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Home My Public Portal About5728 KAUFFMAN AVE_Electrical__ D.S.S.SA 25M SETS 10-47 APPU"�ATIOSAT FOR PERTTVIIT DEPARTMENT C OF BUILDING OSAN 1''t lt4l1 SAFETY �. sELECTRIC tl,■��Ll�aH�1V� ��i1L��/L�� C®iJi�'Y OF I� 1�NGEY..ES J. FO H F E GI EE a NAME �}�. �� -(�7�Af!" (✓ ry DISTRICT NO. GROUP ZONE Pu EEERMIT NO. ADDRESS D h''.2- LA v`I' AI S 7" / �+ �`� ~ �f�S �} ' TEL.NO.S%1�-37% JIVED13X READY FOR FIRST INSPECTION DATE A 31;SUED. U CITY -1 COUNTY N CERT NO. �` /� EXPIRES 3,9 APPLICANT PILI. INIIEAV.Y iJ'I'I.I1o1E® PORTION ONLY JOB DESCRIPTION OF WORK DDRESS � V-5-,A r—A4 P/✓ S7 NUMBER OF OUTLETS ON CIRCUITS LOCALITY / �r �Lt�r �. / 9`v LOCATION BY ROOMS NEAREST LIGHT OUTLETS 16W. PLUGS FdT CROSS ST. CIRCUIT /4 B C D E F G H C NAME �i�FR R�.� /V/lv6r.0 no n/ 3 MAIL ADESS / 7* /'(//j o/m m O CITY / te-/bJ 0/-/, /S"' TEL.No. I AM THE LEGAL FOSSESS R OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION.. LHCTR! :AN. Y I AN THE LEGAL OWNER OF THE PROPERTY DESCRI ABOV9 ` OWNER. CORRECTIONS Q z a FZ o TOTAL NO. OF OUTLETS $ APPROVALS NO. OF FIXTURES DATE INSPECTOR'S NAME" NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS TRANS. J S WIRING NO. OF RANGES OR4dEMffq5A& / $ FIXTURES MISCELLANEOUS $ POWER PERMIT FEE $ UTILITY CO.NOTIFIED Q TOTAL FEE Z) FINAL ( .S BS-5A D3.55ELECTRICAPPLICION FOR ELECTRIC PERMIT �Y DBS-5A DIVISION OF BUILDING AND SAFETY Department of County Engineer - 7.) ��p County of Las Angeles BUILDING `� T XA MPfMA WM.J. FOX, COUNTY ENGINEER ADDRESS rY Irk tie v "o-6'3 IV CASSATT D.GRIFFIN, SUPT OF BUILDING `y e LOCALITY (�-> c FOR APPLICANT TO FILL IN NEAREST PERMIT FEES CROSS ST. NUMBER EACH FEE OWNER d'✓SA49D •�Im_9 r LIGHT OUTLETS MAIL ,�/ RECEPTACLES ADDRESS CJ WALL SWITCHES TOTAL OUTLETS 5¢ $ CITY 8 TEL. NO. A fl ELEC. RANGES 25 ELECTRI 1AN D m C` e B'W11®� �' R"_ELEC. HEATERS 25 ADDRESS ewa P KW EA CITY ASAD /�n /Vp`S',., FIXTURES I5 LICENSE NO. C .NUMBER OF LIGHT CIRCUITS DISTRICT - GROUP I Z0V READY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS !• 5 7- v MOTORS NUMBER HORSEPOWER I INSPECTION RECORD FEE NEW MVD. HP I OVER I INC. EACH 1/2&LESS $ .25 2 5 1.00 ! -��j;s�• 5 15 1.50 15 50 2.50 50 200 5.00 MISC. NO.SIGNS NO.TRANS. .'I NO.SIGNS NO. LAMPS FOR EACH PERMIT: WIRING $1.00 FIXTURES $1.00 SUPPLEMENTARY .50 � APPROVALS TOTAL FEE g l DATE INSgqPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS-APPLICATION CONDUIT rl AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY — 1� jjjj WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING 1I Z -Ij dlt.l.e� ELECTRICAL WIRING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR _FIXTURES LICENSED AS REQUIRED BY LOS_.ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENTI L PRO ERTY, UTILITY CO.NOTIFIED SIGNATURE OF PERMITTE Im FINAL WILLIAM J. FOX.COUNTY ENGINEER VALIDATION A. C.VEIT.CHIEF ELECT. INSPECTOR "CO 9 6 0 ,LL; NOV 2 2 2.4 5 ' WORKERS'COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I her y Effirm that I have a certificate of consent to self CE-806G s e, or a rer?ifica4 of Workers' Compensation Insurance, COUNTY OF LOS ANGELS r BUILDING AND SAFETY or o certifiedacopy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN , +'- Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADD S � t/1'M AtJ AV;a ❑ 1 & 2-Family, S Ft. $ — $ LOC,�LITY 9 a; ` Certified copy is filed with the county building inspec- Y, q� NEAREST tion department. Multi-family Sq. Ft. CROSS ST. � Residential Swimming Pools OWNER T. ^•n Date Applicant , FIRM NAME -e Y CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL First 20 COMPENSATION INSURANCE Outlets: Rec Light�Sw. ADDRESS e- ' Y—'k ,;" 10` (This section need not be completed if.the work involved by Total No.— Additional (� CITYT-.�rn l�i�� Tel. No. the permit is for one hundred dollars ($100)or less.) I certifythat in the of the work for which this PLAN CHECK e performance APPLICANT permit is issued, I shall not employ any person in any manner so as to become s bject to the Workers'Campers tion Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional � CITY Tel. No. Date Applicant � � Fixed Appliances Not Over 1 HP PERMIT i NOTICE TO APP (CANT: If, after making this Certificate of APPLICANT '��L..bV CX t Exemption, you should become subject to the Workers' Range_ Heater—D.W. — 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. Hood Fan _ Other— CITY �WA.,•A_ Tel. No:� LICENSED CONTRACTORS DECLARATION uCENS R p, ,x I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER _671 Class. (commencing with Section 7000) of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO.� PROCES ED BY and Professions Code,and my license is in full force and effect. Size & Type HP, KW, KVA, or KVAR License Number Lic. Class Up to 1 Incl. FINAL %; Over 1 to 10 Incl. DATE /1 VA DATION Contract n 3e Over 10 to 50 Incl. FIN �j to ❑ I am exempt under Sec. Over 50 to 100 Inc. BhrY Over 100 B.&P.C. for this reason Nf Services, Swbd., MCC & Ponelboards Date: 0 -200 Amp. Under 600 V loop. 9 8 2 2 3 A Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V # o o o o o 2 J o - 37.75 SINGLE FAMILY Temp. Power Pole &Appurtenances o o,o HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ) 0,2 1 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, as owner of the property, will do the work and the Misc. Conduits & Conductors structure is 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 Lender's Address I certify that I have read this application and state that the TOTAL FEE ?r' above information is correct. 1 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 A G� Q Signature of Permittee Date WORK®RS'COMPENSATION DECLARATION I CE 806G (2-80) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING,AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.) //� FOR APPLICANT TO FILL IN ,JOB Policyd. Company EACH NO. FEE ADDRES New Residential Bldgs.&Pools Certified copy is hereby furnished�� / �� 1 &2-Family,Sq. Ft. $ — $ LOCALI Y Multi-family Sq. Ft. NEAREST • Certified copy is filed witAthVy building inspection CROSS ST ¢ dep t i�b Residential Swimming Pools OWNER OR FIRM NAME - 64!W e-, Date Applicant Outlets: Rec:_Light_ Sw. AMAIL DDRESS First 20 CERTIFI ATE OF EXEMPTION FROM WORKERS' Total No, Additional CIT LG el No �a } COMPENSATION INSURANCE PLAN CHECKV CL APPLICANTO (This section° need not be completed if the work involved U Additional by the permit is for one hundred dollars ($100) or'less.) Lighting Fixtures First onal ADDRESS ccTotal No. I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. � permit is issued, I shall not employ any person in any manner PERMIT U so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICAN a Oven _ Dryer_�AI.M._ ADDRESS Date Applicant Top FAU _ Jrzi W.H.. Hood — Fan _Other_ CITY Tel No. NOTICE TO APPLICANT: If, after making this Certificate of Disp. — Room Air Cond.— LICENSE OR y Exemption, you should become subject to the Workers' REG. NUMBER Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT ® _✓ P ESS D'BY with comply with such provisions or this permit shall be Size&Type HP, KW, KVA,or KVAR / ar/ deemed revoked. Up to 1 Incl. FINAL Over 1 to 10 Incl. 4 DATE � ' �� VALIDATI LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL BY 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 ness and Professions.Code, and my license is in full force and effect. � Services License Nu be,3 �f Lie.Class e 0-200 Amp. Under 600 V e �y 201-1000 Amp. Under 0 V rac o �� Date Over 1000 Amp.or Overr 600 V E OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, Busi= Additional Sign Branch Circuits ;912 3.7,17 A ness and Professions Code): # o?o;o o o 2 Misc.Conduits&Conductors 1, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— 2.0,0 ,� �. 0 structure is not intended or offered for sale (Section . 7044, Business and Professions Code). _ CONSTRUCTION LENDING AGENCY o!o 0 a v 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub-Total) 12 1 $1— 1 issued.(Sec. 3097,Civ.C.). Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address PERMIT ISSUING FEE I certify that I have read .this application and state that the TOTAL FEE above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby autho 'ze representatives of this County to enter upon thea e- entioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE YAP/ Signature of Permittee 15atV 1 ' f W(JRKERS'COMPENSATION DECLARATION CE-806G D�81 APPLICATION FOR ELECTRICAL PERMIT {� I hereby affirnf that 1 have a certificate of consent to self insure, CE-806LI or a certificaX of ;workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy the`egf(Sec.3800,Lab.C.) r Policy No. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRESS ❑ 1 & 2-Family,Sq. Ft. $ _ $ LOCALITY Certified copy is filed with the county building inspection NEAREST department. Multi-family Sq.Ft. CROSS T. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec— Light Sw. MAIL COMPENSATION INSURANCE ADDRESS (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 CITY Tel.No. I certifythat in the performance of the work for which this permit PLAN CHECK P APPLICANT is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensate ws. Lighting Fixtures First 20 ADDRESS Additional " Total No. CITY Tel.No. Date _ Q Applicant Fixed Appliances Not Over 1 HP PERMIT i NOTICE TO APPLICANT: If, afte making this Certificate of Exemption,you should become subje o the Workers'Compensation Range_ Heater_ D.W. APPLICANT (�i L provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS �/ provisions or this permit shall be deemed revoked. Top — FAU _ W.H. LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ CITY p Loi Tel.No �- I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR (commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Class. Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCE D BY /o, Size& Type HP,KW,KVA,or KVAR d License Numben�/ l/ _ /�7 Lic.Class 0-119 Up to 1 Incl. FINAL ^,n U Contractor Ii g , &h L A4 Date �/"3a LL Over 1 to 10 Incl. DATE I%v!1v/ O VALIDATION ❑ Over 10 to 50 Incl. FINAL U I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C.for this reason Over 100 Q. � N Date: Services, Swbd.,MCC& Panelboards ® Z 0-200 Amp.Under 600 V "M 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 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit y _ I herebyaffirm that I am exempt from the Contractor's License Law a for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits rel, os Code): 33i17 ....._-. 49.00 7T I,as owner of the property,will do the work and the structure Misc.Conduits & Conductors i ITEMS is not intended or offered for sale (Section 7044, Business Other (See Complete Fee Schedule) _ and Professions Code). L , TOTAL 49 - 00 CONSTRUCTION LENDING AGENCY CHECK 49.00 1 hereby affirm that there is a construction lending agency for the CHANGE performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) CHANGE .00 Civ.C.). PLAN CHECKING FEE Lender's Name 011113-10131 6 8/90 PERMIT ISSUING FEE Lender's Address 1173 1 AM 7:331 1 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- f this County to' r upon the above-mentioned prop e ty for' s ection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE , Si ture of Permittee Date _ - i WORKERS'COMPENSATION DECLARATION 76A663 rte. CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a cert i d yop, e S 3800,Lab C. , /y�/� 11 FOR APPLICANT TO FILL IN JOB r! Policy o. om ADDRESS New Residential Bldgs.&Pools EACH NO. FEE � ❑ Certified copy is hereby furnished. r— 1 &2-Family,Sq. Ft. $ — $ LOCALITY Multi-family Sq. Ft. — NEAREST Certified copy is filed with the county build' inspection CROSS ST Cj department. Residential Swimming Pools OWNER OR � ( FIRM NAME Date/ R 1 Applic n '1 Outlets: Rec.—Light— Sw. First 20 ADDRESS CERTIFICATE OF EX MPTION FROM WORKERS' Total No. Additional CITY Tel COMPENSATION INSURANCE PLAN CHECK >_a (This section need not be completed if the work involved APPLICANT Q by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS U Additional Total No. I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. Q permit is issued, I shall not employ any person in any manner ' PERMIT so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. i APPLICANT W Oven _ Dryer_W.M._ ADDRESS �r N Top — FAU — Cl W.H.., Date Applicant T Hood Fan —Other---: NOTICE TO APPLICANT: If, after making this Certificate of Disp. — Room Air Cond. LICENSE OR . a Exemption, .you should, become subject to the Workers' REG. NUMBER J Class 6° Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. P=RSS BY . with comply with such provisions or this permit shall be deemed revoked. Size&Type HP, KW, KVA,or KVAR � Up to 1 Incl. '4!.v FINAL ' LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl DATE /� VALIDATI N Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL f 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY ness and Professions Code, and my license is in full force and r — effect. Services 07M Lie ns um b ic.Class 1� 0-200 Amp. Under 600 V (� 201-1000 Amp. Under 600 V Co rac Date O Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances ` I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits I ness and Professions Code): Misc.Conduits&Conductors ❑ I, as owner of the property, will do the work and the Other (See Complete Fee Schedule) 2.2 3..7 A structure is not intended or offered for sale (Section 7044, Business and Professions Code). - �'o o,o 0 0 2 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 2'o'-.2 3 5 0 for the performance, of the work for which this permit Js PERMIT FEE (Sub-Total) z issued (Sec. 3097,Civ.C.). 0 0 o 2 3'5 0 Lender's Name PLAN CHECKING FEE (One-Fourth.Permit Fee) . I 2,10=8 1 Lender's Address PERMIT ISSUING FEE td I certify that I have read this application and state that the TOTAL FEE above information is correct.I agree to comply with all County ordinances and State laws regulating Electrical wiring, and ,hereby authorize represe tives of this County to enter upon the above-mentione� ropert spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE i gnature of Permittee Date WORKERS'COMPENSATION DECLARATION 76A663 CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified cop thereof(sec. 3800,Lab.C.) Q !7 FOR APPLICANT TO FILL IN ,JOB �j Policy No.G oinpan ADDRESS / /� New Residential Bldgs.&Pools EACH NO. FEE 7�ts �U� Qt^ Certified copy is hereby f rniked. , 1t 1 &2-Family,Sq. Ft. $ — $ LOCALITY :E,_ t. Multi-family Sq. Ft. — NEAREST C9 Certified copy is filed with the county building inspection CROSS ST 1 LP 0 1" department. Residential Swimming Pools OWNER OR FIRM NAME Sikmes ou G Date Applicant Outlets: Rec.L Light_Sw. -- ADDRESS S6t~ro_.2 First 20 CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. � Additional CITY Tel No.' 1a COMPENSATION INSURANCE PLAN CHECK tl - APPLICANT 0 (This section need not be completed if the work involved U Additional by the permit is for one'hundred dollars ($100) or less.) Lighting Fixtures First ADDRESS Additional cc Total No. p I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. 0 permit is issued, I shall not employ any person in any manner PERMIT W so as to become subject to the Workers' Compensation Laws. Range_Heater_D.W. APPLICANT<- 10[&.-, C ee Zfd 0. Oven _ Dryer_W.M. ADDRESS b�Z O (. cnz Date Applicant Top _ FAU _W.H.,_ Hood _ Fan _Other_ CITY (fx V-*Z, Tel No.3314 NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ Room Air Cond.— LICENSE OR Exemption, you should become subject to the Workers' REG. NUMBER Class C34 G Lj>/ Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT P$0. PROCESS D BY with comply with such provisions or this permit shall be Size&Type HP,KW, KVA,or KVAR deemed revoked. � &0_ Up to 1 Incl. Over 1 to 10 Incl. FINAL LICENSED CONTRACTORS DECLARATION DATE �'Jo Z� Q VALIDATION Over 10 to 50 Incl. Q� I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY ness and Professions Code, and my license is in full force and t effect. Services / �(�� p G.�6 S-C 14y 0-200 Amp. Under 600 V License Number Lic.Class 201-1000 Amp. Under 600 V Contractor cm1i Sc.,(,L, Date 14-F1 Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit O License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— structure is not intended or offered for sale (Section 7044, Business and Professions Code). 9 A CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency #:0 to 0 0'0 2 for the performance of the work for which this permit is PERMIT FEE (Sub-Total) issued (Sec. 3097,Civ.C.). 2.0'0 1 21 0 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) 0 0'0 1 ,21 06 Lender's AddressPERMIT ISSUING FEE 1 2 3 0:-8.1 I certify that I have read this application and state that the TOTAL FEE 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 abo e-mentioned property f r inspection purposes. p SEE'REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date A COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0309160001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: EES PA I D BUILDING ADDRESS: TR: 6561 LT: 503 5728 KAUFFMAN AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802505 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LIVE OAK 8587-023-020 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, C G1 OUTLETS-LGT,SW,RECP 1.00 OUT 1.95 TENANT: TOTAL FEES 29.70 ISSUED ON: PROCESSED Y: PLAN BY: EXPIRES ON: 09/16/03 VG 03/14/04 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: LIU SUCHIN (626) 286-1077- p / 5728 KAUFFMAN AV l V3 V TEMP 917802505 DESCRIPTION OF WORK RELOCATE 1 RECEPTACLE APPLICANT: TEL. N0: LIU (626) 286-1077- SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE AMELEC CO., JAMES (818) 280-8318- 9422 E. NAOMI AVE. LIC. NO TEMPORARY POWER POLE ARCADIA, CA 91007 519503 C10 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508