HomeMy Public PortalAbout9644 LAS TUNAS DR_Electrical__ owl '°'" APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER JOB
BUILDING AND SAFETY DIVISION ADDRESS S C&ffat iot
FOR APPLICANT TO FILL IN LOCALITY ff
New Residential Bldgs.&Pools EACH NO. FEE CNEAREST
ROSS ST. S /�} �'G
1 &2-Family,Sq. Ft. $ 025 — $ OWNER OR
Multi-family Sq. Ft. .02 — FIRM NAME o".,.-H rra gLiv
Residential Swimming Pools 25.00 AMAIL
DDRESS
Outlets:RecLight_Sw. 50 CITY ARc lA Tel.No.
First 20 PLAN CHECK
Total No. Additional .30 APPLICANT
ADDRESS
Lighting Fixtures First 20 .50 CITY Tel. No.
Total No. Additional 30 PERMIT APPLICANT >?��
Fixed Appliances Not Over 1 HP ADDRESS
r c 2
Range_Heater_D.W._ CITY ' Tel. No.
Oven_Dryer—W.M._ LICENSE OR
Top —FAU —W.H._ REG.NUMBER 63 Class.C/U
Hood_Fan _Other- I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
Disp. _ Room Air Cond. 2'50 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN-
ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING.
Power Apparatus&Large Appliances
Size&Type HP, KW,KVA,or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM y.
Up to 1 Incl. 2.50 THE LEGAL OWNER OFT ABOVE DESCRIBED RESIDENTIAL PROPERTY
Over 1 to 10 Ind. 5.00 v
Over 10 to 50 Incl. 12.50 PERMITTEE C C r,
Over 50 to 100 Inc. 25.00 SIGNATURE I_,
Over 100 40.00 DISTRICT PR ESS BY d
v8 z
Services
0-200 Amp. Under 600 V 12.50 INSPECTORS
201-1000 Amp.Under 600 V
25.00 APPROVALS D SIGNATURE
Over 1000 Amp.or Over 600 V 50.00 TEMP. POWER POLE
UNDERSLAB WORK
Temp. Power Pole&Appurtenorces
10.00
Sign with One Branch Circuit 10.00 ROUGH CONDUIT
2.00 WIRING
Additional Sign Branch Circuits
Misc.Conduits&Conductors 10.00 FIXTURES
Other(See Complete Fee Schedules POWER AUTHORIZED
UTILITY CO.NOTIFIED
FINAL
PERMIT FEE (Sub-Totol) NOTES
PLAN CHECKING FEE (One-Fourth Permit Fee,
PERMIT ISSUING FEE $7.00 7 �`–
TOTAL FEE �add d d...z1
PLAN CHECK VALIDATION CKM O. CASH PERMIT VALIDA ION SCK. M.O. CASH
o f 2 4 o .it,
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
DS 5-A 4-39 25M APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
�����
COUNTY OF LOS ANGELES
WM. J. FOX, CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. GROUP I ZONE PERMIT No.
WIRING FIXTURES SERVICE .2- , 'T E G Z`
READY FOR RECEIVED BY DATE ISSUED
RANGE _ HEATER I POWER r— FIRST INSPECTION
SIGNS I MISCELLANEOUS
R APPLICANT FILL IN HEAVILY OUTLINED PORTIO/yN ONLYJOB
/ ' ?
Q NAME / J r/R ��(//P fu, Call— ADDRESS Z �"S V f-N,S / L•�H�'�`•_
ADDRESS 37 Ale, -!' LOCALITY
I-
J� T NEAREST
J CITY 4f�TEL No. CROSS ST. �✓�
W COUNTY y` s�
REG. NO. 7�/ EXPIRES „['-fp�y� tr NAME I - /0*
DESCRIPTION OF WORK Z MAIL
NUMBER OF OUTLETS ON CIRCUITS R, ADDRESS
LOCATION BY ROOMS D
CITY TEL No.
LIGHT OUTLETS III SW.J PLUGS IFIXT. CORRECTIONS
CIRCUIT A I B II C I D I E k F I G I H I
LIVING ROOM -I FI 71
�
DINING ROOM i I I�
i- I-I-I-j-
BRFST. RM. __ II
BATH
——I—J`--
ENT. HALL
HALL NO.
Z
FRONT PORCH
OUTSIDE
KITCHEN
SERV. PCH.
BDRM. NO. I� �_I_I_�
CLOSET I� II ItI
�
I --
BDRM. NO. I _
CLOSET _ 7-1_1_ APPROVALS
7 DATE INSPECTOR'S NAME
M'. RUh I _I_IT� CONDUIT
_ ___ WIRING
F T_OTAL �I I FIXTURES
NO. OF OUTLETS $ POWER
NO. OF FIXTURES $ UTILITY CO. NOTIFIED__ I -
NO. OF MOTORS H. P. 1 $ �a FINAL
NO. OF SIGNS 1 TRANS. / $ I AM THE LEGAL OWNER O ABOYS LOS ANGELES
COUNTY REGISTRATION N
NO. OF RANGES OR HEATERS $
ELECTRICIAN.
MISCELLANEOUS $
M THE LEGAL OWNER OF THE PROPERTY DESCRIBED
AB E.
PERMIT FEE $ y
TOTAL FEE $ & d OWNER.
Da 5-A 4-39 25M APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
��� �
COUNTY OF LOS ANGELES
WM. J. FOX, CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. GROUP I ZONE PERMIT NO.
WIRING FIXTURES SERVICE
j READY FOR RECEIVED BY DATE ISSUED
RANGE I HEATER I POWER FIRST INSPECTION
SIGNS MISCELLANEOUS '
$ APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
zloe
I Q NAME ADDRESS
U
ADDRESS r L- LOCALITY
JF - cc nn NEAREST /?
CITY I -C TEL No.J 'V ,� CROSS ST. �J
COUNTY �� /'1 '
U REG. NO. EXPIRES NAME t _ ' �.f.
DESCRIPTION OF WORK % Z MAIL
NUMBER OF OUTLETS ON CIRCUITS 3 I ADDRESS
LOCATION BY ROOMS O
1 CITY . .�� TEL NO.
LIGHT OUTLETS I SW.1 PLUGS IFIXT. CORRECTIONS
CIRCUIT A I B I C I D I E k I F I G I H
LIVING ROOM -I I I
DINING ROOM ,_I_ —�� _I_I_�
BRFST. RM. IITI��� —I I I—1"—_ j
BATH I�I
ENT. HALL J
1 HALL NO.
FRONT PORCH
OUTSIDE j I I
KITCHEN I I --� .'� ---
1 SERV. PCH. � I—_ I I --�— "°� i •`'{ �
BDRM. NO. I I I- I "
CLOSET
BDRM. NO. i I I I Imo_ F
j CLOSET I �� I ( 1 APPROVALS
– IF
DATE INSPECTOR'S NAME
CONDUIT
J��-,_Gjji-,���
WIRING
&I
TOTAL J 1 1 I I FIXTURES J_
NO. OF OUTLETS $ i POWER
NO. OF FIXTURES $ - UTILITY CO. NOT:::E A �— —
NO. OF MOTORS H. P. ._ T F $ FINAL I '
NO. OF SIGNS TRANS. $ I AM THE LEGAL OWNER OF THE ABOVE LOS ANGELES
COUNTY REGISTRATION NUMBER.
NO. OF RANGES OR HEATERS $
ELECTRICIAN.'i _
MISCELLANEOUS $ �—� k� -
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIIk`6
PERMIT FEE $ -= 'ABOVE.
TOTAL FEE $ a OWNER.
DB 5-A 4-39 25M APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY �����
COUNTY OF LOS ANGELES
WM. J. FOX, CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. ZONE PERMIT No.
GR UP
WIRING FIXTURES SERVICE r— 17 - 7, le ! r- _` f 7el� - '
READY FOR RECEIVED BY DATE ISSUED
RANGE HEATER I POWER FIRST INSPECTION 7
SIGNS MISCELLANEOUS C^-16
APPLICANT FILL IN, HEAVILY OUTLINED PQRTION QNL t►
JOB w
c NAME ' ADDRES P
U
ADDRESS /Vj - LOCAL
U ARES
yl CITY Y TEL OSS ST.
W COUN
REG. NO. ,`: EXPIRES • NAME
DESCRIPTION OF WORK I Z MAIL .
NUMBER OF OUTLETS ON CIRCUITS ADDRESS
9ADDRESS
LOCATION BY ROOMS i U CITY TEL NO.
a LIGHT OUTLETS II SW.1 PLUGS IFIXT.• CORRECTIONS
[[s CIRCUIT IA I Bic I D I E h I F I G I H II
114 ROOM j
I IRM. .
a
a.
J
-- -- J
FR
OUTSIDE —— 0
KITCHEN
SERV. PCH. i (—
BDRM. NO.
CLOSET
BDRM. NO. _
CLOSET APPROVALS
iI _ DATE INSPECTOR'S NAME
CONDUIT _
WIRING
TOTAL ? FIXTURES
r
NO. OF OUTLETS t��j �99• $ POWER I
NO. OF FIXTURES ! p $ UTILITY CO. NOTIFIEDI
NO. OF MOTORS H. P. $ FINAL
NO. OF SIGNS TRANS. $ 1 AM THE LEGAL OWNER OF THE ABOVE LOS ANGELES
COUNTY REGISTRATION NUJABER.
NO. OF RANGES OR HEATERS 66 _ __
ELECTRICIAN
MISCELLANEOUS $ I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
PERMIT FEE $ ABOVE. -
TOTAL FEE e $ / 9ij OWNER.
F30611_,, APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER ADORES G�! 7/,,BUILDING AND SAFETY DIVISION
LOCALITY ��'/
NEAREST �+
FOR APPLICANT TO FILL IN CROSS Sly--���'� 4-/-,,a
OUTLETS N0. EACH FEE p��
$ $ OWNE../�- Ax
RECEPT._ ADDRE (J E?� ID-C LIGHT TOTAL FIRST 20 25
SWITCH OVER 20 10 CITY✓ (3� ,✓ TEL.
PLAN CHECK
FIRST 20 25 APPLICANT
LIGHTING TOTAL
OVER 20 ADDRESS
FIXTURES �10
RESIDENTIAL APPLIANCES CITY -C TEL. NO.
IT
RANGE DRYER_WTR. HTR. APPPERLIICAN/Sl4' y�-LG'ie�h`T/�"T �'�'�
STA. COOK DISP. F.A.U. ADDRESS 3� ,jr,&,G-1-
SPACE HTR. AIR COND. CI TY%jJ 1/A/ TEL. N0. _S(�
CLOTHES WASH. DISHWASH. LICENSE N0.?,e� I ' CLASSY'/-d
FAN OTHER 1.00 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING 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 - 1 1.00 LICENSED AS REQUIRED B. LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I HE EGAL OWNER OF, AND INTEND TO O
1 - 1O 300 CL
RESIDE IN, THE D BED RESIDENTIAL PROPERTY.
v
SIGNATUR oe
10 - 50 5.00 OF PER T O
50 - 100 10.00 1—
DISrTRICT NO. CL ZONE RO SS ED BY `,i
100 - 500 15.00 ,�Q�/ C N
Z
SIGN, GAS SIGN
TUBE, A AND ONE CIRCUIT 5.00 NOTES:
MARQUEE ADDITIONAL CIRCUITS 1.00
SERVICENOT OVER 600 VOLTS OR 200 AMP 3.00
APPROVALS DATE INSPECTOR'S SIGNATURE
SERVICEOVER 600 VOLTS OR 200AMP 10.00
TEMP.POWER POLE
TEMP SERVICE,POLE, &APPURTENANCES 5.00
UNDERSLAB WORK
TEMP LIGHT OR RECEPT. SYSTEM 3.00
ROUGH CONDI UT
WIRING
FIXTURES
POWER AUTHORIZED
LUING
E (SUB TOTAL)
UTILITY CO. NOTIFIED
K FEE t T
FE 3.00 eINALEE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALID TIbNCK. M.O. CASH
VA,O " 4 ? 3 �JAN 9 2 D 1 6,0 0,,
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
76A663CE-806(11 /78) APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN JOB
New Residential Bldgs.&Pools EACH NO FEE ADDRESS 5/
1 &2-Family,Sq. Ft. $ .025 — $ LOCALITY �
Multi-family Sq. Ft. .02 — NEAREST
CROSS ST.
Residential Swimming Pools 25.00 OWNER OR
FIRM NAME -�
Outlets: Rec "LlEight—Sw. MAIL
First 20 .50 ADDRESS
Total No. Additional 30 CITY Tel. No.
PLAN CHECK
APPLICANT
Lighting Fixtures First 20 50 ADDRESS
Additional 30
Total No. CITY Tel. No.
Fixed Appliances Not Over 1 HP PERMIT
q_
Range_Heater_D.W. APPLICANT
Oven—Dryer_W.M.— ADDRESS $(�
Top _FAU _W.H. _ CITY . Tel.4oC/(��—3>77
Hood_Fan —Other LICENSE OR
Disp.—Room Air Cond. 2.50 REG. NUMBER 174063 Class CA
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCA
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Size&Type HP, KW, KVA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
yp2.50 REGULATING ELECTRICAL WIRING. O
Up to 1 In . 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR V
Over 1 to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF Ix
Over 10 to 50 Incl. 12.50 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE O
25.00 DESCRIBED RESIDENT ROPERTY F
Over 50 to 100 Inc. U
Over 100 40.00 PERMITEE tDR
RM
�7 ��� yj
Services �' ^ PROCES BYE L r
0-200 Amp.Under 600 V 12.50 l.,
201-1000 Amp. Under 600 V 25.00
Over 1000 Amp.or Over 600 V 50.00 Z
O
Temp. Power Pole&Appurtenances 10.00 Sign with One Branch Circuit 10.00
Additional Sign Branch Circuits 2'00TION >
ATION vMisc.Conduits&Conductors 10.00 ERSE _Other(See Complete Fee Schedule) EZ
CL
�' - r.
PERMIT F (Sub-Total w
-Z7r 2•, -
PLAN CHECKING FEE (One-Fourth Permit Fee O
� J
PERMIT ISSUING FEE $7.00
TOTAL FEE d def >
INSPECTION FINALED / W
date: / r /� . p' BY ` tj -�C ,1.. a Pa
76A 663-C E3Jc 3-6 /�
APPLICATION FOR ELECTRICAL PERMIT/"
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDREISs
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST lti 1-1-14
CROSS ST.
NO. EACH FEE
RECEIPT $ $ OWNER
._ MAIL n�
/7
LIGHT TOTAL FIRST 20 .20 ADDRESS -
CITY TEL.N0.
SWITCH OVER 20 .10 PLAN CHECK
LIGHTING TOTAL FIRST 20 ,20 APPLICANT
FIXTURES O4ER 20 .10 ADDRESS
RANGE_DRYER_WTR. HTR. CITY �j TEL.NO�.
STA. COOK_DISP. F.A.U. CONTRACTOR
SPACE HTR. AIR COND. ADDRESS
CLOTHES WASH._DISHWASH. CITY � �(,/ L 1G TEL.N0. ,S-J6
FAN OTHER 1.00 LICENSE NO. / F CLASS.
MOTORS,TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
IND. HEATERS, ETC, HP. KW. KVA. AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
JF( ELECTRICAL WIRING.
Jy D — 1 '�,/ 1'00 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR `
C
LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
1 — 10 3.00 CALIFORNIA OR THAT I AM THE LEGAL ZWNEF, AND INTEND TORESIDE IN, THE ABOVE D CRIBED RESIP RTY,.
10 — 50 5.00 C
SIGNATURE F
50 - 100 10.00 OF PERMITT -
u
100 — 500 15.00 DISTRICT NO. GROUP ZO PR SSED BY C
L
SIGN,GAS SIGN AND ONE CIRCUIT 3.00
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES:
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
WIRING
PERMIT FEE (SUB TOTAL) FIXTURES
FOWER AUTHORIZED
PLAN CHECK FEE (50% PERMIT FEE)
PERMIT ISSUING FEE 2.00 !J UTILITY CO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL
TOTAL FEE G� JOSEPH C. ROOHAN
SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.o. CASH
f „ Fs 4 t` JAI IN
N 22 2 D 5.00
SFF BACK OF APPI -All— 10a CO.-ITE FFF SCHEDULE
WORKERS'COMPENSATION DECLARATION 10/81
CE-806G APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self CE-806
insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS
D —
Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ $ LOCALITY
tion department. Multi-family Sq. Ft. — NEAREST
CROSS ST.
Date Applicant Residential Swimming Pools OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw. MAIL
COMPENSATION INSURANCE ADDRESS
First 20
(This section need not be completed if the work involved by Total No. Additional CITY Tel. No.
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
Total No. Additional CITY Tel. No.
Date Applicant 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' 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 Tel. No.
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER Class. >_
(commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY d
and Professions Code,and my license is in full force and effect. O
Size &Type HP, KW, KVA, or KVAR V
License Number Lic. ClassUp to 1 Incl. FINAL
Contractor Date Over 1 to 10 Incl. DATE //1J VALIDATION }
❑ Over 10 to 50 Incl. FINA `v CCCJJJ W
I am exempt under Sec. Over 50 to 100 Inc. BY
B.&P.C. for this reason Over 100 a
Date: Services, Swbd., MCC& Panelboards
0 -200 Amp. Under 600 V LU
Signature �:_�/y 201 - 1000 Amp. Under 600 V ~
Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect.
SINGLE FAMILY Temp. Power Pole &Appurtenances t'
HOME OWNER-BUILDER DECLARATION
Sign with One Branch Circuit ;. • ,• • • � ...
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): • S .n a n
I, as owner of the property, will do Misc.the work and the Conduits&Conductors
• s j {;?",5 ;
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 Nome
PERMIT ISSUING FEE
Mender'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
the above-mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
City of Temple Cit
76A663-CE8061/70 APPLICATION FOR ELECTRfCAL PERMIT u
COUNTY OF LOS ANGELES
DEBUIBTMENT OF LDING AND SAFETY YDIVISIONER ADDRESS 9644 E. Las Tunas
JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING
NEAREST Camel a
FOR APPLICANT TO FILL IN CROSS ST,
OUTLETS NO. EACHI FEE 7
OWNER Texaco
RECEPT. $ $_ MAIL
LIGHT TO'rAL FIRST 20 .20
ADDRESS
CITY TEL. NO.
SWITCH OVER 20 10
PLAN CHECK
LIGHTING TOTAL FIRST 20 20 APPLICANT
FIXTURES
OVER 20 .10 ADDRESS
APPLIANCES CITY TEL. NO.
PERMIT
RANGE DRYER_WTR. HTR._ APPLICANT Vic Stein Elec. Inc.
STA. COOK DISP. F.A.U. ADDRESS 312 S. Melrose
SPACE HTR, AIR COND. CITY Placentia, TEL. N0.
CLOTHES WASH. DISHWASH. LICENSE NO. 219596 CLASS. Clo
FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AN STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING W ITH 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 - 1 100 ! LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
1 - 1O 300 RESIDE N, THE ABO E DESCRIBED RESIDE N7IAL PRO ERT Y.
SIGNATURE 0:
10 - 50 5.00 OF PERMITTEE v O
V
50 - 100 10.00
DI STRI CT NO. ICLASS I GROU ZONE PROCE SED A,,Y,'
100 - 500 15.00 '_5C
v
SIGN, GAS SIGN AND ONE CIRCUIT 3.00 NOTES:
TUBE, O �v d
TUBE, OR Z
MARQUEE ADDITIONAL CIRCUITS 1.00
SERVI CENOT OVER 600 VOLTS OR 200 AMP 2.00
APPROVALS DATEI SPECTOR'S SIGNATURE
SERVI CE OVER 600 VOLTS OR 200 AM P 5.00
TEMP.POWER POLE I
TEMP SERVICE,POLE, &APPURTENANCES 3.00
UNDERSLAB WORK
TEMP LIGHT OR RECEPT. SYSTEM 3.00
ROUGH CONDIUT
WIRING
PERMIT FEE (SUB TOTAL) FIXTURES
PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED �
UTILITY CO. NOTIFIED
PERMIT ISSUING FEE 2.00 '%
FINAL
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
JOSEPH ClOOHAN
TOTAL FEE �"� SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION M.O. CASH PERMIT VALIDATION CK. M.0. CASH
tArLG27 2 D 3.00...
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
WORKERS'COMPENSATION DECLARATION CE 806G (2-80) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BU_ ILDING ND AFETY
insure, or a certificate of Workers'Compensation Insurance,or
a pert?fled copy thereof(Sec. 3800,Lab.C.)
Policy NO.-
4
7����e/Company FOR APPLICANT TO FILL IN JOB
New Residential Bldgs.&Pools EACH NO. FEE ADDRESS
Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY ` 1:YM C C
Multi-family Sq. Ft. NEAREST
Certified copy is filed with t ounty building inspection Residential Swimming Pools CROSS ST
partment. g OWNER OR �^/��
Date y�,� FIRM NAME 4RF—., C� �CN�E
�ICpplican C- Outlets: Rec.—Light—Sw. MAIL �If ed
First 20 ADDRESS s�ssl�ee „11�✓n
CERTIFICATE OF E MPTION FROM WORKERS' Total No. Additional CITY �y2(Ig NA Tel No. L)yZ–/Je b
COMPENS TION INSURANCE PLAN CHECK }
APPLICANT
(This section need not be completed if the work involved O
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS V
Total No. Additional tr
I certify that in the performance of the work for which thisCITY Tel No.
Fixed Appliances Not Over 1 HP
O
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. APPLICANT V W
CL
Oven _ Dryer_W.M. ADDRESS N
Date Applicant Top _ FAU _W.H. 3 Z
Hood — Fan _Other_ CITYTel No 3r
NOTICE TO APPLICANT: If, after making this Certificate of Disp. — Room Air Cond. LICENSE-UR ,I
Exemption, you should become subject to the Workers' REG. NUMBER dt( Class C16
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCESS D 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
FINAL
Over 1 to 10 Incl. DATE 2O_
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. J �G VALIDATION
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
effect. Services
0-200 Amp. Under 600 V
License Nu e Lic.Clas 201-1000 Amp.Under 600 V
Contracto ^ Date J<<t"4 ���s Over 1000 Amp.or Over 600 V
H ME OWNER-BUILDER DEVLARATION 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
ness and Professions Code):
Misc.Conduits&Conductors
1, 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).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is
PERMIT FEE (Sub-Total)
issued (Sec. 3097,Civ.C.).
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE G�
I certify that I have read this application and state that the TOTAL FEE T O
above information is correct.I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby aut orize representatives of this County to enter upon
the abo entioned property for inspection rposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE
�
gnature of Per tee Date / ��
WORKERS'COMPENSATIONDECLARATION CE-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES C` BUILDING AND SAFETY
insure, or a certificate of Workers'Compensation Insurance,or T
a certified copy thereof(Sec.3800,,Lab.C.)
„I / FOR APPLICANT TO FILL IN ,JOB 4 L
V av U Company/�p �7EI r New Residential Bldgs.&Pools EACH NO. FEE ADDRESS
Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY v
rn Multi-family Sq. Ft.
!� Certified copy is filed with the county building inspection CROSS STkkA t
part ment. Residential Swimming Pools OWNER OR J
r FIRM NAME
Date Applicant Outlets: Rec._Light_Sw. ADDRESS !•'
First 20
CERTIFICATE OF EXE TION FROM WORKERS' Total No. Additional
CITY
COMPENSAT N INSURANCE PLAN CHECK O
APPLICANT
(This section need not be completed if the work involved U
cr
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS
Total No. Additional O
I certify that in the performance of the work for which this CITY Tel No. F-
Fixed Appliances Not Over 1 HP
permit is issued, I shall not empl any person in any manner PERMIT LU
so o become subject to th o kers' Compensation Laws. Range_ Heater_D.W. APPLICANT
N
Oven _ Dryer_W.M. ADDRESS �3 C � Z
Date Applicant G 4 Top _ FAU _W.H. �y4— /7
Hood _ Fan —Other_ CITY r Ol Tel N +
NO CE TO APPLICANT: If, fter making this Certificate of Disp. — Room Air Cond. LICENSE OR
Exe ption, you should b ome subject to the Workers' REG. NUMBER Class
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCES ED BY I
with comply with such provisions or this permit shall be
deemed revoked. Size&Type HP,KW,KVA,or KVAR
Up to 1 Incl.
FINAL
Over 1 to 10 Incl.
DATE
LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. .� VALIDATION
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINALBY l
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 r 7 G O Lic.CFARAT�ION
v 0-200 Amp. Under 600 V
t 201-1000 Amp.Under 600 V
Contracto Date Over 1000 Amp.or Over 600 V
H ME OWNER-BUILDER DE 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
ness and Professions Code):
Misc.Conduits&Conductors o a a
El 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).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is PERMIT FEE (Sub-Total)
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 C�
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 abov ntioned propertyf s1i pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
r
,2
70ture of Permittee ate
WORKERS'COMPENSATION DECLARATION 16A663 10/81 APPLICATION ®11� ELECTRICAL E E Iii®VPY'�
1 hereby affirm that I have a certificate of consent to self CE-806G
insure, or a certificate of Workers'Compensation Insurance, I COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof(Sec. 38 b. C.)
Policy NoIl Company �G FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnis ed. New Residential Bldgs. 8 Pools
EACH NO. FEE ADDRESS
❑ 1 8 2-Family, S Ft. $ _ $ LOCALITY D
Certified copy is filed with the county building inspec- y' q' 'NEAREST
tion epart ent. Multi-family Sq. Ff. CROSS ST. ;g
A ` Residential Swimming Pools IOWNER OR
Date Applican FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL
COMPENSATION INSURANCE ADDRESS
First 20
This section need not be com leted if the work involved b
tY he permit is for one hundred dollars(;100)or less.) Total Nb. Additional CITY C Tel. No.
PLAN CHECLIF rd
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
Total No. Additional CITY Tel. No.
Date Applicant Fixed Appliances Not Over 1 HP
T 09
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT
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 &) ^' n
with comply with such provisions or this permit shall be Top _ FAU —W.H. —
deemed revoked. Hood _ Fan —Other— Cl 0,9j Tel.. IVo.
LICENSED CONTRACTORS DECLARATION LICE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _'Room Air Cond. REG. NUMBER Class��
(commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. PROCESSED BY
and Professions Code,and my license is in full force and effect. IL
v.f �4Size 8 Type HP, KW, KVA, or KVAR' 990— O
License Number ? Lic. Cla Up to 1 Incl: FINAL U
DATE rd Over 1 to 10 Incl. .!` VALIDATION
„u 09
Contracto t'�_ ate Over 10 to 50 Incl. 6L
.❑ ;Z 9
FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY �
Over 100
B.BP.C. for this reason
Date: Services,Swbd.; MCC 8 Ponelboards e
0 -200 Amp. Under 600 V
Signature 201 -1000 Amp. Under 600 V
❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY Temp. Power Pole 8 Appurtenances ^ ?2 4 A '
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit :` o o a o o 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 ) o o 2 S 0
Professions Code):
I, as owner of.the property, will do the work and the Misc. Conduits 8 Conductors
❑
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_
7044, Business and Professions Code). L
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 repres tatives of this County to enter upon 1.
th�aboe-mentloned ro rty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
ateSigP it ee .
WORKERS'COMPENSATION DECLARATION 10/81 ffi%PPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of conCE-806 sent to self CE-806G
insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES �� BUILDING AND SAFETY
or a certified copy thereof(Sec. 3800, Lab. C.)
Policy No.#1 y i Q q Compony �f/x�f �/,Hv1. FOR APPLICANT TO FILL IN JOB ` )
Certified co is hereby furnished. ADDRESS [J 1
Py y I. New Residential Bldgs. &Pools EACH NO. FEE
❑ — LOCALITY
Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $
tion department. Multi-family Sq. Ft. 'NEAREST
CROSS sT.
Date Applicant Residential Swimming Pools OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: ReLight Sw. MAIL
� ADDRESS Q .�
COMPENSATION INSURANCE c
First 20 �
(This section need not be completed if the work involved by Total No.:7 Additional CITY Tel. No.G
the permit is for one hundred dollars($100)or less.)
that in the performance of the work for which this PLAN CH C
I certify P 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 o ADDRESS
�j � �
Total No. 3/ Additional CITY j91 Tel. No.1 f � 7
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANTExemption, you 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.
Hood Fan _Oth
—
deemed revoked. CITY Tel. No.tf ���
_
LICENSED CONTRACTORS DECLARATIONer—
. LICENSE OR /
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. REG.NUMBER S—C9 Class.
(commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROCESS BY
and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances p�
Size&Type HP, KW, KVA, or KVAR J s�O O
License Number i-C 4<_5Lic. Class lass_[�2= Up to 1 Incl. FINAL
�,,,//� Over 1 to 10 Incl. DATE VALIDATION
Contractor lA� v✓,"0Date Over 10 to 50 Incl. FINA �
1 am exempt under Sec. Over 50 to 100 Inc. BY in
B.&P.C. for this reason Over 100 to
' Z 10 Services, Swbd., MCC&Panelboards . �Q s 0
Date 0 -200 Amp. Under 600 V
Signatur 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V
Ezen:l for Reg. Maint. Elect.
SINGLE FAMILY Temp. Power Pole&Appurtenances = 1.�' p
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit o 0 0 0 0
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits 2
Law for the following reason (Section 7031.5, Business and
p
Professions Code): 1 C7.CC
Misc:Conduits&Conductors ,.c
I, as owner of the property, will do the work and the :. 1 C '7 (ti
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_
7044, Business and Professions Code). 0-8 6
CONSTRUCTION LENDING AGENCY
1hereby 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 0 6-
Lender's Address
1 certify that I have read this application and state that the TOTAL FEE 7
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
Ve
thorize representatives of this County to enter upon
- enfioned roperty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE ,
ignature of Permittee Date
c `
COUNTY OF LOS ANGELES TEMPLE CITY #.0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1206180070
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I
ITR: 6561 LT: 533 BL: .001 I I ' 9644 LAS TUNAS DR I
I FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917802139 I
(ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: [
18587-021-018 Al PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, CI
I IG2 LIGHTING FIXTURES 1.00 LGT 2.00 [
ITENANT: TOTAL FEES 29.80 ISSUED ON: PROCESSED BY: PLAN BY: [
106/18/12 SR I
1OWNER: TEL. NO: I IFINAL DATE FINAL BY: CODE: [
1KAO LEE - I I I
9644 LAS TUNAS DR. I I I
ITEMPLE CITY CA 91780 1 IDESCRIPTION OF WORK I
I I
11 LIGHT FIXTURE I
(APPLICANT: TEL. NO: I I I
IWONG, DAN (626) 922-3189- I I
15444 ALHAMBRA AVE I [SPECIAL CONDITIONS:
ILOS•ANGELES CA 90032
(CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE
IJCKW, INC. (323) 223-0886- I 1 I
15444 ALHAMBRA AVE LIC. NO I ITEMPORARY POWER POLE I I I
LOS ANGELES CA 90032 891044 I 1 I [
I I [UNDERGROUND CONDUIT [
[ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND II I
LIC. NO: [ ROUGH CONDUIT [
I I I [
1 ROUGH WIRING I I
[ I X
q- �MAIN WATER LINE IA�I'� AAA ED I PLASTIC Y/N METAL Y/N I I [
IUTILITY COMPANY NOTIFIED(
I I [ I I I
[ I [ I I I
I I I [
I I I I [
I I I I I [
I I I I I
I i II I I I
I IREPORT ID: DPR265 ROUTE TO: BS0508 [ [ I
[ I I [ I
r6A663 CE-12106 NF 6.78 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN JOB
New Residential Bldgs. &Pools EACH NO FEE ADDRESS
1 &2-Family,Sq. Ft. $ — $ LOCALITY
Multi-family Sq. Ft. — NEAREST
CROSS ST
Residential Swimming Pools OWNER OR
FIRM NAME
Outlets:Rec kLight Sw. MAIL
First 20 ADDRESS
Total No. Additional CITY Tel. No.
PLAN CHECK
APPLICANT
Lighting Fixtures k First 20 ADDRESS
Total No. Additional
CITY No.
Fixed Appliances Not Over 1 HP PERMIT
Range_Heater_D.W. _ APPLICANT A- fr�tF'
Oven—Dryer_W.M.— ADDRESS
Top _FAU — W.H._ CITY 2.c_ Ca Tel. N L/qG
Hood_Fan —Other LICENSE OR / 7% 06'_C
Disp._Room Air Cond. REG.NUMBER ` 4' Class
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCA
Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
Size&Type HP, KW, KVA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS }
Yp REGULATING ELECTRICAL WIRING. d
Up to 1 Incl. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR G
Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF U
CALIFORNIA OR THA AM THE LEGAL OWNER OF THE ABOVE
Over 10 to 50 Incl. DESCRIBED RESIDE PROPERTY 0
Over 50 to 100 Inc.
PERMITEE
Over 100 SIGNATURE
Vl
Services DISTRICTN P ESS�D BY �� Z
0-200 Amp.Under 600 V G r
201-1000 Amp. Under 600 V
Over 1000 Amp.or Over 600 V �� Z
Temp. Power Pole&Appurtenances I��/"J -71-7 G�s�a
Sign with One Branch Circuit
Additional Sign Branch Circuits INSPECTION >
INFORMATION
Misc.Conduits&Conductors ON REVERSE i
Other(See Complete Fee Schedules SIDE v
� , 7A
CILJ
�• # . 2
PERMI FEE (Sub-Totoli 2 • •
Z
PLAN CHECKING FEE (One-Fourth Permit Fees O • • • 0.Q Q
PERMIT ISSUING FEE J 0628-79
Q
TOTAL FEE >
INSPECTION FINALED o�c
W
date: z�1 17.1'
By d��'"' ®s