HomeMy Public PortalAbout5033 SANTA ANITA AVE_Electrical__ COUNTY OF IAS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1503100017
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 13363 IT: 15 5033 SANTA ANITA AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803618
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: GRAND
8574-009-016 JAI PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY CAI
ILA 100 AMP PANELS, MCC 1.00 PAN 38.90
TENANT: TOTAL FEES 66.70 ISSUED ON: PROCESSED BY: PLAN BY:
03/10/15 SR
OWNER: TEL. NO: (FINAL DATE / F BY: CODE:
INGUYEN, THOMAS DUNG (626) 922-4909-
15031 SANTA ANITA AVE
TEMPLE CITY CA 91780 JDASCRIPTION OF WORK
INSTALL 100 AMP SERVICE PANEL
APPLICANT: TEL. NO:
LAM, MARTIN (310) 548-6199-
12510 S ALMA STREET i iSPECIAL CONDITIONS:
SAN PEDRO CA 90731
CONTRACTOR: TEL. NO:
APPROVALS DATE INSPECTOR SIGNATURE
TONY ELECTRIC INC (310) 548-6199- 1 ( I
2510 S ALMA STREET LIC. NO ITEMPORARY POWER POLE
SAN PEDRO CA 90731 706957 1
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. NO: JUFER GROUND
LIC. NO: (ROUGH CONDUIT
ROUGH WIRING
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
I I
(REPORT ID: DPR265 ROUTE TO: BS0508
WORKER COMPENSATION DECLARATION YsA883 10/81
AE-806G APPLICATION FOR ELECTRICAL PERMIT
•° I.hereby affirm tHat I have a certificate Of consent to self Aure,
or a' '9 of.Workers'CbmpenalAtion Inswrance:ppla certif]ed•' ;'I u COUNTY OF LOS ANGELES I BUILDING AND SAFETY
copy the)eof'(See.3800,Lab.C.)
POlicy-lo. Company I FOR APPLICANT TO FILL IN JOB -t
ADDRESS_
❑ •Certified copy is hereby furnished. I New Residential Bldgs.&Pools EACH NO. FEE ,
❑ I y &2-Family,.Sq.Ft. $ — $ LQCALITY'� It A
Certified copy Is filed with the county building inspection NEAREST
department. Multi-family Sq.Ft. CROSS ST.
Date Applicant I Residential Swimming Pools OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec—Light—Sw.— MAIL /k
COMPENSATION INSURANCE iFirst ADCITY Tel.No.
,'DRESS (J
QA-
(This section need not be completed if the work involved by the I Total Nb. Additional
�. (
permit is for one hundred dollars($100)or less.) PLAN CHECK
I certify that in the performance of the:work for which this permit APPUCANT B
is issued, I shall not employ any person in any manner so as to. ` ^
become.subject to the Workers'Compensation Laws. i'iLighting Fixtures First 20 ADDRESS [!
! Additional 6
Total No. C1TY i.No.
,Date Applicant fixed Appliances Not Over 1 FiP' PERMIT
NOTICE TO APPLICANTS If, after making this Certificate of APPLICANT
Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. _
provisions of the Labor Code,you must forthwith comply with such. I Oven _ Dryer_ W.M._ ADDRESS
provisions or this permit shallbe deemed'revoked. Top, _ FAU W.H. _ CITY Tei.No.
LICENSED CONTRACTORS DECLARATION Hood _ Fan Other_
I hereby affirm that I am licensed under provisions.of Chapter 9 ILICENSE OR
(commencing with Section 7000)of Division 3 of the Business and l. Disp. — Room Air Cond. REG:NUMBER Class.
Professions Code,and my license is in full force.and effect. I DISTRICT Gt,,, PR ED BY
Power Apparatus&Large.Appliances i
Size&Type HP,KW,KVA,or KVAR i' d
License Number Lic.Class Up to-1 Incl, FI���111AAAL
Over 1 to 10 Incl. DATE 0
Contractor Date I VALIDATION 0 I
Over 10 to 50 Incl. FINA
❑ I am exempt under Sec. Over 50 to 100 Inc. By 1.
B.&P.C.for this reason Over 100 1 N
Services,Swbd.,MCC&Panelboards ® Z
Date: 0-,200 Amp.'Under 600'V r E°
Signature i 201 - 1000 Amp.Under 600 V 11
❑
Over 1000 Amp.or Over'600 V
Exemption for.Reg.Maint.Elect. i
SINGLE FAMILY Temp.Power Pole&Appurtenances 00 ;f'f 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit tl
I hereby affirm that I.am exempt from the Contractor's License Law I I. ACCT &
for the following reason(Section 7031.5,Business and Professions :Additional Sign Branch Circuits A
Code):, ;I I3307 3 3.00
El1,as owner of the property,will do.the work and the structure Misc.Conduits&Conductors � 1 ITEMSis not intended or offered for sale (Section 7044, Business Other'(See Complete Fee Schedule)
and Professions Code). i ® TOTAL ' 33.00 '
CONSTRUCTION LENDING AGENCY i CHECK 33.00
1 hereby affirm that there is a construction lending agency for the
performance ofthe work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total) �' CHAKE ■00.
Civ.C.). '
PLAN CHECKING FEE
Lender's Name 'i 1 0000-11001 5/23/90
PERMIT ISSUING FEE
Lender's Address 0879 1 AM 9°08
I certify that I have.read.this application and state that the above TOTAL.FEEo Q
information is correct.I agree to comply with all County ordinances l I
and State laws regulating Electrical wiring, and hereby authorize
representatives of this County to enter upon the above-mentioned ` I
property for inspection purposes.. j SEE REVERSE FOR EXPLANATORY LANGUAGE
Signaturef of Permitt a Date
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