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78A883 CE8061059 APPLICATION FOR ELECTRIC PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS d`+
JOHN A LAMB19 COUNTY ENGINEER _
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PEPMT FEES CROSS ST
ITEM NUMBER I EACH FEE OWNERMAIL
OUTLETS $ $ ADDRESS Af
IGHTS RECEPT SW 10 �J ("
LI TING FIXTURES 10 CITY TELA /NO� /�v
ELEC RANGES CLO DRYERS ELECTRICIAN` K! C
WATER HEATERS 50 ADDRESS
ELEC SPACE HTRS DISHWASHERS CITY TEL NO
GARBAGE DISPOSERS AUTO STATE
WASHERS STA COOKING UNITS 25 LICENSE NO
MOTORS OVER INC HP DISTRICT NO GROUP7ZNE P ES D BY
0— 1/s 251/z- 2 50 INSPECTIOCO
2- 5 100
5— 15 150
Is— 50 250
50-200 Soo
SIGNS NO TRANS
NO LAMPS
SERVICE O 600V 100
SERVICE OVER 600V Soo
MISC
WIRING PERMIT 100
FIXTURE PERMIT too
SUPPLEMENTARY PERMIT SO
TOTAL FEE $
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR WIRING
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LEGAL OW OF THE ABOVE ADESCRIBED RESIDENT PROPERTY POWER
SIGNATURE ( UTILITY CO NOTIFIED
OF PERMITT FINA o ���
®r LMATION ART R C VEIT V
CK Mo cases SUPERVISING ELECTRICAL EE
NGINER
SCO 4 0 4 7 SO JUL ? 2 U 2 0 U �°
)
WORKERS COMPENSATION DECLARATION CE 806 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby a'Rrm that I have a certificate of consent to self-Irhure CE 906G
orts certificate of Workers Compensatiall Insurance o• a certifbd COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy`thereof(Sec 3800 Lab C)
Policy No Company FOR APPLICANT TO FILL IN JOB I� ,��'^ILZ ,
❑ F t-
(Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ADDRESS
❑ 1 & 2 Family Sq Ft �� $ _ $ LOCALITY
Certified copy is filed with the county building inspection
(department Multi family Sq Ft NEAREST It f f��
Date Applicant OWNER
Residential Swimming Pools CROSS O
1"r
FIRM NAME ME �
CERTIFICATE OF EXEMPTION FROM WORKERS D 1� i MAIL +_��
COMPENSATION INSURANCE Outlets Rec Light Sw ADDRESS�f x3 / 4/'J ei S0 V I
(This section need not be completed if the work Involved by the ♦ First 20
permit is for one hundred dollars ($100)or less)
Total No Additional CITY ✓A L /�®/� Tel No
I certify that in the performance of the work for which this permit ' J PLAN CHECK
is issued I shall not employ an y + APPLICANT
y person in an manner so as to � 4!
become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS
t
Total No Additional +
CITY Tel No
Date Applicant Fixed Appliances Not Over 1 HP
NOTICE TO APPL CANT If after make t i Certih of PERMIT n r
Exemption you should become subject to the Wo s Comp tion Range Heater_ DW -I— APPLICANT CA1AJ4J VW N W
provisions of the Labor Code you must forthwith comply with such Oven _ Dryer J— WM -I— ADDRESS Y P —/
provisions or this permit shall be deemed revoked Top FAU _ WH
LICENSED CONTRACTORS DECLARATION Hood A— Fan _ Other_ CITY 0 " p , Tel No
I hereby affirm that I am licensed under provisions of Chapter 90 LICENSE OR S� r,
(commencing with Section 7000) of Division 3 of the Business and Disp � Room Air Cond REG NUMBER Class
Professions Code and my license is in full force and effect Power Apparatus& Large Appliances DISTRICT NOPROCESS Y
/' i Size& Type HP KW KVA or KVAR �' OL �-
License Number.s � t I�F- Lic Class 1 Up to 1 Incl FINAL 8
U AA j Over 1 to 10 Incl DATE
Contractor-C K w!� `-'t VALIDATION
N Date �''- Over 10 to 50 Incl FINAL V
❑ I am exempt under Sec Over 50 to 100 Inc BY W
B&PC for this reason Over 100 Q„
Services Swbd MCC & Panelboards ® Z
Z
Date 0 200 Amp Under 600 V r"
Signature 201 1000 Amp Under 600 V
❑ Over 1000 Amp or Over 600 V
Exemption for Reg Maint Elect
SINGLE FAMILY Temp Power Pole & Appurtenances .�
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit `
1 hereby affirm that I am exempt from the Contractors License Law ACJ a
for the following reason(Section 7031 5 Business and Professions Additional Sign Branch Circuits .a
Code) 3307 93.6'1
❑ I as owner of the property will do the work and the structure Misc Conduits& Conductors 1 ITEMS
is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule)
and Professions Code) ® TOTAL 93 - 60
CONSTRUCTION LENDING AGENCY (HECp K.60
1 hereby affirm that there is a construction lending agency for the CHANGE
.�I
performance of the work for which this permit is issued(Sec 3097 PERMIT FEE (Sub Total) `T'ANGE
Civ C)
PLAN CHECKING FEE
Lenders Name PERMIT ISSUING FEE OGOO-01301 6/22/91)
Lenders Address 147- 1 'AM g"1'
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
property for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Nermitl Date
r.
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0207150005
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID -------BUT099G ADDRESS P=aq
ON FILE 5438 BALDWIN AV C®
FEE DESCRIPTION QUANTITY UOl1 AMOUNT TEMP CC9178A 917802624 VE ��L
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET OLI
8586 023-014 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID B4 LOCALITY TEMPLE CITY
JS AC UNITS +3-10HP 1 00 AC 19 65
TENANT TOTAL FEES 47 40 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
07/15/02 JK 01/11/03
OWNER TEL NO FINAL D J, L� CODE
XIE,YUAN KENG (626) 579 1559 l
5438 BALDWIN AVENUE
TEMPLE CITY 91780 MOMPTION OF WORK
RELOCATE A/C UNIT
APPLICANT
SAME AS OWNER
SPECIAL CONDITIONS
CONTRACTOR T L NO APPRO ALS DATE INSPECTOR SIGNATURE
SAME AS OWNER LIC NO
TEMPCRARY POWER POLE
���
/ UNDEPGROUND CONDUIT
ARCHITECT OR ENGINEER TEL NO GROUND
LIC N0�'� - � �� ROUGH CONDUIT
ROUGH
J i �
AN WATER LINE
o
PLASTIC Y/N METAL Y/N
- - - - - N
REPORT ID DPR265 ROUTE TO BS0508