HomeMy Public PortalAbout5271 1/2-23-23 1/4-23 1/2-25-25 1/2 TEMPLE CITY BLVD_Electrical__ v.�w aXt eA �,ra APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES ELECTRIC 1
WILLIAM J. FOX, CHI[r ENGINEER
FOR APPLICANT TO FILL IN , DISTRICT NO. GROUP I ZONE PERMIT NO.
r369�
ELECTRICIA lgljj ty
R [ o er READY ran DA to
ADDRESS r ro FIRST INSPECTION
CITY T[L NO
DOUPMY LICENSE NO rXPIRKSBUILDING �J/� I
PERMIT PEES ADONE m /
NUMBER OUTLETS EACH F[[ LOCALITY
LIGHT M NEAREST
OROBB ST
RECEPTACLES B
L4 4 FIXTURES s 0 OWNER
WALL SWITCHES S MAIL
[LEO RANGES 13 ADDRESS
ELEO. HEATERS IIS CITY TEL No
MISC 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
NUMBER or CIRCUITS INSTALLEDJ O /♦_a
Tar I `I APPLICATION AND STATE THAT THE ABOVE IB CORRECT
LRECEPTACLES AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
MOTORS AND STATE LAWS REGULATING ELECTRICAL WIRING
NuwrEX HORSEPOWER FEE 1 CERTIFY THAT 1 PO®ESS THE ABOVE VALID LOS
NEw MVa. HP Ova. i No [AOFI ANGELES COUNTY LIQ[NBE, OR I AM THE LEGAL OWNER
Or THE RESIDENTIAL PROPERTY DEBCR [D ABOVE
1 V2 • LEa 13
4 SO BIGNATUR[ Or
1 S 100 PERMITTKN
s is I so INSPECTION RECORD
i s so 4 so
so BOO Goo "6`�
4 z
400 SaG 14DD
BOD 1000 10 DO Cy p p U J
OVER IOM 44OD _
M G BET FR CHANGER-HP �d 4 C
Y�Feq
wcLDenelwo-KVA ¢
GENERATORS - KW O
TRANSrORMERS - KVA
TEMP MOTORS (76 or DK,a) r
MOVED MOTORS (76 or often)
MIs6
SIGNS
TYPE. N4 TRANS
TYPE No LAMPS APPROVALS
FOR EACH PERMIT DAT[ INSPEOTOWS NAM[
WIRING elm lj0 CONDUIT
FIXTURES e/ 00 WIRING
SUPPLEMENTARY 60 FIXTURES
POWER
TOTAL FEE e / t� UTILITYCO NOTI►IED
FINAL /
WORKER'S hveacertificate
COMPENSATION DECLARATION 26G01s DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
]0AfiB3
I hereby affirm that I have a certificate of consent to self Insure,
or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec. 3800 Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
ADDRESS
Certified copy is hereby furnished. New Residential Bidgs.&Pools NO. EACH FEE
❑ _ $ $ LOCALITY
Certified copy is filed with the county building inspection 1 ul i--Family,Sq.Ft.
department. Multi-family Sq.Ft. — �gp�ysT-r,
Residential Swimming Pools ASSESSOR
Date Applicant MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Else.—Light_Sw._ OWNER OR
COMPENSATION INSURANCEFIRM NAME
(This section need not be completed It the work Involved by the First 20 MAIL
Additional ADDRESS
permit Is for one hundred dollars($100)or leas.) Total No. -
I certify that in the performance of the work for which this permit CITY _ TeL No,
is issued, I shall not employ any person in any manner eb as tar PLAN CHECK
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional
ADDRESS
Date - I, L- Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITU T.I.No.
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Cade, you must forthwith comply with such PERMIT
provisions or this permit shall be deemed revoked.
Power Apparatus&Large Appliances APPLICANT /
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS /..
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl. }
(commencing with Section 7000) of Division 3 of the Business and CITU T.I.No. EL
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. - 0
Over 50 to 100 Incl. LICENSE OR s Class.
/r REG.NUMBER i- 0
License Number ^.4- Lie.Class +/'T Over 100 DISTRICT NO. PROCESSED BY W
J
_ Services,Swbd.,MCC&Panelboards lL
C 0-399 Amp.Under 600 V FINAL }
Contractor - Date DATE
LJ I am exempt under Sac - y� 3 9 ~ 400-1000 Amp. Under 600 V
/,- VALIDATION Q
Over 1000 Amp.Or Over 600 V FINAL Cr
B.&P.C.for this reasonBRANCH CIRCUIT FEES By d
Date: r 15A,or 20A,120V,Lighting or Recept.
/� 1 To 10 Branch Circuits W
Signature - it To 40 Branch Circuits H
❑ -" ''r 41 Or More Branch Circuits
Exemption for Reg.Maint."Elect. 16A.20A,20 VV To 277V Lighting Br.Circuits
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 Law
for the fallowing reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits
Cyode):
❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)
and Professions Code).
CONSTRUCTION LENDING AGENCY
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)
Civ.C.)
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and under penalty of purjury state TOTAL FEE
that the above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring,and hereby authorize
representatives of this County to enter upon the above-mentioned property
for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
s,
SIGNATURE OF PERMITTEE DATE
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0904290003
BUILDING AND SAFFTY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ITR 6561 LT 606 ON 0025721 1/2 TEMPLE CITY-BL
FEE DESCRIPTION QUANTITY UOM AMOUNT I TEMP CA 917802510
IASSESSOA INFORMATION NUMBER I NEAREST CR095 STREET LIVE OAR
8587-016-005Al PERMIT ISSUANCE FEE 27 75 1 THOMA9 PAGE 596 ARID J3 LOCALITY TEMPLE CITY Cl
TF1 120V 15/20A BR CM 3 00 BR 51 75 1
TENANT F2 208, 277V LGT BR CKT 2 00 BR 54 60 ISSUED ON PROCESSED BY PIAN BY EXPIRES ON
c G1 OUTLETS-LOT,SW,RECP 4 00 OUT 7 80 04/29/09 SR 10/26/09
IG2 LIGHTING FIXTURES 2 00 LOT 3 90 �p�, �9'f�
OWNER TEL 9- IHS RES AMP MACH LT 3HP 4 00 MAS 43 80 �PV / I I FINAL Y CODE
IPUERTAS ANGELO (626) 319-3406- IIA 100 AMP PANELS, MCC 1 00 PAN 38 85 bi
129 WINNIE F TOTAL FEES 228 45
ARCO 910064672 _ IDESCR IOIlOFWOR— K
INSTALL (1) 100 AMP PANEL 4 OUTLETS FOR LAUNDRY MACHINES,
APPLICANT TEL NO (2) LIGHT FIXTURES
JACK T Y FAN (626) 202-4762-
426 A SOUTH ORANGE ISPECIAL CONDITIONS
MONTEREY PARR 91754
CONTRACTOR TEL NO I IAPPROVAL9 DAM INSPECTOR SIGNATURE
JAGR•$ fiLECTRIC (626) 202-4762-
426 A SOUTH ORANGE AVENUE LIC NO [TEMPORARY POWER POLE
MONTEREY PARR, CA 91754 383529 CIO
UNDERGROUND CONDUIT
I
ARCHITECT OR ENGINEER TEL NO UFER GROUND
LIC NO ROUGH CONDUIT
_ IROUGH WIRING
I MAIN WATER LINE
- i PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED[
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I
I
IRBPORT ID DPR265 ROUTE TO DS0508
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