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7GA666-CESOG 4.60 APPLICATIONFOR ELECTRICAL PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A.LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY CL
7F.0R APPLICANT TO FILL IN NEAREST
CROSS ST
PERMIT FEES
OWNER 2�lt
M NUMBER EACH FEE MAIL
OUL $ $ ADDRESS
LIGT. SW. D C7 .10
LIRES O .10 mQ CITY EL.NO.
/
ELEC. RANGES CLO. DRYERS ELECTRICIAN •� f-G[� ,
W A T E R H E A T E R S .50 ADDRESS Z/- 3 a �Cd c-� v
ELEC.SPACE HTRS. DISHWASHERS CITY LI (J'•�G TEL.NO. /• I' d'O
` GARBAGE DISPOSERS AUTO.- STATE
WASHERS STA.COOKING UNITS ,25 1 LICENSE NO.
MOTORS: OVER INC. H.P. DISTRICT NO. GROUP ZONE I PRQCESSED BY
O — %2 .25j
1�2 — 2 .50 INSPECTION RECORD
2 5 1.00
a
5 — 15 1.50
V
15 — 50 2.50
O
50 — 200 5.00 V
W
SIGNS: No TRANS. N
NO. LAMPS
Z
SERVICE 0.600V 1.00
° SERVICE OVER 600V 5.00
misc.
WIRING PERMIT , 1.00 &O
FIXTURE PERMIT 1.00 0
SUPPLEMENTARY PERMIT ,S0
TOTAL FEE $ 'j
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED B LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT THE EG AL OWN THE ABOVE
DESCRIBED REBIDENTI PR PE
SIGNATURE UTILITY CO. NOTIFIED •
OF PERM[TTE
FINA
IDATION ARTHUR C.VEIT.
CK MO CASH__, SUPERVISING ELECTRICAL ENGINEER
5 3 ' FEB 42 -D 5.15
WORKERS'COMPENSATION DECLARATION76-806G �to/et
CE-906 /APPLICATION, FOR -ELECTRICAL' PERMIT
I heret�%w.� affirm that I have a certificate of consent•to self insure, ` rf
or a certificate of Workers' Compensation Insurance, or a certified' - COUNTY OF LOS ANGELES BUILDING AND SAFETY
#copy thereof(Sec 3800,Lab C) .
Policy No 317,002 Company STATE, COME FOR APPLICANT TO FILL'IN - - JOB •- - `_
❑ Certified copy is hereby furnished, +` qT-
New Residential Bldgs & Pools EACH NO FEE , ADDRESS'9 4 6 0 '
UX Certified copy is,filed with the county building inspection 1 & 2-Family,Sq Ft $ $ LOCALITY MAP #38 'B-1
department < NEAREST
Residential
Multi-family Sq rI i ,CROSS ST" L•ONGD S
+ Residenhat Swrmmm Pools
'Date Fi/Q 7' _ Applicant rTRRRs' $Rf,S g OWNER OR
'FIRM NAME BILL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec Light Sw -MAIL
i COMPENSATION INSURANCE - -ADDRESS 9 4 6 2 EAST •LEMON' ST.
(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 CITYTEMPLE CITY Tel No 4 4 7—5 9 9 4
I certify that in'the performance of the work for which this permit PLAN CHECK
is issued,'I shall not employ,any person in any-rrfanner so-as to rt ;APPLICANT
become subject to.the Workers'Compensation Laws Lighting Fixtures First 20, ADDRESS
Additional
CITY Tel No
Date {Applicant Total
Fixed Appliances Not Over 1 HP
NOTICE ,TO APPLICANT, If, after-making. this Certificate of PERMIT
Ran a
Exemption,you should become subject to the Workers'Compensation g Hearier— DW APPLICANTELECTRIC CO. INC-
r
provisions•of,the,Labor,Code, you must forthwith comply.with such Oven Dryer _ WM 'ADDRESS P,O,B OX 31021
provisions or this permit shall be deemed revoked Top-,— FAU WH
• LICENSED CONTRACTORS DECLARATIONHood — Fan Other—
CITY 'LOS ANGELES T0AIo 2 2 5—5 9 4
,I hereby affirm that I'am,licensed under•provisions;of Chapter 9 Disp Room Air Cond _. 3.. 50 •.l 3 LICENSE OR 169324 Class C-10
(commencing with Section 7000) of Division 3.oflthe,Busmess and., REG NUMBER-
Professions
UMBER-Professions Code,and my license;Is in full force and effectDISTRICT No PROCESSE Y
Power Apparatus& Large Appliances
7 Size& Type HP„KW,'KVA,or KVAR Q
License Number 16 9 3 2 4 Lic Class C-10 Up to 1 Incl FINAL' U
DATE f67,
r}r J D VALI TION
GIBBS BROS .• 7/8 7- Over 1 to 10 Incl 67 r
Contractor Date t
Over 10 to'50 Incl .
❑ I am exempt under Sec Over 50 to 100 Inc BY A 2�f
00 1
- 8&PC for this reason Over' • �•-�,
Services,Swbd,MCC& Panelboards �h,}ti jr�} Z ”
Date 0-200 Amp Under 600 V �• �i`0,±3,1 y'7,i�i ( ,��
Signature 1 4201'- 1000 Amp Under 600 V
❑ Over 1000 Amp or Over 600 V
Exemption for Reg Mamt Elect
" SINGLE FAMILY, Temp Power Pole& Appurtenances "
HOME OWNER-BUILDER DECLARATION Sign with One'Branch Circuit M !
I hereby affirm that I am exempt from the,Contractor's License Law
for the following reason(Section 7031 5, Business and Professions ' Additionab Sign Branch Circuits • 7
Code)
El "Mise Conduits& Conductors' " 2•
I,as owner of the property,will do the work and the'structure # o o'o 0 0
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)
and Professions'Code) - pollt( o'o A Q Q; ,
' CONSTRUCTION LENDING AGENCY o o,o (I Q Q
I hereby,affirm that there Is a construction lending agency for the - 0 6 Q 3=87'
performance of the work for'which this'permit is issued(Sec 3097, PERMITTEE -
Civ C) (Sub-Total) 3 'S 0
PLAN,CHECKING FEE
Lender's Name
" PERMIT ISSUING FEE 10 5 _
Lender's Address'
I'certrfy that I have read this application and state that the above TOTAL FEE 14 -00
information is correct I agree to comply with all County ordinances
and State laws regulating Elec I
g g g, and hereby authorize ,
,and
s-af this Coun er•up n the above-mentioned
prop for ins os
-SEE REVERSE FOR EXPLANATORY-LANGUAGE: _
05/12/87
atu of rmi Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0706200013
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT.
ILEGAL ID I FEES PAID I BUILDING ADDRESS. 1
I ON FILE I 1 9460 LEMON AV
IFEE DESCRIPTION QUANTITY UOM: AMOUNT I TEMP CA 917801302
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET. 1
15382-014-021 1A1 PERMIT ISSUANCE FEE 27 75 I THOMAS PAGE- 596 GRID J1 LOCALITY TEMPLE CITY, Cl
I 1G2 LIGHTING FIXTURES 1.00 LGT 1 95 1 I
ITENANT: I TOTAL FEES 29 70 (ISSUED ON PROCESSED BY PLAN BY: EXPIRES ON
1 106/20/07 SR 12/17/07
I
(OWNER TEL NO FI)fAL DATE FIN CODE 1
GRUNWALD MARIE (626) 447-5994- 1 I
19462 LEMON AV 1 I r
1TEMP 917801302 1 lf'2-51CITIPTION OF WORK
(INSTALL LIGHT FIXTURE 1
(APPLICANT: TEL NO: I I I
IKELLY CONSTRUCTION (626) 939-0133- 1 I I
11760 W CAMERON AVE 1 ISPECIAL CONDITIONS. 1
1WEST COVINA CA 91790 1 I I
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ICONTRACTOR: TEL NO- 1 1APPROVALS DATE INSPECTOR SIGNATURE 1
IKELLY CONSTRUCTION (626) 939-0133- 1 I I
11760 W CAMERON AVE #101 LIC NO I ITEMPORARY POWER POLE I I I
IWEST COVINA, CA 91790 835093B 1 I I I I
I I (UNDERGROUND CONDUIT I I I
(ARCHITECT OR ENGINEER. TEL. NO- 1 IUFER GROUND I I I
1 LIC- NO 1 IROUGH CONDUIT I I
I I IROUGH WIRING 1
I 1 IMAIN WATER LINE 1 1 1
PLASTIC YIN METAL YIN I 1 1
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1UTILITY COMPANY NOTIFIEDI I
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1 1 I I I I
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IREPORT ID: DPR265 ROUTE TO BS0508 I I I I
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