HomeMy Public PortalAbout5421 PERSIMMON AVE_Electrical__ I
WORKERS'COMPENSATION DECLARATION 20M19 DPW 3/87
41, I -1 a Fby affirm that I have a certificate of consent to,self 76 APPLICATION FOR ELECTRICAL PERMIT ;
insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or a certified thereof(Sec. 3800, Lab. C.) I {�
`Policy NoIaLZ✓�—L Company �5TAT'E 60M FOR APPLICANT TO FILL IN JOB
❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESSZ✓1
Certified co is filed with the count buildin ins ec- 1 &2-Famil S Ft. $ — $ LOCALITY e- CI
Py y g P y� q NEAREST
tion department. Multi-family Sq. Ft. "—
S'7A A pplicant /��Ster s Residential Swimming Pools CROSS ST.
Date OWNER OR
f I FIRM NAME U' S U w1
CERTIFICATE OF EXEMPTION FROM WORKERS' j Outlets: Rec�Light�SA— I AMAIL
DDRESS >OI
COMPENSATION INSURANCE �//nn First 20
(This section need not be completed if the workinvolved by Total No.� Additional. CITY Tel. No.
the permit Is for one hundred dollars($100)or less.) PLAN CHECK
I certify that in the performance of the work for which this APPLICANT
permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS
so as to become subject to the Workers'Compensation Laws. g g
Additional
Total No. CITY Tel. No. ,
Date Applicant Fixed Appliances Not Over 1 HP PERMIT –J
NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION ,j P.i ewIGGGS
Exemption, you should become subject to the Workers' Range— Heater—D.W. — I
Compensation provisions of the Labor Code, you must forth= Oven — Dryer —W.M.— ADDRESS
with comply with such provisions or this permit shall be Top — FAU W.H. —
deemed revoked. I Hood — Fan Other— d CITY �(��- r✓oy�✓1Ar Tel. 60
LICENSED CONTRACTORS DECLARATION 3 ! LICENSE OR pp��cy
Disp. _ Room Air Cond. REG. NUMBER 1593 / 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 NO. /� PRO ED BY a
and Professions Code,and my license is in full force and effect. Size&Type HP, KW, KVA, or KVAR (/U
License Number �}�5g3 / Lic. Class Up to 1 Incl. FINAL U
,,,,� / Over 1 to 10 Incl. DATE _Z t�� VALIDATION
Contractor'^/mo w' Date - L 7'9/❑ Over 10 to 50 Incl. U FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY W
B.&P.C. for this reason I Over 100 I Il
Date:
Services, Swbd., MCC&Panelboards ' Z
� —
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 <-1
Tem Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION p' < =
i Sign with One Branch Circuit -
I hereby affirm that I am exempt from the Contractor's License 2 7600
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits -�=
Professions Code): HE-Cl"',
❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors
structure is not intended or.offered for sale(Section 70;44, Other(See Complete Fee Schedule)— .0
Business and Professions Code). ® .,_,_. --. �-
CONSTRUCTION LENDING AGENCY �`
I hereby affirm that there is a construction lending agency for f : ':=�+�
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.). TOTAL 76 - 00
PLAN CHECKING FEEf,
Lender's Name �y'�ECS
PERMIT ISSUING FEE 13 ;r;HANGw
Lender's Address
I certify that I have read this application and state that the I TOTAL FEE
above information is correct. I agree to comply with all County -?
ordinances and State laws regulating Electrical wiring, and :;l][(}
hereby authorize representatives of this County to enter upon - I �.� o-:-
the above-me Toned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE j At
®s
ignature of Permittee V AV Date
• I
1eAe63CE.e0elVFe"8 APPLICATION OR 'ELECT AL PERMIT
COUNTY OF LOS ANGELES BUILDING AN SAFETY
FOR APPLICANT TO FILL IN JOB I+
New Residential Bldgs.&Pools EACH NO. FEE ADDR
1 &2.Family,Sq.Ft. $ — $
LOCALITY .,
Multifamily Sq.Ft. — NEAREST
CROSS ST.
Residential Swimming Pools OWNER OR
FIRM NAME
Outlets:Rec Light Sw. MAIL
First 20 ADDRESS
Total No. Additional CITY Tel.No.jN18343-12
PLAN CHECK
APPLICANT
Lighting Fixtures First 20 ADDRESS
Total No. Additional CITY Tel.No.
Fixed Appliances Not Over 1 HP PERMIT �.
Range_Heater._D-W._ APPLICANT 011 SYSMA45
Oven—Dryer l M. ADDRESS
ir
Top —FAU —W.H._ CITYIWAtTel.
Hood_Fan —Other Ic LICENSE O
Disp._Room Air Cond. IREG.NUMBER 7Closs.e
I HEREBY ACKMOWLEDGE THAT I HAVE READ THIS APPLICA-
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Size&T e HP,KW,KVA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
YP REGULATING ELECTRICAL WIRING.
Up to 1 Incl. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AICD/OR
Over 1.to 10 Incl. �' LICENSED.AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
Over 10 to 50 Incl. CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE 99
DESCRIBED RESID AL PROPERTY. 0
Over 50 to-100 Inc. PERMITEE
Over 100 SIGNATURE
IA
Services 7 DISTRICT NO. PROC ED B
0-200 Amp.Under 600 V U
y.
201-1000 Amp. Under 600 V
Over 1000 Amp.or Over 600 V e/
"r0
Temp.Power Pole&Appurtenances �0 OG fc5/S
Sign with One Branch Circuit
Additional Sign Branch Circuits INSPECTION >
INFORMATION
Misc.Conduits&Conductors ON REVERSE s
Other(See Complete Fee Schedule) SIDE u
5 25627A
d
�# oaoao2
PERMIT FSE (Sub-Total) 2 0 o27.00
PLAN CHECKING FEE (One-Fourth Per Feel O o 0 0 2'].
PERMIT ISSUING FEE o
0723-79
TOTAL FEE ev 7• >
INSPECTION FINALED
date//3AB By ®s
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS
EL 0508 1202230009
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID
JTR: 13613 LT: 45 1
1 BUILDING ADDRESS:
5421 PERSIMMON AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802804
ASSESSOR INFORMATION NUMBER: I INEAREST CROSS STREET:
8573-003-020 JAI PERMIT ISSUANCE FEE 27.80 1 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY, Cl
JG1 OUTLETS-LGT,SW,RECP 6.00 OUT 12.00
TENANT: JG2 LIGHTING FIXTURES 2.00 LGT 4.00 ISSUED ON: PROCESSED BY: PLAN BY:
TOTAL FEES 43.80 102/23/12 SR
OWNER: TEL. NO: IFINAL nj&E FIN • Y:, CODE:
SUM PAUL;PAULINE C (626) 215-2456- 15 ,
5421 PERSIMMON AV I ;
TEMP 917802804 1 DES TION&OF WORK
ELE ECAL FOR ALUM PATIO COVER 6 OUTLETS AND 2 LIGHT
F
APPLICANT: TEL. NO:
MORTON, EVONNE (714) 288-1314-
131621 PEPPERTREE ISPECIAL CONDITIONS:
(SAN JUAN CAPISTRANO
CONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE
ALL PRO REMODELING (714) 288-1314-
1706 N TUSTIN AVENUE LIC. NO ITEMPORARY POWER POLE
ORANGE, CA 92867 574698-B
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. NO: JUFER GROUND
LIC. NO: i ROUGH CONDUIT
TROUGH WIRING
(MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
I
J* ADDITIONAL DATA ON FILE
REPORT ID: DPR265 ROUTE TO: BS0508