HomeMy Public PortalAbout6129 RENO AVE_Electrical__ 76A663
'WORKERS' I have a cerci DECLARATION CE-8(M 10/81 APPLICATION FOR ELECTRICAL PERMIT
G' CE-BO6G
I hereby affirm that I have o certificate of consent to self
insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof(Sec. 3800, lob. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB / D
Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE
ADDRESS
❑ Certified copy is filed with the county building inspec- 1 8 2-Famil S y, q. Ft. $ LOCALITY
— $ / . r
tion deportment. Multi-family Sq. Ft. — NEAREST
CROSS ST.
Residential Swimming Pools
Date Applicant WNER OR
FFIIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' s: MAIL
OutletRec g
Liht S _
COMPENSATION INSURANCE w. ADDRESS
(This section need not be completed if the work involved by First 20
the pormit Is for one hundred dollars($100)or less.) Total INO. Additional CITY Tel. No.
I certify that in the performance of the work for which this PLAN CHECK
APPLICANT
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers'Compens n Laws. Lighting Fixtures First 20 ADDRESS
'-0 6J` Z4 Total No. Additional
Date pplicant CITY Tel. No.
NOTICE TO APPLICANT: If, after ma ing his Certificate of Fixed Appliances Not Over 1 HP PERMIT
Exemption, you should become subject to the Workers' Range_ Heater_D.W. APPLICANT
Compensation provisions of the Labor C.
you must forth- Oven —Dryer —W.M.— ADDRESS
with comply with such provisions or this permit shall be Top _ FAU —W.H. —
deemed revoked. CITY Tel. No.
LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_
Disp. Room Air Cond. LICENSE 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 power Apparatus 8 Large Appliances DISTRICT NO. PRO D Y a
and Professions Code,and my license is in full force and effect. f 0
Size 8 Type HP, KW, KVA, or KVAR
License Number Lic.Class Up to 1 Incl. FINAL (>:
Over 1 to 10 Incl. Q V IDATION 1—
DATE 0
Contractor Date Over 10 to 50 Incl. FINAL W
❑ I am exempt under Sec. Over 50 to 100 Inc. BY Q„
100 N
B.BP.C. for this reason Over -9332- 1 R �
Date: Services, Swbd., MCC 8 Ponelboards
0 -200 Amp. Under 600 V P01111, # 0 0 0 0 0 2
Signature 201 - 1000 Amp. Under 600 V❑ o o (a 2 j Over 1000 Amp, or Over 600 V
Exemption for Reg. Maint. Elect. 0 0 0 2(�2 5._`SINGLE FAMILY Temp. Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I L129-85
I 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
Proessions Code):
I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors
structure is not intended or offered for sale (Section Other (See CoTplete Fee Schedule)_ Poo7044, Business and Professions Code). Adm
1-5
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
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 i
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the above-mentioned ro erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Si nature of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0710250006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 5904 IT: 47 UN: .002 6129 RENO AV
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917801533
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
15384-002-022 IA1 PERMIT ISSUANCE FEE 27.75 1 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl
IG1 OUTLETS-LGT,SW,RECP 2.00 OUT 3.90 1
ITENANT: ILA 100 AMP PANELS, MCC 1.00 PAN 38.85 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
TOTAL FEES 70.50 10/25/07 SR 04/22/08
(OWNER: TEL. NO: I IS DAT F BY: CODE: 1
IKESSLER CHARLEEN J;PHILLIP J16129
AV
TEMP 9917801533 I I IPTIO OF WORK
NEW ELECTRICAL SERVICE 100 AMP AND 2 OUTLETS
[APPLICANT: TEL. NO: I I I
IMULTER ELECTRIC (957) 360-3429- [ I I
111098 VENTURA DR. [ ISPECIAL CONDITIONS: [
IMIRA LOMA, CA 91752 [ [ I
(CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE 1
IMULTER ELECTRIC (909) 360-3424- 1 1 I
111098 VENTURE DRIVE #D LIC. NO 1 [TEMPORARY POWER POLE I I I
IMIRA LOMA, CA 91752 296043 C10 I I I I
UNDERGROUND CONDUIT I I [
(ARCHITECT OR ENGINEER: TEL. NO: 1 JUFER GROUND I I I
1 LIC. NO: 1 ]ROUGH CONDUIT [ [ [
1 (ROUGH WIRING [
[ I 1MAIN WATER LINE [ 1
PLASTIC YIN METAL YIN I 1 1
1 ] ]UTILITY COMPANY NOTIFIED[
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IREPORT ID: DPR265 ROUTE TO: BS0508 1 ] I I