HomeMy Public PortalAbout4343 TEMPLE CITY BLVD_Electrical__ " °63a-w°"' APPLICATIO FOR ELEC ICA_L-PERIb11T'
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN JOB
ADDRESS4.3 --
New Residential Bldg`s &Pools EACH NO FEE- '-
1 8 2 Family Sq Ft E 025 - E LOCALITY r
Multi family So Ft 02 - - NEAREST
Resldennal Swimming Pools2500 ROSS ST ;2 427Z uSA-
_ WN R R
�
FIRM NAM �-b
Outlets Rec_Llght j_VSw _ _ MAIL
Int 20 50 '- ADDRESS
Total No Additional 30 CITY _ _ _ Tel No--.-, -
PLAN CH KK
. _ APPLICANT - --
Lighting Fixtures First 20 50 ADDRESS �^
4 Total No 4 Additional' 30 �5 � "
CITY Tel No
Fixed Appliances Not Over I HP . _ - PERMIT -- -
APPLICANT - - -�
Range—Heater_D W ADDRESS
Oven - Dryer_W M — _ -Ck,
Top _FAU _ WH _ _ CITY _
HTel N � �
ood_Fan- _Other_ LICENSE OR �q
Disp �Room Air Cond 250 _ REG NUMBER 2 10 a CIMS L'! Q_ ___
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Size HP KW KVA or KVAR ` COMPLY WITH ALL COUNTY ORDINANCES-AND STATE LAWS
2 50 'Z REGULATING ELECTRICAL WIRING
Up to 1 Ind I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANDYOR 'Y
^Over 1 to 10 Mcl 5 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF y
Over 10 to 50 Incl 1250 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE 0
25 00 DESCRIBED REST L PROPERTY
Over 50 to 100 Inc PERMIT EE_
Over 100 40 00 - - -
SIGNATURE N
Services - - - - 1 - DISTRICT NO —�- - P ED BY"' —'-"- _
0 200 Amp Under 600 V 1250 S a
201 1000 Amp Under 600 V' 2500Over 1000 Amp or Over 600 V 5000 -
Temp Power Pole&Appurtenances 1000-.
Sign with One Branch Circuit 1000 , t
Additional Sign Branch Circuits 2 00 - INSPECTION
0 00 ' INFORMATION
Misc Conduits&Conductors ON REVERSE x 9 3 6 4 A.
Other(See Complete Fee Schedule)_ SIDE u
z # . . . . . 2
t
2 - 22600
PERMIT FEE ISub T6tal1 -- e _ _ ^� •.� 2 260 0 5 '
PLAN CHECKING FEE (One Founh Permn�Fee)
PERMIT ISSUING FEE
$700 jo
TOTALFEE /�oZ�p/U >
INSPECTION FINALED '
date 60*�P O BY � IIICCC ®s
6 r
WORKERSIhaveCOMPENSATION DECLARATION Ca 8MG 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm That I have a certdicate d consent to sell insure,
or a certificate of Vvorkem Canpensahon Insurance or a cernf COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof Sec 3 00 Lab C)
Pool No Company FOR APPLICANT To FILL IN JOB
Certified copy at hereby furmshed New Residential Bldgs 8 Pools EACH NO FEE ADDRESS '
❑ Cerofied copy a filed with the county buildag P t & 2-FamIH Sq Ft $ — S MEN ITY �(
department Muih-family Sq Ft
Date
�/� pp Residential Sw mming PodR O
Pools W R
L ¢�Applicant
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS Outlota Rec— Light Sw MNL
COMPENSATION INSURANCE ADDRESS
(This t for not be completed rt the work Involved 20 ad by the Total No Additional
CITY Tel No
Is for
permit la ons,
hundred dollars (S 100)or less)
I cerbly that m the performance of the work for which this permit PIAN CRECK
•is issued I shall rot employ any person in
any manner Bo as to
became subject to the Workers Compensation Laws• Lighting Fixtures First 20 ADDRESS
• AdditionalTotal No - CITY Tel
Date Applicant Fixed Appliances Not Ovar 1 HP PERM
y msu
NOTICE TAPPLICANT It, after making this Co of
IT
Exemption you should becoe bject to the Workers Compensation Range— Heater_•DW APPUC_,'M
or
Provisions of tha Labor Code you must forWwth comply with such Oven _ Dryer — W M _ ADDRESS - -
Provisions or this permit shall be deemed revoked v Top -— FAU _ WH
LICENSED CONTRACTORS DECLARATION Hood — Fan Other—
hereby
Tel No
_
I hereby eNum that I em licensetl under prowspns of Chapter BLICEN6E OR
(commencM with Section 7000)of Division 3 of the Business and Disp — Room Air Cad REO NUMBER 70 Cjate
Professias Code and my license rs in full face and effect Power Apparatus 8 Large Applunces DISTRICT NO PROC By
Sae 8 Type HP KW KVA a KVAR i
Lrensa Number Lc Class� Up to 1'Incl FINAL 8
Over 1 to 101nc1 DA VAUDATION
Corltracta Date a -� Over 70 to 50 InG O
❑ FINAL U
I am exempt under Sec Ocer 50 to 100 Inc By
BBPC fa this reason Over 100
Services Swbd MCC &Panelboards , 21 264 A Z
Date O- 200 Amp Under 600 V r `^
Signature 201 - 1000 Amp Under 600 V t 1 t,�5 9
❑ Over 1000 Amp or Over 600 V i • • • 14.505
Exemptgn to Reg Maim Elect
SINGLE FAMILY Temp Power Pole 8 Appurtenances 1206,-88
HOME OWNER-BUILDER DECLARATION SW with One Branch Circuit
hereby affirmm that I aexempt from the ContraGaa License Lew '
for the (clawing reason(Section 7031 5 Business and Professions Additional Sign Branch Cncwts _
Cade)
❑ I as owner of the Property will do the work and the structure Mac; Conduits & Conductom
is riot intended or offered for sale (Sedan 7044 Business Other(See Complete Fee Schedule) — pop.
Professions Code)
i CONSTRUCTION LENDING AGENCY
I hereby affirm that there s a construction lending agency for the
performance of the work for which this permit Is issued(Sec 3097 PERMIT FEE, (Sub-Total)
Cry C)
PLAN CHECKING FEE - - -
Lenders Name -
PERMIT ISSUING FEE
Lenders Address
1 certify that I lava mad this application and state that the above _ TOTAL FEE
Information Is correct I agree to comply with all County ordinances '
and Stale laws mpdatDq Electrical wanng and hereby authonze
representatives of this County to enter upon the above-mentioned '
property for nspectaxl purpoys
Joe A /� /� /'
�� SEE REVERSE FOR EXPLANATORY LANGUAGE -
oast/uurre% mutteee/e Date
WORKER S COMPENSATION DECLARATION 20MIO DRV(12 91) )I
I hereby affirm that I have a certificate of consent to self Insure 70AM i APPLICATION FOR ELECTRICAL PERMIT LI
or a certificete of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy therm Sao 00 an
0 LeD C)I �ti , r
Policy No -A 3C'f' Compy bL ? rz.. l e FOR APPLICANT TO RLL IN CESS
❑ Cemfied copy ro hereby furnished 'r Residential ResidentNBldgs &Pods NO EACH FEE
LOCALITY
h Certified copy is filed with the county building Inspection 1&2 Family Sq Ft
— $ $
r department
Muth family Sq Ft — NEAREST
Date &-44T Ap scam C ST
91
N- IieeidenaASSESSOR
swimming Pools OR
MAP BOOK PAGE PARCEL
r CERTIFICATE OF FX N FROM WORKERS OWNER OR
V COMPENSATION INSURANCE Outlets Rec —Light Sw O / FIRM NAPE
20
(This section need not be completed If the work Involved by the FirstTotalpermit le for one hundred dollars(5100)or lava) Total No Additiond
.I certify that in the'Performance of the work for which this permit CITY _ Tr No
is issued I shall not employ any person in any manner so as to PLAN�
become subject to the Workers Compensation Laws � Lphmig Futures First 20 APPLIGINT
Total No Additional ADDRESS
Date• Applicant '
NOTICE'TO APPLICANT If after making^this,Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP Cm, Tel Ns
Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP
provisions of the Labor Code you must forthwith comply with such MR
provisions or this permit shall be deemed revoked Power Apparatus d Large Appliances PUC"x' LICENSED CONTRACTORS DECLARATION Size&Type HP KW KVA or KVAR _ ADDRE
I he'retiyleffirm that I am'licensad under provisions of Chapter 9 Over 3to t0lncl
(commencing with Section 7000) of Division 3 of the Business and CRY — CCA4 TM Na 'y
Professions Code and my license is in full force and effect Over 10 to 501nol a
IENSE OR
Over 50 to 100 Ind REG NUMBER ,J p°A a
6o S9 1 LIC Clear Over 100 DE9rRICT NO SED BV V
License Number p
'Services Swbd MCC&Panelboards cc
Camraclor R-te• 0 399 Amp Under SOO V DF AI O
❑ 1 am"It + 4001000 Amp Under 6DD V �� VALIDATION Q
ampt under SaoOver 1000 Amp or Over 600 nNAL W
B&P C for this reason - a
BRANCH CIRCUIT FEES � Cl)
Date ISA or 20A 120V Ughbng or Recept _ _ Z
- 1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
❑ Exemption Inc _ 41 Or More Branch Circuits
Reg Mann Elect ISA 20A 209V To 277V Br Circuits 2
SINGLE FAMILY Temp Power Pole&Appurtenances y y
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit Fit CT•r
I hereby affirm that I am exempt from the Contractor a License Law �r'l
for the following reason (Section 7031 5 Business and Professions Adtlitional Sign Branch Circuits 3303
Code)
❑ Moc Conduits&Conductors _ 1 ITEMS
1 as owner of the property will do the work and the structure
is not intended or offered for sale(Section 7044 Business Other(See Complete Fee Schedule)_ 90110.
_ TOTAL 44 - 40
antl Professions Coda) CHECK 44.40
CONSTRUCTION LENDING AGENCY �HF ,(I[I
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued(Sec 3097 PERMIT FEE (Sub Total) Q _
Cit C)
PLAN CHECKING FEE _ ONO-UQ01 11/ 8/94
Lender a Name '
PERMIT ISSUING FEE 7620 1 AM 9.Sy
Lender a bty as TOTAL FEE
I certhat
I have read thiseppliceban and under penalty of purjury lusts
that the above information is correct I agree to comply with all County
ordinances and State lawn regulating Electncal wiring and hereby audiorim
representatives of this County to enter upon the abo ae rnentimed property
for inspe purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
-� w� a PERiarrEE DATE
WORKERS CI have COMPENSATIONDECLARATION
of-CION APPLICATION FOR ELECTRICAL PERMIT O
I hereby affirm that I have a certificate of•consent rp self ��
insura,or a certificate of Workers Compensation Insurance, COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS
or a c�erti ed c he eof Se c 336002 Lob C
Party 17a J -00 ' rry 7 �� FOR APPLICANT TO FILL IN JOB 1
C died copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE ADDRESS
Pied
copy is filed with the county building mspec 1 8 2-Family Sq Ft $ — f LOCALITY
honssd/d/pp''pp.a��artment Multi-family Sq Ft — NEAREST
CROSS Date.PL_(� Applicant tF3 /'
, vResidential Swimming PoolsR pR
CERTIFICATE OF EXEMPTION FROM WORKERSMAIL
COMPENSATION INSURANCE Outlets Rac ight_Sw_ D ADDRESS
,✓� First 20
(This section I nod not be red leteddolga If the work Inrolrod 6T Total No JL. Additional CITY Tel No
the permB Is for oo hundred dollen (1100)or Inns )
PLAN CE
I certify that in he 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 Laws Lighting Fixtures First 20 ADDRESS
I Additional
I Dote hcont Total No CITY Tel No
'4F'p
( NOTICE TO APPLICANT If, after making this the We of Fixed Appliances Not Over 1 HP PERMIT
� Exemption you should become subject to the Workers'
._kers' RangeHeoter_D W APPLICATION
Compensation provisions of the Labor Code you must forth Oven — Dryer —W M _ ADDRESS 2 O C"(7-05- 7_
( w th comply with such provisions or this permit shall be To — FAU —W H
t deemed revoked Hood — fon —Other_ CITY 6v4- T 00 3! �, 1 6/9-7
LICENSED COMRADECLARATION Disp _ Room Air Canal LREEG NU%ZR 1� S Class 70
I hereby affirm that I am licensacled un under provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Apphonces DISTRICT NO P a
and Professions Code and my license is in full force cpd effect p
'// r 3 / � .6 to Size 8 Type HP KW KVA, or KVAR ��O O
License Number �tL� V L¢ Clan C� Up to I InclFINAL
��� �' g �3 Over 1 to lO Incl DATE VALIDATION Q
Contractor Date Over 10 to 50 Incl •� a FINAL V
❑ I am exempt under Sec Over 50 to IOD Inc By 0
UJI
B 8P C for this reason Over 100 A
Q.
L Dote Services Swbd , MCC& Ponelboards , 5-(7 -4( Z
0-200 Amp Under 600 V /
Signature 201 1000 Amp Under 600 V
❑ Exemption for Reg Moint Eject Over 1000 Amp or Over 600 V
SINGLE FAMILY
HOME OWNER BUILDER DECLARATION Temp Power Pole 8 Appurtenances
I hereby affirm that I am exempt from the Contractor s License Sign with One Branch Circuit _ �{�:T.i
Low for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits _
Professions Code) 1117 171.SIO
❑ I as owner of theproperty, Mix Conduits 8 Conductors
of will f o the work and the Other See Complete Fee Schedule)--
Business
chedule , 1 1 f E�=�
structure s not intended or offered for sole(Section 7044 ( P '� _ ILII AL 197 - 50
Business and Professions Code)
CONSTRUCTION LENDING AGENCY CHECK - 15'7.5_I
I hereby affirm that there is a construction lending agency for l "6E ,13
the performance of the work for which this permit is issued PERMIT FEE (Sub Total)
(Sec 3097 Civ C )
PLAN CHECKING FEE
lenders Name vDLYI-OIJUI v716/`'1
PERMIT ISSUING FEE A X57,;, 1 AI110:t1
Lender's Address TOTAL FEE p d
I certify that I have rood the application and state that the
above mformalton is correct I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize reprtpentativois of this County to enter upon _
the abov do rope y for ms coo;n urpos
SEE REVERSE FOR EXPLANATORY LANGUAGE
/3 9/ ,
Signature of Pelirmittee 9 Date ®s
WORKER I haveCOMPENSATION e of con RATION 711AM PW(12 81) APPLICATION FOR ELECTRICAL PERMIT IJ ,
I hereby affirm that I have a certificate of consent to sell insure ��
or a;ertdicatecf Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
COPY thereof(Sao 38800 Lab`C)
PON__991 wd Company moi?f � n FOR APPLICANT TO RLL IN AO�RE6S 7
Certified copy is hereby furnished �— NO EACH FEE
,x / New Residemiel Bldgs 8 Pools
_ $ $ LOCALITY
UQ Certified copy Is filed with the county budding Inspection 1 8 2 Family Sq FI
department � Mulo family Sq Ft CRROOSSSBST
4::1S
Date —2� V Applicarit � Residenbel Swimming Poole - ASSESSOR-1
b k1AP BOOK 1 PAGE PAP.CEL
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec —Light Sw IgexENRAI�IE
' COMPENSATION INSURANCE
(This a Uori need not be completed 11 the work Involved by the First 20 MNL
permit Is for one hundred dollars($100)or bee) Total No Additional �'" ADDRESS
I certify that in the performance of the work for which this permit ' CITY TO No
Is Issued I shall not employ any person in any manner so as to PLAN OREC � /
become subject to the Workers Compensation Laws Lighting Fixtures First 20 PLICAM V$ GTS l G
Total No Addrtxmal
ADDRESS
Date Applicant - RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICE TAPPLICANT alter methis Certificate of CITY Lp TeI /bj(�(�
Exempiwyou cu ehouid becomea subject to the
Workers Compensation OTHER APPLIANCES NOT OVER 3 HP
PERMR _
provisions of the permit
Code you deemed
frevokeh comply with such Power Apparatus A Large Appaences APPLK) .0
provisions or this permit shell be deemed revoked
LICENSED CONTRACTORS DECLARATION Size 8 Type HP KW KVA or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9
Over 3 to 10 Incl CITY Tei
P 7—
(commencing scions with Section 7000) of in full f 3 0l the Business and
Professions Code and my license Is m lull force and effect Over 10 to 50 Incl }
CENSE OR
/ ''7 Over 50 to t001nd REO NUMBER �Q -7 a-L -/0 Il
Lnoense Numbar 7 �/�Lic Class ��O - Over 1DO DISTRICT NO 'D P ESSEO B:j
� / 1 Services Swbd MCC d Panelboards _ C T
Conbact.,R sl C 6 Date_AR o y Amp neer V �� >:�U.�ii TTT�T�L--HFI 07.':4
❑ I am exempt under Sec 400 n r 800 V 2 _ VAJ6A TQ 15 W
Over 1000 Amp or Over 800 VTOTAL 303 _ 9!i
B 8P C for this reawn erg
BRANCH CIRCUIT FEES
Date ISA or 20A 120V Lighting a Recept CHECK 105.5"Y
1 To 10 Branch Circuits
Signature 11 To 40 Branch Crouits - - CHANGE .00
❑ Exempoal lar Reg Mamt Elect 15A 20A 200V To 277V Ughti41 Or a Brits
Cue int 7��ITL_T',�
SINGLE FAMILY Temp Pawer Pole 8 Appurtenances 11ILrgO iUUO1 2/24/94
HOME OWNER BUILDER DECLARATION c�gn with One Branch Circuit
YIl i.f r
I hereby affirm that I em exempt from the Contractors License Lew I Ahs
for the following reason (Section 7031 5 Business and Professions Additional SBranch Cts J
Cade) ign ncCircuits
1 ITEN3
❑ I as owner of the property will do the work and the structure Misc Conduits 8 Conductors
Is not intended or offered for sale (Section 7D44 Business Other(Sae Complete Fee Schedule) ® TOTAL 98 - 770
and Professions Code) CHECK 95.711
CONSTRUCTION LENDING AGENCY CHANGE .0I3
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec 3087 PERMIT FEE (Sub Totep /
Civ C)
PLAN CHECKING FEE q
�N pOdD-0001 5/11/9,t
Lender s Name PERMIT ISSUING FEE G 5151 1 AN 2:50
Lender a Address
I cerDty that I hew read this application and under penalty of pugury State TOTAL FEE
that the above information In coned I agree to comply with all County
ordinances and State Laws regulating Efectncal winng and hereby authorize
represernativaa of this Ccunry to enter upon the above-mermoned property
f mSpecb rposes SEE REVERSE FOR EXPLANATORY LANGUAGE
OF PER DATE
COUNTY of LOS ANGELES TEMPLE CITY a 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0710110018
BUILDING AND SAFETY / LAND DEVELOPPIFNT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ON FILE 4343 TEMPLE CITY BL
(FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917804229
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET
8592-004-053 JAI PERMIT ISSUANCE FRE 27 75 THOMAS PAGE 597 GRID AS LOCALITY TEMPLE CITY, C
JK1 SIGNS, OUTLINE LOT 1 00 SIG 38 85
TENANT TOTAL FEES 66 60 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
10/11/07 SR 04/08/08
OWNER TEL NO
Y
HOME BUY _ I FI PI CODE
14343 TEMPLE CITY BL
(TEMPLE CITY CA 91780 IDE IPTION OV FORK
(ELECTRICAL FOR A SIGN
(APPLICANT TEL NO
IJ S H SIGN INC (626) 449-1166-
9441 VALLEY BLVD ISPECIAL CONDITIONS
ROSEMEAD CA 91770
CONTRACTOR TEL NO JAPPROVALS DATE INSPECTOR SIGNATURE
J AND H SIGN (626) 448-1166- I
9441 VALLEY BLVD LIC NO I ITEMPORARY POWER POLE
ROSEMiM, CA 91770 873439 C45
UNDERGROUND CONDUIT
IARCHITECI OR ENGINEER TEL NO UFER GROUND
LIC NO ROUGH CONDUIT
ROUGH WIRING
MAIN WATER LINE
IPLASTIC YIN METAL YIN
(UTILITY COMPANY NOTIFIEDI
I I I I I
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I � - IRRPORT ID DPR265 ROUTE TO BS0505