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7GA663-CE606-11-57APPLICATION FOR ,ELECTRIC PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS /4 71/x'
JOHN A LAMBIE County Engineer
CASSATT D. GRIFFIN. Sup t of Buildlag LOCALITY �L O.L� 7--i/
NEAREST
FOR APPLICANT TO FILL IN CROSS ST L/ C
PERMIT FEES OWNER -5 S _
ITEM NUMBER EACH FEE
OUTLETS S g MAIL
LIGHTS RECEPT SW 10 ADDRESS
LIGHTING FIXTURES 10 CITY t� TEL NO
ELEC RANGES CLO DRYERS
ELECTRICIAND
WATER HEATERS 50 , � /
ELEC SPACE HTRS DISHWASHERS ADRESS A
GARBAGE DISPOSERS I AUTO- /CITY A AN T.G f3FLGi: TEL NO
WASHERS STA COOKING UNITS 25 5 STATE
MOTORS OVER INC H P LICENSE NO
o — +i2 25
��_ DISTRICT NO GR UP NE I REA FOR INSPECTI N
' _� � e
1/2 — 2 50 ✓'
2 — 5 100
INSPECTION RECORD
5 — 15 1 50
15 — 50 250
50— 200
Soo
SIGNS NO TRANS
NO LAMPS
SERVICE 0-600V 100 GG
SERVICE OVER 600V 500
MISC
n
i
c
t WIRING PERMIT 100 6,9
FIXTURE PERMIT 100
SUPPLEMENTARY PERMIT 50
TOTAL FEE $ qAPPROVALS'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP ICA�TION DATE INSPECTOR S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING WIRING (�
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR i
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDEN AL PR PERTY
SIGNATURE UTILITY CO NOTIFIED
OF PERMITTE �� /' / r
FINAL
77 ARTHUR C VEIIT—'
CK7 M ATION SUPERVISING ELECTRICAL ENGINEER
WORKERS COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self CE 806G
insure' or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES � BUILDING AND SAFETY
or a certified copy thereof (Sec 3800 Lab C ) I/IJP .4'
f
Policy No�yCompany � FOR APPLICANT TO FILL IN JOB
Certified copy is herebyfurnished EACH NO FEE ADDRESS
New Residential Bldgs & Pools
Certified copy is filed with the county building inspec- 1 & 2-Family Sq Ft $ _ $ LOCALITY
tion dNEARESTepar mens Multi-family Sq Ft CROSS ST G
7 � �J p� Residential Swimming Pools OWNER T Op
'Date Applicant FIRM NAME l
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec Light Sw_ MAIL
COMPENSATION INSURANCE ADDRESS
First 20 (�
(This section need not be completed if the work involved by Total No Additional CIT /e Tel No 70-64017
the permit is for one hundred dollars ($100)or less ) J
I certify that in the performance of the work for which this APPLCANTcnV1rbMP6A&&1I
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 Q '.el/ V
Date Applicant
I Total No Additional l�
CITY ` ' WQ Tel No 7(ol
i
I
NOTICE TO APPLICANT If after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT-
T
Exemption you should become subject to the Workers Range_ Heater_D W APPLICAN
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—
Disp _ Room Air Cond LICENSE t- Class
MM BER
(commencing with Section 7000) of Division 3,of the Business power Apparatus 8 Large Appliances DISTRICT NO PROCE ED BY
and Professions Code and my license is in full force and effect d
t L Size &Type HP, KW KVA or KVAR �� 0
License Number 7 Lic Clas- .mss( �' Up to 1 Incl FINAL V
G (�I Over 1 to 10 Incl DATE �� � � VALIDATION
IM
Contractor �� Ji �/ Date 2 _
❑ Over 10 to 50 Incl FINAL ~
I am exempt under Sec Over 50 to 100 Inc BY d
t` 8 &P C for This reason Over 100 W fA
Services, Swbd , MCC & Ponelboards
Date
0 - 200 Amp Under 600 V ► w �
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 3 9 U 4 p
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 # 0 0 o e o 2
Professions Code)
❑ I as owner of the property, will do the work and the Misc Conduits&Conductors 2 o 0 1 i( 50- -
structure
( 5Qstructure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_
7044, Business and Professions Code) ► ° ° ° C1
CONSTRUCTION LENDING AGENCY 07 2 6-S 3'--
1 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 O
PERMIT ISSUING FEE
Lender`s Address '
I certify that I have read this application and state that the TOTAL FEE s(�
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
th above mentioned pr perty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
Si lure of Permittee uate + 1
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9611270001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE (818) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
TR 4902 LT 9 BL E 10765 FAIRVIEW AV
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917804102
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET
8574-024-031 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID D4 LOCALITY: TEMPLE CITY
G1 OUTLETS-LGT,SW,RECP 26 00 OUT 47 10
TENANT G2 LIGHTING FIXTURES 9 00 LGT 17 55 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
HA FAU LESS 3HP 1 00 FAU 10 80 11/27/96 LC 11/27/97
JB AC UNITS +3-10HP 1 00 AC 19 65
OWNER TEL NO TOT L FEES 122 85 FINAL DATE FINAL BY CODE
GONZALEZ JOSE N,CHRISTINE M (818) 444-0606— / 11-2-7_
10765 FAIRVIEW AVE,
TEMP 917804102 DESCRIPTION OF WORK
ELECTRICAL FOR ADDITION OF FAMILY ROOM AND ONE BEDROOM
APPLICANT TEL NO
Z P ABREGO (818) 350-4355-
��� SPECIAL CONDITIONS
CONTRACTOR TEL NO �j� APPROVALS DATE INSPECTOR SIGNATURE
Z P ABREGO (818) 350-4355-
11220 DAINES DRIVE LIC NO �jl TEMPORARY POWER POLE
TEMPLE CITY, CA 91780 520040/6
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER TEL NO 14 UFER GROUND
LIC NO- 11110 ROUGH CONDUIT
_
5� ��� ��S
U ROUGH WIRING
VVoES" MAIN WATER LINE
P
_ o PLASTIC Y/N METAL Y/N
0o 1� ��� UTILITY COMPANY NOTIFIED
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REPJRT ID DPR265 ROUTE TO BS0508