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--Des 5-A I2-44 APPLICATION FOR PERWr
DEPARTMENT OF BUILDING AND SAFETY, ��T�����
COUNTY OFF LOSLOS ANGELES � �i
WM J. FOX CHIEF ENGINEER
Q NAME I DIST NO. GROUP (�IZZONE PERMIT NO.
ADDRESS Z 3 V ♦ ✓-
+���� `BY READY FOR DATE ISSUED
CITY TEL NO
h! IRST INSPECTION
W CERT NO DCOUNTY '� EXPIRES
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
DESCRIPTION OF WORK A DRESS 9,6Z ,
NUMBER OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS NEAREST
LIGHT OUTLETS ISW PLUGS FIXT CROSS ST
CIRCUIT A B C D E F G 1H W NAME
ILI
= MAIL
3
ADDRESS
O
CITY TEL NO.
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGgLES COUNTY CER�AT F QUALIFICATION.
ELECTRICIAN.
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE
OWNER.
' CORRECTIONS
— a
_Z
• o
TOTAL
NO. OF OUTLETS $ APPROVALS
j NO OF FIXTURES $ DATE INSPFQCTOR;0 NAME
NO OF MOTORS H P $ CONDUIT - 2—
NO OF SIGNS TRANS $ WIRING
NO OF RANGESP@I . $ FIXTURES
MISCELLANEOUS $ POWER
PERMIT FEE $ u G UTILITYCO NOTIFIED7_ L
TOTAL FEE ___ IL FINAL
"WOrm that
I have a cerci! DECLARATION 76A663CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT
�I hereby affirm that I have a certificate of consent to self CE-8066 __
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 co is hereby furnished EACH NO FEE ADDRESS
copy Y New Residential Bldgs & Pools
❑ 1 & 2-Family, S Ft $ _ $ NEAREST
LOCALITY
Certified copy is filed with the county building inspec- Y• q
tion department Multi-family Sq Ft CROSS ST (C V
Residential Swimming Pools OWNER OR /
Date Applicant (/_ `4f Y
FIRM NAME
Up"AJ
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Recl-Light 3 Sw�
COMPENSATION INSURANCE t �ADD�REFirst 20
(This section need not be completed if the work involved by Y Tel No _
the permit is for one hundred dollars ($100)or less ) Total No Additional r�
PLAN CHECK
I certify that in the performance of the work for which this APPLICANT J /�[� L
permit is issued, I shall not employ any person in any manner S
so as to become subject to the Workers'Compensation Laws Lighting Fixtures First 20 ADDRESS
Total No 3 Additional CITY Tel N'o
Date ' pplicant
IT
NOTIC TO A PLICA If, aft king t i Cer is to of Fixed Appliances Not Over 1 HP APPPERLICANT
Exemption, you sh Id beco a subject t the Workers' Range— Heater_D W
Compensation provisions of t Labor Code, you must forth- Oven _ Dryer — W M — ADDRESS
with comply with such provisions or this permit shall be Top _ FAU W H — CITY Tel No
deemed revoked Hood — Fan _L Other—
J
LICENSED CONTRACTORS DECLARATION � LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp — Room Air Cond REG NUMBER Class
(commencing with Section 7000) of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO P O SSED BY
and Professions Code,and m license is in full force and effect CpJ�
Size & Type HP, KW, KVA,,or KVAR �_ Q
License Number Lic Class Up to 1 Incl FINAL U
Over 1 to 10 Incl DATE Z^_ �� VALIDATION
Contractor Date Over 10 to 50 Incl V
FIN
I am exempt under Sec Over 50 to 100 Inc BY �
B &P C for this reason Over 100
Date Services, Swbd , MCC & Panelboards -
0 - 200Amp Under 600V
Signature 201 - 1000 Amp Under 600 V T! 7
❑ Over 1000 Amp or Over 600 V o c c 2 7.5 0 5
Exemption for Reg Maint Elect
SINGLE FAMILY Temp Power Pole & Appurtenances 0 $2 0-0
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
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)
xj, as owner of the property, will do the work and the Misc Conduits & Conductors
structureis 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)
(Sec 3097, Civ C )
PLAN CHECKING FEE -
Lender's Name
PERMIT ISSUING FEE J'
Lender's Address
I certify that I have read this application and state that the TOTAL FEE t
above information is correct I agree to comply with all County
ordinances and State jaws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the above-mentioned prop rty for inspection purposes
J� ^ SEE REVERSE FOR EXPLANATORY LANGUAGE
I r ture a it a Date
J -
J
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0311190013
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
_tEGALI BUILDING :
TR: 12410 LT: 20 5520 ENCINITA AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT. TEMP CA 917802307
ASSESSOR INFORMATION NUMBER- NEAREST-CROSS STREET: BROADWAY
8588-002-020 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID• J4 LOCALITY TEMPLE CITY
G1 OUTLETS-LGT,SW,RECP 4 00 OUT 7 80
TENANT HA FAU LESS 3HP 1.00 FAU 10 95 ISSUED ON PROCESSED : PL .
JB AC UNITS +3-10HP 1.00 AC 19 65 11/19/03 JK 05/17/04
LA 100 AMP PANELS, MCC 1 00 PAN 38.85
OWNER: TEL NO: TOTAL FEES 105.00 FINAL DATE FINAL Y• CODE:
PENG JAIME J (626) 795-8162- _ y
DESCRIPTION OF
INSTALL NEW CENTRAL AIR AND HEATING; UPGRADE SERVICE PANEL
TO 125AMP
APPLICANT. L NO.
AIR CARE (626) 442-6792-
10037 RUSH ST SPECIAL CONDITIONS
S EL MONTE 91733
CONTRACTOR: TEL NO: APPROVALS DATE INSPECTOR SIGNATUR
AIR CARE CO. (626) 442-6792-
10037 RUSH STREET LIC. NO PORAR P L
SOUTH EL MONTE CA 91733 516562 B
UNDERCRO ND CONDUIT
ARCHITECT OR ER: TEL N ER GROUND
LIC. NO ROUGH CONDUIT
ROUGH G
MAIN WATER LINE
PLASTIC Y/N METAL Y/N
UTILITY PANY D
* ADDITIONAL DATA ON FILE
REPORT ID: DPR265 ROUTE TO: BS0508