir:a; Y/H f
UTILITY COM ANY 1 Oi I ZrO
REPORT ID: DPR265 ROUTE TO: BS0508