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SA883-CEBOS 3-62 APPLICATION FSR- E.L�C AL PERMIT
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
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT. TOTAL NO. EACH FEE " d d
B_ OUTLETS FIRST 20 b $2O E ®� MWNER ,
LIGHT ED
SWITCH. OVERADO'L .:10 ® ADD SS .
O t�
LIGHTING TOTAL FIRST 20 .20 CITY. Qd3�v '_d} dLo�Q-A� TEL.NO.
FIXTURES ,b ADD'L1 !
OVFR 20 10 ELECTRICIAN
RANGES CLO. RYERS WTR.HTRRo 1.00 Q® ADD SS
GARB.DISP. O
// P
CITY142
DISHWASH. AUT :-W STATE
SPACE HTR BTA.APP.(q=H.P. I y .50 6d LICENSE NO. (f fE�'�!1'• a—f'
MOTORS: OVER NOT OVER H.P. DISRICT NO. GROUP ONE PR ED
0 t 1.00
I a t.so INSPECTI N RECORD
J'
9 S 2.00 - A !
B t s 2.50 Y a
is so 3.00 IC ! } G u
so too 15.0cr D:
O
SIGNS: NO.TRANS. G
NO.LAMPS U,1
n.
N
SERVICE 0.000V-NOT OVER 200A 1.00 ® Z
SERVICE O-SOOV•OVER 200 A. 2.00
SERVICE OVER SOOV 5.00
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI TION APPROVALS DATE iNBPECTOR{ BIfGNATUR6
AND STATIC THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES'AND STATE LAW. REGULATING
ELECTRICAL WIRING. WIRING , lI 117 i d/���..ilJ '-sir
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/Oft -y y�f y(•�� '� �f/_',
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OP FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE !
DESCRIBED RESIDENTI PROPERT POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTEE 9 FINAL
0LIDATION ARTHUR C.\VETT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
LAUc14 7 6 8 SEP 2 5 . 2 D 1 9.3 ON co
WORKERS'GOMPENSATIONDECLARATION II. 'CE-8 6G (2-80) APPLICATION FOR ELECTRICAL PERMIT
I hereby,afgrm that I have a certificate of consent"to self' COUNTY O LOS GELES °--- BUILDING AND SAFETY
insure,oe a certificate of Workers'ComPelisatign Insurance,or
:01icy
certified�}olp�therof(Sec.3800,Ld� Corn/any-
.
/lFOR APPLICANT TO FI N gDDRESS6323 Primrose
N Com any New Residential Bldgs.&Pools EACH NO. FEE
Certified'copy is hereby furnished. 16.--�l d / 1 &2-Family,Sq. Ft. $ — $ LOCALITY Templ..e Cit
Certified co is filed•with count b 'idin Multi-family Sq. Ft. NEAREST
PY y g inspection CROSS ST
depa mef►t. Residential Swimming Pools OWNER OR
FIRM NAM= F k'Turiace
Date �l Applica Outlets: Rec.—Light Sw. MAIL
First 20 ADDRESS 6393 Primroq'e
CERTIFICATE OF E MPTION FROM �RKERS' Total No. Additional CITY Tem le Cit Tel N0287-4385
COMPENSATION INSURANC PLAN CHECK
APPLICANT tl
('Phis section need not be completed if the work involved Lighting Fixtures First 20 U
by the permit is for one hundred dollars ($100) or less.) g g ADDRESS
' Total No. Additional CC
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. O
permit is issued, I shall not employ any person in any manner PERMIT V
so as to become subject to the Workers'Compensation Laws. Range_Heater D.W. _ APPLICANT Bryant Heat. & AS. W
a
Oven — Dryer_W.M._ ADDRESS to
Date Applicant ' Top _ FAU —W.H.._ Z
Hood _ Fan _Other— C'T'S.an Gabriel Tel"°•296-1141
NOTICE TO APPLI.CANT: If, after making this Certificate of Disp. —Room Air Cond— LICENSE OR
Exemption,' you should become subject to the Workers' ' REG.NUMBER 221751 Class fL
Compensation provisions of the Labor Code, you must forth- Power Apparatus&Large Appliances DISTRICT�NO. PRO D BY
deemed revoked.
with comply with such provisions or this permit shall be Size&Type HP,KW,KVA,or KVAR p
GsL
Up to 1 Incl.
FINAL
p
LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATEOver 10 to 50 Incl. Q ffC) V I DATION
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL '
9 (commencing with.Section 7000)of Division 3 of the Busi- Over 100 BY
ness and Professions Code, and my license is in full force and
effect. I Services
License
0-200 Amp.Under 600'V
'Number Lic.Class 201-1000 Amp.Under 600 V
Contractor Date Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's Sign with'One Branch Circuit
License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits
ness and Professions Code):
Misc.Conduits&Conductors
El I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)—
structure is not intended or offered for sale (Section
7044,Business and Professions Code). ane use rum b,� R
CONSTRUCTION LENDING AGENCY am t0 am
I hereby affirm that there is a construction lending agency ZU
for the performance of the work for which this permit is # o c 0,0 c
issued(Sec. 3097,Civ.C.), PERMIT FEE (Sub-Total) 7 0
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) 2 0 0 0;9 5 Q
0 i
Lender's Address PERMIT ISSUING FEE 0 0 0,9.:,
I certify that I have read this application and state that the TOTAL FEE 9 5C C. a 1 J.-
3 0above information is correct.I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby representatives of this County to enter upon
the above- a neooperty for inspection purposes. SEE'REVERSE FOR EXPLANATORY LANGUAGE '
Si a ure of Perini Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0804280024
BUILDING AND SAFETY f LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAIDBUILDING ADDRESS:
ON FILE 1I 6323 PRIMROSE AV
ASSESSOR INFORMATION NUMBER: (FEE DESCRIPTION: QUANTITY: TJOM: AMOuvT:I TEMP CA 917801346
5382-022-045 1 NEAREST CROSS STREET: LONGDEN
Al PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, C
LB 200 AMP PANELS, MCC 1.00 PAN 38.85
ITENANT: TOTAL FEES 66.60 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
104128/08 SR 10/25/08
OWNER: TEL. NO: F CODE:
TAW, STEVE (626) 614-9441-
6323 PRIMROSE AV
TEMP 917801346
ISCRIPTI OF WORK
JUPGRADE SERVICE PANEL TO 200 AMP
1APPLICANT: TEL. NO:
(SAME AS OWNER
I [SPECIAL CONDITIONS:
(CONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER I
LIC. NO ITEmPommy POWER POLE
UNDERGROUND CONDUIT
`ARCHITECT OR ENGINEER: TEL. NO: IUFER GROUND ATI
1
I LTC. NO: I 1V -I
i6il CONDUIT T
IROUGH WIRING
IMAIN WATER LINE
PLASTIC YIN METAL YIN
JUTILITY COMPANY NOTIFIE
REPORT ID: DPR265 ROUTE TO: BS0508