HomeMy Public PortalAbout10506 LYNROSE ST_Electrical__ '
76A663-CE80610-61 APPUCTIO a�® EL�EC�T'.�R` L' PERMIT RMIT L/II��CJJ97'
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING M
BUILDING AND SAFETY DIVISION ADDRESS 16506 Ose Street
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A JENSEN, SUPT OF BUILDING LOCALITY OAEfffl, rrL- Tot 12'
_ NEAREST _
FOR APPLICANT TO FILL IN CROSS ST. Temple Cit
1 T E M NO. EACH FEE
OUTLETS RST 20) �•� `-�• �$20 $ �� OWNER Thunderbird states
LIGHTS - RECEPT V SW. J MAIL
OUTLETS ADD�L UNITS ADDRESS
LIGHTS RECEPT. SW1_3 •1O ��
LIGHTING FIXTURES (FIRST 20) 20 CITY - TEL.NO.
LIGHTING FIXTURES (ADDITIONAL) ,10 ELECTRICIAN Walton'Elef-tric Corp.
RANGES CLO DRYERS WTR.HTRS 1.00 ADDRESS Monrovia
Soo Peck Hi
GARB 5 STA COOK Monrovia Hi -2131
CITY TEL. NO.
HWASH AUTO- STATE
9 BTA.APP (+/II H P.MAX 3 .50
LICENSE NO 15116g
MOTORS. ovE H.P. DISTRICTp. GROUP ZONE P ESSED B�'
o t 1.00 -C� 2
I 3 150 INSPECTION RECORD r
a
3 B 200 0
U
8 15 2.50
Ix
15 50 300 O
50 100 500
a
SIGNS- NO TRANS. h
NO.LAMPS Z
SERVICE 0-60OV-NOT OVER 200A 1.00
SERVICE 0.60OV-OVER 200 A. 200
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 200 OC
SUPPLEMENTARY PERMIT ISSUING FEE 100
TOTAL FEE $ D�
' 1HEREBY ACKNOWLEDGE THAT I 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
I HEREBY CERTIFY THAT PROPERLY REGISTERED AND/OR
_ LICENSED AS REQUIRED BY OSS ANGELES COUNTY AND STATETE OF FIXTURES
CALIFORNIA OR THAT i A THE LEGAL OWNER OF THE ABOVE {'
DESCRIBED RESIDE IA PR PERTY POWER -
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTE �
FINAL
LIDATION ARTHUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
2 7 S 9 1 ViiAr 17 2 D 16.0 U n
A
WORKERS'COMPENSATION'DECLARATION 76A663 10/81 ,p�'�+ ��pp (� pp qq pp pg��� L
hereby affirm that l have a certificate of consent to self insure, CE-806G APW_LQ, ATION FOR E LECTR�CAL PERMIT
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
❑ 'ADDRESS i~�.� in ros
Certified copy is hereby furnished , ;� :"• New Residential Bldgs & Pools„ ,_ EACH" NO FEE, ,
' $ _ $ LOCALITY '^'TQ y.
❑ z •u .1 & 2-Family,Sq Ft —
Certified,copy is fded~with-the county bwldmg inspection
department ,'f ,, ;t. Multi-family Sq Ft-
CROSS
�'�.� in A�`
CROSS ST `V\
Date• tApplticant Residential Swimming Pools OWNER OR i, �, t,
rr, •, •• D _ '• - FIRM NAME M CP�'FS _
CERTIFICATE OF.EXEMPTION'FROMi�WORKERS' ,, S y' IL
-,,COMPENSATION INSURANCE 'Outlets Rec Light — Sw * ADDRESS l c7 S G •L.-' v,
•. (This section need not be completed if the work involved+by the First 20 CITY C j,Tel No tl
permit is for one hundred dollars,($100)or less) Total No Additional Te/W. �e
" PLAN CHECK : •.
I,certify that in the,performance,,of,the work fof which this permit ., APPLICANT ,
is issued, I shalknot employ any person in,any manner,.so as to
become subjec(to the Workers',Compens t Laws Lighting Fixtures First 20: • ADDRESS- - 4'
• t *.'• Total No Additional CITY- Tel No.
"`Date Applicant Fixed Appliances Not Over 1 HP, r
NOTIC TO,!APPLICANT", If, aft ,ma ng., i ;Certificate of , PERMIT �+
,Exemption;you should become sublecf to the_Workers'Compensation Range— Heaterj_.D W APPLICANT
c1�wOt
provisions of the Labor'Code„you must forthwith comply with such Oven Dryer _ W M ADDRESS t c3Lzonjtiin�t�
provisions�or this permit shall be deemed revoked, _. . _ "Top' FAU. W H
�,LICENSED CONTRACTORS'DECLARATION Hood Fan Other_ CITY .�� k Tel No'`3"SS 2�6�F
I,hereby, affirm• that i am,licensed under prov-ispns'of Chapter,9 v uCENSE OR
"
Disp Room Air Conti' ”�'4 9 I'Z ' Class 'C_
(commencing with Sectlor: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 PROCESSED BY
• Size& Type HP,KW,KVA;or KVAR•, • , ✓�✓ (J Q
License Number .Lic Class "} FINAL ` C)
Up to 1 Incl '
= , a Over-1 to 10 Incl"' DATE �- �� SVA TION
Contractor" "' Date' "• T' Over 10 to 50 Incl:", . 0 '
FINAL
❑_
lam exempt under Sec _Q'i_ Over 50 to 100 Inc_ BY
W
B&P C for this reason 1• Over 100 ;' rkZ_6aC/)
Services,Swbd,MCC&'Panelboards _Z
Date '0-200 Amp Under 600'V,
`F201 - 1000'Amp Under 600 V,
Signature � r
over 1000 Amp or over,600 V p
Exemption for Reg Maint Elect
' SINGLE FAMILY Temp Power Pole & Appurtenances .f}7 0211
HOMEOWNER-BUILDER DECLARATION ± "
'Sign with One,Branch Circuit,, � J � ,,+• ,�
I hereby affirm that I am exempt from the Contractors License Law' Additional Sign Branch Circuits
,for-the following reason (Section 703-1 5,Business and Professions
Code) `, M :1 Ti!T&l i-
❑ ° Misc`Conduits & Conductors t s'
I,as owner of the property,will do the work and the structure ,tt�� ,6 7 -
is not intended or offered for sale (Section 7044, Business Other,(See Complete Fee Schedule) qV
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 �7
PERMIT ISSUING FEElo
Lender's Address -
I certify that I have read this application and'state that the above _ TOTAL FEE a ';
information is correct I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
representatives of thisounty to enter upon the above-mentioned,jZt -
property forX! purp es SEE REVERSE FOR-EXP LANGUAGE _
/
+
Sigfiature,6f Pqrfnitt5K Dat