HomeMy Public PortalAbout6257 ROSEMEAD BLVD_Electrical__ jay � �p n 2- (��
'_ WORKERS'KERS' COMPENSATION DECLARATION CE-806 10/81 APPA C /rA MN FOR ELECTI ICAL� PLSRUI7
- I's re,5y a nrm that I have a certificate of consent to self CE-8066 L� tT'A 1I't; IS
insL,6e,Ior a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec 3800, Lab C )
Policy No Company FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS
1 & 2-Famil S Ft $ — $ LOCALITY
Certified copy is filed with the county building inspec- Y, 9
tion department Multi-family Sq' Ft — NEAREST
y CROSS ST
Residential Swimming Pools
WNER OR
Date Applicant FOIRM NAME /
CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL
COMPENSATION INSURANCE Outlets Rec Light Sw_ ADDRESS
First 20
(This section'need not be completed'if the work involved by Total No Additional CITY Tel No 6
the permit is for one hundred dollars($100)or less.)
I'certify that in the performance of the'work for which this PLAN CHECK
. permit is ued;I shall not employ any person in anAPPLICANT
y manner _ '
so as to a orae subjgct'to-the Wo{kers'Compens6tion Laws Lighting Fixtures First 20 ADDRESS
j�
Total No All
Additional
Dat / Z51"•&G�Pcv lica � CITY Tel No
PPFixed Appliances Not Over 1 HIP PERMIT
NOTI T APPLICANT -If,/after making this Certificate of APPLICANT
Exempti , you should become subject to the Workers' Range_ Heater_D W
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' Hood•_ Fan _OtherCITY Tel No
_
LICENSED CONTRACTORS,DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Air Cond REG NUMBER Class }
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO PRO=111Y le As 8 Lararatugppiances0-
and Professions Code,and my I•icensefis in full force and effect Power AppO
Size &Type HP, KW, KVA, or KVAR 7 0
License Number Lic Class- Up to 1 Incl FINAL
Contractor Date Over 1 to 10 Incl DATE �� VALID IOM
Over 10 To 50 Incl ,
I am exempt under Sec Over 50 to 100 Inc BYAL
13-
Over 100 N•
B 8P C for this reason` Z
Date Services, Swbd , MCC-8 Ponelboards
0 -200Amp Under 600V
Signature 201 - 1000 Amp Under 600 V
Over 1000 Amp or Over 600 V
Exemption for Reg Maint Eject
SINGLE FAMILY Temp Power Pole&Appurtenances 23 1 Q 8 A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # o o o a o 2
j hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuitso•0 2 J�
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 o 0 02 5 cj 0 v*
structure is not,intended or offered for sale (Section Other (See Complete Fee Schedule)_ ( Q O9 $57044, 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 PERMIT FEE (Sub-Total)
(Sec 3097, Civ C)
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE 19
U
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 jaws regulating Electrical wiring, and
hereby uthorize representatives of this County to enter upon
the a ve-mentioned
property inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
�.✓
Signa/ re of Permittee / Date
COUNTY OF LOS ANGELES' 'APPLICATION FOR PERMIT
DEPARTMENT OF COUNTY ENGINEER
DMSION OF BUILDING & SAFETY
WILLIAM J. FOB, COUNTY,ENGINEER
FOR PLI ANT TO FI L IN DISTRICT NO. GROUP ZONE PERMIT NO.,-
ELECTRICIA
ADDRESS RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
CITY TEL' NO.
COUNTY LICENSE N , EXPIRES BUILDING
PERM FEES FEE ADDRESS
rr+c�
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES CROSS 6T
WALL SWITCHES OWNER
TOTAL OUTLETS Sc $
MAIL '
ELEC. RANGES 25 ADDRESS '
ELEC. HEATERS 25
FIXTURES 5 CITY TEL. NO.
MISC. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE IS_CORRECT
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 HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEW MVD. HP OVER INC. EACH 'OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE
I/x a LESS $ .25 OF
OF ('
I/z ' 2 .50 PERMITT
2 S 1 00
5 15 1.50 INSPECTION RECORD
`
15 50 2.50
50 1 200 5.00
200 500 10.00 J
500 1000 15.00 Z
OVER 1000 20.00
M.G. SET/FREQ. CHANGER-HP `
WELDERS: AC-KVA O
GENERATORS -KW
TRANSFORMERS-KVA
TEMP. MOTORS (75% OF oats.)
MOVED MOTORS (75% OF ORIG.)
MISC.
SIGNS
N0. NO. TRANS.
NO. NO. LAMPS LS
APPROVA
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 01-0 CONDUIT / /i 11�. „ A
FIXTURES $1.00 WIRING S
SUPPLEMENTARY •50 FIXTURES /f
9q POWER
TOTAL FEE $ ® h
UTILITY CO. NOTIFIED _�-',,,,ov
FINALC-
76A 663 ObS#1 8A.,4-51 �/
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0801220023
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0468 EXT
LEGAL ID FEES PAID • BUILDING ADDRESS 1
ITR 5904 LT- 86 UN 002 1 6257 ROSEMEAD BL 1
I IFEE DESCRIPTION QUANTITY DOM AMOUNT I TEMP CA 917801543
ASSESSOR INFORMATION NUMBER- I� NEAREST CROSS STREET LONGDEN
15384-003-022 Al1PERMIT ISSUANCE FEE 27 75 1 THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY, Cl
I ILB 200 AMP PANELS, MCC 1 00 PAN 38 85 1 1
TENANT ILN OTHER PNL 0-399 AMPS 2.00 PAN 77 70 JISSUED ON PROCESSED BY PLAN BY EXPIRES ON.
I I TOTAL FEES 144 30 101/22/08 SR 07/20/08 1
I I
(OWNER TEL NO I IF NAL DATE FINAL BY CODE 1
(SNOW, DARRELL - 1
16257 ROSEMEAD BL I I G j
ITEMP 917801543 r� DIESCRIPTION OF WORK ki
I JUPGRADE ELECTRICAL PANEL 200 AMP AND 2 SUBPANEL 100 AMP
1APPLICANT TEL NO.
IBROWNING (562) 929-7687- 1 1
IP 0 BOX 1972 - ISPECIAL CONDITIONS
IDOWNEY, CA 90241
I
ICONTRACTOR TEL NO: I _ 1APPROVALS DATE INSPECTOR SIGNATURE
IH E BROWNING ELECTRIC - (562) 929-7687- 1 1
IP 0 BOX 1972 LIC NO I ITEMPORARY POWER POLE
IDOWNEY, CA 90241 709373 C10 I II 1 _
I - I 1UNDERGROUND CONDUIT I 1
(ARCHITECT OR ENGINEER TEL NO. I IUFER GROUND
I - 1
LIC- NO i (ROUGH CONDUITIex
1
I
1 IROUGH WIRING 1
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IMAIN WATER LIUE
PLASTIC Y/ MET /N
1 11
1UTILITY COMPANY NOTIFIEDI�
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IREPORT ID. DPR265 ROUTE TO BS0508
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