Loading...
HomeMy Public PortalAbout9417 LA ROSA DR_Electrical__ 76.463C- CEu06B 75 - APPLICATION FOR ELECTRICAL PERMIT - BUILDING D SAFETY D4S4w- FOR APPLICANT TO FILL IN /'�jDo , FResidentialntial Bldgs.&PoolsEACH NO. FEE ADDR /--/��Tia—T aily Sq. Ft. $ — $ LOCALITY ily Sq. Ft. - NEARESTCROSSST.al Swimming Pools OWNER M FIRM NAMEht, Switch &Receptacle MAIL cA I`1 / ��Z^S� I,�ADDRESS t l� ��.JQ7Val CITY C( Tel. No. 2.191 307-S PLAN CHECK Lighting Fixtures / APPLICANT First 20 /d ip v ADDRESS Additional CITY Tel. No. PERMIT Fixed Appliances Not Over 1 HP APPLICANT Range Heater_ D.W. ADDRESS Oven Dryer AL W.M. �_ Top FAU L W.H. CITY el. No. Hood Fan LICENSE OR oma.. UQ, REG. NUMBER Class. p Disp. A.C. v I HEREBY ACKNOWLEDGE THAT 1 NAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY 0 Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING Size&Type HP, KW, KVA,or KVAR ELECTRICAL WIRING. LU a Up to 1 Incl. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR Z Over 1 to 10 Incl. LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF/T�XE ABOVE Over 10 to 50 Incl. DESCRIBED R DENTIAL ROPER E Over 50 to 100 InCI. PER MITE Over 100 SIGNATURE DISTRICT NO. PROC SSED Services .--�U 6 0-200 Amp. Under 600 V r (j 201 - 1000 Amp. Under 600 V APPROVALS DATE I ECTURE Over 1000 Amp,or Over 600 V SIGNATURE TEMP. POWER POLE Temp. Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit ROUGH CONDUIT Additional Sign Branch Circuits (Other) WIRING .71 FIXTURES POWER AUTHORIZED PERMIT FEE (Sub-Total) UTILITY CO.NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Feel FINAL PERMIT ISSUING FEE OTES TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 6 3. 3&Z APR 1.3 2 10 2 5.7 AO' CITY OF TEMPLE CITY 76A663-CE806 4-68 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES D OF COUNTY ENGINEER BUILDING BUILDING 9417 La Rosa Dr. BUILDING AND SAFETY DIVISION JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY Temple City NEAREST FOR APPLICANT TO FILL IN CROSS ST. NO. $ $ACHFEE OWNER Mr. Mike milt RECEPT MAIL as job LIGHT TOTAL FIRST 20 .20 1 80 ADDRESS SWITCH 2 OVER 20 .10 CITY TEL. NO.AT• 7-9579 PLAN CHECK LIGHTING TO L FIRST 20 .20 APPLICANT FIXTURES OVER 20 .10 ADDRESS RANGE_DRYER—WTR.HTR.— CITY TEL. NO. STA.COOK_DISP. F.A.U._ CONTRACTOR Cobine Electric Co. SPACE HTR:' IR COND. ADDRESS 1607 Chestnut St. CLOTHES W TH. DISHWASH._ CITY Alhambra 282-0315 � TEL. NO. FAN—OTHER 1.00 LICENSE No. 229847 CLASS. C-10 MOTORS,TRANSFORMERS RATING IND. HEATERS, ETC. HP. KW. KVA. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. O — 1 1.00 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1 — 10 3.00 LICENSED AS RED IRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO 10 — 50 5.00 RESIDE IN, THE ABOVE DESCRIP.ED RESIDENTIAL PROPERTY. 50 — 100 1000 SIGNATURE � .(/y�� 0- . OF PERMITTEE V 100 — 500 15.00 DISTRICT O. G P Z P E p TUBN,GAS E, OR SIGN AND ONE CIRCUIT 3.00 U W MARQUEE ADDITIONAL CIRCUITS 1.00 CL SERVICE NOT OVER 600 VOLTS OR 200 AMP 1 2.00 21 00 SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK 0 ROUGH CONDUIT tf PERMIT FEE (SUB TOTAL) WIRING FIXTURES PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED J PERMIT ISSUING FEE 2.00 2 00 UTILITYCO 1. .NOTIFIED ��� SUPPLEMENTARY PERMIT ISSUING FEE 00 FINAL /` e //A T� �sa� TOTAL FEE r ,V JO,%EPH C. ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDATIONcK.' �rn.o. 0cASH 7 6 3 2 N 140-!,1'! 6 2 D 6 EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE C�[ti 76663-CES06 4-68 APPLICATION FOR ELECT-RICA PERMIT COUNTY OF LOS ANGELES DEPARTMENT NG AND SAFETY DIVISION BUILDING 9417 La Rosa Dr. JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY Temple City NEAREST FOR APPLICANT TO FILL IN CROSS ST. CloVerly NO. EACH FEE $ $ OWNER Mr. Hike Schmidt RECEPT._ MAIL LIGHT TOTAL FIRST 20 .20 ADDRESS as job SWITCH_ OVER 20 .10 CITY TEL. NO. A �/t• ( -9579 PLAN CHECK LIGHTING �TOTAL, FIRST 20 .20 APPLICANT FIXTURES OVER 20 10 ADDRESS RANGE—DRYER_WTR.HTR._ CITY TEL. NO. STA.COOK_DISP._F.A.U. CONTRACTOR Cobine Electric Col SPACE HTR. AIR COND. ADDRESS 1607 Chestnut St CLOTHES WASH._DISHWASH._ CITY Alhambra "TEL. NO. 282-0 1 FAN—OTHER 1.00 I ©� LICENSE 1,10. 229847 CLASS. C-10 MOTORS,TRANSFORMERS RATING IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. 0 - 1 1.00 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1 - 10 3.00 LICENSED AS RED IRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO 10 - 50 5.00 RESIDE IN, THE ABOVE DESCRIP.ED RESIDENTIAL PROPERTY. SIGNATURE �- 50 - 100 10.00 OF PERMITTEE U 100 - 500 15.00 DISZRIC Q GR Z ED CD SIGN,GAS SIGN AND ONE CIRCUIT 3.00 TUBE, OR W MARQUEE ADDNOTES: ITIONAL CIRCUITS 1.00 � SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT PERMIT FEE (SUB TOTAL) 0 WIRING b FIXTURES PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED PERMIT ISSUING FEE 2.001 UTILITY CO.NOTIFIED � nTJ_ 0 /1 SUPPLEMENTARY PERMIT ISSUING FEEL1.00 FINAL TOTAL FEE OCA IJ JOSEPH C. ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK M.O. CASH Cv EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ' WORKERS',fOMPENq TION DECLARATION A663 10/81 1 -.1 hereby affirm that I have a certificate of cons0t-to seZwCE -806G APPUCA`ION FOR ELECTRICAL PERMIT {) or a certifidate' of Workers' Compensation Insurance, or a certified �!'. COUNTY OF LOS ANGELES BUILDING AND SAFETY copy therdof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB 4 /T ❑ ADDRESS 1 Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE Certified copy is filed with 'the county building inspection 1 & 2-Family, Sq.Ft. $ — $ 1 LOCALITY C` department. Multi-family Sq.Ft. — NEAREST CROSS ST. �(J Date Applicant Residential Swimming Pools OWNER OR CERTIFICATE OF EXEMPTION FROM WORKERS' FIAM NAME 1 COMPENSATION INSURANCE Outlets:Rec Light Sw. ADDRESS ( (05 �I�I V This section need.not be completed if the work involved First 20 ( b P Y the \ CITY � fi C Tel.No. y(,� ' permit is for one hundred dollars($.100) or less.) Total No.fid--- Additional ew I certify that in the performance of the work-for which this permit PLAN CHECK APPLICANT is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. n Lighting Fixtures First 20 ADDRESS 119.3„ AltwLE -&b' to Total No. Additional CITY Tel.No. xNOTDate Applicant along WWW KIIV Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, ,after making this Certificate of APPLICANT Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. 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. CITY Tel.No. LICENSED CONTRACTORS DECLARATION Hood Fan _ Other_ 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. DISTRICT NO. PROCESSED BY Power.Apparatus& Large Appliances � Size& Type HP, KW,KVA,or KVAR J V O License Number Lic.Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE 0 Contractor Date VALIDATION 0 ❑ Over 10 to 50 Incl. FINAL V am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C.for this reason Over 100 Cl) Swbd.,MCC & Panelboards / / ® ✓l Z ��200 Date: Amp.Under 600 V Jesa Signature 201 - 1000 Amp.Under 600 V El Exemption 1000 Amp. or Over 600 V Exemption for Reg.Maint.Elect. ' SINGLE FAMILY Temp.Power Pole & Appurtenances d HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit p A R I hereby affirm that I am exempt from the Contractor's License Law AC CTA Sign Branch Circuits q�Ct for the following reason (Section 7031.5, Business and Professions Code): 33n! 29 a 25 1,as owner of the property,will do the work and the structure Misc.Conduits & Conductors 1 ITEMS is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). , TOTAL 29.2-5 CONSTRUCTION LENDING AGENCY CHECK 29.25 � I hereby affirm that there is a construction lending agency for the 4K .00 performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) 7 Civ. C.). PLAN CHECKING FEE 0030—OMI Name 6iit30-OM1 $/ 3/89 PERMIT ISSUING FEE �a 4861 1 � yaa2 Lender's Address +C 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 of this County to enter upon the above-mentioned j4Sinea4trefo& roprtyiec�on pur oses.[ SEE REVERSE FOR EXPLANATORY LANGUAGE Gmit e Date T–