HomeMy Public PortalAbout5322-5326-5328-5330 VILLAGE CIRCLE DR_Electrical__ TEMPLE CITY I
78.0863-CE80610/76 APPLICATION FOR ELECTRICAL PERMIT
Cir- Dr-
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY BUILDING AND SAFETY DIVISION ADDRESSBldg. 5 5324,26,28 30 N. Villa e
LOCALITIR#29 -parcel 3 Tmple City
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. AT �1 ��j�
OUTLETS NO. EACH FEE OWNER OR
FIRM NAME NOe1 '�`^'�""do
RECEPT 102 $ $ AMAIL
DDRESS '5302 Baldwin Ave.
LIGHT 66 TOTAL FIRST 20 20 .25 1 00
SWITCH-00 268 OVER 20 CITY le C�, TEL. NO.448-3907
48 '10 3 2 PLAN CHECK
LIGHTINGFIRST 20 .25 APPLICANT
TOTAL
FIXTURES 66 OVER 20 10 ADDRESS
RESIDENTIAL APPLIANCES CITY TEL. NO.
PERMIT
RANGE DRYER_WTR. HTR. APPLICANT IP " McGee
STA. COOK DISP. 4 F.A.U. 4 ADDRESS P.O. BOX 2186
SPACE HTR. AIR COND. CITY Pomona TEL. NO. Id 69A_1921
CLOTHES WASH. 4 DISHWASH4 LICENREG. NUMBER 153378 CLASS. C-10
FAN 14OTHER 4 34 LOD 5 00 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND S.TATE LAWS REGULATING
IND. HEATERS, ETC. HP. KW.KVA. ELECTRICAL WIRING.
SIZE & TYPE OVER TO
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
O - 1 100 LICENSED AS REQUIRED BY LOS ANG ES COUNTY AND STATE OF ?.
CALIFORNIA OR THAI' I AM THE L AL OWNER OF THE ABOVE C3
C 1 - 1O 4 3.00 1E 00 DESCRIBED RESIDE L PROPU cj
PERMITEE v'
10 - SO 5.00 SIGNATURE CD
50 - 100 1MOD pW
DISTRICT NO. SED BY H
100 - 500 15.00 ` a Z
SIGN, GAS=SIGN ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR' GNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE
SERVICE NOTOVER 600 VOLTS OR 200 AMP 3.00 0 UNDERSLAB WORK
SERVICEOVER 600 VOLTS OR 200AMP 10.00 ROUGH CONDUIT
n
TEMP SERVICE,POLE,&APPURTENANCES 5.00 WIRING
TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIED
FINAL 7—/
PERMIT FEE (SUB TOTAL) 147 10 NOTES:
PLAN CHECK FEE
PERMIT ISSUING FEE 3.00 0
TOTAL FEE 151.bu
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK. M.G. CASH
%
8 4 7 n!gOv 17 2 0 1 5 1.6 0 ,&w
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
0
Jl f WORKER'S COMPENSATION DECLARATION ,. 200019 DPW 9/89 APPLICATION F ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure, 76A663
or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELESePT F PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 Lab.C.) f
Policy IVo. Company FOR APPLICANT TO FILL IN q0B cy i f a
❑ Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE _DDRES
❑ 1 &2-Family,Sq.Ft. $ — $
Certified copy is filed with the county building inspection _ NEAREST
department. Multi=family Sq.Ft. CROSS ST. i
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK - _5 1 PAGE601 PARCEL1350
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER OR r 1F 1
Outlets:Rec._Light Sw. FIRM NAME
COMPENSATION INSURANCE I
First io MAIL }\s,
(This section need not be completed If the,work Involved by the Total No. Additional ADDRESS
permit is for one hundred dollars($100)or less.)
I certify that in the performance of the work for which this permit CIYP ) Tel.No:5
is issued, I shall not employ any person In any manner so as to PLAN CHECK
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional ADDRESS
Date Applicant 15 OR 20A,120V BRANCH CIRCUITS
NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No.
Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH
provisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMIT
1
provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH �.
LICENSED CONTRACTORS DECLARATION ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH O
(commencing with Section 7000)of Division 3 of the Business and CITY Tel.No. U
Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR
Power Apparatus&Large Appliances REG.NUMBER Class.
License Number Lic.Class Size&Type HP,KW,KVA,or KVAR DISTRICT NO. p PROC SED BY
Up to 3 Incl. Rd W
Contractor Date Over 3 to 10 Incl. DDATE
Over 10 to 50
❑ I am exempt under Sec. Over 50 to 100 Incl.
147/4 f� VALIDATION Z
FINAL
B.&P.C.for this reason Over 100 BY
Services,Swbd.,MCC&Panelboards
Date: 0-200 Amp.Under 600 V
Signature 201-1000 Amp.Under 600 V
❑ Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V /
SINGLE FAMILY Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION
ith Ci
B
with One Branch rcu
I hereby affirm that I am exempt from the Contractor's License Law Sign w
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits .A..
,Code):
®"'op 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) a7.
C,
and Professions Code).
CONSTRUCTION LENDING AGENCY r.
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 state that the above TOTAL FEE »�
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
propertydor insp2' 13 rposes. , SEE REVERSE FOR EXPLANATORY LANGUAGE
✓ -.J
SIGNA RE OF APPLICANT OR AGENT rDATE1