HomeMy Public PortalAbout5036 1/2 SERENO DR_Electrical__ °B"'
eB ewa APPLICATION FOR ELECTRIC PER IT , I
eDVISION OF BUMDING AND SAFETY O '�
t D,P=tmDnt of Couaty En81nWE
Count Of Los a
AyRes BUILDING
WM -J Fo .COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROS9ST Rosemead Blyd
LIGHT OUTLETS NUMBER EACH FEE
OWNER Boyden
MAIL
RECEPTACLES ADDRESS 8469 Lon den Ave
WALL SWITCH ES
TOTAL OUTLETS PA 5f CITY Temple City TEL NO
ELEC RANGES 25 ELECTRICIAN Sullivan
ELEC HEATERS 25 ADID 484
NW EA CITY a TEL NO T.
FIXTURES 7 D L CE S
NUMBER OF LIGHT CIRCUITS
DISTRICT NO GROUPO READY roE INSIECTION
NUMBER OF RECEPTACLE CIRCUITS 3-
MOTORS MOTORS
NUMBER HORSEPOWER FEE INSPECTION RECORD
N2W NVD HP OVER INC EACH
e LESG f 25
2 50
2 6 1 00
5 16 1 BO
le 50 250
So 200 500
MISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING 100
FIXTURES •1 00
SUPPLEMENTARY 50 APPROVALS
TOTAL FEE 555
DATE INSP CTOR S SIGNATURE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING S b
ELECTRICAL WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTEREDND/0A FIXTURES
LICENSED AS REQUIRED BY LOS ANGEL OUNTY AND S TE OF
CALIFORNIA OR THAT I THE LEG INNER OF T ABOVE POWER
DESCRIBED RESIDENTIA P
SIGNATURE UTILITY CO NOTIFIED Z S`
OF PERMITTEE FINAL
WILLIAM J FOX.COUNTY ENGINEER VALIDATION A C VEIT.CHIEF ELECT INSPECTOR
(G4 8 0 3A APR 5 2 355 in
m
j I WORKERS'COMPENSATIONDECLARATION 8
CE 806G (2 80) APPLICATION FOR ELECTRICAL PERMIT {�
08LJ
1 hereby affirm that 1 have a certificate of convent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure or a certificate of Workers'Compensation Insurance,or
a certiftedicopy thereof(Sec 3800,Lab C)
Policy No company-SX •�D FOR APPLICANT TO FILL IN JOB // \�
New Residential�Blrfgs &Pools EACH NO FEE ADDRESS �!O )oZ �Q S�
❑ Certified copy at hereby furnished 1 &2 Family,Sq Ft $ — S LOCALITY At Cj• r
'Certified co y g p Multi family Sq Ft
department Py at filed with count building inspection Residential Swimming Pools CROSS ST 0$Pi P
Date -3—V ``N Applicant Vim-'*AIA( ���, (Lzr/�r ' MAIL NAME AI
Outlets Rec_Light Sw _ MAIL ' ?/ SF Cyt ,ST
first 20 ADDRESS J(O 7 C/ry
CERTI FiCCOMPENSATION INSURANCE WORKERS r }
Total No Addinanal CITY �A/'4 G! Tel No ;L8
PLAN CHECK d
APPLICANT GV7
(This section need trot be hundred
d tf the work100) involved Lighting Fixtures First 20
by the perms[ at for one husMred do8ars ($100) a len) �' g Additional
ADDRESS �
I certifythat in the Total No
performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No 0
permit at issued I shell not employ any person in any manner PERMIT �7 7� W
ao as to become subject to the Workers' Compensation taws Range_ Heater_D W APPLICANT y, ggeeZ to�
'
,• r Oven _ Dryer_W M _ ADDRESS 2-3.;Z 3 /1/0 U Z
Date Applicant - Top _ FAU _W H ��J
Hood — Fen _Other_ &TY ^l)AI d Ll,(J Tel No S.?Q;;iq?
NOTICE TO APPLICANT If after making that Certificate of Disp _Room Air Cond— L C NSE OR i2� Claes G—/D
Exemption you should become subject to the Workers' REG NUMBER i
Compensation provations of the Labor Code you must forth- Power Apparatus& Large Appliances DISTRICT NO PROCESSE�
with comply with such provisions or this permit shall be
deemed revoked Size&Type HP,KW,KVA or KVA ✓A OO
_ Up to 1 incl
Over 1 to 10 Incl FINAL
LICENSED CONTRACTORS DECLARATION DATE Z�eJ _�J VALIDATION
Otter 10 to 50 Incl J �C• Q
I hereby affirm that 1 am licensed under provations of Chapter Over 50 to 100 Inc FINAL I "
9 (commencing with Section 7000) of Division 3 of the Bust Over 100 BY �r P!�`_•—`J. '
nm and Professions Code, and my license is in full force and
effect Services
License Num
3 r2 3 A 3 C �/� 0.200 Amp Under 600 V S e/v 1 f e, Nom• -#t 6 3��
Number
/Lic Class 201-1000 Amp Under 800 V
Contractor GANk *N Date 3— 9— l Over 1000 Amp or Over 800 V
t_ '
HOME OWNER BUILDER DECLARATION ' Temp Power Pole&Appurtenances
- - i
I hereby affirm that 1 am exempt from the Contractor's Sign with One Branch Circuit --
License Law for the following reason (Section 7031 5, Bust + Additional Sign Branch Circuits it - )
ness and Professions Code)
Mis❑ 1 as owner of the property will do the work and the Other
Conduits&Conductors
Other (SSeeee Complete Fare Schedule)—
structure at not intended or offered for Bale (Section _ •
7044, Business and Professions Code)
CONSTRUCTION LENDING AGENCY i
1 hereby affirm that there is a construction lending agency '
for the performance of the work for which this permit is PERMIT FEE (Sub Total)
issued(Sec 3097 civ C> - 2431.8A
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
# eeeee '2
Lender s Address PERMIT ISSUING FEE Oo
2 • • 1950
I certify that 1 have read this application and state that the TOTAL FEE t
above information is correct 1 agree to comply with all County • • • 19 rJ 055
ordinances and State lases regulating Electrical wiring and
hereby authorize representatives of this County to enter upon 0 31091-81
the above ention P proparty orinspection purposes 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 0912160012
BUILDING AND SAFETY / LAND DEVELOPMENT _ TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ON FILE 5036 1/2 SERENO DR
IFEE DESCRIPTION QUANTITY DOM jamAMOUNT TEMP CA 917803037
(ASSESSOR INFORMATION NUMBER -
NEAREST CROSS STREET
5388-012-029 Al PERMIT ISSUANCE F8£ 27 75 j THOMAS PAGE 596 GRID H5 LOCALITY TEMPLE CITY C
M AC UNITS a3-10HP, 1 00 AC 19 65 1
TENANT TOTAL FEES 47 40 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON 1
- - (12/16/09 SR 12/16/10
OWNERTEL NO FINAL DATE FINAL BY CODE
IPLATON .YUAN (626) 451-0309- '` n15036 1/2 SERENO DR ay�ty
I TEMP 917903037 OF WORK
1 DESCRIPTION 1
DISCONNECT BOX FOR HVAC INSTALLATION 1
APPLICANT TEL NO
IYENULONIS (909) 213-1640-
2574 BRYCE COURT SPE=IAL CONDITIONS
COLTOH, CA 92324 i
� 1 1
CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE
ALLIED PLOMESNG HEATING AND AIR (719) 998-4300-
422 JENKS CIRCLE LIC NO TEMPORARY POWER POLE
KORONA CA 92880 ' 610780 C20 ii
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER TEL NO JUFER GROUND
LIC NO ROUGH CONDUIT �� 1
ROD WIRING
MAIN FATER LINE
- IPLASTIC Y/N MAL Y/N
" 1 JUTILITY COMPANY NOTIFIED(
I I
1 I
I
- IREPORT ID DPR265 ROUTE TO BS0508
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