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ISA603-CE00611/70 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING ]
BUILDING AND SAFETY DIVISION ADDRESS t +
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITYT J,
NEAREST
rIa
FOR APPLICANT TO FILL IN CROSS ST,
OUTLETS NO. EACHI FEE -
$
S OWNER C
O; 1141., - �•� •
RECEPT.�� 'Tf MAIL •'J /
1 FIRST 20 J 25 - o ADO RESS �I t Qe' v! Q
LIGHT-1H_ TOTAL �n
CLTY Oct 4f.71 �� C TEL. NO. �•�� l
SWITCH L r OVER 20 10 PLAN CHECK I •\
GHTING
LFIRST 20 25 APPLICANT
FIXTURES .10 ITOT L
OVER 20 ADDRESS
� .
APPLIANCES CITY ! TEL. NO.
PERMIT
RANGE_ORYERWTR. HTR._ APPLICANT - {/
STA. COOKDISP./F.A.U._ ADDRESS
SPACE HTR. AIR GOND. CITY 5^ 41j,PISTEL.
CLOTHES WASH. OISHWASH._ LICENSE NO. l 'd'�,Gj CLASS.C� (J
FAN_OTHER 1,00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
v 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. KVA. ELECTRICAL WIRING.
SIZEB TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
O - 1 100 LICENSED AS REQUIPA LOS A GELES UNTY AND STATE OF
CALIFORNIA OR THAW M T L AL R OF, AND INTEND TO �.
1 - 10 300 RESIDE IN, THE' E IP. SIOENTIAL PROPERTY. CL
p
10 - 50 5.00 OF PERMRTTE SIGN u
K
50 - 100 10.00 O
OISTR(ICTNO. CLASS ZONE PR CEASED BY F
100 - S00 1500 VJ LWJ
a
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES: H
Z
TUBE, OR I i -
MARQUEE ADDITIONAL CIRCUITS 100
SERVI CENOT OVER 600 VOLTS OR 200AMP 300
APPROVALS DATE INSPECTOR'S SIGNATURE
SERVICE OV ER 600 VOLTS OR 200 AMP I0.00
TEMP.POWER POLE
TEMP SERVICE,POLE, &APPURTENANCES 5.00
UNOERSLAB WORK
TEMP LIGHT OR RECEPT. SYSTEM 3.00
ROUGH CON DIUT
WIRING
FIXTURES
PERMIT FEE (SUB TOTAL) j �. O POWER AUTHORIZEd
!O UTILITY CO. NOTIFIED
PLAN CHECK FEE
FINAL I RERVSING
PERMIT ISSUING FEE 3.00
�D I J . ROOH
TOTAL FEE S ELECTR AL ENGINEER
PLAN CHECK VALIDATION CK. M.O. L CASH PERMI TVALIDATION CK. M.O. CASH
I
o6 7N MyA 9.50-
1 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE `,,�
76AG03.CEBOB_„_BTAPPLICATION, FORELECTRIC PERMIT
COUNTY OF LOS ANGELES - -
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS S r/.3 27
IOffii A. . GRIFFIN,
, S.P Engineer
CASSAT!D, bIBIE, , Supt of Huil. _ LocAUTY iE-,C•—' ��-A-IS�L.�_�
FOR APPLICANT TO FILL IN CROSS sr. �-L. -�PERMIT FEES /
ITEM NUMBER EACH I FEE OWNER ('
OUT
ET
RECEPT. SW. $ $ MAIL J o
.10 D ADDRESS J p 7/ //
LIGHTING FIXTURES .10 CITY TEL. NO:• Tza V
F ELEC.RANGES CLO.DRYERS - ELECTRICIAN d''W .c-tS
WATER HEATERS .50 ADDRESS
ELEC.SPACEHTRS. DISHWASHERS _
GARBAGE DISPOSERS AUTO.- CITY TEL.NO.
WASHERS STA.COOKING UNITS 25 STATE '
LICENSE NO.
F MOTORS: OVER INC. H.P. '• - -- - -= -
o — '/z 25 t DISTRICT NO. G,$L] P ZONE eADr FOR INsveeTloN
2 .50
2 - 5 I.Oo INSPECTION RECORD
5 — Is 1.50
15 — 50 2.50 - ZAI/£. �/ .<..,.r✓
so — 200 5.00 _• _
SIGNS:' NO.TRANS.
r NO.LAMPS
SERVICE 0-6OOV 1.00
1.
SERVICE OVER 60OV ' 5.00
S
I MISO.
WIRING PERMIT 1.00 0
r
FIXTURE PERMIT 1.00 Q(�-
SUPPLEMENTARY PERM IT ,50
t TOTALFEE $ Q APPROVALS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
j ELECTRICAL WIRING. WIRING A/�Ru- �/•9JO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES O-1ST
r LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIAL PRO�PERT�gY. p /-'�. -
' SIGNATURE _T/ L I L�- �L, UTILITY CO. NOTIFIED
' OF PERMITTEE - •/!i"• TGL- I —G p� p,
VALIDATION ARTHUR C.VEIT,
CK Mo ' CASH SUPERVISING ELECTRICAL ENGINEER
D21339,. JAN26 2 A002.90
� n
r
�L^ Y
OF i-CS ANGELES TEMY. Lc -IT 4 0-lGe, 2;.ECfi,7CAL PERMIT
—jT OF PUBLIC WORKS 9701 LA9� Ti2WS 0508 0009160027
BU1,DIN:; IAFETf LAND DEVCLOPMuNT TEMPLE ',.IT' LA 91730
PCC;;:: „2:', 285-0488 EXT:
—FEES
JIR: 5903 L", 0 5938 K�FTCN 1q,V N
FEE DESCRIPTI,7,1, QUANTITY: UG': I T:IIIIII SGAS CA 01775?670
ASSES G2 i�� f T Cr NEARE' STREET: LAS TUNAS
153`16-01� X50 NEAREST -�O'�S
Al PERMIT ISSUANCE iE- 27.71 THOMAS PA ; 590 GRID; G3 LOCA-; 7f' SAN GABRIE'
T-NAM77— G1 OUTLETS-1-G! SU,R;Cpz 18.00 OUT 35.10
jG2 LIGHTING FIX7;jRrz 7.00 LET 13.65 T`SSUED—ON.- BY'—PLAN BY: !R-S ON;
TOTAL FEES 76.50 09/23/04 JK r3l2;
1 UWW�W TEL 1LEt, I)AVIII (626) L
5933 ''UR"ON AV
SGAS ')17� �, 7
,5263C D 4S&Rff
ELECTRICAL F'R 1--N AND REMODEL
WON G (626)
I611 C ?W3'SION ?D
SAN GA3R7EL CA
WAI TAK CONSTRI-Cl (626,
611 E. M�ssioki RDLic. NO
ISAN GABRtFL, CA -! 7 61P, B
I i UNDERGRUITNff-t�,�D(J-.T
OAR-CY T i QCT JR �o zit ff 77T"- 'L,� R Gpuul�-
NG, SAM -57
133 N. 4TH ST.; 3It LIC. W;;
!ALHAMRRA, CA "'IFOII N^NI
%
PLASTIC Y/:= '-IEAL YIN
REPORT 10: DPR265 ROUTE TO:
WORKERS'COMPENSATION DECLARATION to/et
I hereby affirm that I have a certificate of consent to self CE-8066 APPLICATION FOR ELECTRICAL PERMIT
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
Icy, Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS
Ip 7Ll Certified copy is filed with the count building inspec- I & 2-Family, Sq. Ft. $ — $ LOCALITY
tion department. Multi-family Sq. Ft. — NEAREST
1t Residential Swimming Pools CROSS ST.
Date Appican OWNER OR
FIRM NAME 'T't
CERTIFICATE OF EXEMPTION FROM WORKER!r. Outlets: Rec2-LightSw. MAIL
COMPENSATION INSURANCE ADDRESS _
This section need not be completed if the work involved b First 20
( P T Total No. CITY Tel. NoZ -7 Q
the permit is for one hundred dollars($I00)or less.) AdditionalOle A
I certify that in the performance of the work for which this PLA CHECK
APPLICANT
permit is issued, I shall not employ any peison in any manner
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Total No. Additional
Date Applicant CITY a Tel No
NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over I HP PERMIT
Exemption, you should become subject to the Workers' Range_ Heater_D.W. _ APPLICA
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. CITY Tel. No.
LICENSED CONTRACTORS DECLARATION Hood _ Fan Other_ 0/0/�
Disp. _ Room Air Cond. — LICENSE OR A� Class. ` D
I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER VV
(commencing with Section 7000) of Division 3 of the Business- Power Apparatus 8 Large Appliances DISTRICT NO. PROCE SED BY
and Professions Code,and my license is in full force and effect. d
(- Size 8 Type HP, KW, KVA, cr KVAR' O
License Number a7 Lic. Class C J D _ Up to 1 Incl. FINAL V
Controcto Date ' !/- 3 Over I to 10 Incl. DATE /2 VALIDATION O
❑ _ Over 10 to 50 Incl. H
FINALt-
1 am exempt under Se . Over.50 to 100 Inc. BY LVit
B.BP.C. for this reason Over 100 uai
Services, Swbd., MCC & Ponelbaards Z
Date: Ivy�p / t
0 -200 Amp. Under600 V � J T J-
Signature 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Mainz. Elect.
SINGLE FAMILY Temp. Power Pole 8 Appurtenances 1 0.7 A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit �{` e e e e's 2I hereby 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): 2 e - 30,50
'
I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors o e o 3 Q v Q
structure is not Intended or offered for sale (Section Other (See Complete Fee Schedule)_ D
7044, Business and Professions Code). p Q 1 1 -83
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)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name ^
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this applicationand state that the TOTAL FEE O
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby outhori a representatives of this County to enter upon
Xg
e- a honed property for ins action purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Dat'o arm ittee Date