HomeMy Public PortalAbout9142 WOOLLEY ST_Electrical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1310310015
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS:
ITR: 12115 LT: 15 I 1 9142 WOOLLEY ST
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917801349
(ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 1
15382-023-007 IA1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CAI
I IG1 OUTLETS-LGT,SW,RECP 5.00 OUT 10.00 I I
ITENANT: G2 LIGHTING FIXTURES 4.00 LGT 8.00 (ISSUED ON: PROCESSED BY: PLAN BY: 1
TOTAL FEES 45.80 110/31/13 SR
(OWNER: TEL. NO: I IF DATE F BY: CODE: 1
ILAU, YVONNE (626) 400-0358- 1 1I
19142 WOOLLEY ST I I fff
ITEMP 917801349 ID9SCAIPTI0N OF WORK I
I 15 OUTLETS AND 4 LIGHT FIXTURES 1
1APPLICANT: TEL. N0: 1 1 I
SAME AS OWNER - I ISPECIAL CONDITIONS: I
I I ]APPROVALS DATE INSPECTOR SIGNATURE ]
(CONTRACTOR: TEL. N0: 1 I I
SAME AS OWNER - ]
LIC. NO 1 ITEMPORARY POWER POLE I
I I (UNDERGROUND CONDUIT I I I
(ARCHITECT OR ENGINEER: TEL. NO: ] IUFER GROUND I I I
I LIC. NO: 1 IROUGH CONDUIT I I I
] I (ROUGH WIRING I I I
I I IMAIN WATER LINE I I I
I I IPLASTIC Y/N METAL Y/N I I I
I ] JUTILITY COMPANY NOTIFIEDI I I
I I I I I I
I i I I I I
I I I I I I
I I I I I
I I I I
I I I I I I
I I I 1 I
IREPORT ID: DPR265 ROUTE TO: BS0508 I I I
I I I I I
COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer ELECTRIC 1
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
FOR APPLICANT TO FILL IN DISTRICT NO. GRDLIP ZONE PERMIT NO.
ELECTRICIAN —6-11Mi —z ��_ O
— RECEIVED Y���///!" READY FOR DAT ED
ADDRESS � �� FIRST INSPECTION
f
CITY �%t TEL NO. -,
91
COUNTY LICENSE NO. /J EXPIRES BUILDING ADDRESS
PERMIT FEES
FEE -
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
�.
RECEPTACLES CROBS ST.
WALL SWITCHES OWNER ItI. OS-s
TOTAL OUTLETS SO M MAIL
ELEC. RAN13EB 25 � ADDRESS _Y
ELEC. HEATERS 26 CITY TEL NO.
FIXTURES S
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IB CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER
rNEw MVO. HP OVER I INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
I/2 A LESS $ .25 SIGNATURE OF
%2 2 .60 PERMITTEE /
2 s 1.013 INSPECTION RECORD
5 15 1.50
75 5O 2.SO
50 2130 5.00
200 500 113.00 _I
Boo 11300 15.00 Z
OVER 1000 20.00 L7
M.G. BET/FREQ. CHANGER-HP Q'
WELDERS:AC-KVA D
GENERATORS - KW
TRANSFORMERS - KVA
TEMP. MOTORS (75% OF CRIS-)
MOVED MOTORS (75% OF ORIG.)
MISC.
SIGNS
NO. NO.TRANS.
APPROVALS
NO. NO.LAMPS
FOR EACH PERMIT: /
ATE INSPECTOR'S NAME
CONDUIT ? f��}I/i
WIRING $1.00
FIXTURES $1,00 WIRING
SUPPLEMENTARY .50 FIXTURES
r
rPOWERTOTAL FEE 9 / TY CO.NOTIFIED ,7 t"i i r n sl�ifl'L
76A663 DBS#5A 4-52
WORKER'S COMPENSATION DECLARATION 20.0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm tha;I have a certificate of consent to4self insure, 76A663
or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
cop t e La .C.)
POIICy NO. �3�:9�?a FOR APPLICANT TO FILL IN JOB — ! I
'` ADDRESS
Certified copy is hereby furriish�d. p�ti~`cl/S� ew Residential Bldgs.&Pools NO. $EACH $ FEE n cG
LOCALI r
1&2-Family,Sq.Ft.
ECertified copy is filed with the o my building inspection NEAREST
departMulti-family Sq.Ft. — CROSS ST.
Date _�I a Applie I Residential Swimming Pools ASSESSOR
/ MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. L_Light Sw. OWNER OR
__/_COMPENSATION INSURANCE + FIRM NAME
First 20 MAIL ...{�
(This section need not be completed If the work Involved by the Total No. Additional ADDRESS Z ,p—7,� !/
permit is for one hundred dollars($100)or less.) b G
I certify that in the performance of the work for which this permit CITY p I — CAR)
is issued, I shall not employ any person in any manner so as to PLAN CHECK
become subject to the Workers'Co nsation Laws. Lighting Fixtures / First 20 APPLICANT---
�t Total No. Additional ADDRESS
Date Applicant ` /
NOTICE TO APPLICANT: If, after making this Certificate of RESIDENTIALAPPLIANCES'NOTOVER3HP. CITY
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 J
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KV ,//oJJ�VAR ADDRESS LPG
41
1 hereby affirm that I am licensed under provisions of Chapter 9 _� Ove t6101ncl. /� �) /}�1 ,�"j
(commencing with Section 7000)of-Division 3 of the Business and CITY I v++--05
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR bAllki
Over 50 to 100 Ind. REG.NUMBER 3 v`�� Class.C00-0
30�� C--1 D Over 100 DISTRICT NO. P SED BY V
License Number Lic.Class
p s O
ServiceSyM8 bd anelboards '�A
��'X0/3 it
mp. rider 600 V 0 FINAL
Contractor ( Date DATE ^ U
❑ 400-1000 Amp.Under 600 V r-'/�j( VALIDATION
1 am exempt under Sec. UJ
Over 1000 Amp.or Over 600 V FINAL d.
B.&P.C.for this reason BRANCH CIRCUIT FEES BY (n
Date: 15A,or 20A,1�V,Ligfltjpg�,ip-r-ih Cir.
1 T 10 an h Circuits
Signature 11 To 40 Branch Circuits
❑ Al Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 2
SINGLE FAMILY Temp.Power Pole&Appurtenances ACCTov
HOME OWNER-BUILDER DECLARATION with One Branch Circuit n wZ'"n 10�e
I hereby affirm that I am exempt from the Contractor's License Law Sig330 S
55
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits ITEMS
F1 .se
-n
I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL 08.6-55
is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) CHECK 108°55
and Professions Code).
CHANGE o0U
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the Q'
performance of the work for which this permit is issued(Sec. 3097, PERMIT FEE (Sub-Total) (J 7/T,./96Civ.C.) 0000-0001
PLAN CHECKING FEE 7659 1 AM110-54
Lender's Name PERMIT ISSUING FEE
Lender's Address TOTAL FEE XOO
I certify that I have read this application and under penalty of purjury state
that the above information is correct. I agree to comply with all County
ordinP-1,
nd State laws regulating Electrical wiring,and hereby authorize
rep r ves of is County to enter upon the above-mentioned property
for purp es. 115rl,�_ SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF PERMITTEE DATE