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as".NO. EXPIRES
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IMS ON OP WORK ADDRESS �� ��
NUMBER OF OUTLEM ON c1,ROul= LOCALITY <
LOCATION my iRooMB NEAREST �
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NO. OF OUTLETS _ 3 . APPROVALS1¢O. OF FDCRIREB A DATE INSPECTOR'S NAME
p. OF MOTORS H.P. CONDUIT / /.6
NO. OF SIGNS TRANS. WIRING
NO. OF RANGES OR HEATERS QI FIXTURES /
MtOCELLAHROUSE POWER
PERMIT FEE / :7, UTILITYCO.NOTIFIED /
TOTAL -� Vii` FINAL �'��Gis� __ /
Z' COUNTY OF LOS ANGELES -' APPLICATION FOR PmmT
DEPARTMENT OF COUNTY ENGMM
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FOR APPLICANT TO FILL IN DISTRICT NO. G\\R IOU ZONE PERMIT NO.
ELECTRICIAN b W A/F,r-
ADDRESS �-I— L- Ll& q/� G�s/'I�IVED Y READY FOR DATE ISSUED
FIRST INSPECTION
CITY / C I TEL. NO. D. I/�� .d
COUNTY LICENSE NO. EXPIRES ADDRESS
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PER=FEES
NUMBER EACH FEE LOCALITY P
LIGHT OUTLETS
NEAREST r. %L
RECEPTACLES S I`.
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WALL SWITCHES OWNER F6 /C. a OL/M
TOTAL OUTLETS Sc 5 fl MAIL 9 _
ELEC. RANGES 25 ADDRESS V / - l If L- I l'7�- ✓� /o
FXTURESATERS 2Szl— CITY 're G� LE CI f Y TEL. NO. o/ 0�/&`DTII
MISC. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE IB CORRECT
�• AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF'RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEW Mvo. HP OVER INC. EACH OF THERESIDENTI OPERTY DESCRIBED� ABOVE.
_ I/2 a IF88 5 25 / �y6i/G.k.•
99SIGNATURE OF I
l' I/2 2 .50 'J/Q PERMITTE
g 15 1.00
- z INSPECTIONREC
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15 50 2.50 tr•wf./ - V sP //i'4C/i4r
SO 200' 5.00 «� / - '
200 500 .10.00
500 1 1000 i 15.00 a
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OVER 1000 20.00 0
M.G. SET/FREQ. CHANGER-HP lz
{{ •WELDERS. AC-KVA 0
GENERATORS•KW
TRANSFORMERS-KVA
TEMP. MOTORS (75% OF ORIG.)
MOVED MOTORS (75% OF ORIG.)
MISC.
SIGNS
NO.. NO. TRANS. APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT, //�� DATE INSPECTOR'S NAME
WIRING $1.00�_U o CONDUIT
FIXTURES $1.00 r Q Q WIRING
SUPPLEMENTARY 50 FIXTURES
POWER
TOTAL FEE 5 3 UTILITY CO. NOTIFIED ♦ _
r 7eA 663 oes¢ sw. a-aa i r.�.,.o� /�i1.
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COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1008180013
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
]LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 12205 IT: 27 I 5122 PAL MAL AV
I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:1 TEMP CA 917803433
ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: FREER
18585-030-032 ]A1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, Cl
ILB 200 AMP PANELS, MCC 1.00 PAN 38.80 I I
TENANT: TOTAL FEES 66.60 [ISSUED ON: PROCESSED BY: PLAN BY:
108/18/10 SR
(OWNER: TEL. NO: I ]"CRZIPTION
F NAL BY: CODE:
HAKE, STEPHEN D (626) 443-0578— ]5122 PAL MAL AVTEMP 917803433 IF WORK
IRE LACE 40 AMP FUSE PANEL WITH 200 AMP PANEL
APPLICANT: TEL. NO:
SAME AS OWNER —
ISPECIAL CONDITIONS:
I
CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER —
ILIC. NO I (TEMPORARY POWER POLE I I I
(UNDERGROUND CONDUIT
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(ARCHITECT OR ENGINEER: TEL. NO: — I IUFER'GROUND �f
LIC. NO: I IROUG4 CONDUIT
(ROUGH WIRING
]MAIN WATER LINE
IPLASTIC Y/N METAL Y/N
(UTILITY COMPANY NOTIFIB ]
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] IREPORT ID: DPR265 ROUTE TO: BS0508
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