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HomeMy Public PortalAbout5743 LOMA AVE_Electrical__ 76"63W.'806 12/75 APPLICATION FOR ELECTRICAL PERMIT � COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEEtR JOB ? BUILDING AND SAFETY DIVISION ADDRESS �J O(=; - FOR APP 1CANT LO.E" N 1 LOCALITY/ gm New Residential Bldgs & Pools EACH NO. FEE NEAREST _ CROSS ST. 1 & 2-Family, Sq. Ft. $ •025 OWNER OR Multi-family Sq. Ft. 02 — FIRM NAME Residential Swimming Pools 20.00 MAIL --7 , ADDRESS Outlets: Light, Switch &,Receptacle I © CITI/ arthp4.eel.No. �� First 20 •50 PLAN CHECK Additional .30 APPLICANT ADDRESS Lighting Fixtures First 20 .50 CITY LTel.No. Additional 30 PERMIT APPLICANT ,, L j Fixed Appliances Not Over 1 HP ADDRESs,3 Range_HeaterD.W. CITY Te 1.No. ,_�}o/��'T Oven_ Dryer_W.M._ E C!y LICENSE OR Top _ FAU _W.H._ � REG.NUMBER ; ,S— Class.C-- Hood_/�Fan 2.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION DISp. ✓ A.C. ___ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. Power Apparatus& Large Appliances I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Size& Type HP, KW, KVA, or KVAR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF >_ Up t0 1 Incl. 2.00 40CE LIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE �' 5.00 SCRIrED RESIDENTIAL PROPERTY. Over 1 to 10 Incl. U Over 10 t0 50 Incl. 10.00 ERMITEE IGNATUR V1Over 50 to 100 Incl. 20.00 ®C Over 100 30.00 ISTRICT NOS SSED BY _ ` U Services I LU 0- 200 Amp. Under 600 V 12.50 INS . CTOR'S 9L 201-1000 Amp. Under 600 V 25.00 APPROVALS DATE S NATURE Over 1000 Amp. or Over 600 V 50.00 TEMP.POWER POLE UNDERSLABWORK Temp. Power Pole& Appurtenances 10.00 Sign with One Branch Circuit 10.00 ROUGH CONDUIT Additional Sign Branch Circuits 2.00 WIRING (Other) FIXTURES POWER AUTHORIZED UTILITY CO.NOTIFIED /l FINAL �Z17—Jl' PERMIT FEE (Sub-Total) NOTES 'o' PLAN CHECKING FEE (One-Fourth Permit Fee) 2117 9 , O,10 U� i PERMIT ISSUING FEE $6.00 TOTAL FEE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. MO., CASH U SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE 76A663-CE806 9-66 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS �?44 1 a C� JOHN A. LAMBIE, COUNTY ENGINEER P COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS S . RECEPT. TOTAL NO. EACH I FEE OUTLETS FIRST 20 �$.20 $ OWNER LIGHT MAIL SWITCH ADD'L 10 ADDRESS OVER 20 TOTAL FIRST 20 .20 CITY LGHTING FIXTURES TEL. NO. I FIXTURES CONTRACTOR Y OVERVER 2 20 10 RANGES DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK CITY TEL. NO. DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA. APPL. .50 LICENSE NO. MOTORS: OVER NOT OVER H.P. DIG+ N GR�-P �NE PROCESSED BY O 1 1.00 L 1 3 1.50 INSPECTION RECORD 3 8 2.00 8 15 2.50 15 50 3.00 d O 50 100 5.00 V NO.TRANS SIGNS: - NO.LAMPS O V SERVICE 0.600V-NOT OVER 200A 1.00 Lu CL SERVICE 0-600V-OVER 200 A. 2.00 h z SERVICE OVER 600V 5.00 OTHER (SEE COMPLETE FEE SCHEDULE) PERMIT ISSUING FEE 2.00 C1(J SUPPLEMENTARY PERMIT ISSUING FEE 1.00 APPROVALS DATE INSPECTOR'S SIGNATURE TOTAL FEE UNDERS LAB WORK 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ROUGH CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING '] ELECTRICAL WIRING. WIRING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO POWER ! RESIDE IN,THE ABOV SCRIBED RESIDENTIAL PROPERTY. / � SIGNATURE UTILITY CO.NOTIFIED F/ OF PERM ITTE -FINAL VALIDATJON` JOSEPH C. ROOHAN CK MO( CASH SUPERVISING ELECTRICAL ENGINEER WORKERS'COMPENSATION DECLARATION 76A663 � 0;81 • CE APPLICATION FOR ELECTRICAL PERMIT {� I hereby affii m that I have a certificate of consent to self insure, ' LJ or a certificate of Workers' Comaensaticn Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof (Sec.�3800,1_ab.C.) Po`icy No. Company FOR APPLICANT TO FILL IN JOB +y Q Certified copy is herebyfurnished. EACH NO. FEE ADDRESS S /14*5 N • LONA 4.\JE , New Residential Bldgs.& Pools ❑ _ , Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ $ LOCALITY T 6_M ( E C 17-7 department. Multi-family Sq.Ft. NEAREST CROSS ST. L.4 S TU N 4 S Date Applicant Residential Swimming Pools OWNER OR FIRM NAME M R, ^R 'RVC-4-605A 60YQ CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Recce�/ � Sw. � MAIL y —y, COMPENSATION INSURANCE Light 9a )O Jai ADDRESS,S/'743 //. O-Z U��/9 This section need not be completed if the work involved by the First 20 /zT ( p -t-�,f Total No. Additional . CITYtPL� C1T Tel,No. I� a�is permit is for one hundred dollars($100)or less.) PLAN I certify that in the performance of the work for which this permit APPLICANT CHECK is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compe tion Laws. /Lighting Fixtures First 20 ADDRESS Total No.4— Additional CITY Tel.No. Date l Applicant Fixed Appliances Not Over 1 HP PERMIT �7 NOTICE O PPLICANT: If, after akin this Certifi e of APPLICANT aJ R6� Exemption,you should become subjec o th Workers'Compensation Range_ Heater_ D.W. provisions of the Labor Code, you m st forthwith comply with such Oven _ Dryer _ W.M._ ADDRESS ;kQ I Nis to 78 ST provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _ CITY `�S �L�S Tel.No. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. LICENSE OR (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER S Class. C-1 d Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY _ L� Size& Type HP,KW,KVA,or KVAR • 1) 0 License Number �� f Lic.Class C��� Up to 1 Incl. FINAL / U Over 1 to 10 Incl. DATE /L��� Q Contractor Date_ `�� VALIDATION O ❑ Over 10 to 50 Incl. FINAL I am exempt under Sec. Over 50 to 100 Inc. BY B.&P.C.for this reason Over 100 N Date: Services,Swbd.,MCC&Panelboards ® Z 0- 200 Amp.Under 600 V r 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 s I hereby affirm that I am exempt from the Contractor's License Lawt_l `'a for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits }} Ll e'' 4 01.01,31 Code): ❑ Misc.Conduits & Conductors i IT ENS 1,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ TOTAL 40 - 00 and Professions Code). CHECK CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the CHANGE ,it performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) Civ. C.). PLAN CHECKING FEEIs— _IU I �y V9/ 4/90 Lender's Name PERMIT ISSUING FEE � •+124 1 AN 34 Lender's Address I 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 proty for inspect' purposes. c SEE REVERSE FOR EXPLANATORY LANGUAGE OO Z f� Sig ature f Plefittee D to '`NCRKERS' COMPENSATION DECLARATION zo-oolaDPW 3ia7 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 DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB �9 F1 Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS /f-3 /�. LomA G E Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST CROSS 5T. Residential Swimming Pools Date Applicant OWNER OR T FIRM NAME G' LLQ CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL {J COMPENSATION INSURANCE ADDRESS First 20 (This section need not be completed if the work involved by Total No. Additional CITY �'� � ` Tel. No. a- -�( the permit is For one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT 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 Additional Total No. CITY Tel. No. Date Applicant Fixed Appliances NotOve 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION Exemption, you should become subject to the Workers' Range— Heater D.W. — ;R? a 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. .�.�Lsd� / CITY Tel. No. Hood — Fan —Other Ply LICENSED CONTRACTORS DECLARATION o O r LICENSE OR Disp. — Room Air Cond. REG. NUMBER Class. I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PRO SSED BY and Professions Code,and my license is in full force and effect. CL Size &Type FiKW,�KVA, or KVAR �D -✓ License Number Lic. Class r U Up to 1 Incl. FINAL Q Over 1 to 10 Incl. DATE L `� ,� 'V3i4LIDATION tr Contractor Date -- Q Over 10 to 50 Incl FINALf� __ ((�� I am exempt under Sec. Over 50 to 100 Inc. BY Q _E-1' W B.&P.C. for this reason Over 100 1 -'s_'`•?tft. 8 d 4 OFIP Date: Services, Swbd., MCC& Panelboards ' _ O0- 200 Amp. Under 600 V - I TI Signature 201 - 1000 Amp. Under 600 V f Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit -= Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits 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 7044, Other (See Complete Fee Schedule)_ , 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 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 thea ove-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 5`/ Fe) Signature of Permittee Date ©s WORKERS' COMPENSATION DECLARATION76A66vDPW sie7 APPLICATION FOR ELECTRICAL PERMIT O 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 DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lob. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB C �LI 2 L��p O 1 J Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS J Cprtified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. LOCALITY$ _ $ EM IF,L'r- Cl-I/ tion department. Multi-family Sq. Ft. NEAREST CROSS ST. _.v/U , Date Applicant Residential Swimming Pools OWNER OR D FIRM NAMEMR AJ L Er CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ ADDRESS LOM COMPENSATION INSURANCE First 20 (This section need not be completed if the work involved by Total No. Additional CITY �M - C.17-7Tel. No. S- /5- the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'Compensation Laws. Additional 2 y' T Total No. CITY Tel. No. Date /Applicant `�' 1 Fixed Appliances Not Over 1 HP PERMIT NOTICE TO AP LICANT: If, after makingthis Certificate of APPLICATION �R(y� Pe--b 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;Q�` 1 N�/rJ ,eS with comply with such provisions or this permit shall be Top — FAU —W.H. — EV S1- deemed revoked. Hood — Fan —Other— CITY L 01 N Tel. No.26 Y 7Z_� LICENSED CONTRACTORS DECLARATIONLICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. — REG. NUMBER Class. �. 0 (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PRQPSSED BY d D_ Professions Code,and my license is in full force and effect. /� (� L> Size &Type HP, KW, KVA, or KVAR c:� U G�1-t�� o License Number 5q 594 Lic. Class C` Up to 1 Incl. FINAL U To R6r_ �1 ye4? Z ZQ r)`/ Over 1 to 10 Incl. DATE VALIDATION 0 Contractor to Over 10 to 50 Incl. aFINAL q U I am exempt under Sec. Over 50 to 100 Inc. BY G W B.&P.C. for this reason Over 100 d Z Services, Swbd., MCC& Ponelboards .p I /p Z Date: 0- 200 Amp. Under 600 V OO Signature 201 - 1000 Amp. Under 600 V El Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit oY Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): Misc. Conduits&Conductors 1 3 r I, as owner of the property, will do the work and the -�- structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— Business and Professions Code). - X1)9: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency forMV fj; 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 / (I(-)=_II_I`''•_ff !; %.irl/%'1 PERMIT ISSUING FEE Lender's Address -• :AM I certify that I have read this application and state that the TOTAL FEE L 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 t e above-m; tioned prope y for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE gn re of Perm' e D e ©s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT 44 DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508.96112600137 t. BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: 2 LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 12977 LT: 1 5743 LOMA AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802453 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5387-022-001 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 10.00 OUT 19.50 TENANT: G2 LIGHTING FIXTURES 2.00 LGT 3.90 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 51.15 11/26/96 LC 11/26/97 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: LEE RUE F;TAI C (818) 285-1588 5743 LOMA AV Z'27 TEMP 917802453 DESCRIPTION OF WORK ELECTRICAL FOR DINNING ROOM APPLICANT: TEL. NO: SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO TEMPORARY POWER POLE UNDERGROUND CONDUIT s ARCHITECT OR ENGINEER: TEL. NO: - LIFER 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