HomeMy Public PortalAbout4917 ROBINHOOD AVE_Electrical__ 'S
76A68 CESp9-I,-.,APPLICATION FOR ELECTRIC PERMIT 1.
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEEII FkDDRESSING ..
BUILDING AND SAFETY DIVISION
C"
A.LADSIB.County 8ng'aaoe:CI TP V.Graff#N.Sup tITY
EST
FOR APPLICANT TO FILL IN CROSS ST.
t PERMIT FEES
ITEM NUMBER EACH FEE OWNER
OUTLET /� MAIL
LIGHTS RECEPT S $ .150 $ (i ADDRESS
LIGHTING FIXTURES 10 LJ CITY r TEL.NO.
ELEC.RANGESCLOS 'n+rjf ELECTRICIAN AA
WATER HEATERS •$(a iJ ,�•d
ADORE S- '
ELEC.SPACE NTRB. DISH I+TTSS J
•""' TEL.
CITY
GARBAGE DISPOSERS AUTO.-
STATE �J
WASHERS STA.COOKING UNITS .28 LICENSE NO. ``
MOTORS: OVER INC. H.P.
D.r7 RI Q, R O READY FOR INBFECTION
.25
2 ', ',,.sa
INSPECTION RECORD
2— s , 1:00
g Is 1.80
Is — s0 9.50
00— 2500 5.00
.SIGNS-' NO.TRANS.
NO.LAMPS _
SERVICE 0=6aOV 1.00
SERVICE OVER 600V 8.00
MISC. "
WIRING PERMIT I.Oa. -
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .SO
TOTAL FEE , .� APPROVALS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIODATE INSPECTOR'S SIGNATURE'
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING . i r'+L I l�Mi ` r•
ELECTRICAL WIRING. . • y WIRING �b I t
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE GAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIA R a I '
SIGNATURE UTILITY CO..NOTIFIED 1 T
OF PERMITTE FIN P
ARTHUR C.VEIT.
VALIDA SUPERVISINGi ELECTRICAL ENGINZER '
CK 'M CASH .
5 5 5 8 O° OCT 7 2 A .�. 5 M .`.
• WORKERS'COMPENSATION DECLARATION 883 tD�et
CEAPPLICATION FOR ELECTRICAL PERMIT
T hereby,,affirm that I have a certificate of consent to self Insure,
CE-806G
or a E'ertificate of Workers'Compensation Insurance, or.a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,1-ab..C.)
Policy No.. Company FOR APPLICANT TO FILL 1N JOB
❑ Certified copy is hereby furnished. EACH ' NO. FEE ADDRESS
New Residential Bldgs.&Pools -
❑ 1 &2-Family,Sq.Ft. $ $ LOCALITY
Certified copy is tiled with the county building inspection NEAREST �
department. Multi-family Sq.Ft.
GROSS 3T. 6 160
Date Applicant Residential Swimming Pools OWNER OR
FIRM NAME ` ' t
CERTIFICATE OF EXEMPTION FROM WORKERS' AIL
COMPENSATION INSURANCE ' Outlets:Rec Light SW. M ILa 14 M,4
yXZQ
ADDRESSfid
'I�Z
(This section need not be completed If the work Involved by the" First 20'
permit is for one hundred dollars($100)or less.) Total•Noe t Additional CITY Tel.No
� .
1 certify that in.the performance of the.work for which this permit PLAN CHECK
is issued, I.shall not employ any person in any manner so as to APPLICANT
•
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20• ADDRESS
t' Additional.
j � � •�. Total No. CITY, I.No,
Date, V" 2—.Applicant Fixed,Appliances Not Over 1 HP
NOTICE,TO APPLICANT:. If , after making this b rtificate of PERMIT
Exemption,you should become.subject to the Workers' mpensation Range_ Heater_ D.W. APPLICANT
provisiohs.of the Labor Code,you must:forthwith com ly with such Oven Dryer_ W.M._ ADDRESS'
provisions'.or,this permit,shall be deemed revoked. Top FAU _ W.H. _ CITY Tel.No,
LICENSED,CONTRACTORS DECLARATION , Hood — Fan _ Other_
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG.NE B
- REG.NUMBER Class.
(commencing with Section 7000)of Division 3 of the Business and
Professions Code,and my license is in full.force and effect. Power Apparatus&Large Appliances DISTRICT NO. P S
,
Size&Type HP,KW,KVA,or KVAR �I Q
License Number Z Lic.Class (➢_ Up.to 1 Incl. FINAL
Over 1 to 10 Incl. DATE ,�
Contractor Date s �(�j �� , VALIDATION
Over 10.to 50 Incl. FINA 7��..�..
❑ I am exempt under Sec. Over 50 to 100 Inc. gY
Over 1 9 $ 6 A W
0.0 •. 0-
B.&P.C.for this reason fn
Services,SWbd.,.MCC&PanelboaMs pool #,o o, o o-0 2 Z .
Date: 0-200 Amp.Under 600 V
Signature 20.1 - 1000 Amp.Under 600 V .1 ° o 1 &0 0
I; Over 1000 Amp.or Over 600.V _
❑ Exemption for Reg.Ma'int.Elect. 0 0 0 1 a d
SINGLE FAMILY Temp.Power Pole&Appurtenances 030,2-88
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 Other(See Complete Fee Schedule)
is not intended or offered for sale (Section 7044, Business ,
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)
'Civ.'C.).
PLAN CHECKING FEE
Lender's.Name
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application andstate that the above TOTAL FEE rQ�
Information is correct.I.agree to comply with all.County ordinances
and State laws regulating Electrical wiring, :and hereby authorize
representatives of. this County to enter upon the above-mentioned
property for inspe,n purp se SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
A
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1208070062
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: 1
ITR: 19043 IT: 6 I 1 4917 ROBINHOOD AV [
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917804031
(ASSESSOR INFORMATION NUMBER: [ I NEAREST CROSS STREET: RYLAND Cl
18585-008-001 Al PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: B5 LOCALITY: TEMPLE CITY,
1JX MOTORS, LT 3 HP 1.00 MOT 15.30 I I
TENANT: T2 NO PERMIT R3 OWN-BLD 166.40 DOL 166.40 [ISSUED ON: PROCESSED BY: PLAN BY:
TOTAL FEES 209.50 108/07/12 SR [
(OWNER: TEL. NO: I IFINAL DATE FI BY: CODE:
[CHEN, IRENE (626) 442-2331- 1 1_
14917 ROBINHOOD AV I Y
ITEMP 917804031 1 J OES IPTION OF WORK [
[INSTALL NEW MOTOR FOR AN ELECTRIC GATE OPENER [
(APPLICANT: TEL. NO: I I I
]SAME AS OWNER
ISPECIAL CONDITIONS: [
1CONTRACTOR: TEL. NO: ] 1APPROVALS DATE INSPECTOR SIGNATURE
ISAME AS OWNER - I I I
[ LIC. NO 1 ITEMPORARY POWER POLE 1-1 ]
I [UNDERGROUND CONDUIT i [ 1
[ARCHITECT OR ENGINEER: TEL. NO: - [ [UFER GROUND I ] I
LIC. NO: [ IROrH CONDIIIT 1 ---a'9 - / 1
1 1 [ROUGH WIRING
[ [MAIN WATER LINE I I I
[ [ [PLASTIC YIN METAL YIN I I I
I 1 [U.TILITY COMPANY NOTIFIEDI I I
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I IREPORT ID: DPR265 ROUTE TO: BS0508 I I [ I
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