HomeMy Public PortalAbout9237 LOWER AZUSA RD_Electrical__ 76A663-CE906 0 72 APPLICATION MR ELTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER DDRESS
BUILDING AND SAFETY DIVISION ,237
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
OUTLETS N0. EACH FEE OWNER OR.
• $ $
FIRM NA11/0
RECEPT._ MAIL
LIGHT 0'7 TOTAL
FIRST 20 ADDRESS
CITY TEL. N0.
SWIT OVER.20 10
PLAN CHECK
TOTAL
LIGHTING l FIRST 20 iry APPLICANT
FIXTURES f0
)} CJ
OVER 20 ADDRESS
.
RESIDENTIAL APPLIANCES CITY TEL. NO.
PERMIT
RANGE DRYER_WTR. HTR. APPLICANT
STA. COOK DISP. F.A.U. ADDRESS
SPACE HTR. AIR COND.- CITY TEL. NO.
CLOTHES WASH. DISHWASH. LICENSE OR
REG; NUMBE 10 C3 CLASS.
FAN OTHER 1.00 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. H.P. KW. KVA. ELECTRICAL WIRING.
SIZE & TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
O - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR HAI I AM THE LEGAL OWNER OF THE ABOV
1 - 10 3.00 DESCRIBED S NT11lL I R
• e-'wL V.
PERMIT
10 - 50 5.00 SIGNATURE • �.'
O
50 - 100 10.00 v
DISTRICT N0. V C S BY yJ
100 500 15.00 d
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOfSSIGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE
SERVICE NOT OVER SOOVOLTS OR 200 AMP 3.00 UNDERSL'AB WORK
SERVICEOVER 600VOLTSO 200AMP 10.00 ROUGH CONDUIT
TEMP SERVICE,POLE,&APPURTENANCES 5.00 WIRING
TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES
POWER AUTHORIZED
UTILITY CO. NOTIFIED
FINAL 7-/ 7
PERMIT FEE (SUB TOTAL) NOTES:
PLAN CHECK FEE
PERMIT ISSUING FEE 3.00
TOTAL FEE
PLAN CHECK VALIDATION CK. M.O.. CASH PERMIT VALIDATIONC M.0. CASH
2 8 3�.17FR 20 2 D 1 8.5 0 A:z
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
W irrh that
I have 6 cerci DECLARATION CE-806 lb/81 APPLICATION FOR ELECTRICAL PERMIT
.;he-reby 8ffirm that I have a certificate of consent to self CE-806G .I
,.
'ah'ure,+.or'o certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES I BUILDING AND SAFETY
or a certified copy thereof(Sec. 3800, Lab. C.)
a cy No. Company j FOR APPLICANT TO FILL IN JOB n
Certified co y is hereby furnished. ADDRESS -7 V i1JaI /'
p Y New Residential Bldgs. &Pools $ EACH NO. $ FEE G
❑ 1 &2- amil S Ft. — LOCALITY
Certified copy Is filed with the county building inspec- y� q' NEAREST
tion department. Multi-amily Sq. Ft. CROSS:ST. s_ .
Date —Applicant Residential Swimming Pools OWNER OR/��` r n
pp I ,/ FIRM NAMEK/t U_ • Ce C /Gr�
CERTIFICATE OF EXEMPTION FROM WORKERS' S � MAIL
COMPENSATION INSURANCE. Outlets: �iec Light Sw._20 O ADDRESS Awm Zvi f/a!T
(This section need not be completed if the work involved by First ti
the permit is for one hundred dollars($100)or less.) Total I o. Additional CITY CjTel. No `�3
PLAN CHECK
I certify that in the performance of the work for which this
APPLICANT
permit is issued,Lshall not employ any person in any manner
so as to become subject to the Workers'Compensation Laws. Lighting ixtures First 20 1.5 ADDRESS
Additional
QQ' Total o. CITY ` Tel. No.
Dater8L Applica• Fixed Appliances Not Over 1 HP
NOTICE TO APPLICANT: If; after makingthis Certificat of PERMIT: / / �+`
APPLICANTsv �L G��GCwi
Exemption, you should become subiect to the Workers' Range Heater—D.W. —
Compensation provisions of the Labor Code, you must forth- Oven Dryer,—W.M.— ADDRES 7 AOL,—W vm4ild
with comply with such provisions or this permit shall be Top C FAU —W.H. — .�-,
I CITY C Tel. N.,W_/3YZ
deemed revoked.
Hood _ Fan =Other._
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. �'Room Air Cond. REG.NUMBER 3 Class.`°—�O
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO: PROCESSED BY
and Professions Code,and my license is in full force and effect. Power Al paratus&'Large Appliances D d
,,` '�� Size&Type HP, KW, KVA, or KVAR- : r O
License Number 12jr Lic. Class ��L� II Up to 1 Incl. FINAL' U
r
�'' Z Over 1 to 10 Incl. DATE . V IDATION o
Contracte,� �r ate , Over 10 to 50 Incl.
❑ 7�- FINAL U
I am exempt under Sec. i Over 50 to 100 Inc. BY
BAP.C. for this reason Over 100 1
Date:
Services,ISwbd., MCC&Panelboards ` 7 7 7.8 A
0 -
�j00 Amp. Under 600 V
Signature 201 - 1000 Amp, Under 600 V 0 0 0 0 0 2
❑
Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V ( o o 3 1.7 5
SINGLE FAMILY Temp. Power Pole&Appurtenances 0 0 0 3 �,�]5
HOME OWNER-BUILDER DECLARATION Sign wit One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits o a 2 7 "8 7
Law for the following reason (Section 7081.5, Business and
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 Other(Se Complete Fee Schedule)_
7044, Business and Professions Code).
i
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
i
the performance of the work for which this permit is issued PERMIT FIE (Sub-Total) 26
(Sec.3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name /
PERMIT ISSUING FEE L
Lender's Address
I certify that I have read-this application and state that the TOTAL FE
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
,
^-L7yl
Signature of Permittee Date '
i
i
- WORKER'S COMPENSATION DECLARATION ¢0-0019 DPW a/e9 I.
I hereby affirm that I have a certificate of consent to self insure,• 16A689 APPLICATION FOR ELECTRICAL PERMIT
or a certificate of Worker's Compensation Insurance, or a certified COUNTY'OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 Lab.C.)
Poll cy No. Company FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished. EACH NO. FEE ADDRESS 9237 Lower Azusa Rd. ��K
New Residential Bldga.&Pools LOCALITY Temple Cit
Ft
Sq
Family,; . . $
El Certified copy is filed with the county building Inspection 1 &2- NEAREST
department. Multi-famlly Sq.Ft. CROs ST.
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK 8590 PAGE 029 PARCEL 034
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:RBC.T LightSw. OWNER OR
'COMPENSATION INSURANCE FIRM NAME First 20 C 3• em City ndu a
(This section need not be completed if the work Involved by the Total No. Additional MAIL s
permit is for one hundred dollars($700)or less.) 17.7 E. Front Street.
I certify that In the performance of the work for which this permit CITY .na- CA .No, _
027
is issued, I shall not employ any person in any manner so as to PLAN CHECK
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT A. Dominguez
Total No. Additional
ADDRESS
Date Applicant 15 OR MA,120V BRANCH CIRCUITS 9237' Lower Azusa Rd. 1AK
)
NOTICE TO APPLICANT: Ii, after making this Certificate of CITY Tem le CityTel.No. I�)
791, 1
Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH
provisions of the Labor Code,you must forthwith comply with such 1.1 TO 40 INCLUSIVE EACH PERMIT
provisions or this permit'shall be deemed revoked: 41 OR MORE BRANCH CIRCUITS EACH APPLICANT Above
LICENSED CONTRACTORS DECLARATION ADDRESS d
I hereby'affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH O
(commencing with Section 7000)of Division 3 of the Business and CITY Tel.No. 0
Professions Code,,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO SHP LICENSE OR j=
Power Apparatus&Large Appliances. REG.NUMBER CIS
License Number Lie.Class. Size&Type HP,KW,KVA,or KVAR DISTRICT NO. POC SED BY U
Up to 3.-Incl. � LU
a
Over 3 to 10 Incl. FINAL
Contractor Date DATE U)
Over 10 to 50 Incl. q Z
❑ I am exempt under Sec. Over 50 to 100 Incl. d�� 12, VALIDATION
100 FINAL
B.&P.C.for this reason Over BY
Services,Swbd.,MCC&Panelboards
Date' 0-200 Amp.Under 600 V
Signature 201-1000 Amp.Under 600 V
❑
Over 1000 Amp.or Over 600 V 1 Exemption for Reg.Maim.Elect. ?�3 f
SINGLE FAMILY
Temp.Power Pole&Appurtenances z ',
HOME OWNER-BUILDER DECLARATION ' ! ,,';
;E
I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit ,.4
for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits ITN13
Code)' ol
Utri i' i F7Tt.rt 1
1
,.F
1,as owner of the property,will do the work and the'structure• Misc.Conduits&Conductors f ^'
is not Intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule)
and Professions Code).
CONSTRUCTION LENDING AGENCY i(�3•./ �f/r
. {1P� .F/'ice
I hereby affirm that there is a construction lending agency for the �'_ c-- C,a E)-
performance of the work for which this permit is Issued Sec.3097, i ! i `I ` `='
P P ( PERMIT FEE t(Sub-Total)
Civ.C.)
PLAN CHECKING FEE ;
Lender's Name
PERMIT ISSUING FEE
Lender's Address EE
•I certify that I.have read this application and state that the above TOTAL Fare. '
Information is correct. I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize I
representatives of this County to enter upon the above-mentioned
props for inspec' rp s. —� SEE REVERSE FOR EXPLANATORY LANGUAGE
TORE OF APPLICANT OR AGENT DATE
WORKERS'COMPENSATION DECLARATION ";7E 10,91 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure, CE-806G
or a certificate of Workers' Compensation.Insurance, or a certified COUNTY OF LOS ANGELES. BUILDING AND SAFETY
cogvt�he of(Sec.3800.Lab.C.) i {
Po
cop
N Compa C! ' FOR APPLICANT TO FILL IN JOB.
Certified copy is hereby furnished. /toEACH NO. FEE ADDRESS
New Residential Bldgs.&•Pools
rl Certified copy is filed with the county building inspection
1 &2-Family,Sq.Ft. $ — $ LOCALITY
department. :I Multi-family Sq.Ft. — NEAREST
X11 ,G/ Residential Swimming Pools CROSS ST,'
Date vv ✓ Applicant + OWNER OR
FIRM NAME.
CERTIFICATE OF EXEMPTION.FROM WORKERS' �.LiMAIL G -_,,.
COMPENSATION INSURANCE Outlets:Rao Light.—Sw. �O f�' / ADDRESS �j
(This section need pot be completed if the work involved by the First 20 v G�
'permit Is for one hundred dollars'($100)or less.) Total No. Additional CITY'� �� �` ° Tel.No.
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 manner so as to + APPLICANT
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Additional
' Total No. CITY Tel.No.
Date Applicant Fixed Appliances.Not Over 1 HP
'NOTICE TO APPLICANT: If, after making this Certificate of PERMIT ,
Exemption,you should become r subject to the Workers'Compensation , ' Range_ Heater, D.W. APPLICANT
provisions o{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 No.
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ Tel. -
t hereby affirm that I amlicensed under provisions of Chapter 9 I I LICENSE OR
Dlsp. - Room Air Cond. REG.NUMBER Clasa 6-/Q
(commencing with Sectioni 7000)of Division 3 of:the Bdsiness and
Professions Code,and my license is in full force and effect. DISTRICT NO. P O SSED BY
Povyer Apparatus&Large Appliances
Size&Type HP,KW,KVA,or KVAR
'License Number t!I•f�� � Uo.Class.,_ U + FINAL V
�j, Over DATE VALIDATION,
ContractorAAA1 tj T.C.I.Cate Over 10 to 50 Incl. FINAL
EI. I am exempt under Sec. Over 50 to 1'00 Inc. I BY LLI
B.BP.C.for this reason Over 100 N
Services,Swbd.,MCC&Panelboards , R
Date: 0 200 Amp.Under 600 V
Signature 201 - 1000 Amp.Under 600 V
❑ Over 1000 Amp.or.Over 800 V +
Exemption for Reg.Wlaint.Elect..
'SINGLE FAMILY Temp.Power Pole&Appurtenances
HOME'OWNER-BUILDER DECLARATION Sign with One Branch Circuit + Eri
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
Code):.
❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors
Other(See Complete Fee Schedule) _ l
is not.intended or offered for sale (Section 7044, Business
and Professions Code), I
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(Sec.3097, PERMIT FEE (Sub Total)
Civ.C.).
I
1 PLAN CHECKING FEE
Lend'er's Name
PERMIT ISSUING FEE
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 Statelaws regulating Electrical wiring, and hereby authorize 1
represent tives Of this County to enter upon the above-mentioned
property inspectioq-purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
ur f r 'tte Date ,2Gp
WORKERS'COMPENSATION DECLARATION j 76A663 10/81 1
I
, I•here lyi affirm that I have a certificate of consent to self CE-110613 APPLICATION FOR ELECTRICAL PERMIT,
• insure; or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
4W,p certified copy thereof(Sec. 3800, Lab. C.)
Policy No. Compan i FOR APPLICANT TO FILL IN JOB tJLU L f e
Certified copy is hereby furnished. New Residential Bldgs. &Pools
EACH NO. FEE ADDRESS L_6
' 1 &2-Family, S Ft. $ _ $ LOCALITY C-,X �' or
Certified copy is filed with the county building inspec� y. q• NEAREST
tion department. Multi-family Sq. Ft.
Residential Swimming Pools CROSS ST.
Date Applicant QWNER OR ,
FIRM NAME/#i"' n Q /K
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:.Rec�Light_�Sw,� MAIL Q�
COMPENSATION INSURANCE / p ADDRESS
(This section need not be completed if the work Involved by Total No. Z Additional" CITY• �l Tel. No
the permit is for one hundred dollars($100)or less.)
I certify that in the performance of the work for which this APPLAPLICANT CCANT
pe.rmit'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 i CITY Tel. No.
Date- ` +� �pplicant �•�C�GtiMlf�GLyl./ e Fixed Appliances Not,Over 1 HP PERMIT �+
NOTICE TO APPLICANT: If, after making this Certificate of I APPLICANTA 6—AY G• G'—��
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. — ICITY Tel. IVo �, u yv
deemed revoked. Hood — Fan _Other— - -f 3 C
LICENSED CONTRACTORS DECLARATION i' LICENSE R ,,r�rr
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room.Air Cond. REG:NUMBER 'L rr Class.C—`(,
(commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROCESS
v Power Apparatus&Large Appliances �
and Professions Code,and m license is in full force and effect, (J 4
Size&Type HP, KW, KVA, or KVAR'
License Number �43g Z94/Lic. Class L`CFINAL
Up to 1 Incl.
ContractorW_&�t'4F4X 9Is'G��iGDate //"'//-87 Over 1 to 10 Incl. DATE. �� VALI ATION
❑ 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 up
Date: Services, Swbd., MCC&Panelboards
0 -2&J.Amp. Under 600 V
Signature , = �Z201 - 1000 Amp..Under 600 V
❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect: r ;183668A
SINGLE FAMILY Temp. Power Pole&Appurtenances # 0 0 0 0 0 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby off irm that I am exempt from the Contractor's License Additional Sign Branch Circuits ) ° - 27,25
Law for the following reason (Section 7031.5, Business and
Professions Code): Misc. Conduits&Condyctors o o 0 2] x
I, as owner of the property, will do the work and the
2 5 n
structure is not intended or offered for sale. (Section Other(See Complete Fee Schedule)—: ® ) 1,16-87
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 Name
PERMIT ISSUING FEE ,S
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
the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
WORKERS COMPENSATION DECLARATION 20.0019 DPW(12'91) 1APPLICATION FOR ELECTRICAL PERMIT
63
7ky aPFirm that I have a certificate of consent to self insure,
certificate of Worker's Compensation. Insurance,or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 C) ,
Compariy • FOR APPLICANT TO FILL IN JOB
ADDRES
Policy
Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE
❑ — S $ LOCALITY U
Certified copy is filed with the C b ildin 1&s ion 2-Family,Sq.Ft.
de p ftme t. Multi-family Sq.Ft. NEAREST:
Date Applic' Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
C RT.IFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OwNER OR
COMPENSATION INSURANCE FIRM NAME (�
(This section need not be completed the work Involved by the Total No. First 20 MAIL Additional ADDRESS!3= '
permit is for one hundred dollars(S7000)or lees.)
I certify that in the performance of the work for which this permit
is issued, 1 shall not employ any person in any manner so as to PLAN CHECK
become,subject to-the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional
ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If,. after making this Certificate of CITY Tel.No.
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
rovlslons of the Labor Code, ou must forthwith com I with such PERM
provIT /
p •i's)ons• or this permit sjiall�be deemed revoked.+' y p y Power Apparatus&Large Appliances APPLI
'
LICENSED.CONTRACTORS DECLARATION Size&Type HP,KW, A,or KVAR ADDRES g U
I hereby affirm that I am licensed under provision's of Cfiapter 0 7sgF 3 to 10 Incl. O
(commencing with Section 7000)of Division 3 of the Business and CITY amu.
Professions.Code,and my license is in full force and effect. Over 10 to 50 Incl. }
LICENSE AR -5 4575 �1�
Over 50 t0 100 Incl. REG.NU BER J✓�•J Class.
.SSQ3
Over 100 0
DISTRICT NO. SED BY
License Number Lic.Class
Swbd.f MCG&Panelboards jkl, FINAL
�� 9
Conv alaer-/j - e ? 399 Amp.Under 600 V DATE /ppp/ n /
❑ 400-1000 Amp.Under 600 V /
I am exempt under See. ✓ U VALIDATION V
Over 1000 Amp.or Over 600 V FINAL W
B'.&P.C..for this reasonBRANCH CIRCUIT FEES BY U)
Date- 15A,or 20A,120V,Lighting or Recept. Z
Signature 1 To 10 Branch Circuits
11 To 40 Branch Circuits
41 Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits
SINGLE FAMILY Temp.Power Pole&Appurtenances 303 3,334.44
HOME OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit �( ITEMS
for the following reason(Section 7031..5, Business and Professions .Additional Sign Branch Circuits OT -� _
Code): CHAT 47,4W
y'"t•
1
❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors CHANGE
is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) r °
and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction Lending agency for the W� 000} 61 6/95
performance of the work for which this permit Is issued(Sec. 3097, PERMIT FEE (Sub-Total) 1 P
Civ.C.) .
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and under penalty of purjury state TOTAL.FEE Y/L�
that the above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring,and hereby authorize
011NAE.
esKI —
SEE REVERSE FOR EXPLANATORY LANGUAGE
PE
Ii
WORKERS'COMPENSATION DECLARATION 76A663 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby-affirm that I have a certificate of consent to self j CE-Bow
insure, or a certificate of Workers'Compensation Insurance, - COUNTY OF LOS ANGELES I' BUILDING AND SAFETY
or a cer/fieeddcco y thereof(Sec. 3800,✓�Lob.
//C.)
Polieyw=�Compan`l�J'S1T �►`ren"'i*1°'e:V FOR APPLICANT TO FILL IN I JOB
Certified copy is hereby furnished. I New Residential Bldgs. &Pools EACH NO. FEE ADDRESS
Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ _ $ LOCALI
tion de artm nt. Multi family Sq. Ft. NEAREST
r Residential Swimming Pools CR ST.
OWNER OR
Date Applicant .\ FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw— MAIL
COMPENSATION INSURANCE Al
First 20
(This section need not be completed if the work involved by i CITY Tel. --0
the permit is for one hundred dollars($100)or less.) I Total'No. Additional
PIAN CHECK
I certify that in the performance of the work for which thisAPPLICANT
i
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 NQ-_ Additional CITY Tel. No.
Date Applicant I Fixed Appliances Not Over 1 HP PERMIT �/�
NOTICE TO APPLICANT: If, after making this Certificate of APPLICA G►s/ Q
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.— ADDRES f
with comply with such provisions or this permit shall be Top — FAU —W.H. —
deemed revoked. Hood _Fan. —Other_ Te. 14 +
LICENSED CONTRACTORS DECLARATION ( 'LICENSE OR
'17I hereby affirm that I am.licensed under,provisions of Chapter 9 ,j Disp.. — Room Air Cond. REG.NUMBERClass. Carl
(commencing with Section 7000)of Division 3 of the Business ` DISTRICT NO. P C SED BY
and Professions Code,and m license is in full force and effect. Power Apparatus&Large Appliances f�
y Size&Type HP, KW, KVA, or KVAR CJ
License'Number. Lic.Class�_ Up to 1 Incl. FINAL � 4o
' LAAC "�lalDate 11 *� Over'tl. to-10 Incl. DATE e7lZ� 7�. VALIDATION 0
Contract
❑ i Over 10 to 50 Incl. FINA
1 am exempt under Sec. Over 50 to 100 Inc. BY 0.
B.BP.C. for this reason 0.
Over 100 �
iServices, Swbd.,MCC.&Ponelboards ►
Date: 0 :200 Amp. Under 600 Y �61 5-3 A.
Signature 201 - 1000 Amp. Under 600 V
❑
Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V # 0 0 0 0 0 2
SINGLE FAMILY Temp. Power Pole&Appurtenances # 0 0 0 0.0 2
HOME OWNER-BUILDER DECLARATION Sign with.One Branch Circuit
1,hereby affirm that I.am exempt.from the Contractor's License Additional Sign Branch Circuits I 0 o 2 a 5 0
Law for the following reason (Section 7031.5, Business.and I o o. 0 2 5 0
Professions Code): c:
❑ I, as owner of theproperty, will do the work and the Misc. Conduits&Conductors
i, 1223=86
structure is not intended or offered for sate (Section Other(See Complete Fee Schedule)_
7044, Business and Professions Code). i
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 • j
I certify that I have read this application and statethat the TOTAL FEE 7-ILS
above information is correct. I agree to comply with all County
ord' antes and State law gulating Electrical wiring, and
he by authorise repre fives of this.County to enter upon
tli Bove- a io 'ed rty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
tgnature of Per a Date /
o Nr� �
hereby WORKERS'jli�Ee a,certificate oSATION f consent to self ATION CE"�G '°'B' APPLICATION FOR EL,ECTRI.CAL PERMIT
insure, or a certificate of Workers'Compensation. Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or&certified copy thereof(Sec. 3800, Lob. C.) �
Policy No. Company FOR APPLICANT TO FILL IN JOB It
Certifiedcopy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS
S
Certified copy is filed with the,cd1 &2-Familurfty ,building inspec- Y. q• Ft. $ —Is I LOCALITY
tion department. Multi-family Sq. Ft. — NEAREST
CROSS ST.
Date Applicant. Residential Swimming Pools OWNER OR
FIRM NAME /N/l O
CERTIFICATE OF EXEMPTION FROM'WORKERS' Outlets: Rec�Light 7✓ Sw. r ' MAIL. �t t
COMPENSATION.INSURANCE � ADDRESS Z S
leted if the work Involved b First 20
This section need not be com
p Y 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
I Total No. 3 Additional CITY Tej./6d.
Dateif/ 22 pplicont r Fixed Appliances Not Over 1 HP PERMIT
NOTICE7f0 APPLICANT: If, after ma king 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.. CITY Tel. No.
LICENSED CONTRACTORS DECLARATION Hood _ Fan _.Other_
Disp. Room Air Cond. LICENSE OR Class
I hereby affirm that I am licensed under provisions of Chapter 9 REG.NUMBER
(commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO� PROC D
and Professions Code;and my license is In full force-and effect. �.
Size&Type HP, KW, KVA, or KVAR'
License Number Lic. Class Up to 1 Incl. FINA..L tJ
Over 1 to 10 Incl. DATE //t �g 09
Contractor Date (f (/ VALIDATION
Over 10 to 50 Incl.
FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY 8i
B.&P.C. for this.reason Over 100
Services, Swbd.,MCC.&Ponelboards ► 7 9 8 5 A Z
Date: 0 -200 Amp. Under 600 V
Signature •201 - 1000 Amp..Under 600 V
❑ Over 1000 Amp. or Over 600 V # 0 0 0 0 0 2
ZVI
Exemption for Reg. Maint. Elect. 1.
1 - 21•,75
SINGLE FAMILY Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION z
Sign with One Branch Circuit o o ®2 },7 515
1 hereby am ffirthat I am exempt from the Contractor's License Additional Sign Branch Circuits
Low for the folling reason (Section 7031.5, Business and Q,2 3 i$7
Pro ssions 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 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 Name
PERMIT ISSUING FEE l
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 ve-me.nt' ned property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE'
�� lT 7
Signature of1lermittee Date
WORKERS'COMPENSATION DECLARATION 78-8 10/81
CE-a0BG APPLICATION FOR ELECTRICAL, PERMIT
I hereby affirm that I have a certificate of consent to self insure, os
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.. Company FOR APPLICANT TO FILL IN JOB
❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS
New Residential Bldgs:&Pools
❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ _ $ LOCALITY
department. Multi-family Sq.Ft. NEAREST
CROSS ST.
Residential Swimming Pools
Date Applicant OWNER OR ,
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec�'Light'�Sw. M
. AIL
COMPENSATION INSURANCE ADDRESS 3 IrJCI" �
(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. X Additional CITY Tel.No.
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 manngr so. as to APPLICANT
become subject to the Workers'Comp n ation L Lighting Fixtures First 20 ADDRESS �37 4
�j Total No. Additional CITY Tel.Nqft. _
Fly
Date u Applicant Fixed Appliances Not Over 1 HP
NOTICE TO APPLICANT: If, after mE g. this Certificate of PERMIT
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT
provisions of,the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS d, 4
provisions or this.permit shall'be deemed-revoked. Top — FAU W.H. _ CITY T.I.No.
LICENSED CONTRACTORS DECLARATION Hood Fan _ 'Other_
I hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR
(commencing with Section 7000)of Division 3 of the Business and Disp: — Room Air,�ond. REG.NUMBER Clasa
Professions Code,and my license is in full force and effect. DISTRICT NO� PROCES E BY O
Large Appliances
Size&Type HP,KW,KVA,or KVAR
Power Apparatus& ,
• License Number Lic.Class Up to 1 Incl. FINAL / V
Over 1 to 1:0 Incl. DATE f // na
Contractor Date (/ �! ALIDATION 0
❑ Over 10 to 50 Incl. .FINA i
I am exempt under Sec. Over.50 to 100 Inc. BY W
'
B.&F.C:for this reason Over 100 ILrA
Services,Swbd.,MCC&Pa0eiboards Z
liate: O-200 Amp:Under 600 V A 8 2&,1 A
Signature 201 - 1000 Amp.Under 600 V
Over 1000 Amp,or Over 600 V # 0 0 0 0,0 2
❑ Exemption for Reg.Maint,Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances I o ° 1 a Q o
HOME OWNER_BUILDER DECLARATION Sign with One.Branch Circuit
1 hereby affirm that I am exempt from the Contractor's License Law o 0 0 1 $.Q of
for the following reason(Section 7031.5,Business and Professions Additional.Sidn Branch.Circuits
Code):❑
Misc.Cdnduita&Conductors 11. 04—8 7 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)
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(Sec.3097, PERMIT FEE (Sub Total)
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 above TOTAL FEE
information.is correct.I agree to comply with all County ordinances
and State laws regulating Electricalwiring, and hereby authorize
rep entatives. f this Cc my to enter upon the above-mentioned
prophrty f ' ectio poses; SEE REVERSE FOR EXPLANATORY LANGUAGE
/o-2 -6'1
Signatufedf Permittee Date ,t
WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) 1
76A663 APPLICATION FOR ELECTRICAL PERMIT �J
I hereby affirm that I have a certificate of consent to self insure,
or a certificate of Worker's compensation Insurance, or a certifi d A...rCOUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 Lab.C.) '
POIi � /�j3s413 Company FOR APPLICANT TO FILL IN JOB
��cJy'�V ADDRESS 9� Low 2U4Q b Owl I—
Ila Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE
LOCALITY
ElCertified copy is filed with the count�bui g Inspection 1 &2-Family,Sq.Ft. _ $ $ NEAREST '
depart ent.. //``/� Multi-family Sq.Ft. CROSS ST.
Date �� pelican !LV Residential Swimming Pools + ASSESSOR
_ thv.1v.d
MAP BOOK PAGE PARCEL
ERTIFICATE OF EXE tSN FR WOR,. OWNER OR
' Outlets:Roo.—Light Sw. FIRM NAME 0.V`y Y_I.V kI,-L
COMPENSATION INSURANCE i
(This section need not be completed if the work bythe First 20 4 MAIL t
permit Is for one hundred dollars($700)or less.) Total No. Additional ADDREss �� 'LL)r:.&. e_
I certify that in the performance of the work for which this permit CIT?7�b 4S gL-_ Tel.No.
Is issued, I shall not employ any person in any manner so as to I y PLAN CHECK
become subject to the Workers'Compensation.Laws. 'I Lighting Fixtures First 20 APPLICANT
Total No. Additional
ADDRESS
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP.I CITY Tel.No.
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Code,you must forthwith comply with such j PERMIT
p y p y APPLICANT
provisions or this permit shall be deemed revoked.. Power Apparatus&Large Appliances h4,D7Z*JJs UJ J®NINV_1.AC4,t-
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,,or KVAR I ADDRESS ,a %7Cyg &I60 q 61
I hereby affirm that I am licensed.under provisions of Chapter 9 , Over 3 to 10 Incl. � �� h�
(commencing with Section 1060)of Division 3 of the Business and I CITY ��l.r�r +).� T.I.NO, L�
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. !��r �G/t�
Over 50 t0 100 Incl. J RICENSE OREG.NUMBER /�+ r d uV ��! l O
Close.
f Over 100 DISTRICT NO. R SSED BY U
License Number x3C 110 Lic:Class r �r/ y
Services,Swbd.,MCC&Panelboards cc
Contractor N f�''���r�L� Date � 0-399 Amp.Under 600 V p�E //�� 0
F-1I am exempt under Sec. 1 400-1000 Amp.Under 600 V s^'( VALIDATION LU
Over 1000 Amp.or Over 600 V FINAL: LLL
B.&P.C.for this reason ' CL
BRANCH'CIRCUIT FEES BY
Date' 15A,or 20A,,120V,Lighting or Recept. _
Signature 1 To 10 Branch Circuits
11 To 40 Branch Circuits
F141 Or More Branch Circuits '
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 2
SINGLE FAMILY Temp.Power Pole&Appurtenances ACCTog
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 41e J�
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
Code): 1 ITEMS
❑ I,as owner of the property,will do the work and the at Misc.Conduits&Conductors TOTAL 61.-50
Is not Intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) , CHECK 61.50
and Professions Code). CHANGE o00
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 (Sec.3097, PERMIT FEE (Sub-Total)
Civ.C.) 0000-0001 2/28/96
PLAN CHECKING FEE 5066 1 FM 5:54
Lender's Name
PERMIT ISSUING FEE
Lender's Address /
I certify that I have read this application and under Penalty of purjury state I TOTAL FEE
that the above Information is correct. I agree to comply with all County 1
ordinances date laws regulating Electrical wiring,and hereby.authorize
repres alive of this County to enter upon the above-mentioned property I
for. spectio spur Fes. SEE REVERSE FOR EXPLANATORY LANGUAGE
a—,16-76
S
ERI PER nTEE DATE'
1,
1:Y ARKER'S COMPENSATION DECLARATION 211.0019 DPW(12-91) '
I hereby affirm that I have a certificate of consent to self insure, j8ASe3 APPLICATION FOR ELECTRICAL PERMIT LI
or a certificate of worker's Compensation Insurance,or a certified. f COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof,(Sec.3800 Lob.C.)
Policy No. 'Company FOR APPLICANT'TO FILL IN JOB
ADDRESS
Certified copy'Is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE
$ $ LOCALITY
❑ Certified copy is filed with the county building inspection 1 &2-Fatuity,Sq.Ft. _ NEAREST / /I
department. Multi-family Sq.Ft. CROSS ST.
Date. '_Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec.—Light Sw. OWN R OR II�.GWCI. L1 M.
COMPENSATION INSURANCE
(This section need.not be completed If the work Involved by the First io MAIL
permit is for one Hundred dollars($100)or less.) Total No. Additional ' ADDRESS ��' ��. LL
I certify that in the performance of the work for which this permit CITY , C e.No. 30�1�
Is Issued, I shall not employ any person in.any manner so as to I PLAN CHECK
become subject to the.Workers'Compensation Laws. Lighting Fixtures First 20 I APPLICANT
Total No. Additional
ADDRESS ••
Date ���� �r� Applicant
NOTICE TO APPLICANT: If, site making this ertifi.ate RESIDENTIAL APPLIANCES NOT OVER 3 HP. CITY Tel.No.
Exemption,you should become subje to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
PERMIT
provisions of the Labor Code,you must forthwith comply with such APPMA S Y`is r
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances ^
LICENSED CONTRACTORS DECLARATION Size&Type HP,.KW,.KVA,or KVAR ADDRESS � �5� /� �('._
I hereby affirm that I am licensed under provisions of Chapter 9 ' Over 3 to 10 Incl. CITYV&M Tel.No. `3 ( 9
(commencing'with.Section 7000)of Division 3 6f the Business and Over 10 to 50 Incl. ��
Professions Code,and my license is in full force.and effect. LICENSE.oR 1 }
Over 50 to 100 Incl. REG.NUMBER 1-- Class' �. d
Over 100 DISTRICT NO. P SSED BY ,�
License Number 1 70 Lic.Class I� (,)
COServices,Swbd.,MCC&Panelboards �O
Contractor/AS CNST- Date //- 3L?- ! 0-399 Amp.Under 600 V I DATE
400-1000 Amp.Under 500 V VALIDATION V
❑ I am exempt under Seca i j�
Over 1000 Amp.or Over 800 V FINAL
B.&P.C,for this reason 1 BRANCH CIRCUIT FEES BY 0-
/-3 0 -9 SL 15A,or 20A,120V,Lighting or Recept. z
00 Date: z
� _ �'r 1 To 10 Branch Circuits _ ,
Signature 11 To 40 Branch Circuit's
�- 41 Or More Branch Circuits
Exemption for Reg.Maint.Elect. 1 20A, To 277V Lighting Br.Circuits
n
SINGLE FAMILY ; Temp:Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION r k
I hereby affirm that I am exempt from the Contractor's License.Law Sign.with One Branch Circuit i{�(,I�$
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 7 7� arr
Code): 1007 r•..a 7V
F1 1,as owner of the property,will do the work and the structure Misc.Conduits&Conductors fITEMS
is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule).— oilt�•-pi _�-
and Professions Code). I' :"'e m 90
.z tee: rl
CONSTRUCTION LENDING AGENCY 4• �� I f °'
I hereby affirm that there is a construction lending agency for the. ' L 4;,I .00
performance of the work for which this permit is issued(Sec. 3097, PERMIT FEE (Sub-Total)
Civ.C.)
PLAN CHECKING FEE i 13 GO
Aj0(i# 12 f 14/51.
Lender's Name '
PERMIT ISSUING FEE fd i{'pir ,; Pr rveti,
Lender's Address i �
I certify that I have read this application and under penalty p of ur'ury TOTAL FEE state.r J.• ��:
that the above information 1s;correct. I agree tocomply 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 inspectio poses. SEE REVERSE FOR EXPLANATORY LANGUAGE 7
o-�
SIG ATUOF PERMITTE DATE
ON
TION 20-0019
I heteby.affi m that I'have Ma certificate lof conse t to self insure, 76A663 DPW(12181) APPLICATION FOR ELECTRICAL PERMIT lJ
or a certificate of Worker's Compensation Insurance, or a certified COUNTY,OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 Lab.C.) I +y
Policy No. Company FOR APPLICANT TO FILL IN Jog
ADDRESS
Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE
_ LOCALITY
❑ Certified copy is filed with the county building Inspection
1 &2-Family,Sq.Ft.
department. Multi-family Sq.Ft. — CROSS ST. 7--
�e .vi
Date Applicant Residential Swimming Pools ASSESSOR
- MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. OWNER OR
COMPENSATION INSURANCE FIRM NAME. O Nlv6—
First 20 MAIL ` t—
(This section need not be completed If the work Involved by the Total No. Additional ADDRESS 77 G"'e 7 r
permit is for one hundred dollars(5700)or less.)
I certify that in the performance of the work for which this permit CITY TL G Tel.No. ,$-YbV
is issued, I shall not employ any person in any manner so as to PLAN CHECK
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional
Q eto Pec. 1 ADDRESS
Date +• 7 Applicant i
-
NOTICE TO APPLICANT: If, after making this Certificate of RESIDENTIAL APPLIANCES•NOT OVER 3 HP.
CITY Tei.No.
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3HP.
provisions of the Labor Code,you must forthwith comply with such IERMpower Apparatus&Large Appliances APPLICANT T fl E -P rollC,
provisions provisions or this permit shall be deemed revoked.
10
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVARADDRESS .1,0/
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl.
(commencing with Section 7000)of Division 3 of the Business and CITY ru-"4,4 cif`f} Tel.No.
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl.
LICENSE.OR, N y� "y
Over 50 to 100 Incl. REG.NUMBER
R 7 J
/. 0 Over 100 DISTRICT NO: P O SED BY
License Number �� Y�Lic.Class �•f V
(°7 i c4 Services,Swbd.,MCC&Panelboards
Contractor ✓/erl� ����ryl� Date 0-399 Amp.Under 600 V FINAL
DATE
❑ 400-1000 Amp.Under 600 V
I am exempt under Sec. I VALIDATION V
Over 1000 Amp.or Over 600 VIIIFINALa.
B.&P.C,for this reason C T EES BY
Date: o9 ng—/9Qt. f O Z
1 To 10 Branch Circuits /
Signature 11 To 40 Branch Circuits
❑ Al Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits 3303
FAMILY Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION V 1 ITEMS
I hereby affirm that I am exempt'from the Contractor's License Law Sign with One Branch Circuit
for the:following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits TOTAL. 44.4a
Code): CHECK 44.413
❑ I,as owner of the property,will do the work and the structure Misc..Conduits&Conductors
is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) Poo. CHANGE .00
and Professions Code).
CONSTRUCTION LENDING AGENCY 6/ 5/96
I.hereby affirm that there is a construction lending.agency for the , _,
performance of the work for which this.peris issued(Sec. 3097, PERMIT FEET (Sub-Total) 7 . O 6749 1 AMILI°1U
Civ.C.)
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE , Q
Lender's Address
I certify that I have read Misapplication and under penalty of purJury state TOTAL FEE ' 79--
that the above information is correct. I agree to comply with all County.
ordinances and State laws regulating Electrical wiringi and hereby authorize
representatives•of this County to enter upon the abovwmentioned property
for inspectiopi purpose . SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNA .OF .EE' - DATE
i ,
WORKERS'COMPENSATION DECLARATION 78-883 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure, CE-806G
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. ComJOB
pany ��/1lrT �//Sdd� FOR APPLICANT TO FILL IN ADDRESS 23 l.4K/ A �.�
Certified co is hereby furnished. EACH ANO. FEE'
Pdx�bAj .Y New Residential Bldgs.&Pools LOCALITY
❑ 1 &2-Family,S Ft. $ _ $
Certified copy is filed with the county building inspection Y' q'
department. Multi-family Sq.Ft. NEAREST
CROSS ST
Date4- 6- 89, Applicant Residential Swimming Pools OWNER`OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec.1G Light IO Sw. MAIL
COMPENSATION INSURANCE / ADDRESS $i1 O
(This section need not be completed if the work involved by the First 2.0
permit is for one hundred dollars($100)or less.) Total No. Additional a CITY ECIC Tel.No. 02
I certify that in the performance of the work for which this permit APPLICPLAN ANT
is issued, I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws.. Lighting Fixtures First 20ADDRESS
�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 O . -r-so i
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 i6 6 #,(4 MR DIR"
provisions or this permit shall be deemed revoked. Top '— FAU _ W.H.
CITY HerTel.No.
LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_
I hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR
Disp. — Room Air Cond. ����-
(commencing with Section 7000)of Division 3 of the Business and . REG::NUMBER 38376 0 Class. C-yd.
Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NN'O'.'' PROC SS BY
/ Size&Type HP,KW,KVA,or KVAR Q,
License Number 38376 IP Llc.Class G� �- VALIDATION Up to 1 Incl. FINAL V
Contractor Date 11-2 141 R F6 Over 9 to 10 1"ncl, 0
DATE. V
Over 10 to 50 Incl. FINAL ���///
❑ I am exempt under Sec. Over'50 to 100 Inc: BY W
B.&P.C.for this reason Over 100 9 4 8 - Z
Services,Swbd.,MCC&Panelboards
Date: 0-200 Amp.Under•600 V' •0 0 0 0'o 2
Signature 201 - 1000 Amp.Under 600 V' j
Over 1000 Amp.or Over 600 V. I .o 3.650
❑ Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances o - 365020:
HOME OWNER-BUILDER DECLARATION Sign with One.Branch Circuit
I.hereby affirm that 1.am'exempt from the Contractor's License Law. Additional,Sign Branch Circuits 028-88
for the following reason(Section 7031.5,Business and Professions
Code):
Misc.Conduits&Conductors
El 1,as owner of the property,will do the work and:the structure Other(See Complete Fee Schedule)
is not intended or offered for sale (Section 7044, Business polo.
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(Sec.3097,. PERMIT FEE (Sub-Total).
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 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
pro inspe ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
l��26��Pr
Signy�ure of rmitte Date
ON
heGstiy,a VrnOj,Rha aha eMa certificate oEconseMlOto self insure, NZ13 DPw(12-91) APPLICATION FOR ELECTRICAL PERMIT
or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec.3800 Lab.C.) /J
Policy No. Company FOR APPLICANT TO FILL IN ADDRESS �p��/
Certified copy is hereby furnished. New Residential Bldgs.&Poole NO. EACH FEE
$ $ LOCALI
❑ Certified copy is filed'with the county building inspection 1&2-Family,Sq.Ft. _ NEAREST
department. Multi-family Sq.Ft. CROSS ST.
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._ NER OR
Light Sw.
FlRM NAME
COMPENSATION INSURANCE First 20
(This sectlon need not be completed If the work Involved by the
permit is for one hundred dollars($100)or less.) Total No. Additional ADDRESS
I certify that in the performance of the work for which this permit CITY Tet.No.
is issued, I shall not employ any person in any manner so as to PLAN CHECK
Become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT
�// Total No: Additional
Date? "�3' Applicant,l� JR `� RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS CITY Tel.No.
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Code,you must forthwith comply with such PERMIT
p Y. P Y APPLICANT
provisions or.this permit shall be deemed revoked. Power Apparatus&Large Appliances
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS4l�3�
I hereby affirm that I am licensed under provisions.of-Chapter 9 Over 3 to 10 Incl.
(commencing with Section 7000)of Division 3 of the Business and CITY Tel.No. _
Professions Code,and my license is.in full force and effect. Over 10 to 50 Incl. LICENSE OR.
Over 50 to 100 Incl'. REG.NUMBER Q Cle �Q
/` a
License Number q I—Q132 Lid.Class C-1 p Over 100 DISTRICT NO. p R EBBED BY V
.-t�y� Services,Swbd.,MCC&Parielboarde
Contractor IR1814 9- DIAMate. 0-399 Amp.Under 1300 V DATE
❑ I am exempt under Sea 400-1000 Amp.Under 600 V 1 —g3 VALIDATION W'
Over 1000 Amp,or Over 600 V FINAL
B.&P.C.for this reason BRANCH CIRCUIT FEES BY 0.
./' Date- �� 15A,or 20A,120V,Lighting or Recept. Z
SiariamreK�qey Ifs. &,►/J•f 1 To 10 Branch Circuits
�L 11 To 40 Branch Circuits
El 4.1 Or More Branch Circuits
Ezemiitton for keg.Maint.Elect. 15A,20A,208V To 2771 Lighting Br.Circuits
SINGLE FAMILY Temp.Power Pole&Appurtenances -{•• •�
HOME OWNER:BUILDER DECLARATION Sign with One Branbh:Circuit _ t'tfr.l d3 .
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 3303 174-W;
Code): ;}
❑ Misc.Conduits&Conductors 1 1 CI 9v
f,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) '�'(, TAL "7-.a 90
and Professions Code). CHECK 174.90
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for theCHANE o00
performance of the work for which this permit is issued(Sec. 3097, PERMIT FEE (Sub-Total) OC7
Q
Civ.C.)
PLAN CHECKING FEE i3�`-I�r]0 " 0 $/fit.i ,•0;
-
Lender's Name :
PERMIT ISSUING FEE 1.700 1 A11,7-511
Lender's Address
I certify that Ihave read this application and under penalty of purjury state TOTAL FEE D ;
that the 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 innss�pecttiioonn purposes. �,J Q' SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF PERMITTEE DATE
� ,r'�WORKERS'COMPENSATION DECLARATION 10/e1 APPLICATION FOR ELECTRICAL PERMIT
' T�� kerefiy affir� that I'�iave a certificate of consent to self CE-806G ;
' nsure, br or certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy tthyere�of c 3800, Lab. C..)
Policy Na4�� "oCornpar;y_ g FOR APPLICANT TO FILL IN ADDRESS CP
ESS CWR7�
❑ Certified copy is hereby furnished. New Residential Bldgs. & Pools
EACH NO. FEE,
Certified copy is filed with the county building inspec- 1 $2-Family, Sq. Ft. $ — S LOCALITY A E
F -tion department. a� _ Multi-family Sq. Ft. NEAREST
CROSS ST. �JVc+7ri�1T'A
Date Z*��'-07 Applicant V�1- -E4akT�ldo Residential Swimming Pools OWNER OR
FIRM NAME t-IDRRN �Rda.
CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL
COMPENSATION INSURANCE Outlets: Rec 2 Light-15b_S ._ 157 AbDRESS
(This section need not be completed If the work Involved by { 0^�® First 20
the permit Is for one hundred dollars($100)or less..) Total No. Additional g2rl iggo CITY Tel. No.
I certify that in the performance of the work for which this PLAN CHECK �+
permit is issued;I shall not employ any person in-any manner /CC APPLICANT ri L.TGC—ria iG
so as to become subject to the Workers'CompensationI�Laws! Lighting Fixtures First 20 ADDRESS &Pr A &4 1
Total No) !0 Additional
Date Applicant CITYSi414 Tel. No. 12-207
NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT
Exemption, you should become subject to the Workers',• Range_ Heater_D.W. — APPLICANT dJAP 11 e-
Compensation provisions of the Labor Code, you must forth- Oven —Dryer —W.M. ADDRESS
with comply with such provisions or this permit shall be Top _ FAU —W.H. —
deemed revoked. CITY Tel. No.
LICENSED CONTRACTORS DECLARATION Hood _ Fan Other_
p'
Dis Room Air Cond. � p LICENSE OR �� � b
affirm that I am licensed under provisions of Chapter 9
I hereby aREG.NUMBER Class.
(commencing with Section 7000)of Division 3 of the Business DISTRICT NO'. PROC D BY
and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large Appliances 0
Size&Type HP, KW, KVA, or KVAR' �r 0 V
License Number � 7� Lic. Class f0
8qe� Up to 1 Incl. FINAL' �
Contractor. V hu SA elc ' Date z'46-�7 Over 1 to l0 Incl. DATE. v O
VAL ATION
❑ Over 10 to 50 Incl. FIN W
I am exempt under Sec. Over 50 to 100 Inc. BY W
B.BP.C. for this reason Over 100 Cl)
Date: Services, Swbd.,MCC&Panelboards ''ll
0 -200 Amp. Under 600 V VU
Signature 201 -1000 Amp. Under 600 V
❑ i Over 1000 Amp, or Over 600 V
Exemption for Reg. Maint. Elect. 6 5a 2
SINGLE FAMILY Temp.,Power Pole&Appurtenances ] C
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit o ojj 1 v
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Q 2 2 6-$
Law for the following reason (Section 7031.5, Business and
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).
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.).
i +
Lender's Name. PLAN CHECKING FEE a�U
PERMIT ISSUING FEE
Lender's Address.
I certify have t s application and state that the TOTAL FEE SD
abov nforma n' e I agree to comply with all County
or nonces and S t a regulating Electrical wiring, and
re outhoriz r es tatives of this County to enter upon
he ove-me d roperty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
i
ti er itfee Date
I
;,,j•eby', ffi1m*thJ�RKIRS'COMJENSATION
cerci DECLARATION CE-663 10/81 APPLICATION FOR ELECTRICAL PERMIT
•1 hereby'affiTm"ihaY I have a certificate of consent to self CE-&W
insure, or a certificate of Workers'-Compensation Insurance; COUNTY OF LOS ANGELES s` BUILDING AND SAFETY
or a certified copy thereof(Sec. 3800 Lab. C.)
Policy No. Corppdny6 FOR APPLICANT TO FILL IN JOS 4� 7 how v
Certified copy is hereby furnished. EACH, NO. - FEE _AQPRESS
New Residential Bldgs. &Pools\.'
❑ Certified copy is filed with the county building inspec- 1 &2-Family,Sq. Ft. $ —� $ LOCALITY
tion department. Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools CROSS ST. "
Date Applicant OWNER OR
�r I'IOQ
CERTIFICATE OF EXEMPTION FROM WORKERS' FIRM-NAME
Outlets: Rec�Light"Sw.==QQ 3 i MAIL '
• COMPENSATION INSURANCE f� First 20 = ADDRESS
(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 VAL, M.M.-Om/k.)
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 a ADDRESS MA-4c dxm
po'' Additional
Total No.– CITY OAA yW. Tel. No.. 03"33a
Date-- Applicant i
Fixed Appliances Not Over:) HP PERMIT
NOTICE TO APPLICANT: If, after makingAPPLICANT •
this Certificate of S 8
Exemption, you should become subject to the Workers' Range_ Heater_D.W. I
Compensation provisions of the Labor Code, you must forth- Oven —Dryer —W.M..— ADDRESS
`t, with comply with such provisions or this permit shall be , Top _ FAU —W.H. —
'deemed.revoked. CITY Tel. IVo.
LICENSED CONTRACTORS DECLARATION Hood —Fan _Other_
Disp. _ Room Air Cond. 13 0
LICENSE OR /J ®� ClCOVE
I hereby affirm that I am licensed under provisions of Chapter 9 + REG.NUMBER 7 7 ass. •
(commencing with $action 7000)of Division 3 of'the Business power Apparatus$Large Appliances DISTRICT NO. PROCESSE Y
and Professions Code,and my license is iri full force and effect. O
Size&Type HP, KW, KVA, or KVAR' V
License Number, Lic. Class Up to 1 Incl. FINAL
Over 1 to 10.Incl. DATE VALIDAT
Contractor `` Date Over 10 to 50 Inch FIN W
❑ I am exempt unde,Sec. Over 50 to 100 Inc. I B
BAP.C. for this reason Over 100 I.. Z
Services, Swbd., MCC&Panelboards
Date: 0 -200 Amp. Under 600 V P X 3 0 1.1 A
Signature \ 201 - 1000 Amp. Under 600 V '.
❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V # 0 0 0 0 1 9
SINGLE FAMILY `�� Temp. Power Pole&Appurtenances '') o 2 8 Q 2 5
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit v
I hereby affirm that I am exempt from the-Contractor's License o o 2 8 0.2 5 5 '
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits
Professions Code): 1 0926 . 85
❑ I, as owner of the property, will do the work and the + Misc. Conduits&Conductors
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 PER41T�FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name o
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 1Z,_5
Ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the above-mentioned property for inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee 'Date-
i ;'
WORKERS'COMPENSATION DECLARATION 78A663 70/87 '
I hereby affirm that 1 have a certificate of consent to self insure,
CE-806G APPLICATION FOR ELECTRICAL PERMIT
or a certificate of Workers' Compensatio Insurance,'or a certifieb COUNTY OF LOS ANGELES , ' BUILDI G'AN TY �r
copy theieof(See.38p0,Lab.CA tc
6—
I
�0 i V' FOR APPLICANT TO'FILL IN 'JOB
Policy No. Compan1 G
❑ Certified copy is hereby furnished, New Residential Bldgs.&Pools EACH NO. FEE ADDRESS. .
' i, $ —. $ LOCALITY
Certified copy is filed with the county building inspection 1 &2-Family„Sq.Ft. _ •
A rt 'Multi-family Sq.Ft. CROSSNEARES �+ T
Residential Swimming Pools CROSS O > Nfl
OWNER OR
Date J Applicant FIRM NAME `SCJZ5 4-
CLRTIFIC T F EXEMPTION FROM WORKERS' Outlets:Rec�Light—'SW: 017
MAIL
'COMPENSATION INSURANCE ADDRESS vef
(This section need not be completed if the work Involved by the First 20 1 CITY I
permit is for one hundred'dollars($100)or less.). Total No. Additional• i
I certify that in the performance of the work•far which this permit, PLAN CHECK
is issued,'I shall not employ any.person'in,any manner so as t' 1 APPLICANT
become subject to the Workers'Compensation.Laws: Lighting Fixtures First 20' ADDRESS
) Total No: CITY 'Tel.No;
)hh Additional, + )
Date:v :?APpiicanf
NOTICE TO,APPLICANT: If, after making, this Certificate of. Fined Appliances Not:Over 1 HP PERMIT ,
'Exemption,you should become subject'to the Workers'Compensatidnj Range_ Heater D.W. APPLICANT t
provisions of the Labor Code,you must forthwith.comply-with such Oven Dryer_ W.M._ ADDRESS '.
provisions or this perm..if shall be deemed revoked. s • Top FAU W.H. _
LICENSED CO:NYRACTORS DECLARATION ; Hodd _ Fan Other CITY
I,hereby affirm that I.am licensed under provisions of. Chapter.91 UCE OR
Disp, — Room.Air Con..d.
(commencing With-Section.7000)of Division 3 of the'Buslness and REMNUMBER CI
• Ft asa
Profession§.Code,antl.my license is-in full force and effect. I , DISTRICT NO. PROCESS �BY
Powe Apparatus'&..L,'arge Appliances•
P.KW,KVA, r KVAR
�I I o J 1
License Number Lic:Class Cs' -; . / to 1 Incl. FINAL
DATE —"
Over 1'to 10'Incl. ) C
ContraCtdr Date �" V DATION.
Over 10 to'50'Incl. FIN.
❑ Iam exempt under Sec: ' Over'$0 to 100 Ind:
BY
` Over 100 a•� •
B.&P.C,for this reason I ,
Services;Swbd.,MCC&Panelboards fn.
Date; i 0.-200 Amp.Under 600 V 291 1,0 A
Signature T 201 - 1000 Amp.Under`600 V
' Over 1:000'Amp.or Over 600 V # o o o. o'0 2
❑ Exemption for Reg.Maint:Elect:.
1'0'0 2450
SINGLE FAMILY Temp.Power Pole&.Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One.Branch Circuit o o a 2:4 5 0 6.'•
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 O .0.4"-88
'
Code) r
Misc.Conduits.&Conductors
❑' I,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) _
and Professions Code). I ,
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(See.3097,
(Sub
PERMIT FEE• Tdtaq. -
PLAN CHECKING FEE.
Lender's Name _ 'i
PERMIT ISSUING FEE
Lender's•Address ,i
I certify that I have read this.,application and state that the above TOTAL FEE
inform 'ori is correct.i agree to comply with all County ordinances
and to laws regulating Electrical wiring, and hereby authorize i
repr entatives of this Cc er uport.'the above-mentioned
prg&rty for'ins _ n. po SEE'REVERSE FOR EXPLANATORY LANGUAGE
S gna lire of- .. a pate .
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1304150030
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
[LEGAL ID: I FEES PAID I BUILDING ADDRESS:
[ ON FILE [ [ 9237 C LOWER AZUSA RD
[FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ TEMP CA 917803743 [
ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET:
8590-029-034 IA1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: JS LOCALITY: TEMPLE CITY CA
IK1 SIGNS, OUTLINE LGT 1.00 SIG 38.90 [ [
TENANT: TOTAL FEES 66.70 [ISSUED ON: PROCESSED BY: PLAN BY: [
A-ZAD'S AUTO PARTS I 104/15/13 SR
TOWNER: TEL. NO: T [FINAL DATE FINAL BY: CODE: [
JOE'S AUTO & BODY (626) 285-4673- S
9237E I I s [
COVI 917231600 [ [DESCRIPTION OF WORK
I I
NEW WALL SIGN LED CHANNEL LETTERS 1
[APPLICANT: TEL. NO: [ [ I
IWEIMAN, QUAN (626) 673-2888- [
18963 GARVEY AVE ISPECIAL CONDITIONS: 1
JROSEMEAD CA 91770 I
[CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE
[ART SIGNS AND PRINTING INC (626) 288-2283- 1 1
18963 GARVEY AVENUE LIC. NO I ITEMPORARY POWER POLE I I
IROSEMEAD CA 91770 965157 * 1 I 1
I 1UNDERGROUND CONDUIT 1
(ARCHITECT OR ENGINEER: TEL. NO: - I IUFER GROUND 1
LIC. NO: I IROUGH CONDUIT I 1
(ROUGH WIRING I I
I IMAIN WATER LINE
IPLASTIC YIN METAL YIN
(UTILITY 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 1 1 1
I I 1 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
[ 1* ADDITIONAL DATA ON FILE [
[ IREPORT ID: DPR265 ROUTE TO: BS0508 ' 1 I 1
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1304150032
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS:
I
ON FILE I I 9237 Q LOWER AZUSA RD I
(FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917803743 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
18590-029-034 IAl PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY CAI
I In SIGNS, OUTLINE LGT 1.00 SIG 38.90 1 1
TENANT: I TOTAL FEES 66.70 ISSUED ON: PROCESSED BY: PLAN BY:
IAUTO SERVICE 1 104/15/13 SR 1
OWNER: TEL. NO: I IFINAL DATE FINAL BY: CODE: I
JOE AUTO AND BODY (626) 285-4673-
9237E
I
ICOVI 917231600 I IDESCRIPTION OF WORK I
I I INEW WALL SIGN LED CHANNEL LETTERS I
(APPLICANT: TEL. NO: I I I
IWEIMAN, QUAN (626) 673-2888- [ 1 I
18963 GARVEY AVE I ISPECIAL CONDITIONS: I
IROSEMEAD CA 91770 I I 1
ICONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE I
TART SIGNS AND PRINTING INC (626) 288-2283- 1 1 [
18963 GARVEY AVENUE LIC. NO I ITEMPORARY POWER POLE I I I
IROSEMEAD CA 91770 965157 * I 1 1 I [
I I [UNDERGROUND CONDUIT
(ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND I I
LIC. NO: 1 IROUGH CONDUIT I I1
I 1ROUGH WIRING I I
I I [
[ IMAIN WATER LINE I I I
1PLASTIC YIN METAL YIN [
I I
I 1UTILITY COMPANY NOTIFIED
[
[ I I I [ I
[ I I I 1 I
1 1 1 I 1
I I [ I
I I I I I I
I 1 1 I 1 I
I I 1 1 I I
1* ADDITIONAL DATA ON FILE I 1 [
I I [ I I I
IREPORT ID: DPR265 ROUTE TO: BS0508 I [ 1 I
I [ I [ I [
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9611260003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
i
GA D: FEES PAID BUILDING ADDRESS:
ON FILE 9237 LOWER AZUSA RD UNIT Q
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803743
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ENCANITA
8590-029-031 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY
F1 120V, 15/20A BR CKTS 1.00 BR 17.40
TENANT: TOTAL FEES 45.15 ISSUED ON: PROCESSED-BY: PLAN BY: EXPIRES ON:
11/26/96 LC 11/26/97
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
TEMPLE CITY INDUSTRIAL PARK -
177 E 1 1 1ZIb
+� 'I /1i
�lt
COVI 917231600 DESCRIPTION OF WORK
1 CIRCUIT FOR AUTO LIFT
APPLICANT: TEL.—NO:
JOE (818) 447-9151-
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: a APPROVALS DATE INSPECTOR SIGNATURE
STELLA ELECTRIC (818) 447-9151- 1(�
10131 LYNROSE LIC. NOTEMPORARY POWER POL
TEMPLE CITY, CA 91780 442483 C10
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. NO: / FER GRO D
LIC. N0: ROUGII CONDUIT
j
L IO�GfI WIRING
U iL �Jq 1 i C �lf�r G
M MAIN WATER LINE
PLAS';IC Y/N METAL Y/N
'' n /_,1 •�: // �4�
UTILITY COMPANY OTI ED
i a
i��
REPORT ID: DPR265 ROUTE TO: BS0508
s COONTY OF t,OS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0912010017
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I
ON FILE 1 1 9237 LOWER AZIISA RD
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803743
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET-
18590-029-034 1A1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPEL CITY, Cl
1 1F1 120V, 15/20A BR CKTS 2.00 BR 34.50 1 I
ITENANT: IJY MOTORS, SHP 1.00 MOT 19.65 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
(JOE'S AUTO BODY IJZ MOTORS, 10HP 1.00 MOT 19.65 (12/01/09 SR 12/01/10
ILA 100 AMP PANELS, MCC 1.00 PAN 38.85 1 I
10WNER: TEL. NO: I TOTAL FEES 140.40 IFINAL DATE FINAL BY: CODE: 1
(JOE'S AUTO BODY
19237 LOWER AZIISA RD. I I I
ITEMPLE CIYT CA 91780 I IDESCRIPTION OF WORK 1
(INSTALL ONE PRE—FAB SPRAY BOOTH WITH FIRE PROTECTION AND
ISERVICE PANEL 100 AMP
APPLICANT: TEL. NO: 1 I I
IMONDRAGON (562) 755-0625— 1 I I
114059 GARFIELD AVE. I ISPECIAL CONDITIONS: 1
(PARAMOUNT, CA 90723
ICONTRACTOR: TEL. NO: 1 JAPPROVALS DATE INSPECTOR SIGNATURE
1PERFORMANCE SYSTEMS CO. (562) 790-1762— 1
114059 GARFIELD AVE LIC. NO 1 ITEMPORARY POWER POLE I I I
1PARAMOUNT CA 90723 661143 B 1 I I I I
I I (UNDERGROUND CONDUIT 1 I I
(ARCHITECT OR ENGINEER: TEL. NO: i IUFER GROUND I I I
LIC. NO: 1 (ROUGH CONDUIT 1 1
I
I 1ROUGH WIRING 1 1 1
1 I I I
1 � 1MAIN WATER LINB
I 1 IPLASTIC Y/N METAL Y/N 1
(UTILITY COMPANY NOTIFIED 1 1
1 I I I I I
I I I I
I
I I I
I 1
1 IMl'►rt of D I
j I
E[7�f u�► u���� a I i i I
IREPORT ID: DPR265 ROUTE TO: BS0508 1 I
1 I I I I I
• COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS
EL 0508 1010180041
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: I FEES PAID I BUILDING ADDRESS:
ON FILE I I 9237 R LOWER AZUSA RD
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917803743 T
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: ROSEMEAD
8590-029-034 IA1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY, Cl
ILA 100 AMP PANELS, MCC 1.00 PAN 38.80 I I
ITom : TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: T
CLBARWIRE I T10/18/10 SR
TOWNER: TEL. NO: I (FINAL DATE FINAL BY: CODE:
I
ANGUS O'BRIEN (626) 454-5222- I _
14134 TEMPLE CITY BL. I I
TROSEMEAD CA 91770 I IDESCRIEVION OF WORK
(ADD smwie£ PANEL 100 AMP T
I I
(APPLICANT: TEL. NO: I J-
TCLEARWIRE/AMERICAN TOWER, CHIP CLUE (213) 305-1970-
2361 CAMPUS DR. 240 I ISPECIAL CONDITIONS:
TIRVINE CA 92612 T
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(CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE
IBERLINER COMMUNICATIONS INC. (714) 231-5842- I
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114270 ALBERS WAY LIC. NO I TEMPORARY POWER POLE
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(CHINO, CA 91710 908692 I
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TUNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. NO:
1AMERICAN TOWER (972) 999-8900- IUFER GROUND I I
T (
18505 FREEPORT PKWY. LIC. NO: I ROUGH CONDUIT IRVING, TX 95063 NONE T ;-
ROUGH WIRING
(MAIN WATER LINE
PLASTIC YIN METAL YIN
UTILITY COMPANY NOTIFIED( I
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� `COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
i 1 DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL OSOS 0608020021
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE. (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE 9237 LOWER AZUSA RD
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803743
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ROSEMEAD
8590-029-034 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: JS LOCALITY: TEMPLE CITY, C
JI GENERATORS +3-10HP 1.00 GEN 19.65
TENANT: LB 200 AMP PANELS, MCC 1.00 PAN 38.85 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
TOTAL FEES 66.25 08/03/06 JK 01/30/07
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
TEMPLE CITY INDUSTRIAL PARK - -2 Q
177 E. FRONT STREET Q-•
COVI 917231600 DESCRIPTION OF WORK
INSTALLATION OF EMERGENCY BACK UP GENERATOR 48 H.P AND 200
AMP A-1-S ON EXISTING VERIZON SITE
APPLICANT: TEL. NO:
JOE DURAN (619) 247-0229-
P.O. BOX 435 SPECIAL CONDITIONS:
LEMON GROVE 91946
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
BAY CITY ELECTRIC WORK'S INC. (619) 938-8200-
12208 INDUSTRY ROAD LIC. NO TEMPORARY POWER POLE
LAKE SIDE, CA 92040 748133BC10
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND
LIC. NO: ROUGH CONDUIT
ROUGH WIRING
MAIN WATER LINE
PLASTIC YIN METAL YIN
UTILITY COMPANY NOTIFIED
REPORT ID: DPR265 ROUTE TO: BS0508
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0608310029
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT: v •1 y �]
LEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE 9237 LOWER AZUSA RD
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803743
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: RIO HONDO
8590-029-034 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: JS LOCALITY: TEMPLE CITY, C
LB 200 AMP PANELS, MCC 1.00 PAN 38.85
TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
08/31/06 JK 02/27/07
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
TEMPLE CITY INDUSTRIAL PARK (805) 732-6393- ` /��
4134 TEMPLE CITY BL r
ROSEMEAD DESCRIPTION OF WORK
SERVICE PANEL 200 AMP
EXISTING CELL SITE
APPLICANT: TEL. NO:
TOM DUARTE (714) 730-3243-
2913 EL CAMINO REAL SPECIAL CONDITIONS:
TUSTIN, CA 92782
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
JITNEY CO., INC. (714) 998-0995-
1057 E IMPERIAL HWY LIC. NO TEMPORARY POWER POLE
SUITE# 605 719304 HIC
PLACENTIA CA 92670 UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND
TRUSSNET -
8105 IRVINE CENTER DR. LIC. NO: ROUGH CONDUIT h
IRVINE, CA 92618 NONE ,•/
ROUGH WIRING
MAIN WATER LINE
PLASTIC YIN METAL YIN
UTILITY COMPANY NOTIFIED
* ADDITIONAL DATA ON FILE
REPORT ID: DPR265 ROUTE TO: BS0508
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0801100002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 DUPLICATE
PHONE: (626) 285-0488 EXT:
ILEGAI ID: FEES PAID I BUILDING ADDRESS: 1
9237 D LOWER AZUSA RD 1
ON FILE (FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 917803743
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: ROSEMEAD
18590-029-034 1A1 PERMIT ISSUANCE FEE 27.75 1 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY, Cl
I ILB 200 AMP PANELS, MCC 1.00 PAN 38.85 1 1
ITENANT: ILN OTHER PNL 0-399 AMPS 1.00 PAN 38.85 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
(WHEEL COSMO I TOTAL FEES 105.45 01/10/08 SR 07/08/08
[OWNER: TEL. N0: I I
I I (FINAL DATE FINAL 8 CODE:
IMIWALIAN, RAFI (626) 319-9185- I I
19237 LOWER AZUSA RD. I P
ITEMPLE CITY CA 91780 DESCRIPTION OF WORK I
[ [ (UPGRADE EXISTING METER FROM 100 TO 200 AMP FOR UNITS #A & D I
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APPLICANT: TEL. NO:
IKALAJIAM (626) 893-5979- I I I
1385 SIERRA MADRE VIL I ISPECIAL CONDITIONS:
(PASADENA, CA 91107 I
CONTRACTOR: TEL. NO: i (APPROVALS DATE INSPECTOR SIGNATURE I
ISMH ELECTRIC (626) 792-0674- I
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1385 SIERRA MADRE VILLA AVE LIC. NO I ITEMPORARY POWER POLE I I
(PASADENA CA 91107 481689 C10 [ I I
1 (UNDERGROUND CONDUIT I I I
1ARCHITECT OR ENGINEER: TEL. NO: IU R GROUND I I I
LIC. NO: I IROUGH CONDUIT I I
IROUGH WIRING > 1 V
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