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Home My Public Portal About9613 BROADWAY_Electrical__ TEMPLE CITY 76A663-CES06 8.62 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS �. JOHN A. LAMBIE. COUNTY ENGINEER off. f/ T WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY-- e4,1,�ic( NEAREST �_ v FOR APPLICANT TO FILL IN CROSS ST. RECEPT. �. TOTAL NO. EACH FEE " OUTLETS. FIRST 20 S 2O $ �) OWNER 1` LIGHT 1II`I MAIL SWITCH. l OVER 20 .10 ADDRESS L Z' LIGHTING l TOTAL 20 .20 Cl TEL. NO. 7C FIXTURES Ir A. ip ELECTRICIAN OV R L RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK CITY TEL.NO. OISNWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(:/H.P.MAX.) ,$O LICENSE NO. MOTORS: OVER NOT OVER H.P. _ DIST$.�CT N GROUP E PRCj'C S BY O 1 1.00 ` �i 1 3 1.50 INSPECTION RC D 9 B 2.00 l��CT'��1,K I1 �` (..ppV'gl 6� :� •ti4d% B 15 2.60 15 50 3.00 'i/-�,� ;.♦.�! ..2�LL ^ ,l�:f.�� a 50 100 15.00 f - O V SIGNS: NO.TRANS. NO.LAMPS O SERVICE 0.600V-NOT OVER 200A 1.00 SERVICE 0.600V-OVER 200 A. 2.00 D. VJ SERVICE OVER 600V 5.00 ? MISC. PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 i TOTAL FEE $ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DAM INSPECTOR-S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT I A/! WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANOIOR LICENSED AS REQUIREDBY LOS ANGELES COUNTY AND STATE OF FIXTURES Ye21�i^. CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. POWER SIGNATURE UTILI TY CO.NOTIFIED + n S OF PERMITTEE(, FINAL IO VAIIDAT ARTHUR C. VEIT CK MO CA6M SUPERVISING ELECTRICAL ENGINEER Li•1Co 4 3 9 1 Lp JAI 14 2 D 5.40- WORKERS' COMPENSATION DECLARATION 76A663CE-806 lo/et APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self CE-806G J� insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS �, �Q/q ❑ 1 8 2-Famil LOCALITY Certified copy is filed with the county building inspec- y. Sq. Ft. $ — $ tion department. Multi-family Sq. Ft. — NEAREST CROSS ST. Residential Swimming Pools Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw. iVUkIL ADDRESS .�Q Jf' 1:0 COMPENSATION INSURANCE �c s section neenot completed if the work involved b First 20 (Thitid t b P T Total No. Additional CITY / Tel. No. the permit is for one hundred dollars ($100)or less.) I certify that in the performance of the work for which this APPLICANTK permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' m ensation Laws. Lighting Fixtures First 20 ADDRESS Additional I P Total No. CITY - Tel. No. Date —Applicant � NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HE PERMIT Exemption, you should become subject to the Workers' Range_ Heater—D.W. — APPLICANT 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 I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cone. - REG. NUMBER Class. (commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESSED BY } and Professions Code,and my license is in full farce and effect. Type G VTC 0 Size 8 T e HP, KW, KVA, or KVAR' � License Number Lic. Class Up to I Ind. FINAL U Over 1 to 10 Ind. DATE �' 1�� VALIDATION 0 Contractor Date Over 10 to 50 Incl. G' FINAL ~ ❑ am exempt under Sec Over 50 to 100 Inc. BY Lr 6 d B.BP.C. for this reason Over 100 Z Date: Services, Swbd., MCC 8 Ponelboards 0 - 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V Cl S IL 5 .4 ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect #! o o e o o 2 SINGLE FAMILY Temp. Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 2 0 0 2.57. 5 0 1 hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits z Law for the following reason (Section 7031.5, Business and Professions Code): 2 5 5 0 ❑ t, as owner of the property, will do the work and the Misc. Conduits 8 Conductors o829-8.3 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— , 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 issued PERMIT FEE (Sub-Total wwo (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name / O PERMIT ISSUING FEE Lender's _ Address I certify that I have read this application and state that the TOTAL FEE Z� above information is correct. I agree to comply with all County ordinances and State lows regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above- entioned prop�erttyy for inspection urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee to WORKERSirm havea COMPENSATION DECLARATION CE-863 10,31 APPLICATION FOR ELECTRICAL PERMIT I hereby affthat I have a certificate of consent to self insure, CE-Bose or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS �.� New Residential Bldgs. & Pools F1 Certified & 2-Family,Sq.Ft $ — $ LOCALITY Certified copy is filed with the county building inspection — department. Multi-family Sq.FL NEAREST /�� - Residential Swimming Pools OWNER OR Date Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM.WORKERS' / MAIL Outlets:Rec—I-- Light Sw. COMPENSATION INSURANCE ADDRESS 9(0 (This section need not be completedFirst 20 if the work involved by the �s CIT Tel.No.ak permit is for one hundred dollars($100) or less.) Total No. Additional I certify that in the performance of the work for which this permitLAN CHECK 10 APPLICANT is issued, I shall not empy any person in any manner so as to become subject to the Workers'Compensation Laws, Lighting Fixturesn First 20 ADDRESS n/ Total No. Additional CITY Tel.No. Date Applicant Jl e1 �X%.>:_ NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ DW. _ 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 — FAU4�7 W.H. LICENSED CONTRACTORS DECLARATION CITY Tel.No. Hood - Wono� Other_ hereby affirm that am licensed under provisions Of Chapter 9 Died. MOO AIf GOntl. LICENSE B Class. (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PRocESSE v / Size& Type HP,KW,KVA,or KVAR License Number Lic.Class Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE VAL ION Ix Contractor DateOver 10 to 50 Incl. 1— ❑ FINAL / am exempt under Sec. Over 50 to 100 Inc. BY W B&PC. for this reason Over 100 N Services, Swbd.,MCC& Panelboards Z Dale: 0- 200 Amp.Under 600 V - Signature 201 - 1000 Amp.Under 600 V ❑ Exemption for Reg.Mainl.Elect. Over 1000 Amp.or Over 600 V SINGLE FAMILY Temp.Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit :27 DQ 6 A 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 # � 0,0,0 2 Code): I�f IL`I. I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors • * 2675 is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) ► , and Professions Code). 2 6 7 5 5 CONSTRUCTION LENDING AGENCY Mil l a 8 7 I 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.). QJ PLAN CHECKING FEE Lender's Name /I PERMIT ISSUING FEE Lender's Address ` 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 Stale laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspe tion purposes. T SEE REVERSE FOR EXPLANATORY LANGUAGE SilgrifftriWof Permittee Date