HomeMy Public PortalAbout5759TEMPLE CITY BLVD_Electrical �eAaeactc aEae613'I=,�5 'APPLICAT.�. FOR ELECTRICAL PERMIT
BUILDING AND SAFETY DIVISION" N'
FOR APPLICANT TO FILL IN ,JOBf.
New Residential Bldgs.&Pools EACH NO. FEE ADDRES. L'/% Le_ �a 1
1 &2 Frnaily Sq. Ft. $ — $ t'OCALITY
Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools CROSS ST.OWNER OIR
FIRM-NAME
Outlets: Light,Switch&Receptacle MAIL
First 20 ADDRESS
Additibnal CITY e-t.',b �I Tel. No.
PLAN CHECK
Lighting Fixtures APPLICANT
First 20 ADDRESS
Additional CITY Tel.No.
PERMIT
Fixed Appliance$ Not Over 1 HP APPLICANT r—
Range__ Heater_ D.W. _ -ADDRESS
Oven _ Dryer W.NI:
Top _ FAU W.H. "CITY :A Tel. No..� — b�7.
Hood Fan LICENSE.OR: C
Disp. _• A.C.
REG. NUMBER Class. J
.1 HEREBY.ACKNOWLEOG'E THAT I HAVE.READ THIS APPLICATION 1=
AND STATE THAT THE ABOVE.III CORRECT AND.AGREE.TO COMPLY
Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING O
POWer A
Size&Type HP,KW,KVA,or KVAR •ELECTRICAL WIRING.
Up to 1 Incl. I HEREBY CERTIFY THAT'I AM PROPERLY•.REGISTERED AND'/OR ti
Over 1.to 10 InCI: LICENSED- AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
Z
- ry CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
' Over 1.0 to 50 1'ncl. - DESCRIBED RESIDEN IAL PRO PE RTYe /
Over 50 to'100 Incl. PERMITEE ( Q IS
Over 100 SI G'N ATU RE JIv�+�Ml4�
G'jYh)j6'C-GAp. DISTRICT NO. PR CESS BY
Services ;:USa P/�NL.L 5sRv
Q 220�1mp: Under 600 V C� 0
201 -1000 Amp. Under 600 VAP,PROV.ALS' D INSPECTOR'S
SIG44ATURE
Over 1000 Amp.or Over 600 V
IROUGH.
EMP.'POWER POLE
Temp.Power Pole&Appurtenances N'DERSLAB WORK
Sign with One Branch Circuit CONDUIT
Additional-Sign Branch Circuits
(Other) IRING•
XTURES
WER AUTHORIZED
PERMIT FEE (Sub-Total) UTILITY CO.-NOTIFIED
PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL
PERMIT ISSUING FEE
TOTAL FEE NOTES yI3 Z�f Cd'.'.7y2�G9'.�St.+/ �t1Q-p"'
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PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDA 10. CK.. M.O. CASH
-Q 7 9:"L zb ® 9.0 0