HomeMy Public PortalAbout4950 PERSIMMON AVE_Electrical__ 76A669 CBS SA 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY '
COUNTY OF LOS ANGELES ELECTRIC 1
WILLIAM J. FOX, CHIEF ENGINEER
DISTRICT NO. GROUP ZONE PERMIT N.O.
FOR APfLIC�AN
TO FILL IN
ELECTRICIAN � I � .sr.G' '
RECEIVED BY READY FOR µDATE ISSUED
ADDRESS _ FIRST INSPECTION
CITY TEL.,%=.
COUNTY LICENSE NO. EXPIRES —4 BUILDING �j, ` /A
PERMIT FEES ADDRESS GJ
FEE LOCALITY
NUMBER EACH
LIGHT OUTLETS <7 NEAREST �p
CROSS ST .009i.A ll_FOI_166-.e 0.0
RECEPTACLES
WALL SWITCHES OWNER -+.
TOTAL OUTLETS •. .:Sc 9 MAIL
ELEC. RANGES S5 ADDRESS r
ELEC. HEATERS O' 25 CITY TEL NO.
FIXTURES / 5 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MISC. TT_ APPLICATION AND STATE THAT THE ASOVE 19 CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NIIMSER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
NEW MvD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
I/2 A LE99 9 .25 SIGNATURE OF
I/2 2 .50 PERMITTE
2 B 1.00 INSPECTION RECORD
51S 1 1.50
15r-11300
50 2.50 - –�
SO200 5.00 �7�� /!rJsYari.-, 2�a'oX r-e-3
2005OO 10.00 C.•t� •)�;r: +wwi�'+.ewG 1!�2 r.t r+ a
500 15.00 Z
OVER 7000 20.00 �� r_–d 4ong.
M.D. BET/FREQ. CHANGER-HP ��'
WELDERS.AC-KVA-' �y�'J O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF CRIB-)
MOVED MOTORS (7r.% DF ORIO.)
MISC. Iy �Y� e'Q R2 /NSD e', r&;opvee
SIGNS
NO. NO.TRANS.
APPROVALS
NO. NO.LAMPS
DATE INSPECTORS NAME
FOR EACH PERMITI
WIRING 91.0019
. CONDUIT
FIXTURES $1.00 d
WIRING
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE S UTILITY CO.NOTIFIED
J FINAL I 'r y NN
WORKER'S COMPENSATION DECLARATION 20-0019DPW(12-91)
ereby affirm that I have a certificate.of consent to self insure,
Th
76ABes APPLICATION FOR ELECTRICAL PERMIT J�
or a certificate 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.)
P❑OIiOy N0. Company. FOR APPLICANT TO FILL IN• JOB
ADDRESS•
Certified copy Ishereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY
El1&2-Family,Sq.Ft. _ $ $
Certified copy is filed with the county building inspection NEAREST !� �/�
department. Multi-family Sq.Ft. CROSS ST. Le / A
Date Applicant Residential Swimming Pools ASSESSOR r
MAP BOOK PAG�O Z4 PARpEL ASS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR
COMPENSATION INSURANCE Outlets:Rec. Light First 20� Z70 %6 Q FIRM NAME p
(This section need not be completed if the work involved by their MAIU r
.permit is for one hundred dollars($700)or less.)
Total:No. Additional ADDRESS A v
I certify that in the performance of the work for which this permit CI ` _(L Te.No.f(R
Is issued, I shall not employ any person in any manner so as.toG
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 PLAN CHECK
J p APPLICANT
Total No. Additional
ADDRESS
Data Applicant 'RESIDENTIAL APPLIANCES NOT OVER 3 HP:
NOTICE TO APPLICANT: If., after making this Certificate of CITY Tel.No.
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
piovisions of the Labor Code,you must forthwith comply with such PERMIT
provisions or this permit shall be deemed revoked. ( Power Apparatus&Large Appliances APPLICANT �,� tct .L:rrrj
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS
I 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 Tet.No.
Professions Code,and my license is in full force and effect. Over.10 to-501ncl. }
LICENSE OR class d
Over 50 to 100 Ind. REO.NUMBER
Over 100 DISTRICT NO. PROCESSED BY O
License Number Lie.Class r o U
Services,Swbd.,MCC&Panelboards
Contractor Date 0-399 Amp.Under 600 V DATE 0
❑ I am exempt under Sec. 400-_1 000 Amp.Under 600 V VALIDATION W
Over 1000 Amp.or Over 600 V
FINAL a
B.&P.C.for this FeasonBRANCH CIRCUIT FEES BY / U)
Date: 15A,or 20A,120V,Lighting or Recept. _
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
El
41 Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits .,
SINGLE FAMILY '
Temp.Power Pole&Appurtenances _
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACCT
u�
hereby affirm that I am exempt from the Contractor's License Law
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 3307 48.75
E
P�owner
a
of the property,will do the work and the structure Misc.Conduits&Conductors ER—COR
Is not intended or offered for sale(Section 7044., Business Other..(See Complete Fee Schedule) � ���� —48.75
and Professions Code).
CONSTRUCTION LENDING AGENCY —/�/'. •�
1 hereby affirm that there is a construction lending agency for the f'141 u3
performance of the work for which this permit is issued(Sec. 3097, PERMIT FEE (Sub-Total)
Civ.C.) 3307 72.70
PLAN CHECKING FEE ITEMS
Lender's Name 7 TOTAL 72 m 70
PERMIT ISSUING FEE
tender's Address
TOTAL FEE CHECK 7
I certify that I have read this application and under penalty of purJury state .70
that the above Information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring,and hereby authorize CHANGE ON-1
representatives 0 this County to enter upon the above-mentioned property
or Inspection,(pu o _ SEE REVERSE FOR EXPLANATORY LANGUAGE 0000-0001 12/
9/92
Q�N.TUIEITTEE DATE 6960 1
AM i 0 e 1
I
I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1307100070
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS: I
TR: 4902 IT: 3 BL: E 4950 PERSIMMON AV
I
(FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917804114
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA
18574-024-005 IAl PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY CAI
I ILB 200 AMP PANELS, MCC 1.00 PAN 38.90
TENANT: TOTAL FEES 66.70 JISSUED ON: PROCESSED BY: PLAN BY:
107/10/13 SR
OWNER: TEL. NO: FLm
F HY: CODE:
IZAZUETA THOMAS O (626) 429-2380- �
14950 PERSIMMON AV
TEMP 917804114 DtSCRIPTIOR OF WORK
UPGRADE ELECTRICAL PANEL TO 200 AMP
APPLICANT: TEL. NO: I
SAME AS OWNER -
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: 1APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
ILIC. NO ITEMPORARY POWER POLE I I I
I (UNDERGROUND CONDUIT I I I
(ARCHITECT OR ENGINEER: TEL. NO: I IU EF GROUND I I I
I - I
LIC. NO: IROUGP CONDUIT I I I
(ROUGH WIRING
MAIN WATER LINE
PLASTIC Y/N METAL Y/N I I I
(UTILITY COMPANY NOTIFIE 04I
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`REPORT ID: DPR265 ROUTE TO: BS0508
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