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78A66C Ct#806 5 61 APPLICATION FOR ELEC RI AL PERMIT I--I
COUNTY OF LOS /ANGELES
DEPARMENT OF COUNTY ENGINEERBUILDINGI?`
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER If
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY {
MI NEA REST
FOR APPLICANT TO FILL IN CRoss sr J
PERMIT FEES OWNS
I T E M NUMBER EACH FEE MAIL
OUTLETS $ $
ADDRESS
LIGHTS RECEPT� SW 1O CITY TEL NO
LIGHTING FIXTURES 10 ILI
ELEC RANGES CLO DRYERS s ELECTRICIAN '� C
WATER HEATERS 50 ADDRESS G
ELEC SPACE HTRS/DISHWASHERS yL
GARBAGE DISPOSERS AUTO CITY [ TEL N STATE `
WASHERS STA COOKING UNITS y 25 7 1 LICENSE NO
MOTORS OVER INC H P DI ICTFO GROUP ZO E PR ESSED BY
0— 1/2 25
1/2— 2 $o INSPECTION RECORD '
5— 15 ISO p v w v '. , U
15— 50 250 F Im
O
50— 200
500 v
W
SIGNS NO TRANS N
NO LAMPS z
SERVICE O 600V
too
SERVICE OVER 600V Soo
M ISC
WIRING PERMIT r� 100 C
FIXTURE PERMIT too
SUPPLEMENTARY PERMIT 50 4
TOTAL FEE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLAICION APPROVALS 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 WIF+ING WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR y
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THELEG�b OW R OF THE ABOVE V
DESCRIBED RESIDENTIA ROPERTY ' ) POWER R
SIGNATURE / / UTILITY CO NOTIFIED
�'
OF PERMITTEE CCC�e����
FINAL
ILA LIDATION ART R C VEIT\Vl
I CK MO CASH SUPERVISING ELECTRICAL ENGINEER
L 2
SEP '?5 2 D 8 90 klo
y r 11 i
WORKER S COMPENSATION DECLARATION 20 DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT
76A663
I hereby affirm that I have a certificate of consent to self Insure 76A663
or a certificate of Worker 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 rO FILL IN JOB
ADDRESS �J
Certified copy Is hereby furnished New Residential Bldgs &Pools NO EACH FEE `
$ $ LOCALITY ` �
❑ Certified co is filed with the count building inspection 1 &2 Family Sq Ft
PY y g p — NEAREST
department Multi family Sq Ft CROSS ST (w
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec Light Sw Oiaan NAME
COMPENSATION INSURANCE
First 20 MAIL
(This section need not be completed if the work involved by the Total No Additional � ADDRESS � �
permit is for one hundred dollars($100)or less)
I certify that in the performance of the work for which this permit CITY Tel No 252
6275- 3
Is Issued I shall not employ any person In any manner so as to PLAN CHECK
become subject to the Workers Compensation Laws Lighting Fixtures First 20 APPLICANT
Total No Additional
ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICE TO APPLICANT If after making this Certificate of CITY Tel No
Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP
provisions of the Labor Code you must forthwith comply with such PERMIT o
provisions or this permit shall be deemed revoked
Power Apparatus&Large Appliances APPLICANT
LICENSED CONTRACTORS DECLARATION Size&Type HP KW KVA or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl
(commencing with Section 7000) of Division 3 of the Business and CITY Tel No
Professions Code and my license is in full force and effect Over 10 to 50 Incl
LICENSE OR Class
Over 50 t0 100 Incl REG NUMBER a
Over 100 DISTRICT NO P SSED BY O
License Number Lic Class n V
Services wbd CCWnr
Y600
rds (j v� G`:��fii��tJ �
�7 d FINAL
Contractor Date /i]fjr' Amp DATE
❑ I am exempt under Sec 400 1000 Amp Und V H
Over 1000 Amp or Over 600 V FINAL _�` VALIDATION d
B&P C for this reason BRANCH CIRCUIT FEES BYCD
Date 15A or 20A 120V Lighting or Recept Z_
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
❑ _ 41 Or More Branch Circwts
Exemption for Reg Maint Elect 15A 20A 208V To 277V Lighting Br Circuits
SINGLE FAMILY Temp Power Pole&Appurtenances 2`rf
HOME OWNER BUILDER DECLARATION AiL ACCT.T
I hereby affirm that I am exempt from the Contractors License Law Sign with One Branch Circuit es
for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits 36-03 O 1rre60
hi
1 as owner of the property will do the work and the structure Mlsc Conduits&Conductors 1 ITEMS
is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) ® Ti+TAE 65 ® 6101
and Professions Code)
�/
CONSTRUCTION
,LENDING AGENCY CHANGE CHECK69 aO
NE i��
I hereby affirm that there is a construction lending agency for the WJ
performance of the work for which this permit is issued (Sec 3097 PERMIT FEE (Sub Total) O
Civ C)
PLAN CHECKING FEE 0000-0001 12/24/9"
Lenders Name PERMIT ISSUING FEE 0917 1 AN 9°24
Lender s Address
I certify that I have read this application and under penalty of purlury state TOTAL FEE
that the 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 urposes SEE REVERSE FOR EXPLANATORY LANGUAGE
SGN TURE`0F FIERMITTEE DATE
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT 4 "
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0203130013
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285 0488 EXT
LEGAL ID FE5S PAID BUILDING ADDRESS
TR 11454 LT 38 ; 4917 FIESTA AV
FEE DESCRIPTION GUANTI+Y UOM AMOUNT TEMP CA 917803817
ASSESSOR INF-OWTION NUMBER NEAREST CROSS STREET LOWER AZUSA
8590-019 019 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID A5 LOCALITY TEMPLE CITY
G1 OUTLETS LGT SW,RECP 16 00 OUT 31 20
TENANT G2 LIGHTING FIXTURES 4 00 LGT 7 80 ISSUED ON PROCESSED
TOTAL FEES 66 75 03/14/02 JK 09/10/02
OWNER TEL NO FINAL DAT BY CODE
LONGO MICHAEL (626) 287 0953
4917 FIESTA AV XPIR�b
TEMP 917803817 OF-WORK '
REBUILD FIRE DAMAGED GARAGE
APPLICANTL NO
SAME AS OWNER
PECIAL CONDITIONS
CONT (;ELES CO
SAMERASTOWNER 0 �O� APPROVALS TE INSPECTOR SIGNATURE
LIC NO TEMPORARY POWER POLE
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER --r 4TEL NO ER GROUND
LIC NO lllllll ROUGH CONDUITROUGH
WIRING
PU
'B"L C W0 R"K
3 AI WATER LIN
IUB' \v(/� L�� PLASTIC Y/N METAL Y/N
' UTILI OMPANY NOTIFIED
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REPORT ID DPR265 ROUTE TO BS0508