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Home My Public Portal About9416 BROADWAY_Electrical__ 76A663-CE806 10/72 -APPLICATION FOR ELECTRICAL PERMIT � COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER 1oB J BUILDING AND SAFETY DIVISION ADOREss f i LOCAL)TV NEAREST � T FOR APPLICANT TO FILL IN CROSS ST. OlJ?LETS N0. EACH FEE OWNER OR S $ FIRM NAME ` REC EPT. i'l ADDRESS LIGHT TOTAL MAIL FIRST 20 .25 4./ OVER 20 CITY TEL. N0. SWI TC .10 PLAN CHECK LIGHTING 1 FIRST 20 .25 APPLICANT Jy TOTAL OVER 20 ADDRESS FI%TURES .10 RESIDENTIAL APPLIANCES CITY TEL. No. PERMIT RANGE DRYER HTR._ APPLICANT / CC �}-' STA. COOK DISP._F.A.U._ ADDRESS •`�J / SPACE HTR. AIR GOND. CITY, TEL. N0. LICENSE B %O CLASS. CLOTHES WASH.—DISHWASH._ REG. NUMBER FAN—OTHER L00 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. BVA. ELECTRICAL WIRING. .512E & TYPE OVER TO HEREBY CERTIFY THAT AM PROPERLY REGISTERED ANO/0R O - 1 100 LICENS AS RETFA BY LOS ANGELES COUNTY AND STATE OF CALCRI p THAI AM THE LEGAL OWNER OF THE ABOVE y �T OESCPIflED 10 ROPEfl TY, CD 3.00 U PERMI TE 10 - 50 500 SIGNAT RE 50 - 100 1000 DISTRICT N0. PROCES D BY LYG i C 100 - 500 1500 AQ C6 = SIGN, GAS SIGN AND ONE CIRCUIT S.00 ROVALS DATE INSPECTOR'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS H3WRFIXTURES WER POLE SERVI CENOTOVER 600 VOLTS OR 200 AMP AB WOR SERVICEOVER600VOLTSOR200AMP y Q /TEMP SERVICE, POLE, &APPURTENANCES 1••TEMP LIGHT OR RECEPT. SYSTEM POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL /o/V //j' I) PERMIT FEE (SUB TOTAL) NOTES: / 7 ��A_,( 4 -L� Ga' PLAN CHECK FEE PERMIT ISSUING FEE 3.00 ]� TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASHP RMIT VALIDATION CK. M.0. CASH i ;fir 2 " 6 3"r3 N., 16 2 D 7.25A SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 764663-CE80610/72 APPLICATIONR ELECTRICAL Ply( MIT 1, COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER AooREsS 416 Broadway BUILDING AND SAFETY DIVISION LOCALITY Temple Cit NEAREST FOR APPLICANT TO FILL IN CROSS S OUTLETS' BO. EACH FEE OWNER OR S S FIRM NAME renTup ` REG EP T._ MAIL gpORE55 O Wa LIGHT_ TOTAL FIRST 20 25 CITYTEL. NO. SWITCH OVER 20 .10 PLAN CHECK Te ye GHTING TOTAL LFIRST 20 25 APPLICANT FIXTURES .10 I OVER 20 ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT RANGE_ORYERWTR. HTR._ APPLICANT STA. COOK_DISP. F.A.U._ ADDRESS 1602 Che stnut St C SPACE HTR. AIR GOND. CITY Alhambra TEL. NO. 2820315 CLOTHES WASH. DISHWAS N._ qEG NUM 9ER 229847CLAS£10 FAN_OTHER 1.00 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO STATE THAT THE PROVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. MVA. ELECTRICAL WIRING. SIZE 8 TV PE OVER TO HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR 0 - 1 100 LICENSED AS flETLOS ANGELES COUNTY AND STATE OF CALIF THAI I A AM THE LEGAL OWNER OF THE ABOVE � I - 10 3.00 OE5f.A In RESI IAL PR ERTY. CD U PERMI (/ 10 - 50 5SIGNA 00 T R 6 SIGNATURE O H 50 - 100 1000 U DISTRICT N0. PROCE ED B w �^ d 100 - 500 15.00 : /"�� _ SIGN, GAS SIGN AND ONE CIRCUIT - 5.00 APPROVALS GATE - INSPf R'S SIGNATURE TUBE. OR MARQUEE ADDITIONAL CIRCUITS 100 TEMP. POWER POLE SERVICENOTOVER600 VOLTSOR 200AMP 3.00 UNDERSLAB WORK SERVICEOVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT TEMPSERVICE,POLE, &APPURTENANCES 5.00 WIRING TEMP LIGHT OR RECEPT, SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED [ FINAL /LO 1 ',r PERMIT FEE (SUB TOTAL) NOTES: PLAN CHECK FEE - PERMIT ISSUING FEE 300 TOTAL FEE PLAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION cK. M.G. CASH 39 573 sFP28 2D 6.00e SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE Wm that IhaveIa NSATIONDECLARATION 78-863 ,D,a, APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certifil of Workers' CompensationInsurance, or a certified •COUNTY OF LOS ANGELES BUILDING AND SAFETY copy-thereof (Sec.3800,Lab.C.) Policy No. Cornpany' FOR APPLICANT'TO FILL IN - JOB /J//� ❑ Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE . -ADDRESS �"/ ❑ Certified copy is filed with the county building inspection 1,8 2-Family,Sq.Et: < $ — $ LOCALITY - - department. Multi-family Sq.Ft. 'NEAREST ACROSS ST: ,Date• Applicant Residential Swimming Pool OWNER OR ' y� FIRM NAME d Hl�2E'F�N �SP1yF/'(� CERTIFICATE OF EXEMPTION FROM WORKERS' p� X - MAIL COMPENSATION INSURANCE Outlets:,Rec_ Light Sw. - �O BO ADDRESS rh F^ v(This section need not be.completed If the work involved by the First 20 _ Total No. Additional -' - - CITY_ . . Tel.No. 'permit is for one hundred dollars ($100)or less.) • PLAN CHECK ,I certify that in the performance of the.work for which this permit APPLICANT ' - 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 Total No. r �7 Additional,:., CITY"`. Tel.No. . Date Applicant Fixed Appliances NOT Over 1 HP ' 'NOTICE TO APPLICANT: If, after,making this 'Certificate of PERMF ,Exemption,you should become subject to the Workers'Compensation . Range_ Heater_ D.W. APPLICANT provisions of.the Labor Code, you must forthwith comply with such Oven Dryer _ W.M._ ADDRESS provisions or this permit shall be deemed revoked. _ - ,.Top, __ FAIL•.-_.W.H. -. . CITY - TeI:No. ' LICENSED CONTRACTORS DECLARATION Hood — Fan .,_ Other_ ' f hereby affirm-that I am licensed under provisions.of Chapter 9 - - Diso- ` Room Air Cona. UCENSE OR '- (commencing with Section 7000) of Division.3 of the Business and REG.NUMBER Professions Code,and my license is in full force and effect. DISTRICT NO.. P FSSEO S✓ - Power Apparatus 8 Large Appliances -' .. _ .. - p ,a }d Size 8 Type HP,KW,KVA,or KVAR License Number Lic.Class Up to 1 Incl. FINAL. - 3303 .38 Over 1 to 10 Incl. DATE _ O Contractor Date a Z � Over 10 to 501nc1. - FINF- ❑ I am exempt under Sec. ! Over 50 to 100 Inc..• By AL .-_ .T�OTALr 53 ap3� 9 BARG for this,reason _ Over 100 DECK Ja.� Servioes,'Swbd.,MCC& Panelbourds CHPHUE ��. Date: 0-200 Amp,Under 600 V D Signature " 201 - 1000 Amp Under 600 V .. - Over 1000 Amp.or Over 600 V❑ �I�r�1r� 1 Exemption for Reg.Mains.Elect. - -' - - - -, - ,0000-0001 11/ 1195 - SINGLE FAMILY f Temp.Power Pale B;Appurtenances ., 3107 .. .1 PM ,6-09 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law fw the following,reason (Section 7031.5, Business,and Professions' Additional Sign Branch Circuits,- - • - - - - - - I,as owner of the property,will do the work and the structure 'Misc.Conduits 8 Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , and Professions Code). D - CONSTRUCTION LENDING AGENCY - - - hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097, PERMIT FEE ' (Sub-Total) Civ.C.). 00,0 PLAN CHECKING FEE - Lender's Name PERMIT. SSUING,FEE; 0 Lender's Address 5 I certify that I have read this application and.state that the above TOTAL FEE - _ ,/. 30 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 - - • - - - XS ure of Permittee Date Wm t*t I have a certificate of CE-80a tDr- APPLICATION, FOR ELECTRICAL PERMIT {1 I hereby affirm that I have a certificate of consent to�self insure, cE-soot u or a certifipate.of Walkers' Compensation Insurance, or a certified COUNTY.OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.380OTab. C.) Policy No Company - FOR APPLICANT TO FILL IN _-' - '08 - ❑ •Certifiedcopy is hereby furnished. New.Residential Bldgs.8 Pools EACH: NO. FEE ADDRESS f6 p ye, - ❑•' Certified copy is filed with the county' building inspection 1 & 2-Family,Sq.Ft. t S — $ LOCALITY department. Multi-family Sq.Ft. NEAREST, ✓G C c C7 CROSS.ST. 1.(J • Residential Swimming Pools OWNER OR c(/�7A✓K6'�" . - C Date - Applicant _ FIRM NAME O/ZGE�. N :> CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:f�c4"Light _fSw MADDLRESS .-., COMPENSATION INSURANCE ' (This sectionneed not be completed if the work involvedby the ¢^ First 20 - permit is for one hundred dollars($W0) or less.) ,Total No.� Additional." CITY '�7+7 r�iF Cx7 Tel.No."IS"s Icertify that in the performance of the:work for which this permit PLAN CHECK - APPLICANT Js issued, ( shall not employ any person in anymanner.-so as to - ' become subject to the,Workers'Compensation Laws. Lighting:Fixtures s First 20011:5ADDRESS Add .� r ' Total No. 16 CITY- -- .Tel.No. Date ` -Applicant - Fixed Appliances Not Over 1 HP 'NOTICE TO:•APPLICANT: -If, after making this Certificate of PERMIT Exemption,you should become subject to the Workers'Compensation .Range_ Heater_ D.W. _. APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer_ W.M. = ADDRESS - provisions or this permit shall be deemed revoked. •A Top __�r��JF H. CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood —Win• ✓ Other_ I.hereby affirm that I am licensed untler iprevisions of Chapter 9 . _ Disp _ LICENSE OR . . — Room Air Cond. 0 . Class. (commencing with Section 7000) of Division 3 of the Businessand u REG.NUMBER R Professions Code,and my license is in full force'and effect. Power Apparatus& Large Appliances DISTRICT NO. �YYff ^ SED 8Y a' Size& Type HP,KW,KVA,or KVAR �.v� U License Number Lie.Class Up to 1 Incl. - FINAL -- Over 1 to 10 Incl. GATE VALIDATION_ ^ O Contractor Date Over 10 to 50 Incl. FINAL Z ' U ❑ am exempt under Sec. Over 50 to 1001nc. - BY - W B.&P.C. for this reason - _ Over 100 _ d . . , . _ -. - Services,_SS CC,& e o r s "O D Z' Date: -' 0 mp.Untl 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 ., - .. - 2 .HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law - - - for the following reason(Section 7031:5,'Business and Professions. Additional Sign Branch Circuits - - - - ACCL+T" Code) 3303 �r,r .159.40 I,as owner of the property;will do the work rand the structure. Mist.Gontluits 8`Contluctors 1 ITEMS is not intended or offered for sale (Section 7044, Business ..- her(S Cornp a Fee rule) _ _ ,and Professions'Code). D TOOT�AALy 159 .40 CONSTRUCTION LENDING AGENCY — - '" 'M]G,y{a,. 159,,71y 1 hereby affirm that there is a construction lending agency for the - r l.fffifll3G ICU performance of the work for which this permit is issued(Sec.3097, PERMIT FEE '(Sub-Total) - ��• Q, ' Civ.C.). • PLAN CHECKING FEE Lender's Name ' PERMIT ISSUING FEE ;2 Lenders Address Lcertify that I have read this application and state that the above TOTAL.FEE formation is correct. I agree to comply with'all County ordinances nd State laws regulating.Electrical wiring, and hereby authorize Apresentatives of this County to enter upon the above-mentionedroperly for inspection purposes. SEE REVERSE FOR E%PLANATORY LANGUAGEi�ure of Permittee Date - WORKER'S COMPENSATION DECLARATION 20-001 76A663 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT IJ h0teby..9lfirm that l hive a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C.) Policy No. k'9 51113 QQR;any CALCOMP FOR APPLICANT TO FILL IN JOB ADDRESS 9416 BROADWAY Certified copy ie hereby luIni New Residential Bldgs.&Pools, NO. EACH FEE LOCALIT ® •Certified copy is9iled with th court i pection 1&2-Family,Sq.Ft. — $ $ yTEMPLE CITY .department. Multi-family Sq.Ft. — NEAREST CLOVER-LY CROSS ST. DateR"�PIS S Applica Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL e, CERTIFICATE OF EKE ION FROM WORK Outlets:Rec._Light_I SW.�_ FFIIRM NAME G. FISCHER COMPE .SATION IN ,B-O Fife(20 MAIL (This section need not b0 completed(BI B the work.{ volved by the Total No. Additional ADDRESS 9416 BROADWAY Permit is'tor one huntlretl dollars(S100)or lass.) i I certify that-in the performance of the work for which this permit CITTEMPLE CITY T.I.N,285-7959 Is issued, I shall not employ2ny person in any manner so as to PLAN CHECK become subject to the Workers'Compensation.Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date - •` - Applicant RESIDENTIAL APPLIANCES NOT OVER 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 - PERMIT provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT BRYANT HTG & A/C INC LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESI350 E. LAS TUNAS DRIVE I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Ind.(commencing with Section 7000) of Division 3 of the Business and cITSAN GABRIEL TB1'N286-1141 Professions Code,and my license is in full force and effect. Over 10 to 50 Ind. LICENSE 0Ct —2 d ' Over 50 l0 100 Incl. PEG.NUMBER License en?se LiC.Class _ Over 10g DISTRICT NO. P OC SSED BY Q J . X Services,Swbd..MCC&Panelboards g!� A 0-399 Amp.Under 600 V FINAL O Contractor ate DATE ❑ a exempt under S 400-1000 Amp.Under 600 V VALIDATION V Over 1000 Amp,or Over 600 V FINAL W IAB.&P.C.far this reason BRANCH CIRCUIT FEES BY � 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.Mainl.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&Appurtenances 7 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACCT. i I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): 33M 48.70 ❑ 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) and Professions Code). -. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the 1 ITEMS performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) TOTAL 48 . 70 PLAN CHECKING FEE ' Lender's Name CHECK 48.70 PERMIT ISSUING FEE - CHANGE Lender's Address v..�nittltii99 •oo I certify that I have read this application and under penalty of purjury state TOTAL FEE �I�� ffmm 11 that the above information is correct. I agree to comply with all County 7� OOOU—LAJQy S/ 795 ordinances and State law enter ati g Electrical wiring,and hereby authorize f1� ii 1 r esen 'ves oft ' unty enter upon the abovemenbon propert S7W t AM10:44 f r inspeclio po � �� SEE REVERSE FOR EXPLANATORY LANGUAGE SGNAT PERMITTE DATE