HomeMy Public PortalAbout4836 KAUFFMAN AVE_Electrical__ 76A663-CE806 10/72 TEMPLE CITYAPPMC AMN FOR ELEGTMAL p:ER1N11�4 -
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER JOB
BUILDING AND SAFETY DIVISION ADDRESSLot
LOCALITY TR#
NEAREST R
FOR APPLICANT TO FILL IN CROSS ST.
OUTLETS N O. EACH FEE OWNER OR CO.'
FIRM NAME Weber Develon ment
RECEPT.� S $
MAIL
FIRST 20 25 ADDRESS
5926 Tpmplp- Cit� Blvd-
LIGHT�.� TOTAL '
SWITCH_ �_ OVER 20 58 10 - CITY Temple Cit TEL. NO. 286-2818
8 w PLAN CHECK
LIGHTING F
IRST 20 19 .25 7 60 APPLICANT
TOTALVER 20 ADDRESS
FIXTURES .10 '
RESIDENTIAL APPLIANCES CITY TEL. NO.
RANGE DRYERWTR. HTR._ APPLIICANT II "
McGee Electric, Inc. .
STA. COOK DISP. I F.A.U. ADDRESS P • "0. BOX 2186 -
SPACE HTR. AIR COND. CITY Pomona. TEL. N0. 6`28-122.1
CLOTHES WASH. _DISHWASH._-L REG.CENSE NUMBER 15.33-7.8 - CLASS. C-10
FAN 1.OTHER 5 "1.00 7 50 _I. HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATI NG WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND. HEATERS, ETC. HP. KW. KVA. •ELECTRICAL WIRING.
SIZE & TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1100 LICENSED AS REQUIRED BY LOS ANGEL COU TY AND STATE OF
CALIFORNIA OR THAT I A THE LEGA OW R OF THE ABOVE_
A/C 1 4 .50 DESCRIBED RESIDENTIAL P OPERTY O
1 - 10 3.00
PERMITEE U
10 - 50 5.00 SIGNATURE pC
O
50 - 100 10.00
DISTRICT NO. V FEED BY U
�.
15.00 CIL-
1 00 - 500 6 ` 8 Z
SIGN, GAS=SIGN ONE CIRCUIT 5.00 APPROVALS 'DATE INSPECTOR'S IGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE
SERVICENOTOVER600VOLTSOR200AMP 1 3.00 450 UNDERSLAB WORK
SERVICEOVER600VOLTS OR200AMP 10.00 ROUGH CONDUIT '
TEMP SERVICE, POLE, &APPURTENANCES 5.00 - WIRING
TEMP LIGHT OR RECEPT, SYSTEM 3.00 FIXTURES
POWER AUTHORIZED
UTILITY CO-. NOTIFIED
FINAL • " ��'��
PERMIT FEE (SUB TOTAL) 401 qn
NOTES:
PLAN CHECK FEE "
PERMIT ISSUING FEE 3.00
TOTAL FEE
PLAN CHECK VALIDATION - CK. M.Q. CASH PERMIT VALIDATION cK. ' M'.0. CASH
3 9:'r'O.tiRi 2 P 4 5.3'0 69u'
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE ��
WORKERS' COMPENSATION-DECLARATION 76-sb6 10/81 APPLICATION TION FOR ELECTRICAL
0 ECTRICA PERMIT
�-�dd CE-806G Ui``""II�r LL�� ``�b-oLL��lU1 LS L� .`M L� PERMIT
�.
'I herg;�y�ffirto,'that I have a certificate of consent to'self insure,
or a certificate of Workers' Compensation.Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND,SAFETY.
copy thereof(Sec.3800,tab. C.)
Policy No. Company ' FOR APPLICANT TO-FILL IN JOB"
❑ Certified copy.is hereby furnished. ', EACH NO. FEE ADDRESS ( til/C��
-. New Residential Bldgs.& Pools •
Ce led copy' Is filed with, the'county building inspection
1 & 2-Family,Sq.Ft. $ e —_ $ LOCALITY 0-
department. Multifamily"Sq.Ft. '`. ti —� ti \ -•'NEAREST
77.
CROSS ST �,LL�/R—
Residential Swimming Pools - , 4 OWNER OR
Date Applicant �` #"` FIRM NAME !
CERTIFICATE'OF EXEMPTION FROM WORKERS' `S f MAIC
l 4.,
Outlets:Rec Light 3w
COMPENSATION INSURANCE t �s ADDRESS 3�
(This section need-not be completed if the work involved by the First 20 -`
permit is-for one hundred dollars ($100)or less.) Total No. Additional' - CIT "TeL No.
I certify that.-in the performance:of the work-for which this.permit
PLAN CHECK .`
is issued, I'shall;not employ any person i an nner so as t APPLIqANT
'become subject:to the,,Work s'Compensat n Laws. Lighting Fixtures First 20 ADD SS
Additional.,
ZZ Total'No. CITY Tel No.
Date`s �f Ap Fixed Appliances Not Over.1 HP PERMIT
NOTICE. TO APPLICAN If, a• r making". this Certificate f
"Exemption,you should bec `e;sub ct to the-Workers',Compensa n Range_'Heater_ D.W. APPLICANT
provisions of the.Labor..Code, must..forthwith comply with such Oven Dryer _ W.M. ADDRESS 4
provisions or,this perm hall be.deemed revoked. Top -— FAU W.H.
LICENSED CONTRACTORS DECLARATION ., CITY •,Tel.No.
" � Hood — Fan Other_
i'hereby.affirm that"I;am licensed under'provisions of Chapter 9 - LICENSE OR ;
Dlsp.'— Room Air Cond.
(commencing with Section"7000) of.Division 3 of the Business and REG.NUMBER Class.
Professions Code,and my license is in full force and effect. - - DISTRICT NO. `PR C BY
Power Apparatus& Large Appliances
Size& Type HP,KW,KVA,or KVAR a
License Number Lic.Class Up to 1,Incl..
FINALU
Over 1 to 10 Incl. n DATE VALIDATION'
Contractor J Date Over 10 to 50 Incl:
❑. I am,exempt under Sec. = - Over 50 to-100 Inc.: FINAL Y
BY W
B.&P.C.for.thisrreason Over 100 ° 0-
Service- Sw6d.,MCC &Panelboards Z
Date: 0- 200 Amp.Under 600 V D
Signature 201 - 1000 Amp:.Under-600 V ]
Over 1000 Amp.or Over 600 V
,❑ Exemption for Reg.Maint.Elect: {;
s
. e 4'
SINGLE FAMILY Temp.Power.Pole& Appurtenances_ 3307 28.50
HOME OWNER-BUILDER DECLARATION Sign with One Branch,Circuit
I hereby affirm that l`am exempt from the Contractor's'License Law I ITEMS
for the following reason(Section 7031.5,Business and Professions "Additional Sign Branch Circuits -
Code): TOTAL `� 3 50
�.r =�
Misc.Conduits & Conductors
I,
as owner of the property,will do the work and the structure C-HECK 28.50
is not intended or offered.for sale (Section 7044, Business Other(See Complete Fee Schedule)
and Professions Code). ".CHANGE
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) f�f 00 11f�IGi 3/31/99,
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address
I certify th have read this application and state that the above TOTAL FEE /S
nformation's cor . I agree to comply with all County ordinances'
and.State I ws regu ing Electric wiring, and hereby•authorize
representative of this ounty to e ter upon the above-mentioned
property-for ins ection urposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
ignature of Permittee' Ir Date