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78A68G CE.#806 5 61 APPLICATION F R ELECTRICAL PERMIT
COUNTY OF LOS /ANGELES
DEPARMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESs105P7Da i nes,
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A JENSEN,SUPT OF BUILDING LOCALITY Temple C 1ty 12
NEAREST
FOR APPLICANT TO FILL IN CROSS Sr
PERMIT FEES OWNER tartm o b d U e7 �
I T E M NUMBERI EACH FEE MAIL 1
--SSII n '1 ADDRESS Temple City
LOIGHTSEJ.L RECEPT 2 W 1 S10 S 5 -00
1110 CITY TEL NO
LIGHTING FIXTURES 10 l coElec , orp0
ELEC RANGES CLO DRYERS ELECTRFIAN
y r 1J G r
WATER HEATERS SO ADDRESS('� i h c)`�
ELEC SPACE HTRS DISHWASHERS
CITY TEL NO
GARBAGE DISPOSERS AUTO- 1 '_25 - STATE o
WASHERS STA COOKING UNITS 25 LICENSE NO �-79983010
MOTORS OVER INC H P 2 X50 DISTR CT N GR UP I ZONE PR SED Y
0— 1/225
2 50 INSPECTION R ORD
2— 5 100 / S 1 af,a//��`?` i 9 � c `0-
5— 15 150 V
15— 50 250 0
50— 200500
00 W
SIGNS NO TRANS N
NO LAMPS 'z
SERVICE 0.60OV 100
SERVICE OVER 600V 500
M ISC
WIRING PERMIT 100 11,00
FIXTURE PERMIT 100 O
SUPPLEMENTARY PERMIT 50
TOTAL FEE S
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 7 /� �,y�.-� //�� �
ELECTRICAL WIRING WIRING - '+(y � y Ze,_S f�
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ATE OR l y,,„��E� � -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES �j,�9(`�
CALIFORNIA OR THAT I E LEGA OWNER OF THE ABOVE I/
DESCRIBED RESID TY POWER 12 A n _
SIGNATUR - UTILITY CO NOTIFIED rf�ti/� ;Nr f Y/
OF PERMIT E
FINAL V;�2-Zfx '"?, -.;'�? Tssf
�IDATION — ARTHUR C. VEIT
MO CASH SUPERVISING ELECTRICAL ENGINEER
Lire 4 1' 8 ,-8 OCT 1 P ? p 5.18 5 w
i�J�7{�INLGl/iyC./
WORKERS' COMPENSATION DECLARATION 76-806 10/81 APPLICATION FOR ELECTRICAL PERMIT
er;by affirmlthat r'have a certificate of consent to self insure, CE-Bose
}mI I I I - U
or a certficateYof Workers' Compensation Insurance, or a certrfied COUNTY OF LOS ANGELES BUILDING-AND SAFETY
copy thereof(Sect3800,Lab C) ,S
Policy No O /7 1/33 Comnariy FOR APPLICANT TO FILL IN JOB 7�
ADDRESS+(bs� G
❑', Certified copy 19`1ieteby furnished New Residential Bldgs & POOIS' EACH, NO, FEE-
❑ Certified copy is filed with the county budding inspection y,Sq $ — $ LOCALITY G �L G
1 & 2-Family, Ft � 1
' ,department -family Multi Scl Ft + ': NEAREST �%N ,
CROSS ST a -r
�+ Residential Swimming Pools"
Date Applicant
'FIRM NAME
CERTIFICATE OF EXEMPTION'FROM WORKERS' `Z 5 h:'` s`L9 S MAIL
Outlets Rec /
Light Sw
COMPENSATION INSURANCE 4 5 >'� -ADDRESS O�Z
First 20' w -„
(This section need not be completed If the work Involved,by the ' /
permit is for one hundred dollars($100)or less) Total No Additional CITY_ ,� / j f Tel No�lpj — �73
I certify that in the performance of the work for which this permit , PLAN CHECK
CITY-
,I � � APPLICANT'
'
is-issued,•I shall not employ any_person In any manner*so as to a
become subject to,the Workers'Compensation Laws Lighting Fixtures 'First 20 ADDRESS ">
f
Total No Additional CITY Tel No
Date Applicant
Fixed Apphances Not Over 1 HP PERMIT
—NOTICE NOTICE TOS;APPLICANT If;.after making this'Certificate -of ' APPLICANT /�//
',•Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D W '/ ' �r
,provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W M ADDRESS `7 _ S #
provisions or this permit shall be deemed'revokedTop ,— FAU _ WH
LICENSED CONTRACTORS DECLARATION CITY �yf c Gr Tel No
Hood Fan Other_ F,
I}hereby affirm that I am licensed,,under provisions of Chapter 9 Disp -- Room Air Cond LICENSE OR 5-�, Class
(commencing with Section 7000) of Dnnsion,3 of the Business and REG NUMBER 7 `� 77
Professions Code,and my license is in full force and effect -Power-ApparatusDISTRICT NO PROCESS BY
& Large Appliances _ ,•�� ,
Size& Type HP,KW,KVA,or KVAR ✓` ✓�
,License Number 777 Lic Class _ Up to 1 Incl FINAL �7 /
;�- $ Over 1 to 10 Incl DATE V A I IN A 0
Contractor Date Over 10 to 50 Incl (J ( D
❑ I am exempt under Sec Over 50 to_100 Inc _ BY AL 2
# 0 0 0 0 0 ~
w
B&PC for this reason Over 100 N
• Services,Swbd,MCC& Pahelboards � -' - ' I 0 o-:
� 9.50
Date 0- 200 Amp Under 600 V 0 0 0+1 9,5 0
Signature 201 - 1000 Amp Under 600 V,
Over 1000 Amp or Over 600 V _
0 3
'Exemption for Reg Mamt Elect i 818
SINGLE FAMILY Temp Power Pole& Appurtenances
I, ' HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit,
I hereby affirm that I am exempt-from the Contractor's License Law Additional Sign Branch Circuits i
for the following reason (Section 7031 5, Business and Professions ,
'Code)
El
Misc Conduits& Conductors
I,as owner of'the property;will do the work and the structure
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 ;
performance of the work for which this permit is issued(Sec 3097, PERMIT FEE (Sub-Total)
Civ C)
PLAN CHECKING FEE - �• s
Lender's Name
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 State laws regulating Electrical wiring, and hereby authorize
representatives of this County to enter upon the above-mentioned _z
.proper for mspecUogpurp es -
r_ SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Oate