HomeMy Public PortalAbout4933 RIO HONDO AVE_Electrical__ 76A668 DHH SA 7-57 t APPLICATION FOR PEMMi
DEPARTMENT OFNG AND SAFETY ELECTRIC 1
COUNTY OFF LOS LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRIXW—NO. GROUP ZONE 3PERMIT NO.
ELECTRICIAN flor, C/de .q
vS �j E ED READY FOR DATE ISSUED
ADDRESS y g 6 mow/ .� FIRST INBPECTIDN - �Z-�
TEL.NO a 9 TS n
COUNTY LICENSE NO. EXPIRES -,S 0-1� BUILDING V U a� RI
d �-/®
PERMIT FEES ADDRESS �^ ai 1 L/ /'J �f
FEE LOCALITY / �" JO( e & •��
NUMBER EACH
LIGHT OUTLETS NEAREST
HT. / / I'e
RECEPTACLES rA
WALL SWITCHES OWNER�I 4L cS
TOTAL OUTLETS 5c MAIL Y%�1"(!_)
ELEC. RANGES 85 ADDRESS f% �J 6�
ELEC. HEATERS 25 CITY�&f W P I(.,TEL NO.
FIXTURES 6 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIN
APPLICATION AND STATE THAT THE ABOVE IN CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS i CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWERANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
FEE
NEW Mw. HP OVER INC. EAOH OF THE RESIDENTIAL POPPERTY DESCRIBED ABOVE.
ya A LESS $ .25 �� SIGNATURE OF// //_ -
YX 2 .BD PERMITTER/ I�1 C Ze,7,V, (
a s 1.00 INSPECTION RECORD
s is 1.50
Is 50 2.50
60 200 5.00
200 800 10.00 Q
500 1000 15.00 Z
OVER 1000 20.00
M.G. NET/FREQ. CHANGER-HP E
WELDERS.AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% or oRIB-)
MOVED MOTORS (75% or oRlBa
MING.
SIGNS
NO. NO.TRANS. APPROVALS
N0. NO.LAMPN
FOR EACH PERMIT. DATE INSPECTOR'S NAME
WIRING $1.00 CONDUIT
FIXTURES $1.00 WIRING A�-. °'•C'r�. ! '!� :� aA� ?
i
SUPPLEMENTARY ,50 FIXTURES
5+ POWER /
TOTAL FEE s / UTILITY CO.NOTIFIED
FINALr.� ."9'fCylCJ
'6 M3 CE-B(M f11"8' APPLICATI FOR E_LE CA PERMIT _
!COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN JOB: ,
New Residentiaf Bldgs.&Pools EACH NO. FEE. ADdRESS Y.
1 &2-Family,•Sq.Ft.- $ .025 — $ LOCALITYlle I C• ' d
Multi-family Sq.Ft: .02 — NEAREST
25.00 CROSS ST.
Residential Swimming Pools • OWNER OR
FIRM NAME ) 44 e r r'
Outlets:Rec Light'' $w.' MAIC.
First 20 .50 •ADDRESS
Total No: Additional .30 CITY ,� �.�� .•� Tel...No
PLAN CHECK
APPLICANT
Lighting Fixtures First 20 ,50 ADDRESS
Additional ..30
Total No. CITY Tel..No..
Fixed Appliances Not Over.1 HR ' PER
APPLICANT
Range_Heater D,W._ ADDRESS
Oven_Dryer=W.*M.-- ,
Top _FAU —W.N._ CITY Tel..No:
Hood_�Fan _Other_ „ LICENSE OR
Disp._Room Air Cond. 2.50 ; REG.NUMBER - Class.
I HEREBY ACKNOWLEDGE THAT f HAVE READ THIS APPLICA-
Power Apparatus&Large Appliontes TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
COMPLY WITH-ALL COUNTY 'ORDINANCES AND STATE.-LAWS
Size&Type HP,.KW,KVA,or WAR REGULATING:ELECTRICAL WIRING.
Up to 1 Iricl. 2.50 1.HEREBY CERTI FY THAT'I AM PROPERLY REGISTERED AND/OR- U
Over 1 to 10 Incl. 5.00 LICENSED AS.REQUIRED,BY LOS ANGELES COUNTY AND STATE OF.
Over 10 to•50.Incl. 12.50 CALIFORNIA OR THAT 1•AM.,THE LEGAL OWN€R OF THEABOVE :,
Over 50 to 100 Inc.
25.00 DESCRIBED RESIDENTIAL PROPERTY:• iedy��9 Over 1 QOPERMITEE:
'` 40.00 &Im
-
s, SIGNATURE
Services DISTRICT NO-.-. P ED Y 11
0-200 Amp.Under 600 V 2.50 r
201•-1000Amp. Under 6099 25.00
Over•1000 Amp.or Over 600 V 50::00- Z
C
Temp,Power Pole.&Appurtenances 10.00 .
Sign with One Branch Circuit' " 10.00
Additional Sign Branch Circuit's 2,00•, INSPECTION > 3d9 �'�'
t.Q oo INFORMATION W g o.o Q'Q 4 2
Misc.Conduits.&Conductors ON REVERSE x '
Other(See Complete Fee Schedule! SIDEZ o Q 19,50
,
0 Q 0 19,5 Q a
60,
PERMIT FEE (Sub•Tofal). 625-8
1
PLAN CHECKING FEE. (One-Fourth Permit Feel O
PERMIT ISSUING FEE $7..00
TOTAL FEE >
'INSPECTION FINALED
6
dote: � ,.•./ � �. W B.y (((����e: as
76/.•.663 DBS SA I1-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY =
COUNTY OF LOS ANGELES F L FQC`T RI C
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
ELECTRICIAN P 'wRECEIVED BY READY FOR DATE ISSUED
ADDRESSFIRST INSPECTION
M �� Y'b. tj��✓
CITY JQ ri� ��Q /��j TEL.NO. jQ G�ff?I !
COUNTY LICENSE NO. P EXPIRES /9-250- s?V BUILDING
ADDRESS
PERMIT FEES - r
NUMBER EACH FEE LOCALITY /.e'E'V� y
LIGHT OUTLETS I NEAREST ` Pei r l� /�
RECEPTACLES CROSS 9T. e/ �+ /
WALL SWITCHES yf' OWNER Df? f W 1 %— /4 J i' Q W
TOTAL OUTLETS Sc MAIL
ELEC. RANGES S5 ADDRESH PSS�,7 /� fp l� r/��`' /o (j0J /
ELEC. HEATERS 25 CITY/ P�j++.� Ple r, tp TEL. NO.,• "79/2'
FIXTURES � 5 —�
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. o APPLICATION AND STATE THAT THE ABOVE 18 CORRECT
NUMBER OF LIGHT CIRCUITS 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 HORSEPOWERANGELES COUNTY LICENSEr OR I AM THE LEGAL OWNER
FEE OF THE RESIDENTIAL PROPERTY ESCRIBED ABOVE.
NEW MVD. HP OVER INC. EACH
%s b LESS 111 .25 SIGNATURE OF�j
Y2 2 .50
PERMITTEc �'r Y �.obf
l
2 5 1.00 INSPECTION RECORD
5 15 1.50
15 50 2.50
5O 200 5.00
200 500 10.00 „j
SOO 1000 15.00 Z
OVER IOOO 20.00 L7
M.G. BET/FREQ. CHANGER-HP
WELDERS'AC-KVA O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF ORIO.)
MOVED MOTORS (75% OF ORIS.)
MISC.
SIGNS
NO. NO.TRANS.
APPROVALS
NO. NO.LAMPS
FOR EACH PERMIT' DATE INSPECTORPS NAME
WIRING $1,00 (f Q CONDUIT
FIXTURES $1.00 (,� WIRING
SUPPLEMENTARY .50 FIXTURES
�,ry POWER
TOTAL FEE B L' UTILITY CO.NOTIFIED X l4f� ,/•.w3 rti- 5AI �Ly=-
FINAL
Wim a 'COMPENSATION DECLARATION 76-8 ,D,at APPLICATION FOR ELECTRICAL PERMIT {�
I.J
I hereby affirm
I
m that have a certificate of consent to self insure, CE-80606G
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.) D I� _
Policy No.'S 0 Company 66 g-e ')N FOR APPLICANT TO FILL IN JOB
Certified co is hereby furnished. EACH NO. FEE ADDRESS .1=3 o Q .c 0
PY Y New Residential Bldgs.&Pools
Certified copy is filed with the county budding inspection 1 & 2-Family,Sq.Ft. $ — $ NEARESLOCALIT
I 7
department. ��-r I Multi-family Sq.Ft. — NEAREST -•r
Date Applicant', �+f/`r�`� °�'�GI • Residential Swimming Pools CROSS ST /
ORM N OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Ree—Light —Sw.— MAIL
COMPENSATION INSURANCE ADDRESS �"3 / IDN (�
(This section need not be completed if the work Involved by the First 20
permit is for one hundred dollars($100)or less.) Total No. Additional CITY , Tel.
I certify that in the performance of the work for which this permit PLAN CHECK
APPLICANT
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 Applicant Fixed Appliances Not Over 1 HP PERMIT �1 i
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT T� uC l 1 /U�%r
Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. _ , L
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS,/,/j ff, O 0-r!�/JL,
provisions or this permit shall be deemed revoked. Top — FAU _ W.H.
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ CITY )VO A) () 1/p 4 Tel
I hereby affirm that I am licensed under provisions of Chapter 9LICENSE el
n
(commencing with Section 7000)of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Q d � _ Class.a-/
Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. �f P CES D BY
Size&Type HP,KW,KVA,or KVAR �_f v
License Number Q ? Lic.Class Up to 1 Incl. FINAL
C�l
Over 1 to 10 Incl. DATE
Contractor���7✓�a�l/GL� Data �� VALIDATION
Over 10 to 50 Incl. FINAL 0
❑ I am exempt under Sec. Over 50 to 100 Inc. BY i W
BAP.C.for this reason Over 100
Services,S3>Qd.,MCC&Panelboards / N
Date: 0- O Amp.Under 600 V r 0 ���� i ) Z
Signature 201 - 1000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole& Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law additional Sign Branch Circuits
for the following reason(Section 7031.5,Business and Professions
Code): _
Misc.Conduits&Conductors
❑ I,as owner of the property,will do the work and the structure Fee Schedule)See Complete r
is not intended or offered for sale (Section 7044, Business Other( p
and Professions Code). ,
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(Sec.3097, PERMIT FEE (Sub-Total) 0 -:.I - 010,
Civ.C.).
PLAN CHECKING FEE tj•: 31.}�
Lender's Name r
PERMIT ISSUING FEE �/,j vf.i-l>�I��E ei�l_
Lender's Address
I certify that I have read this application and state that the above TOTAL FEE 00
information is correct.I agree to comply with all County ordinances 9/ 5/7:
and State laws regulating Electrical wiring, and hereby authorize
representatives of this County to enter upon the above-mentioned 2-7r-5
Property for inspection urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0704030003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I
ITR: 16475 IT: 153 [ I 4933 RIO HONDO AV [
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917803741
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LOWER AZUSA
18590-028-017 JAI PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY, Cl
I JHA FAD LESS 3HP 1.00 FAD 10.95 I J
TENANT: IJB AC UNITS +3-10HP 1.00 AC 19.65 JISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
TOTAL FEES 58.35 104/03/07 JK 09/30/07
I J I I
I OWNER: TEL. 1 1 FINAL' q FI CODE:
1CLINTON, RICHARD (626) 451-1-5961- I I s ��I JJJ 1
14933 RIO HONDO AV I I 1
ITEMP 917803741 1 IDESCRIPTION OF WORK 1
I I (ELECTRICAL FOR HVAC SYSTEM 1
(APPLICANT: TEL. NO: I I I
ISAME AS OWNER -
I I ISPECIAL CONDITIONS: J
I J I
ICONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE J
ISAME AS OWNER - I I I
I LIC. NO I ITEMPORARY POWER POLE I I
I I JUNDERGROUND CONDUIT I I I
JARCHITECT OR ENGINEER: TEL. NO: 1 IUFEk GROUND I J
1 LIC. NO: 1 IROUGH CONDUIT I I I
(ROUGH WIRING I I I
(MAIN WATER LINE J I I
I J [PLASTIC YIN METAL YIN I I
I [UTILITY COMPANY NOTIFIED[ I I
I I I I I I
I I I I I I
J I I J I I
J I I I I I
I [ I I J I
I I I I I I
I IREPORT ID: DPR265 ROUTE TO: BS0508 [ [ [ J
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