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Home My Public Portal About5105 SERENO DR_Electrical__ '°"5 SA'a Be APPLICATION FOR ELECTRIC PERMIT I DBA 63 DWMON OF BUILDING AND SAFETY Diportment of County Engimm r Mtl-- IIAN ColintYDiLon1�gsBUILDING am/WM J FOX COUNTY ENGINEER AOORE89 �JCABHATT D GRIFFIN HUF T OF BUH.OZNOLOCALITY /FORAPPLICANT TO FILL INNFAREHr PERMIT FEES CROSS HT /Pe SON ONUMBER EACH FEE /WNER t /AVISLIGHT OUTLETBRECEPTACLES MAILADDRESS WALLSWITCHESCITY TOT LOUTLETS B iELEC RANGES 2B 1 ELECTRICNELEC HEATERS 25 ADDRESS NW EA CITY FIXTURES 6 KENS 5 MR NUMBER OF LIGHT CIRCUITS DISTRICT NO GROUP TONE RUDY FOR INSP[CTION NUMBER OF RECEPTACLE CIRCUITS MOTORS NUMBER HORSEPOWER FEE INSPECTION RECORD N[W YVD HP OVGB INC EACH B LEER i 23 2 BO 2 B 1 00 s is 1 BO is 30 250 BO 200 500 MISC NO SIGNS NO TRANS NO SIGNS NO LAMPS FOR EACH PERMIT WIRING 111 00 FIXTURES $100, SUPPLEMENTARY SO APPROVALS TOTAL FEE S DATE INSPECTOR S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIB A PLICATION CONDUIT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING I HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR FIXTURES I LICENSED AS REO BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR 1 AY THE LE 0 Y F THE/A BOYE POWER DESCRIBED H PROFERTY HIGNATU � TILITY CO NOTIPIED OF PERMI MA I INAL 1 WILLIAM J FOX,COUNTY ENGINEER VALIDATION A.C-VEIT.CHIEF ELECT.INBPEcrOR -,raO 2 4 SIR MV23 2 4.50 m WORKERS COMPENSATION DECLARATIOLJ 76^663 10/81 I hereby affirm that I have a certificate of consent to "If C APPLICATION FOR ELECTRICAL PERMIT insure or a certificate of Workers'Compensation Insurance COUNTY OF LOS ANGELES a BUILDING AND SAFETY or a certified copy thereof (Sec 3800, Lab C ) Policy No Company FOR AMCAW TO FILL tN ^JOB Certified copy is hereby furnished New Residential Bldgs 8 Foals EACH NO FEE ❑ 1 8 2-Family Ft 3 — f LOCALITY tion Certified copy n filed with the county budding mspec• Y of bon department Multi-family Sq Ft — NEARESrCROSS ST a2 e Residential Swimming Pools OWNER OR f� Dote App MPTI FIRM NAME / e/N cd Y CERTIFICATE OF EXEMPTION FROM WORKERS outlets Re c_Light_Sw_ MAIL COMPENSATION INSURANCE ADORE55 O rPA✓D O (This section need not be completed If the work In"I"d by First 20 CIN TG' Tel No� the permit Is for one hundred dollars(111100)or Ins) Total No Additional — certify that in the performance of the work for which RAN CHECKh this APPLICANT permit is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws Lighting fixtures Fast 20 ADDRESS - - 1L / ATotal No Additional Dote fC7�J ppbcan Gtr+ CITY Tel No NOTICE TO APPLICANT If after m mg this er ifimte of Fixed Appliances Not Over 1 HP PERMIT Exemption you should become subject to the Workers Range_ Heater_D W _ APPIICAFfI 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 _WH _ deemed WH — deemed revoked Hood fan OtherCITY Tel No _ _ _ LICENSED CONTRACTORS DECLARATION LICENSE OR I here affirm[hot I am licensed under P Disp _ Room Air Cond Class by provisions of Chapter 9 REG NUMBER (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO PROCE D BY and Professions Code and my license is in full force and effect d Size 8 Type HP, KW, KVA, or KVAR •Q O License Number Uc Clan FINAL N Up to 1 Iral VALIDATION Over I to 10 Incl D'4� — 0r Contractor Dole Over 10 to 50 Incl V ❑ I am exempt under Sec FI P Over 50 to 100 Inc BY —�6 B BP C for this reason Over 100 H Data Services Swbd MCC 6 Panelboards / , - _ r 0 -200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V i ❑ Exemption for Reg Maint Elect Over 1000 Amp or Over 600 V SINGLE FAMILY Temp Power Pole 8 Appurtenances _ HOME OWNER BUILDER DECLARATION Circuit h I hereby affirm that I am exempt from the Contractor's License Additional Sign Sign with One Branch Circuits Law for the following reason (Section 7031 5, Business and - Professions Code) ❑ I as owner of thero rt will do the work and the Misc Conduits B Conductors c p ed y ( Other See Complete Fee Schedule 2 ' 2 5 5 0 structure is not intended or offered for sole Section ( P )— , 7044 Business and Professions Code) • •I. 2 5 5 �v CONSTRUCTION LENDING AGENCY L - I hereby off irm that there is a construction lending agency for b 4'—8(a the performance of the work for which this permit is issued PERMIT FEE (Sub Total) /�• _ (Sac 3097 Civ C ) PLAN CHECKING FEE _ - Lenders Name PERMIT ISSUING FEE Q 51 _ Lender's Address I certify that I have read this application and state that the TOTAL FEE 6 t7 above information is correct I agree to comply with all County ordinances and State jaws regulating Electrical wiring and hereby authorize representatives of this County to enter upon the obove-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE s _ Signa a of Permibeof Permute Dote i , l ` I 1 WORKERS COMPENSATION DECLARATION 76AW ID/Bt APPLICATION FOR ELECTRICAL PERMIT I hereby affirmthatthat I have a certificate of consent to self 8060 insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 3800 Lab C ) Policy Na Company FOR APPLICANT TO FIU IN JOB ADDRESS S Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH FEE �/- 10S 77 A4"O;L0 ❑ Certified copy is filed with the county building mspec 1 8 2 Family Sq Ft 3 — >< LOCALITY L e lion department Multi family Sq Ft — NEAREST CROSS ST Residential Swimming Pools _ Dote Applicant OWNER OR FIRM NAME _ _ CERTIFICATE OF EXEMPTION FROM WORKERS Outlets RecLightSw_S - x MAK COMPENSATION INSURANCE ADDRESS � (This section need not be completed If the work involved by First 20 the permit is for one hundred dollars ($100)or leu ) Total No Additional CIN Tel No a I certify that in PLAN CHECK the performance of the work for which this APPLICANT permit is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation ows ghting Futures First 20 ADDRESS I Total No , Additional CIN el No Date — pphcant xed Appliances Not Over 1 HP PERMITNOTICE T APPLICANT If after moA this Censf of APPLICANT Exemption' 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 _Other_ CIN Tel No _ LICENSED CONTRACTORS DECLARATION LICENSE OR Disp _ Room Air Cond Class (commencing with Section 7000) of Division 3 of the Business power Apparatus 8 Large Appliances DISTRICT NO PROCESSED B a and Professions Code and my license is in full force and effect /� O Size 8 Type HP KW KVA or KVAR �J t � U License Number Lic Class Up to I Incl FINAL / d' Contractor pate Over 1 to 10 Ind DATE ID Over 10 to 50 Incl FINAL W am exempt under Sec Over 50 to 100 Inc By B 8P C for this reasonOver 100 _ Z Dote Services, Swbd , MCC 8 Ponejboards , 0 200 Amp Under 600 V Signature 201 1000 Amp Under 600V ❑ Over I ODO 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 h nc Additional Sign BraCircuits Law for the following reason (Section 7031 5, Business and 5 2 0 4 A Professions Code) 2 I, as owner of the property will do the work and the Misc Conduits 8 Conductors # • is e • e 2 structure is not intended or offered for sole (Section Other (See Complete Fee Schedule)_ , 70" Business and Professions Code) I •�• 2 5 5 0 CONSTRUCTION LENDING AGENCY • • • 2 5 5 0 3 I hereby affirm that there is a construction lending agency far the performance of the work for which this permit is issued PERMIT FEE (Sub Total) 0 a 0 7-8 6 (Sec 3097, Gv C ) PLAN CHECKING FEE ' Lenders Name PERMIT ISSUING FEE Lender s Address I certify that I have read this application and state that the TOTAL FEE above information is correct I agree ci comply with all County ordinances and State laws regulating Electrical wiling and hereby authorize representatives of this County to enter upon the above mentioned r perty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Sign re of Permitte ore • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 (ELECTRICAL-PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9807160004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE (818) 285-0488 EXT LEGAL ID FEES PAID BUILDING-ADDRESS BK: 56 PG 12 PC 33 5105-SERENO DR FEE DESCRIPTION QUANTITY LION AMOUNT TEMP CA 91780 NEAREST CROSS STREET ROSEMEAD 5388-017-014 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE GRID LOCALITY TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 2 00 OUT 3 90 TENANT G2 LIGHTING FIXTURES 4 00 LGT 7 80 ISSUED ON PROCESSED BY PLAN BY EXPRES W TOTAL FEES 39 45 07/16/98 UT 7/16/99 OWNER FINAL DATE FiNALjr%X CODE CHANG,CHARLES (626) 449-3090Al - 5105 SERENO DR { f TEMPLE CITY CA 91780 - _ • ELECTRICAL-FOR-BATH REMODEL_AN CLOSET-5105 SERENO APPLICANT TEL NO SAME AS OWNERCONTRACTOR --m- No - SPECIAL CONDITIONS GE ES COIF APPROVALS DATE INsPnT6FlTM9TaffE-- SAME AS OWNER / V� QTY\ LIC NO TEMPORARY POWER PULE UNDERGROUND MOM— ARCHITECT OR ENGINEER TEL NO UFER GROUND LIC NROUGH CONDUIT O USS l I p p Z if � LG JO`„ OO G�KS PLASTIC Y/N METAL Y/N lit -Tt f Servllce 'Tb"t REPORT ID DPR265 ROUTE TO BS0508