HomeMy Public PortalAbout5140 SERENO DR_Electrical__ D 65562
1214 APPLICATION FOR ELECTRIC PERMIT 1
DIVISION OF BUILDING AND SAFETY
DepozHment of Co=tp Engineer
County of Lw Angeles BUILDING O -
WM J FOX COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN, BIP T OF NUILDIMG
FOR APPLICANT TO FILL IN LOCALITY
'PERMIT F� NEAREST l
CROSS ST
NUMBER EACH FEE
LIGHT OUTLETS � OWNER
RECEPTACLES MAIL
ADDRESS
WALL SWITCHES
TOTAL OUTLETS _ Be s CITY TEL NO W Q
ELEC RANGES 25 ELECTRICIAN.
ELEC HEATERS 25 ADDRESS
NW EA TJ
5 c'�J CITY
FIXTURES TEL NO
LICENSE NO
NUMBER OF LIGHT CIRCUITS DISTRICO GRO�p ZdONE {¢ADY FOR INf {tt10N
NUMBOF E U ZON
MOTORS15 1
NUMBER HORSEPOWER FEE I INSPE=ON RWORD
NBW MVD HP OVER INC EACH
25 I
2 5 100 1
5 15 150 __
_ Is 50 250 _
50 200 500
MISc
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT,
WIRING $100
FIXTURES $100
SUPPLEMENTARY 50 _
APPROVALS
TOTAL FEE $ l� �V DATE INSPECTOR S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION [FIXTURES
ONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGWIRING S 0� Sc
ELECTRICAL WIRING
I HEREBY CERTIFY THAT I As PROPERLY REGISTERED AND/OR
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OFM ERCALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVEDESCRIBED RESIDENTIAL P0.0PEflTYGNATURE TILITY CO NOTIFIED910E PERMITTEE INA +J ZO S T
WILLIAM J FOX.COUNTY ENGINEER VALIDATION Z --2-20 ID
5 6S V019 1/
WORKERS COMPENSATIONcerldiDEC consent
78AEea ,ora, APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a cerlrfcate d consent to sell slsure �B080
or a certificate of Workers Compensation Insurance or a certified ` COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec 3800 Lab C) - c//���� c`A
Policy No r Company FOR APPLICANT TO FILL M• JOB
nA
❑ CerUfed copy h hereby furnished n Naw Resdentrel Bldgs 8 Pools EACH NO FEE ����,,�S,,,��,,//��
❑ Certified WPY a filed with the county building Inspection 1 8 2-Family' Sq Ft $ — $ L�^"'drRiE '�N �'SOnifN o{ BQpp)la.f
department Multi-family Sq Ft — NEATESTI CROSS ST H
Date Applcant Residential Swimming Pooh OWNER OR )[. jA,j(
FIRM IAX 11,00111d
CERTIFICATE OF EXEMPTION FROM WORKERSMAIL
T Cutlets Ree—Light — Sw 1
COMPENSATION INSURANCE ADDRESS SRS
(Thin section need not be completed 8 the work involved by the ` First 20
permit Is for one hundred dollars(S 100)a less) Total No Additional r __ CITY _ ,& Tel No
1. t APPLICANT K C �irrc�lA
I certnty that h the t e mploy an d the work for man the permit - '
b issued shall not empty arty person ti any manner so as to • v
become subject to the Workers Compensation Laws Lgharg Fixtures First 20 v � 1• ADDRESS �
Date !�-/ Applicant ow"S ��v(.lr �"/ Total No Additional CITY 'jw 64W<j Tel No ff
NOTICE TO APPLICANT If after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT
Eremphwn you should become subject to the WOrMrs Compensation Range— Heater_OW ^PP-C^NT
provisions of the Labor Code you must forthwith comply with such Oven _•Dryer_ W M ADDRESS --
prowsi0ns or this permd shall be deemed revoked Top _ FAU _ WH
LICENSED CONTRACTORS DECLARATIONCITY 'Tel No
Flood — Fan Other_
1 hereby affirm that I am licensed under(commencing
3 of Business re Chapter 9 Disp Room Air Cond LICENSE OR E.�
(commerp wnDivision3 Of h Section 7000) Of Dthe and REG NUMBER 69 - Class
Professions Code and my license is in full force and effect DISTRICT NO , C SED BY
Power Apparatus 8 Large Appliances
r
Size 8 Type HP KW KVA or KVAR I ...fir O O
License Number 69 3,65 7 Lc Class C-10 _ _ C)
rrpp c` � Up to 1 Incl FINAL �
ConhactorlJT� `I"^`vxC'Date �1'��� Over i to 10 Incl DATE VALIDATION
ElOver 10 to 50 Incl FINAL
I am exempt under Sec Over 50 to 100 Inc BY .1
BAPC for the reason Over 100
ACCT.: z
� a �y3d{�y'!pj��_C y
Signature y D 2201Ove71 ' '00 Amp o�over OOo v 1 ITETIS -65.OV
❑ Exemption for Reg Mam , ,t EIe •
_ TOTAL 65.60
SINGLE FAMILY Temp Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit OECCK - 65'60
1 hereby affirm that I am exempt from the Contractors License Lew L1���1�
for the folbwnrrp reason(Section 7031 5 Business and Professions Additional Sign Branch Grads , CHAHE - .00
Code)
ElI as owner of the property will W time work end the structure -Mist Conclude 8 Conductors
is not intended or offered for sale (Sedan 7044 Business Other($�Complete Fee Schedule) _ 0000-0001 11/14/�
and Professions Cede) - 33p� 1 PM 6:14
CONSTRUCTION LENDING AGENCY -
I hereby affirm that there is a construction lending agency fir the '
Performance of the work for which this permit Ia issued(Sec 3097 _ PERMIT FEE (Sub-Total)
Civ C)
RAN CHECKING FEE
Lenders Name
PERMIT ISSUING FEE
Lenders Address
I cerbty that I have read the application and state that the above TOTAL FEE 6
information is correct I agree to comply with all County ordinances
and State laws regulating Electncel winng and hereby auth onze
representaln'es of this County to enter upon the above-menhoned - - - - -
property for nepection purposes v
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Perruttee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1410020026
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ON FILE _ 1 5140 SERENO DR 1
(FEE DESCRIPTION QUANTITY UQN AMOUNT TEMP CA 91780
ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET
15388-011-008 Al PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID H5 LOCALITY TEMPLE CITY CAI
E1 TEMP SERV POWER POLE 1 00 TMP 43 70
TENANT TOTAL FEES 71 50 ISSUED ON PROCESSED BY PLAN BY
110/02/14 SR
(OWNER TEL NO IFINAL DATE FI�ALCODE
IR L V PROPERTY (626) 731-0619- �� [�/
11129 CALIFORNIA ST V
(SAN GABAIEL CA 91776 CR PTIO OF WORK
I EW
TORARY POWER POLE
IAPPLICANT TEL NO j
IVAN STEVEN (626) 675-7052-
11798 CIGAR TERR (SPECIAL CONDITIONS
WEST COVINA CA 91792 I ,
I
(CONTRACTOR TEL NO (APPROVALS DATE INSPECTOR SIGNATURE
UATKAM CONSTRUCTION INC (626) 675-7052- 1 --
11798 CIGAR TERR LIC NO ITEMPORARY POWER POLE
WEST COVINA CA 91792 859760
UNDERGROUND CONDUIT
(ARCHITECT OR ENGINEER TEL NO J UFER GROUND
I I I
LIC NO IROUGH CONDUIT I I I
ROUGH WIRING
MAIL. WATER LINE
(PLASTIC Y/N METAL Y/N
(UTILITY COMPANY NOTIFIED( I I
I I I
1 1 I I
I
I
I
I I I
1 1
I 1
I 1 1 I I
I 1REPORT IO pPR265 ROUTE TO BS0508
I I I I I