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HomeMy Public PortalAbout4843 DOREEN AVE_Electrical__ oa=s=a,E-=< /APPLICATION FOR ELECTRIC PERMIT DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles BUILDING �/ //�//r� WM. J. FOX. COUNTY ENGINEER ADDRESS d{��'�' "I 1)1-/� CASSATT D. GRIFFIN. SUPT OF BUILDING FOR APPLICANT TO FILL IN _LOCALITY ( i PERMIT FEES NEAREST �� B CROSS ST. FEE NUMBER EACH LIGHT OUTLETS OWNER n RECEPTACLES <_MAIL ADDRESS T WALL SWITCHES �___ TOTAL OUTLETS O SE S O CITY. TGL. NO. ELEC. RANGES 25 ELECTRICIAN ELEC. HEATERS 25 ADDRESS KW EA CITY A TEL. NO. �SY 3 Z FIXTURES 5 LICEN E NO.- NUMBER O.NUMBER OF LIGHT CIRCUITS NUMBER OF RECEPTACLE CIRCUITS DISTRICT NO, GROUP ZONE I BEIDY 10a MIPC710N �—/ MOTORS NUMBER HORSEPOWER FEE. INSPECTION RECORD NEW MVO, HP OVER INC. EACH 1�@ LEBS $ .25 --- I/y 2 .50 — 2 5 1.00 y _ 5 15 1.50 15 50 2.50 p- 50 200 /r�e r � /moi MISC. /1. NO. SIGNS, NO. TRANS. NO. SIGNS NO. LAMPS FOR EACH PERMIT: WIRING $1:00 �}..� FIXTURES $1.00 SUPPLEMENTARY 50 APPROVALS TOTAL FEE $ DATE INSPECTORS S SIGNATURE I HEREBY ACKNOWLEDGE THAT HAVE READ TH15•APPLICATION' CONDUIT AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. FIXTURES I HEREBY CERTIF T T AM PROPERLY REGISTERED ANO/OR LICENSED AS REDU RED BY LO NGELES COUNTY AND STATE OF CALIFORNIA OR Tqq AT AM l�L{EG`A WNER OF THE ABOVE POWER - DESCRIBED RE51DENTIA P / ee � UTILITY CO. NOTIFIED f / !moi• SIGNATURE ul� FINAL x20 J> OF PERMITT WILLIAM J. OX, OUNTY ENGINEER 'VALIDATION ;gDdt� ;71}FEB' .� "2•. 2.80 _. _ _ DEPUTYb 71 A663 CE-806(I 1 /781 COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT•TO FILL IN JOB New Resident,ol Bldgi.&Pools - EACH NO. FEE ADDRESS �_ I &2-Family,Sq. Ft. $ .025 — $ LOCALITY e_ ' qq rt Multifamily Sq. R. '02 ' CROSS ST. �� y r . — NEAREST Residential Swimming Pools 25.00 .OWNER . // --- - FIRM NAME Outlets:.Rec_Light_Sw.,_ MAIL ,_ _._ First 20 .50 ADDRESS Total No.. Additional .30 CITY _Tel..No.� PLAN CHECK ' _ APPLICANT Lighting Fixtures First 20 .50 ADDRESS ' Additional - -30 _ _ _ ___ Total Na. - CITY Tel. No. ' Fixed Appliances.Not Over I HE _ -PERMIT- Range— nrAPPLICANT DryerWA Heater— D.W. _ DDRESS - - -Ove --_ .M._= � �.-. - Top _FAU W.H._ CITY _ _ Tel. No. Hood—Fon _Other_ LICENSE OR W Disp.—Room Air Cond. 2'S0 REG.NUMBER Class. _ _ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA Power Apparatus&Large Appliances TION AND.STATE THAT THE ABOVE IS CORRECT AND AGREE TO SizeBT -- COMPLY WITH-ALL-COUNTY ORDINANCES-AND-STATE CAWS' Type HP, KW, KVA,or KVAR 2 50 REGULATING ELECTRICAL WIRING. O Up to 1 Incl. I HEREBY CERTIFY-THAT PAM PROPERLY REGISTERED AND/OR' - V Over 1 to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF C Over 10.to 501nd_ 12.50.. _ CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _ O 25.00 DFSC_RIBED RESANTITIIAAL PIRO�PERTY HH Over 10 100 Inc. _ PERMITEE Over 1000 .25, 00 SIGNATURE y Services /Alt', - -- DISTRICT NO." " - _ __ ' ROCES D"BY 0 200 Amp. Under 600 V 12.50 /s G 201=1000 Amp, Under 600 V 25.00 - - S,V•O - —Over 1000 Amp.or Over 600 V 50.00 Z p Temp.Power Pofe&Appurtenances 10.00- Sign with One Branch Circuit 1,0.00 - AdditionalSignBranchCircuits 2'00 . INSPECTION ;, m 9081.2A , INFORMATION. W Misc.Conduits&Conductors ON REV ERS x # o a o 0 0.2 Other(See Complete Fee Schedule)_ - -.SIDE- _ V .. .a 2 - 019.50 , . o 19.5,0.Q1 PERMIT FEE ISub-Torah ,� D 0618'-80 Z PLAN CHECKING FEE IOne-Fouah Permit Feel O PERMIT ISSUING FEE $7.00 A .O TOTAL FEE > , INSPECTION FINALED rc - W date: / — /� „„' aBy �^ ©s Des S-A 2-46 DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES TI L�I��R1C WM. J. FOX CHIEF ENGINEER AE 2 NAME DISTRICT NO. GROUP ZONE PERMIT NO. ..I_ ^ On .,.__. S ' �' ADDRESS MI_�7 J t) U •'L ':1., •I. - 1%• Tv RECEIVED BY READY FOR DATE ISSUED 10 CITY i,- TEL.NO. FIRST INSPECTION J COUNTY yy}} _- %'.[_ L. / //'/)< W CERT.NO. 61-22 q EXPIRES " �0�� , APPLICANT FILL IN HEAVILY.OUTLINED POJOBTION ONLY DESCRIPTION OF WORE -ADDRESS a7 NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS 0 NEAREST LIGHT OUTLETS SW. PLUGS FIxT CROSS ST. Ll CIRCUIT A B C D I E F G lH I wNAME Z MAIL ADDRESS O CITY TEL.NO. 1 AM THE LEGAL PO 660 O E ABppVyE LOB ANGELES COUNTY CERTI 1 F IFICNTION.. 'RAW, 12 4zELECTRICIAN. 1 AM THE LEGAL OWVER OF THE PROPERTY DESCRIBED P ABOVE •�� OWNER. CORRECTIONS VAl I � 1 P � J Q Z [7 R O TOTAL NO. OF Ou__ETS $ APPROVALS NO. OF FIXTURES $ DATE INSPECTOR'S NAME NO, OF MOTORS H.P. $ CONDUIT / NO. OF SIGNS TRANS. 15MING / / /� ��'�• ' NO. OF RANGES OR EATERS S FIXTURES /] r MISCELLANEOUS $ PQWZR PERMIT FEE $ UTILITYCO.NOTIFIED /).. ,C ^fI.1 .. TOTAL FEE FINAL .��-���•�� �� Y V 7 76A663CEBOB 3-89 '1. APPLICATION FOR ELECTRI AL PERiot !� COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS p JOHN A. LAMBIE, COUNTY ENGINEER Ir, COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST NO. I EACH FEE RECEIPT.1J)]=� $ $ OWNER MAIL A ADDRESS LIGHT 3 TOTAL FIRST 20 .20 V CITY TE L.NO. SWITCH OVER 20 .10 PLAN CHECK LIGHTING TOTAL FIRST 20 .20 APPLICANT FIXTURES 3 OVER 20 ,10 ADDRESS RANGE_DRYER_WTR. HTR. CITY TEL. NO. STA. COOK_DISP. F.A.U. CONTRACTOR SPACE HTR._AIR COND. ADDRESS CLOTHES WASH._DISHWASH._ CITY TEL.NO. - r•Q6 / Y FAN OTHER 1.00 LICENSE NO. .2- 1 -Z- 7 z- 6 CLASS. C- I U MOTORS,TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION IND. HEATERS, ETC. NP. KW. KVA. AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. D - 1 1.00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED LVO/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 1 - 10 3.00 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO O RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. V 10 - 50 5.00 SIGNATURE 50 - 100 1000 OF PERMITTEE 0 V 100 - SOO 15.00DISTRICT NO. GROV ZON PR 99E Y W SIGN,GAS SIGN AND ONE CIRCUIT 3.00 C- Z TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES: SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT WIRING PERMIT FEE ISUB TOTAL) FIXTURES ` " v 0 •.A POWER AUTHORIZED PLAN CHECK FEE (50% PERMIT FEE) PERMIT ISSUING FEE 2.00 b u UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL TOTAL FEE JOSEPH C. ROOHAN SUPERVISING ELECTR L ENGINEER PLAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION CK M.O. GASH Arl)5 4 7 OR Jml8 2 D 6.40- a SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE J /L//1-W/'✓ 1. DS585A 1,-55 APPLICATION FOR ELECTRIC PERMIT DMSION OF BUILDING AND SAFETY Deportment of County Engineer Su 1LDI NG •f Ciounty Of Los Angeles ADDRESS L JOHN A. LAMBIE.COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST PERMIT FEE'S CROSS ST. NUMBER OWNER i.�/!/��, ✓✓✓YYY✓✓✓ LIGHT OUTLETS MAIL RECEPTACLES ADDRESS WALL SWITCHES FEE CITY li TEL. NO. TOTAL OUTLETS ® 5¢ $ ELECTRICIAN ELEC. RANGES 25 / ADDRESS ELEC. HEATERS 25 /�(P O C..�. /J�.�.•�/E CITY TEL. NO. KW EA STATE / FIXTURES 5 LICENSE NO. MOTORS DISTRICT NO. GR P Z E ADY FOR INSPECTION NUMBER HORSEPOWER FEE •/ NEW I MVD. HP OVER INC. EACH B LESS $ .25 INSPECTION RECORD Ya 2 .So ,Y � i AAS /�O 9 I tq I/Oc s•>'� 2 a 1.00 5 15 1.50 _ 15 SO 2.50 a0 200 5.00 • MISCT ' NO. SIGNS NO.TRANS. NO. SIGNS NO. LAMPS FOR EACH PERMIT: WIRING 51.00 O—>•' FIXTURES $1.00 SUPPLEMENTARY ,50 ^ APPROVALS TOTAL FEE $ 2 C] DATE INSPECTORS SIGNATURE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION I/ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT 'Y WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING n 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REOUIREO BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENTIAL PERTY. / SIGNATURE (��� / UTILITY CO.NOTIFIED OF PERMITTEE FINAL �P JOHN A.LAMBIE. CO NGINEER VALIDATION ARTHUR C.VEIT,CHIEF ELECT. INSPECTOR CK MO GSH SCo9 1 0 &:-'9 AIJG 11D c2 2.8 0 L^ m yJOrrn'th COMPENSATION DECLARATION CE-806 10/8I APPLICATION FOR ELECTRICAL PERMIT 1 F.ereby:bfiirm`that I have a certificate of consent to self CE-B06G insure, ora 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 ADDRESS `f O / �r� Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ❑ Certified copy is filed with the county building inspec- 18 2-family, Sq. Ft. $ — S LOCALITY tFtt',1F e r "7- lion department. Multi-family Sq. Ft. — NEAREST _ CROSS ST. 4 Q LA! Q y Residential Swimming Pools OWNER OR Date Applicant _� S - FIRM NAME L, CERTIFICATE OF EXEMPTION FROM WORKERS' I � 3MAIL Outlets: Rec ti ht $w. y� COMPENSATION INSURANCE ADDRESS T O' Ai !J V h (This section need not baoif the work involved by First 20 CITY �T r the permit is For one hundred red ddollalga rs (SI00)or lass.) Total No. Additional rQ ifJ 04� C. 7 el. No.`'Fy✓^ certify that in the performance of the work for which this PLAN CHECKAPPLICANT 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 Total No. Additional Dat �� G CITY Te. o. �^ Applicant Fixed Appliances,Not Over I HP PERMIT NOTICE TO APPLICANT: If, after mak g this Certificate of t Jtr APPLICANT Exemption, you should become subject to the Workers' Range_ He er�D.W. Compensation provisions of the Labor Code, yoir 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_ 00 CITY Tel. No. LICENSED CONTRACTORS DECLARATION LICENSE OR Room Air Cond. I,hereby affirm that I am licensed under provisions of Chapter 9 Disp. REG. NUMBER Class. (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PRO S D BY d' and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances O. Size 8 Type HP, KW, KVA, or KVAR License Number Lic. Class- - Up to 1 Incl. FINAL `^ / � Over I to 10 Incl. DATE (J/"/6 yp 1 pT10N 0 Contractor Date Over 10 to 50 Incl. FINA LLLI ❑ am exempt under Sec. Over 50 to 100 Inc. BY d' 100 n 8.8P.C. for this reason Over Z_ Date: Services, Swbd., MCC 8 Ponelboards 0 -200 Amp, Under 600 V Signature 201 - 1000 Amp. Under 600 V El Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole 8 Appurtenances ;R 4 0 a 6 A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # o o e o e2 I 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): I o 0 2 0 Jr 0 ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors e e e 2 Q 5 0 structure is not intended or offered for sale (Section Other (See,Complete Fee Schedule)_ 7044, Business and Professions Code). D 0 212-860 12c86 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 S Lender's Address I� I certify that I have read this application and state that the TOTAL FEE aC..0 S 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si m. z- � Signature of P Ofmittee Date 20H)019 WORKER'S thatIhave a certificate DECLARATION 76A663 0PW 9189 APPLICATION FOR ELECTRICAL PERMIT ]6A663 I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worket'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. Company FOR APPLICANT TO FILL IN JOB DDRE55 ❑ Certified copy is hereby furnished. New Residential Bldgs.8 Pools EACH NO. FEE _ ❑ $ dCertified _ $ LOCALITY /t G e department. copy is tiled with the county building inspection 1 ul i- Family,Sq.Fl. epartment. Multi-family Sq.FL CROSS ST coAJEAe AzudA Date Applicant Residential Swimming Pools ASSESSOR _ ' MAP BOOK �J��S PAGE '�>2Y PARCEL �� CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Light Sw.-13-- (/ FRN NAME COMPENSATION INSURANCE First 20 70 6 a NNy cl'(wU n'N IV (This section need not be completed if the work Involved by the MAIL permit is for one hundred dollars($700)or less.) Total No. Additional ADDRE6B/f6./d .9VE I certify that in the performance of the work for which this permit CITY P Tel.rvof 6 d. is issued, I shell not employ any person in any manner 50 85 to �� PLAN CHECK become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. OZ Additional ADDRESS Date - Applicant 15 OR 20A120V BRANCH CIRCUITS NOTICE TO APPLICANT: If, after making this ,Certificate of CITY Tel,No. Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code,you must forthwith comply with such 11 T040 INCLUSIVE EACH PERMIT R P y APPLICANT 6ONE12i provisions or this permit shell be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH LICENSED am and DECLARATION - ADDRESS (L I hereby affirm that I am licensed under provisions of Chapter 9 150R 20A.208V TO 277V LIGHTING EACH d (commencing with Section 7000)of Division 3 of the Business and CITY Tel.No. 0 Professions Code, and my license is in full force and effect. RESIDENTIAL APPLIANCES UP T03HP LICENSE OR Power Apparatus 8 Large Appliances REG.NUMBER Class Q License Number Lia Class Size 8 Type HP,KW,KVA,or KVAR DISTRICT NO. PR9CCCESSED BY 0 Up to 3 Incl ��O W Over 3 to 10 Incl. FINAL Q. Contractor Date DATE Over 10 to 50 Incl. .�❑ 1 am exempt under Sec. Over 50 to 100 Incl. VALIDATION Z 8.8P.C.for this reason Over 100 FINALBY Services,Swbd...MCC 8 Panelboards Dale: 0-200 Amp.Under 600 V Signature 201 -1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maim.Elect. SINGLE FAMILY Temp.Power Pole 8 Appurtenances 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 Code): ❑ 1, 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) D and Professions Code). e 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) /� Q Ci,C.) PLAN CHECKING FEE Lender's Name q PERMIT ISSUING FEE yr y S Lender's Address �� 15 I certify that I have read this application and state that the above TOTAL FEE informro Is correct. I agree to comply with all County ordinances end 5 a( to laws regul ting Electrical wiring, and hereby authorize rep/santetives of 94s County to enter upon the above-mentioned property for inspect' n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 6 iY rZ 5 UPE OF gPPLICAM Oa AGENT ATE WORKER'S thatIhave a certificate DECLARATION 76A663 APPLICATION 9/89 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, 76A663 or a certificate of Wocker'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. Company FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished. New Residential Btdgs.&Pools EACH NO. FEE ❑ $ _ $ LOCALITY _ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. NEAREST department Multi-family Sq.Ft. CROSS ST. O Date Applicant Residential Swimming Pools 'ASSESSOR MAP BOOK pgGF PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec._Light Sw. �iqM NAME COMPENSATION.INSURANCE _ First 20 MAIL N C D (This section need not be completed if the work involved by the AD ESS permit is for one hundred dollars($100)or less.) Total No. Additional ADDR I certify that in the performance of the work for which this permit CITY el.No. is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First APPLICANTK �` p {'/J� / Total No. Additional ADDRESS Date J4 —14 / Applicant (fA_9 —���� C 15 OR 20A,12DV BRANCH CIRCUITS NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.N. Exemption, you should become subject to the Workers'Compensation I TO 10 INCLUSIVE EACH provisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACH A MIT provisions or this permit shalLbe deemed revoked. APPLICANT y Gor P p 41 OR MORE BRANCH CIRCUITS EACH } LICENSED CONTRACTORS DECLARATION ADDRESS )�1 % d 1 hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH (commencing with Section 7000) of Division 3 of the Business and CITY T.I.N1.1/0/ Professions Code, and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP V LICENSE OR / Q r Power Apparatus e Appliances REG.NUMBER C? Class C-/,� O � License Number Lia Cie. /Y &Typ HP W,KVA,or KVAR DISTRICT NO, P SED BY )— / c� Z��L� �_ p /�1 Up to 3 Incl. W Over 310 10 Incl.clDATE U) EL Over 10 to 50 In . g S!12 �+ I am exempt under Sec. Over 50 to 100 Incl. VALIDATION B.&P.D.far this reason Over 100 FINAL BY Services,Swbd.,MCC It Panelboartls ate: Y 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 I hereby affirm that I am exempt from the Contractor's License Law g for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): ❑ 1, as owner of the property,will do the work and the structure Misc.Conduits&Conductors j T"[E- is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). D I I_II IL- F CONSTRUCTION LENDING AGENCY LIC,dSie7 I hereby affirm that there is a construction lending agency for the it;�� °?p+�lJ_ performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) - Civ. C.) PLAN CHECKING FEE nn Lender's Name l.iD(�Lt-'f�e+, PERMIT ISSUING FEE Lender's Address O ..�r.�1*1 a� y 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 Co.nty�9a enter upon the above-mentioned proper fo r'Fspecti pur ��as._ SEE REVERSE FOR EXPLANATORY LANGUAGE ys/9�y SIGNATURE OF APPLICANT OR AGENT DATE COUNTY OF LOS ANGELES TEMPLE CITY M 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0512210011 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 265-0488 EXT: , LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 13645 LT: 48 BL: .001 4843 DOREEN AV ' FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917804140 ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: LOWER AZUSA 8585-024-034 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C5 LOCALITY: TEMPLE CITY, C G1 OUTLETS-LGT,SW,RECP 10.00 OUT. 19.50 TENANT: G2 LIGHTING FIXTURES 5.00 LOT 9.75 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL PEES 57.00 12/05 JK 06/19/06 OWNER: TEL. NO: F/I�qNAL DATE PIN BY: CODE: NGUYEN, PETER - V �� 4843 DOREEN AV V TEMP 917804140 DESCRIPTION OF WORK 10 OUTLETS S 5 LIGHT FIXTURES APPLICANT: TEL. NO: KAMEN LAI (626) 288-2051- 6748 VALLEY BLVD BK SPECIAL CONDITIONS: ROSEMEAD, CA 91770 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE P S REMODELING CORPORATION (626) 378-2781- 9059 WOOLLEY ST LIC. NO TEMPORARY POWER POLE TEMPLE CITY, CA 91780 7540898 UNDERGROUND CONDVIT ARCHITECT OR ENGINEER: TEL. NO: UPER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRINGI ^� MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508