HomeMy Public PortalAbout5033 WILLMONTE AVE_Electrical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
' DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0305210029
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL 10: FEES I S:
TR: 9481 LT: 20 UN: .002 5033 WILLMONTE AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804047
ASSESSOR0 R: NEAREST CROSS STREET: LOWER AZUSA
8589-023-008 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: 94 LOCALITY: TEMPLE CITY
HA FAU LESS 3HP 1.00 FAU 10.95
JB AC UNITS +3-10HP 1.00 AC 19.65SS .
TOTAL FEES 58.35 05/21/03 JK 11/17/03 .
OWNER: . NO: FINAL DATE FINAL BY: CODE:
MOFFETT MICHAEL P;JUDITH A (626) 444-0709-
5033 WILLMONTE AV 6-V-03 10*---'
TEMP 917804047 R
REPLACE HVAC SYSTEM
PP E 0:
CONNOR A/C 8 HTG (626) 286-3157-
4931 ENCINITA SPECIAL CONDITIONS:
TEMPLE CITY 91780
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
CONNOR A C (626) 286-3157-
4931 N ENCINITA LIC. NO TEMPORARY POWER
TEMPLE CITY, CA 91780 403735 C38
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: L. N R GROUND
LIC. NO: ROUGH CONDUIT
ROUGH WIRING
IN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIED
* ADDITIONAL DATA ON FILE
REPORT ID: DPR265 ROUTE TO: BS0508
i
,4RKER'S COMPENSATION DECLARATION 2D-06 01 DPW(12-91)
1 hereby affirm .eve a certificate of consent to self insure, 7 63 APPLICATION FOR ELECTRICAL PERMIT LLII
or a;gertiti-- 0o,f Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.38!!00 L//ab.CCC.1� J� /�
policy No.0 7`06f1ompany 00& �/ alv" FOR APPLICANT TO FILL IN JOB
NO. EACH FEE ADDRESS
E]
Certified copy is hereby furnished. New Residential Bldgs.&Pools _ $ $ LOCALITY
❑ Certified copy is filed with th my 'ding inspection 1&2-Family,Sq.Ft. _ NEAREST L, }
department. Multi-family Sq.Ft. CROSS ST. p U.4/ Iyy
Date pppl ---Residential Swimming Pools MAP BOOK �a
( p PAGE .PARCELOWN ��O
CERTIFICATE OF EXEMPTION FA M WORKERS' Outlets:Rec.�Light AE Sw,
FIRM NOR
COMPENSATION INSURANCE O '-� FIRM.NAME Q
��//�� First 20 d a v—/ MAIL �7
(This section need not be completed if the work Involved by the ' Total No. _off Additional ADDRESS 7
permit is for one hundred dollars($100)or less.)
I certify that in the performance of the work for which this permit' CITY Lp GjrTel.No.y9 �30
is issued, I shall not employ any person in-any manner so as to PLAN CHECK r
become subject to the Workers'Compensation Laws. Llghting Fixtures First 20 APPLICANT
Total No. Additional,
ADDRESS
Date Applicant I APP INA
"NOT
3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of / CITY Tel.No.
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 APPLICANT
IT
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances
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 CITY Tel.No.
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE oR '7 }
Over 50 to 100 Incl. REG.NUMBER ) ( Class. a
Over 100 DISTRICT NO. P SSED BY 0
License Number
Lie.Class v
Services,Swbd.,MCC&PanelboardsC Q
0-399 Amp.Under 600 V FINAL 0
Contractor Date' DATE
❑ 1 am exemAV pt under Sec. 400-1000 Amp.Under 600 V Z—�-� VALIDATION C.1
Over 1000 Amp.or Over 600 V W
BY AL
B.&P.C.for this reason BRANCH CIRCUIT FEES a
Date: 15A,or 20A,120V,Lighting or Recept. Z
1 To 10 Branch Circuits'
Signature 11 To 40 Branch Circuits
❑ 41 Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits
SINGLE FAMILY Temp.Power Pole&Appurtenances
f HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit { ='
for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits `{ C,fa `
Code):
❑ i y€Li1 -Ye
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) ® -.
TITFAIL.•t'-I•_• ,_4� @ a7
and Professions Code). 63.75
CONSTRUCTION LENDING AGENCY iI'•5 e
I hereby affirm that there is a construction lending agency for the - "r—
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total)
Civ.C.)
PLAN CHECKING FEE ;ij,s_(j—j _jY r/j f Ywr
Lender's Name
PERMIT ISSUING FEE ?}S.5' }jI'(,F;%lej
Lender's Address i
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
ordi es and State laws regulating Electrical wiring,and hereby authorize
epresent 'ves of this Co toe r upon the above-mentioned property
for inspecti. a• SEE REVERSE FOR EXPLANATORY LANGUAGE
I for
his
TE
(
BAHHe-CEBCH f0-H. APPLICATION FOR EL CITRIC PERMIT 1•
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS3-3 =
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN.SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS ST.
ITEM NUMBER 1.EACH FEE OWNER
MAIL
uaItTUTLET3: RECEPT. Sw. $ .f0 ADDRESS
LIGHTING FIXTURES lisp 10 d CITY TEL.NO.
ELEC.RANGES CLO.DRYERS yy--hh .ELECTRICIAN
WATER H'E A TE R 8 .SO 7 V ADDRESS
ELEC.SPACE HTRS. DISHWASHERS
d�e / �1 [y CITY r TEL. NO.
GARBAGE DISPOSERS4 22
AUTO.- ✓ STATE
WASHERS STA.COOKING UNITS .25 ZCENSE NO. b
MOTORS: ovER INC. H.P. DISTRICT NO. I GROUP I ZON PROCESSED BY
0— V2 .2s
1 agg�'/2
V2— 2 .50 INSPECTION RECORD
2— S 1.00
s— Is 1.80
1s— SO 2.50
130—200 5.00 `
SIGNS: NO.TRANS.
NO.LAMPS
SERVICE 0-600V 1.00
^` SERVICE OVER 600V 5.00
MISC.
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00 goo
SUPPLEMENTARY PERMIT s0
TOTAL FEE O.r s
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THI APPLICATION APPROVALS DATE INSPE OR'S SIGNATURE
AND .STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT c I'
ELECTRICAL WIRING. WIRING 7� �� C /- �, F!_•��. _
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PR PERTY. POWER I
SIGNATURE U� .UTILITY CO.NOTIFIED 4 -Al !J
OF PERMITTE
FINAL
I9v ^143DATION SUPERVISING ELECTRICAL.CASH TRICAL ENGINEER
CK
U.1aO 7 5 6 N 6 2D 15.0 5 t.
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