HomeMy Public PortalAbout6037 PRIMROSE AVE_Electrical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1208220015
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
]LEGAL ID: FEES PAID I BUILDING ADDRESS: 1
ITR: 44381 IT: 1 UN: D I 1 6037 PRIMROSE AV
I (FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917802006
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LAS TUNAS 1
15385-007-034 1A1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl
I IG1 OUTLETS-LGT,SW,RECP 1.00 OUT 2..00 1 1
TENANT: I TOTAL FEES 29.80 1 ISSUED ON: PROCESSED BY: PLAN BY:
1 i 08/22/12 SR
IOWNER: TEL N0: i IFINAL DATE FINAL BY: CODE:
IFUNG KAI TAK;STELLA W (626) 823-7505- /�
16037 PRIMROSE AV 1 i `$�[)z:-12 �� I
ITEMP 917802006 I IDESCRIPTION OF WORK w
I 1 (INSTALL (1) ONE WALL OUTLET
(APPLICANT: TEL. NO: 1
IX-TREME BUILDERS INC. (626) 786-2347- 1 I
12509 EUCLID CRESENT ISPECIAL CONDITIONS: 1
IUPLAND, CA 91784
1 I I I
ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE 1
IX-TREME BUILDERS INC. (909) 931-4464-
12509 EUCLID CRESCENT EAST LIC. NO ITEMPORARY POWER POLE I I
UPLAND, CA 91784 627142B 1
I I 1UNDERGROUND CONDUIT I I I
(ARCHITECT OR ENGINEER: TEL. NO: 1 IUFER GROUND I I I
I - I
LIC. NO: i TROUGH CONDUIT I I
IROUGH WIRING
I I (MAIN WATER LINE
1 i (PLASTIC YIN METAL YIN
1 i UTILITY COMPANY NOTIFIED] I
] I I I I ]
I I I ] I I
I ] ] I I
1 I I I + I
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REPORT ID: DPR265 ROUTE TO: BS0508
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;.' viO-m tK'COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT
:I I here affirm ffia't I'have a certificate of consent to self CE-806G �j
insure,'or'a certificate•df'Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY lul
OF a certified copy-thereof(Sec, 3860, Lab. C.)
Policy.No. Company FOR APPLICANT TO FILL IN JOB
ADDRESS H
Certified copy is hereby furnished. EACH NO. EE
New Residential Bldgs... &. oo s
❑ .LOCALITY
Certified copy is filed with.the county building inspec- 1 &2-Family;Sq. FLA&E $ — $ e
tion department. Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools CROSS ST.
Date Applicant OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw. MAIL
COMPENSATION INSURANCE First 20�— ADDRESS ..
(This section need not be completed if the work involved by Total No. Additional CITY
aT.I. No
the permit is for one hundred dollars($I00)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
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Total No. Additional
� CITY Tel. No.
Date. pplicont4� Fixed Appliances Not Over 1 HP PERMIT � a
NOTICE T APPLICA T: If, after making this'Ce711C.
ote of APPLICANT C. li/i a0
Exemption, you should become subject to therkers' Range_ Heater_D.W. —
Compensation provisions of the Labor Code, you must forth- Oven _Dryer _W.M.— ADDRESS L ,P
with comply with such provisions or this permit shall be Top — FAU —W.H. — v
deemed revoked. Hood CITY C� Tel. No.
LICENSED CONTRACTORS DECLARATION _Fan _Other_ l
Disp. _ Room Air Cond. LICENSE M Class.
I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER �•.:�'.
(commencing with Section 7000)of Division 3 of the Business DISTRICT NO PROC BY a
and Professions Code,orid m license is in full force and effect. • 'Power Apparatus&Large Appliances /)
y Size&Type HP, KW, KVA, or KVAR' V V
License Number &'Ali atb I—Lic.Class C -fRFINAL I:
Up to 1. Incl.
.�• Over 1 to 10 Incl. DATE v C)
Contractor. �e f_'C�. Date d Over 10 to 50 Incl. VALID ION W
❑ FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY n,
B.&P.C, for this reason Over 100 &4 Z
Services,Swbd., MCC&Ponelboards
Date: 0 -200 Amp. Under 600 V A 6 6 a 0 A
Signature' 201- 1000 Amp. Under 600 V # o 0 0 0.0 2
Over 1000 Amp. or Over 600 V.
Exemption for Reg. Maint. Elect. ° ° 7 4 6 4
SINGLE FAMILY Temp. Power Pole&Appurtenances .0 -'o 7 4,6 4 C=.3
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit T-87,
1 hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and
Professions Code):
❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction.lending agency for c
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total.)
(Sec. 3097,Civ: C.).
PLAN CHECKING FEE
Lender's Name
'PERMIT ISSUING FEE
Lender's Address
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, anal
hereby authorize representatives of this County to enter upon
the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee' S Date