HomeMy Public PortalAbout6334 PRIMROSE AVE_Electrical__ IA669-CES06 6-62 s-APPLICATION FOR ELECTRICAC PERMIT
COUNIfY"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.CA
RECEPT. TOTAL NO. EACH FEE
/ OUTLETS FIRST 20�O 111 20 S a OWNER
LISHT
ADD'LSWITCH. `�' 'ns� OVER 20 .10 ,(�a ADDRESS. �^�(.P ,
LIGHTING TOTAL FIRST 20 .20 d CITY TEL.
-36
FIXTURES } % ADD'L .10 ELECTRiCiiN 5
OV R 20
CLO..DR CRS. WTI.IITRS. 1.00 O O ADDR S of / r/1/1/LL�, •�LL�L�
RB.DIBP. sra.COOK (�1 CITY ok.. TEL.NO. o(r077
ISHWASH. /� AUTO.-WASH. STATE .
_kIPACR HTRS STA.APP.(1A N.P.MAX.)' .SO ` 0 LICENSE NO.
MOTORS: OVER NOT OVER H.P. DIST ®N GR P E I PE
o t 1.00 r
t a 1.50 jNSPECTION RECORD
s 6 2.00 ?W7,7110 �l
8 is 2.50 v CL
�s so 3.00 ( - Ov
so 100 s:oo O
NO.TRANS. I"
SIGNS: NO.LAMPS V
W
o.
SERVICE 0-6 OV-NOT OVER 200A 1.00 ` U In
Z
SERVICE 0.600V-OVER 200 A. 2.00
SERVICE OVERT 600V 5.00
MISC.
PERMIT ISSUING FEE 2.00 ao
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE e= I
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S BIGNATURB
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL•COUNTY ORDINANCES CORRECT
STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AB REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM YHE LEGAL OWNER OF THE ABOVE',
DESCRIBED RESIDCNTJAL PROPY. POWER
SIGNATURE UTILITY CO.NOTIFIED /i
OR PERMITTE �tt . 11
FINAL
LIDATION ARTHUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
U�Go 3 9 2 FEB 2 6 2- D 1 8.7
CITY OF TEMPLE CITY
IA. _82 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
l-D.EFs4RTMENT OF COUNTY ENGINEER BUILDING
1wULDING AND SAFETY DIVISION ADDRESS b 334
JOHN A. LAMBIE. COUNTY ENGINEER 1/
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN clto58 ST. (/
RECEPT. TOTAL NO. EACH FEE I 1
LIGHT OUTLETS FIRST 2O" 20 � MWNER
�f AWL 10 ADDRESS
SWITCH. -l` OVER 20
CITY TEL.NO.
LIGHTING TOTAL� FIRST 20 .20
� w
FIXTURES ADD'L .10 ELECTRICIAN A;K u_e,__
OVER 20 _
RANGES CLO.DRYERS WTI.HTRIL 1.00, ADDRESS p �� a �1- t
GARB.DISP. STA.COOK �1 1 J' L1, �q f 1 6 `17`1
'n�".�'1�'-{I TEL.NO.!:�/ N bri' i3 I
DISHWASH. AUTO.-WASH. STATE T/ /� w
SPACE HTRB. STA.APP.(V.H.P.'MAX.) .50
r
. p ?tedMOTORSt OVER NOT OVER H.P. N GRO ZO E PRO E Y0 1 1.00
S 1.50INSPECTION .RECORD
S S 2.00
13 15 2.50 d
15 50 3.00 OV
50 100 5.00
SIGNS. NO.TRANS. u
NO.LAMPS
'W
IL
SERVICE O.S.00V•NOT OVER 200A 1.00 N
Z
SERVICE O•SOOV•OVER 200 A. 2.00
SERVICE O ER SOOV 5.00
misc.
v
1
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPOCATI N APPROVALS DATE INSPECTOR'S SIGNATURE '
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL-COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
_ LICENSED AB REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE L AL OWNER OF THE ABOVE
DESCRIBED R681OBNTIA ROPEY.
SIGNATURE fvvu�(�' POWERUTILITY CO.NOTIFIEDFINAL
(DATION ARTHUR'C.'V.EIT !.
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
i
�t, 0 1 0 3:o JAN 2 3 2 D 3.4 0
WORKERS'COMPENSATION DECLARATION 76A663
10/81
CE-SOBAPPLICATION FOR ELECTRICAL PERMIT {�
I�ereby affirm that I have a certificate of consent to self insure,
S L1
or a certificate of Workers' Compensation Insurance, or a certified I COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Seo.3800,Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB ��?
❑ Certified copy is hereby furnished. New Residential Bldgs.&.Pools EACH NO. FEE ADDRESS .✓
❑ 1 &2-Family,.Sq.Ft.. $ — $ LOCALITY
Certified copy is .filed with the county building .inspection
department. Multi-family Sq.Ft. — NEAREST
CROSS ST.
Residential Swimming Pools ER OR
Date Applicant L RM NAME AZ`
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec—Light—Sw._ MAIL
COMPENSATION INSURANCE ADDRESS 3
(This section need not be completed If the work Involved by the First 20
CITY l N
Total Additional ` Tel.No.
permit is for one hundred dollars($100)or less.) ToPLAN CHECK.
I certify that in the performance of the work for which this permit APPLICANT
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 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 subject to the Workers'Compensation r Range_ Heater, D.W. _ APPLICANT
provisions of 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.
LICENSED CONTRACTORS DECLARATION Hood Fan OtherCITY Tel.No.
— _
I hereby affirm that I am licensed under provisions of Chapter 9; LICENSE'OR
Disp. - Room Air Cond, REG.NUMBER
Class.
(commencing with Section 7000)of Division.3 of the Business and '
Professions Code,and my license is in full force and effect. DISTRICT No. PROCESSED BY
Power Apparatus&Large Appliances
Size&Ty a HP,KW,KVA,
V
License Number Lic.Class �Up to 1 Incl. d FINAL b
Over 1 to 10 incl. DATE i Q VALIDATION O
Contractor Date Over 10 to 50 Incl.
FINAL 10? U
❑ I am exempt under Sec. Over 50 to 100 Inc.' BY W
B.&P.C.for this reason Over 100 In
Services,Swbd.,MCC&Panelboards Z
Date: 0-200 Amp.Under 600 V
Signature 201 - 1000,Amp.Under 600 V
F1 Exemption
1000 Amp:or Over 600 V
Exemption for Reg.Maint.Elect.
SINGEE FAMILY I Temp.Power Pole&Appurtenances 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACCT
I hereby affirm that I am exempt from the Contractor's License Law n•S
for the following reason(Section 7031.5,Business and Professions Additional.Sign Branch Circuits
Goode)) 33 3 44.40
LI I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors IT
is not intended or offered for sale (Section 7044, Business Other(See.Complete Fee Schedule) _ Oil. TOT �,+ IQI
and Professions Code).
CONSTRUCTION LENDING AGENCY CHECK 44.40
1 hereby affirm that there is a construction lending agency for the CHANGE 000
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub Total) / Q
Civ.C.).
Lender's Name PLAN CHECKING FEE MO-0001 10/ 4/99
f PERMIT ISSUING FEE 2625 1 AH11*36
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
property for inspection.purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
PSignaturee Permittee Date