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768663-CE606 ,D,72 APPLICATION !F!�! EftCT AL PERMIT
COUNTY OF LOS ANGELES"BEPARTMENT OF COUNTY ENGINEJOB
966o E.—Lemon
BUILDING AND SAFETY DIVISION
LOCALITY
NEAREST cy
FOR APPLICANT TO FILL IN CROSS ST
OUTLETS NO EACH I FEE OWNER OR
S S FIRM NAME Keit K. Yamane
RECEPT_ MAIL
FIRST 20 ADDRESS 660 E. Lemon
25
LIGHT 1 TOTAL CITY Arcadia TEL NO 447-7187
SWITCH_j_ OVER 20 10 PLAN CHECK
LIGHTING TOTAL FIRST 20 25 APPLICANT
10
FIXTURES 20 ADDRESS
l OVER
RESIDENTIAL APPLIANCES CITY TEL NO
RANGE DRYER_WTR. HTR APPLIICANT IT Trane H C C
STA. COOK DISP F A.U. Z ADDRESS 2034 N. Peck Raad
SPACE HTR. AIR COND CITY So: El Monte TEL. NO. 579-7982
CLOTHES WASH DISHWASH. LICENSE OR 265094
c
REG. NUMBER LAss.SC-10
FAN OTHER 1 1 001.00 1 HEREBY 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
1/2 0 — 1 1DO O LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE y,
1 — 1O 300 DESCRIPED RESIDENTIAL PROPERTY O
PERMITEE U
10 - 50 500 SIGNATURE
O
I
50 - 100 1000 DISTRICT NO PROCESSE BY W
CL.
100 — 500 1500 Z
SIGN, GAS=ND ONE CIRCUIT 500 APPROVALS DATE INSPECTORS SIGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 100 TEMP. POWER POLE
SERVICENOTOVER600VOLTS OR200AMP 300 UNDERSLAB WORK
SERVICEOVER600VOLTS OR200AMP 1000 ROUGH CONDUIT
TEMPSERVICE,POLE, &APPURTENANCES 500 WIRING '3' `a--7`� 67,�v-a�R-�✓
TEMP LIGHT OR RECEPT. SYSTEM 300 FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIED
FINAL 3- 7 `!/�7
T
PERMIT FEE (SUB TOTAL) 1 51.7 5 NOTES:
PLAN CHECK FEE
PERMIT ISSUING FEE 300 A.00
TOTAL FEE 8.75
PLAN CHECK VALIDATION CK M Q CASH PERMIT VALIDATION cK M Q CASH
1 0 5 EZAL 19 2 D 8.75 A��6
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
( 4 �..
76A663-CE806 8-62 APPLICATION FOR ELECTRICAL PERI(IT
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 LOCALIT
NEAREST / �-
FOR APPLICANT TO FILL IN CROSS ST. - C
RECEPT. TOTALNO. EACH FEE
L /
I� OUTETS FIRST 20 P $20 $ OWNER
LIGHT
s//��� MAIL
SWITCH, l / OVER 20 T,j .1O ADDRESS'
TOTALCITY L.NO.
LIGHTING JJ FIRST 20I .20
FIXTURES OVER
2 /
oV R'L 10 ELECTRICIAN
41— ily"
RANGES CLO. RYERS WTR.HTRS. 1.00 e) ADDRESS - ' s
i
GARE/DISP. STA. OK `
CITY Gg '� TEL.NO. o y -
DISH ASH. AUTO.- ASH. STATE
SPAC R3. STA.APP +/z H.P.MAX.) � .SO
LICENSE. �y
MOTORS: OVER NOT OVER H . DISTRICT NO. GRQUP ZONE PRQfESSED BY
O 1 1.00 r1. i''• ' }
i 3 1.50 INSPECTION REC RD
3 8 2.00
8 15 2.50
15 50 3.00
a
50 100 5.00 0
SIGNS: NO.TRANS- C'
NO.LAMPS 0
SERVICE 0.60OV-NOT OVER 200A 1.00c U
Lu
CL
SERVICE 0.60OV-OVER 200 A. 2.00 to
Z
SERVICE OVER 600V 5.00 —
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE 11 $ �i
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
IM
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 L AL OWNER F THE ABOV
DESCRIBED RESIDENT L PROPERTY. • PO ER
SIGNATURE ILITY CO.NOTIFIED
OF PERMITTE19
FINAL
LIDATION ARTHUR C. VEIT
MO CASH SUPERVISING ELECTRICAL ENGINEER
/LCO 9604b M
3 2 0 19.80-
WORKERS' COMPENSATION DECLARATION 76-663 10/81
wAPPLICATION FOR ELECTRICAL' PERMIT
. l j'ereby CE- 806G affirm that I have a certificate of consent to self insure,
ora'certificate of.Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES' BUILDING AND SAFETY
copy,thereof(Sec 9800,Lab C11
) a
Policy Now t Company- FOR APPLICANT TO,FILL IN JOB /
' ADDRESS ' -
Q ,Certified copy Is hereby furnishedEACH„ + New Residential Bldgs Po Is NO' FEE
- LOCALITY
Certified copy is,,fded with the,•county budding inspection 1 & 2-Family,Sq Ft $ _ $
department; .• • , I Multi-family Sq Ft 'NEAREST
i CROSS ST
x,Date Applicant ' ' Residential Swimming Pools , J ' t - OWNER OR
• n �; '^- FIRM NAME _
CERTIFICATE OF EXEMPTION FROM WORKERS'. 2_ a'`•'_`' ' MAIL
.•COMPENSATION INSURANCE Outlets Rely— Light Sw ADDRESS
(This sectlomneed not be;conipleted if work Involved by the First 20;'
Total No Additional
CITY,. Tel No
permd Is for gone'hundred dollars($160),or iiona
r less.) PLAN'CHECK '
,l certify that'in,the,performance of the work for which this permit APPLICANT'
,is issued, 1 shall,not employ any person in,any manner.so to -
become subject to the,WorkersI Com satlon Laws Lighting Fixtures First 20 ADDRESS
'n ' Additional
' � • I ^� - Total No J� CITY Tel No '
Date Applicant 'Fixed Appliances Not Over 1 HP
NOTICE TO. APPLICANT If„ after ma g this C rhfoate of
Exemption,you should,become subject to t orkers'Compensation. Range— Heater_ DW APPLICANT DOL?lj f Nu2 L
provisions of the Labor Code, you,must forthwith comply with such Oven _ Dryer _ W M _ ADDRESS
provisions,or this permlt shall be deemed-revoked 'Top FAU W H
CITY �y Tel No
LICENSED CONTRACTORS DECLARATION Hood Fan Other_
I,hereby affirm that I am licensed under provisions of Chapter 9 Dlsp — Room Air Cond LICENSE OR _ Class
. ,(commencing with Section 7000) of Division.3 of the Business and REG NUMBER
Professions Code,and my license is in full force and effect Power Apparatus& Large Appliances DISTRICT NO J� PROCESS
•,. Size& Type HP,KW,KVA,or KVAR
License Number Llc Class Up to 1 Incl FINAL V
DATE O
• ., .r Over 1 to 10 Incl / VAIAT •
Contractor Date` S Over 10 to 50 Incl FINAL V'
0 • I am exempt under Sec 7 _ Over 50 to 100 Inc g /: W
Over 100 0.
B&PC for this reason Cl)
Services, Swbd,MCC& Panelboards Z
Date 0-200 Amp Under,600 V
Signature
201.7 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
I hereby affirm that I am exempt from the Contractor's License Law
for'the following reason(Section 7031 5, Business and Professions Additional Sign Branch Circuits L `
Code)
Misc Conduits & Conductors ,
1,as owner of the property,will do the work'and the structure 9 45 7 A
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) ,
o-o,o,o 0 2
and Professions Code)
CONSTRUCTION LENDING AGENCY ` o o 3 3 0'6
I hereby affirm that there Is a construction lending agency for-the "
performance of,the work,for which this permit is issued(Sec 3097, PERMIT FEE (Sub-Total) o o e 3 3 0'0 2
Civ C),
PLAN CHECKING FEE 0 4,2 6—8*$
Lender's Name
PERMIT ISSUING FEE -
Lender's Address '
I ce�tlfy 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" _
rep entatives of this Cou to enter on,the above-mentioned
pr e ty for rnspe on Pur o s
SEE REVERSE FOR EXPLANATORY LANGUAGE - -
Signatur Permittee Date