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Home My Public Portal About9206 BLACKLEY ST_Electrical__ D B 9.5A 25M SETS 10-47 APgCATION FOR PERIKIT I�EPAR�'1N OF AND 8AFE1'Y C ELECTRIC� COUNTY ®FF LOS LOS ANGELES WM J. FOX C I F [NEER Z NAME DISTRICT NO. GROUP ZONE ,ERMIT 1.40. v l 5 ADDRESS _ CITY TEL NO RECEIVED BY READY FOR FIRST INSPECTION GATE ISSUED W COUNTY W CERT NO EXPIRES 1 APPLICANT FILL IN HEAVILY OUTLMD PORTION ONLY JOB IDESCRHFHON OF WORK ADDRESS NUMBER OF OUTLETS ON CIRCUITS LOCALITY T � LOCATION BY ROOMS NEAREST LIGHT OUTLETS SW PLUGS FIXT CROSS ST. &4 CIRCUIT A B C I DIE F G IH cc NAME ,e�®� ��y /1 .erg AIL M 3 AD DR ) f0(/m( LI ''�`Ij /y Ost �J !aC/ / CITY/.,"/- p TEL NO. l i AM THE LEGALY POSSESSOA OF THE ABOVC LOS ANGELM COUNTY CERTIFICATE OF QUALIFICATION. ELCCTRICIAN. I AM THE LEW1.OWNER OF THE PROPERTY DESCRIBED ABOVE ��..,,��rrn11��TT OWNER. DD ,r J Q Z . v O TOTAL No of OUTLETS $ APPROVALS NO OF FIXTURES ffi DATE INSPECTOR'S NAME NO OF MOTORS H P. $ CONDUIT NO OF SIGNS TRANS $ WIRING NO OF RANGES OR HEATERS $ FIXTURES MISCE 6L.A EOUS ffi POWER PERMIT FEE $ S UTILITYCO NOTIFIED: e� TOTAL FINAL 7GA663 DBS 5A 11-50 APPLICATION FOR PERMIT RIFTARTMENT OF BUILDING AND SAFETY 4,a COUNTY OF LOS ANGELES �� 'A WILLIAM J FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRIC O GROUP ZONE PERMIT NO. ELECTRICIAN X-7 6 RECEIVED BY READY FOR DATE ISSUED ADDRESS- 47FIRST INSPECTION - /7 CITY TEL NO / F COUNTY LICENSE NO EXPIRES ADDREIN PERMIT FEES 1/ FEE NUMBER EACH LOCALITY w LIGHT OUTLETS NEAREST CROSS ST L RECEPTACLES WALL SWITCHES OWNER TOTAL OUTLETS 5C $ I D .a MAIL ELEC RANGES 25 ADDRESS ELEC HEATERS 25 CITY TEL NO FIXTURES I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MISC APPLICATION AND STATE THAT THE ABOVE IS 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 HORSEPOWERANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER FEE NEW MVD HP OVER INC EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. I 1/2 &LESS $ 25 SIGNATURE OK 1/2 2 50 PERMITTEE ,JJ��/��`` ��,1, 2 5 1 00 INSPECTION RECORD f 5 15 1 50 1s 50 2 50 so 200 5 00 200 Soo 10 00 J Soo 1000 - 15 00 Q _Z OVER 1000 20 00 (� M G SET/FREQ CHANGER-HP O WELDERS AC-KVA GENERATORS-KW u TRANSFORMERS-KVA TEMP MOTORS (75%OF ORIG MOVED MOTORS (75%OF ORIG ) MISC SIGNS NO NO TRANS I APPROVALS NO NO LAMPS DATE INSPECTOR'S NAME FOR EACH PERMIT CONDUIT 119 WIRING $1 00 U O WIRING FIXTURES $1 00 SUPPLEMENTARY 50 FIXTURES POWER TOTAL FEE I $ I UTILITYCO NOTIFIEDI ® LLLv FINAL ` I i 76A66:4 CE 806 16/78) APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN JOB 9206 _F_ 'RTAMFY New Residential Bldgs &Pools EACH NO FEE ADDRESS 1 &2 Family,Sq Ft $ 025 — $ LOCALITY 'M,pa CI'T'Y Multi family Sq Ft 02 — NEAREST -� Residential Swimming Pools 25 00 CROSS STOWNER OR FIRM NAME Outlets Rec Light Sw MAIL SANT! RAFMI5 First 20 50 ADDRESS ` Total No Additional 30 CITY SA�E Tel No2863 ,76 PLAN CHECK APPLICANT Lighting Fixtures First 20 50 ADDRESS Additional 30 Total No CITY Tel No Fixed Appliances Not Over 1 HP PERMIT _ APPLICANT TRANS HCC Range_Heater_D W Oven—Dryer_W M ADDRESS 2034 N. PEGC — Top —FAU X WH CITY Tel No Hood_Fon —Other 2. 0 LICEN 'O Disp —Room Air Cond 2 50 REG NUMBER 965A94 Class 12-3 Q I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A PLI Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO Size&Type HP KW, KVA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS 2 50 REGULATING ELECTRICAL WIRING Up to 1 Incl 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 3 lw Over 1 to 10 Incl 5 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF Over 10 to 50 Incl 1250 CALIFORNIA OR THAT I AM THE LEGAL OWN OF THE ABOVE Over 50 to 100 Inc 25 00 1 DESCRIBED RESIDENTIAL PROPERTY Over 100 40 00 PERMITEE SIGNATURE wo Services DISTRICT NO PR ESS BY 0 200 Amp Under 600V 12 50 201 1000 Amp Under 600 V 25 00 Over 1000 Amp or Over 600 V 50 00 !' y CO O Temp Power Pole&Appurtenances 10 00 - v / O a r�(e(, Z :I,, t Sign with One Branch Circuit 1000 ! 7K>a-�_ P �- Additional Sign Branch Circuits 200 INSPECTIN �x7 10 0o INFORMATION W Y 1 Misc Conduits&Conductors ON REVERSE x Other(See Complete Fee Schedule) SIDE u nn PERMIT FEE (Sub Total) ;94729A PLAN CHECKING FEE (One Fourth Permit Feel O # 0 0 0 0 0 2 PERMIT ISSUING FEE _ $7 00 710 O 2,o 0 1 [L 5 0 J TOTAL FEE 14.5 > 0 0 0 ! '� 5 0 L INSPECTION FINALE date l ��/y/ 7/<gy ✓� �C O 76A663 CE-806(11 /'78) APPLICATION, FOR ELECTRICAL'OEWIT� COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN JOB �jy " EACH " ,NO - FEE -ADDRESS CiC/6e �-<%�'�-1 + '� New Residential Bldgs &Pools 1 &2 Family,Sq Ft $' 025 — $ 'LOCALITY 02- — NEAREST Multi family Sq Ft' CROSS,ST /VC✓� /�_ ,Residential Swimming Pools _L._ 25 00 OWNEROR-, /� FIRM NAME-\JIB- Outlets Rec�/ bg'ht Sw, _ MAIL First 20 50 ADDRESS w itional" 30 CITY _ _�,}_ Tel No Total No--/e5 Add Y PLAN CHECK APPLICANT Lighting Fixtures First 20, 50 y ADDRESS Total - No itionof' - t` CITY _Tel Noy y Fixed Appliances Not Over 1 HP », - PERMIT, Range_Heater_D W APPLICANT Oven_Dryer_-W M — ADDRESS- Top DDRESS Top _�FAU 'W H CITY _x » $Tel N� _ K .11�9!> r a Hood'_Fan _`Other=` LICENSE OR e D,isp _,Roo�AirConcl _ 250 _ REG NUMBER ' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICAi Power Apparatus&Large Appliances TION•AND STATE THAT THE ABOVE IS CORRECT AND AGREE TOi Size&Type HP KW, KVA,or KVAR COMPLY'WITH ALL COUNTY'ORDINANCES-AND-STATE':LAWS 2 50 REGULATING ELECTRICAL WIRING -Up to_,,Incl 1 HEREBY CERTIFY THAT'l AM PROPERLY REGISTERED'AND/OR -tj Over 1 to 10 Incl 500• LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF as Over 10 to 50 Incl 12 50 - ,w e CALIFORNIA_ORTHAT_1„AM,THEILEGQL,OWNER,OF}THE.ABOVE 25 00' DESCRIBED RESIDENTIAL P PERTY Over 50 to 100 Inc ` Over 100 �-40 00 P,ERMITEE _ SIGNATURE Services 2 SOJ r ' DISTRICT NO Y't PROS BY 0 20o Amp Under 600 V -201 1000 Amp Under 600 V -25 00- Over 0-Over 1000 Amp or Over 600 V 50 00 ` Temp Power Pole&Appurtenances j ' '' 1000 10 00 t C Sign with One Branch Circuit r Additional Sign Branch Circuits 2 00 " INSPECTION—,. > ' l0 00 INFORMATION " 0µ2r6 3�A " Mist Conduits&Conductors ! ON REVERSE" ' Other(See Complete Fee Schedule) ' s SIDE .k= - u �' #''o.o'o o 62, f 7•'5 0 9L 1 PERMIT FEE %� 1 „' '='(SubiTotaU 1�, g_ ' �. _ PLAN CHECKING FEE (One Fourth Permit Feel °S _ O N a'��'$p �' L' PERMIT ISSUING FEE ' $7:00• Swv� G TOTAL FEE > INSPECTION FINALED date . ," By d its I, \,i WORKERS' COMPENSATION DECLARATION 4 76AW 10/81 hereb,i affirm that I have a certificate of consent to self , CE-806G APPLICATION FOR ELECTRICAL PERMIT rte`•insure, or a certificate of Workers Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY " or a certified copy thereof (Sec 3800, Lab C ) i JOB Policy No Company I FOR APPLICANT TO FILL IN} ADORES 2Q6 $, Blackley Certified copy is hereby furnished New Residential Bldgs & Pools EACH NO FEE ❑ 1 & 2-Family, S Ft $ — $ LOCALITY Temple City Certified copy �s filed with the county building mspec- Y� 9 tion department Multi-family Sq Ft — NEAREST J Residential Swimming Pools CROSS ST Date Applicant OWNER OR CERTIFICATE OF EXEMPTION FROM WORKERSFIRM NAME{ p < r, 7 - ' L / IL COMPENSATION INSURANCE Outlets Rec Light Sw_ ADDRESS First 20 (This section need not be completed if the work involved by 70 Total No Additional CITY Tel No 285-8425 the permit is for one hundred dollars ($100)or less ) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner somas to become subject to the Workers'Compensation Laws Lighting Fixtures First 20 ADDRESS _� Additional Ell 7/12/83 � - CITY �'Tel No Date Applicant Total No Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT If,,after makin this Certificate of APPLICANT Exemption, you should become subject to the, Workers' Range_ Heater_D W -_ _ _ _ y_ --Compensation-pT-ovision's of"the Labor Code, you must-forth- Oven _1Dryer —W M �' ADDRESS with comply with such provisions or this permit shall be Top FAU —W H deemed revoked Hood _ Fan _ Other— CITY -Tel No LICENSED CONTRACTORS DECLARATION _ Room Air Cond LICENSE OR Class I hereby affirm that I am licensed under provisions of Chapter 9 Disp REG NUMBER (commencing with Section 7000) of Division 3 of the Business DISTRICT NO PROCES D BY and Professions Code,and my license is in full force-and effecT Power Apparatus& Large,Appliances _ �` _ Size &Type HP, KW, KVA, or KVAR - V Q License Number Lic Class Up to 1 Incl FINAL U Contractor Date 09 Over 1 to 10 Incl DATE r VALIDATION Q ❑ Over 10 to 50 Incl FINAL GJ C~j I am exempt under Sec Over 50 to 100 Inc BY B&P C for this reason Over 100 12 Date Services, Swbd , MCC& Panelboards 0 - 200 Amp Under 600 V 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 j Thereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031 5, Business and Professions Code) 3 5 6 Q A ❑ 1, as owner of the property, will do the work and the Misc Conduits&Conductors structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ► # 0 0 0 0 0 2 7044, Business and Professions Code) 2 ° 1 3,50 CONSTRUCTION LENDING AGENCY � ° I hereby affirm that there is a construction lending agency for o 0 0 1 3,,5 0 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 3 (sec 3097, Civ C ) - 0�7, 1 2—8 3 ' PLAN CHECKING FEE f - _ Lender's Name r PERMIT ISSUING'FEE _ O Lender's Address � ' I certify that I have read this application and state that the TOTAL FEE 3, S above information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring, and i hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes / SEE REVERSE FOR EXPLANATORY LANGUAGE - Signaturof Permittee Date ` WORKERS'COMPENSATION DECLARATION 76A663 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT O I h8reby affirm that-I have o,certificate of consent to self CE 806G inw�re,•or.a•certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS -5r a cei'rified'copy thereof (Sec. 3800, Lab. C. F !'cy No. -? Company FOR APPLICANT TO FILL IN JOB 172-0/, Q�G Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS [� � Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family/� Sq. Ft. — CROSS SNEAREST T. PO Residential Swimming Pools / Dare Applicant _ OWNER TOR . FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec4Light�Sw. MAIL COMPENSATION INSURANCE First 20 U ADDRESS (This section need not be completed if the work involved by Total No.� Additional CITY Tel. No. the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS ,r� Total No.�L Additional CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMITL NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION 41,�E5 Exemption, you should become subject to the Workers' Range— Heater—D.W. Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS Zly t with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — fan —Other— CITY ��7� Tel. No. D, LICENSED CONTRACTORS DECLARATION LICENSE OR 7+ 1 hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. — REG. NUMBER �/J d 39 Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PO SSED BY >• and Professions Code,and my license is in full force and effect. d /J p Size &Type HP, KW, KVA, or KVAR O License Number _L154IS 3 f Lic. Class, Up to 1 Incl. FINAL U Contractor/'� /'� &�A � ate 13 � 1— Z Over 1 To 10 Incl. DATE VALIDATION 0 QOver 10 to 50 Incl. FINAL ~ I am exempt under Sec. •Over 50 to 100 Inc. BY 1 W B.&P.C. for this reason Over 100 LU i Services, 0 Am MCC& Panelboards Z Date: 0-200 Amp. Under 600 V E' � tY Signature 201 - 1000 Amp. Under 600 V QOver 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances E Sign with One Branch Circuit _ I hereby affirm that I am exempt from the Contractor's License Sig --,--: Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): -- - grlf^, Misc. Conduits &Conductors I, as owner of the property, will do the work and the TOTAL 3-p 5 „ fD structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ Business and Professions Code). , CHECK • CONSTRUCTION LENDING AGENCY r•:; I hereby affirm that there is a construction lending agency for RE AU the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) a�= (Sec. 3097, Civ. C.). -.1 }: '1 r .y PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE 00 5611 Pr,i2z=ti. Lender's Address I certify that I have read this application and state that the TOTAL FEE cJ O above 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-me tone property for.inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Date 4f76A66 WORKERS' COMPENSATION DECLARATION aoPw3i8z APPLICATION FOR ELECTRICAL PERMIT O c i .)erehy a firm that I have a certificate of consent to self CE_806G H(sure; or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or.`�uertifiecl-&py thereof (Sec. 3800, Lab. C.) Po11�Vf�No. Company FOR APPLICANT TO FILL IN JOB F—TCertified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS V IN Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. NEAREST CROSS ST. YL(, Date Applicant Residential Swimming Pools OWNER OR II`'� FIRM NAME Od LY CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS Cis Cl This section need not be completed if the work involved b First ti CIT Tel. No• �S4`(d, ( P Y Total No. Additional the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the.performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws. 11 Additional Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION �' Exemption, you should become subject to the Workers' Range— Heater—D.W. _ Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other_ CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR Disp. — Room Air Cond. REG. NUMBER Class. I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section.7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. P SSED BY a and Professions Code, and my license is in full force and effect. Size&Type HP, KW, KVA, or KVAR 0 License Number Lic. Class Up to 1 Incl. FINAL Over 1 to 10 Incl DATE 01 VALIDATION 0 Contractor Date Over 10 to 50 Incl. U FINAL I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C. for this reason Over 100 Services, Swbd., MCC& Ponelboards Z - Date: 0- 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ElExemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License g Law for the following reason (Section 7031.5, Business and Additibnal Sign Branch Circuits M Professions Code): _ Te' 1, as owner of the property, will do the work and the Misc. Conduits&Conductors s s)c..=r•� structure is not intended or offered for sale Section 7044, Other (See Complete fee Schedule)_ , t a 5 ( l e e rt� —1 �...r Business and Professions Code). CONSTRUCTION LENDING AGENCY :n� '"L I hereby affirm that there is a construction lending agency for �� i3.7-lf;r�! _ the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) ply (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name _'•l)a l )— '_ ) 7Vr i;'`; t PERMIT ISSUING FEE 70-1. Lender's Address I certify that I have read this application and state that the TOTAL FEE above 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-mentio d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature 00 Permittee Date r i WQRKEIZS'COMPENSATIONDECLARATION CE-806G (2-80) CE-806APPLICATION FOR ELECTRICAL PERMIT ' C I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or i ✓ a.certilied copy thereof Sec. 3800,Lab.C.) JOB FOR APPLICANT TO FILL IN ! �/ Policy No. Company 1-7494>�yfSFyn/� ADDRESS � �146✓ ZI�' / We aL 17 p'e 77 New Residential Bldgs.&Pools EACH NO. FEE Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY Multi-family Sq. Ft. NEAREST / Certified copy is filed with the county building inspection CROSS ST J depa m nt. Residential Swimming Pools OWNER OR FIRM NAME Date -Applicant Outlets: Rec._Light Sw. MAIL First 20 ADDRESS ss�Yfi� CERTIFICATE OF EXE PTION OM WORKERS' Total No. Additional CITY Tel No. COMPENSATION INSURANCE PLAN CHECK O (This section need not be completed if the work involved APPLICANT U Lighting Fixtures First 20 ADDRESS by the permit is for one hundred dollars (000) or less.) Additional Total No. O I certify that in the performance of the work for which thisFixed Appliances Not Over 1 HP CITY Tel No. h- permit is issued, I shall not employ any person in any manner PERMIT f UJ so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APP LICANTL ��G�/G.vQ�� l CL Oven Dryer_W.M._ ADDRESS. - �o Gfle to G Z Date Applicant Top FAU _W.H.. Hood Fan _Other_ _ CITY tG6t�� Tel Na'�44'!Vv _ NOTICE TO APPLICANT: If, after making this Certificate of Disp. — Room Air Cond._ LICENSE OR •� Exemption, you should become subject to the Workers' REG. NUMBERJQLC7 r Class IL Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCE SED BY with comply with such provisions or this permit shall be Size& Type HP,KW,KVA,or KVAR / C Q deemed revoked. Up to 1 Incl. FINAL Over 1 to 10 Incl DATE t 1 2 LICENSED CONTRACTORS DECLARATION VALIDATION Over 10 to 50 Incl. ° I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL (_ BY 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 `, "—`'"" ✓" ness and Professions.Code, and my license is in full force and effect. Services 0-200 Amp. Under 600 V ' License Number Lic. Class 201-1000 Amp. Under 600 V 6,3J6 Contractor"O /A Sey Date Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— structure is not intended or offered for sale (Section _ ji '� I' 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub-Total) ° " I �1, 5 C! issued(Sec. 3097,Civ.C.). Q Lender's Name PLAN CHECKING FEE (One-Fourth Permit Feel I ` Lender's Address PERMIT ISSUING FEE Q 1 0 G I certify that I have read this application and state that the TOTAL FEE above 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 ab o e-mentio property for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE Signatur of Permittee ate COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9811090004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 11492 9206 BLACKLEY ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803136 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ENCINITA 8590-009-002 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 9.00 OUT 17.55 TENANT: G2 LIGHTING FIXTURES 2.00 LGT 3.90 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRE N: H2 RES GRBG DISP LT 3HP 1.00 DIS 10.80 11/09/98 UT 11/ /99 H3 RES DISHWASHR LT 3HP 1.00 DIS 10.80 OWNER: TEL. NO: TOTAL FEES 70.80 FINAL DATE FINAL BY: CODE: URIBE;RICARDO;BERYL (626) 796-7337- 9206 BLACKLEY ST TEMP 917803136 DESCRIPTION OF WOR ELECTRICAL FOR KITCHEN REMODEL APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - � �� . LIC. NO �/i `"> ��, TEMPORARY POWER POLE y UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. N0: II _ — UFER GROUND ROUGH CONDUIT LIC. N0. ROUGH WIRING C�A� � d MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508