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Home My Public Portal About5036 ROSEMEAD BLVD_Electrical__ 76AG63 OSS SA 3-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY � �� COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GR0 4 - ZONE PERMIT NO. � ELECTRICIAN S G.�iG 1 c p _ // RECEIVED BY READY FOR DATE ISSUED. ADDRESS /-5- /-5- FIRST INSPECTION CITY ...,?_� �ih�iT TEL NO.? -.SF72- COUNTY 2- COUNTY LICENSE NO. / ..523 EXPIRES BUILDING PERMIT FEES ADORERS NUMBER EACH FEE LOCALITY 462 3 9,M LIGHT OUTLETS NEAREST t; RECEPTACLES CROSS BT. WALL SWITCHES OWNER eel TOTAL OUTLETS 5c $ MAIL ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 _ CITY 9 TEL. NO. FIXTURES 5 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS 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 HORSEPOWERFEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER NEW Mvo. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTYDESCRIBED ABOVE. �" %2 6 LESS $ .25 SIGNATF URE O '/2 2 .50 PERMITTEE_e -`'�� 2 5 1.00 INSPECTION RECORD 5 15 1.50 15 50 2.50 50 200 5.00 200 son 10.00 J Soo 1000 15.00 Z OVER 1000 20.00 M.G. BET/FREQ. CHANGER-HP Q� WELDERS:AC-KVA O GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF GRIM.) MOVED MOTORS (75% OF ORIG.) MISC. SIGNS NO. NO.TRANS APPROVALS NO. N0. LAMPS DATF, INSPECTOR'S NAME FOR EACH PERMIT: WIRING $1.00 i CONDUIT .. FIXTURES $1.00 0® WIRING SUPPLEMENTARY .50 FIXTURES v POWER TOTAL FEE $ p UTILITY CO.NOTIFIED /n_ FINAL 76A663 D55 SA 3-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER ELECTRIC I FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZO E PERMIT MO. ELECTRICIAN / RK EIVED BY READY FOR DATE ISSUED ADDRESS z o _ , Av FIRST INSPECTION CITY A:.- 4,OV TEL NO. -n COUNTY LICENSE NO. (�EXPIRES -J BUILDING PERMIT FEES AooRESS NUMBER EACH FEE LOCALITY LIGHT OUTLETS NEAREST RECEPTACLES CROSS ST. WALL SWITCHES OWNER 4 TOTAL 'OUTLETS =L Sc $ MAIL ELEC. RANGES 25 ADDRESS ELEC. HEATERS 25 CITY ..,...`. . TEL. NO. -^ _ FIXTURES `-' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID L09 NUMBER HORSEPOWERFEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRI ED ABOVE. V2 $ LESS $ .25 SIGNATURE OF � � I/2 2 .60 PERMITTE 2 s 1.00 INSPECTION RECORD 5 15 1.50 is 50 2.50 50 200 5.00 200 500 10.00 J 500 1000 15.00 Z OVER 1000 20.00 6 M.G. SET/FREQ. CHANGER-HP WELDERS: AC-KVA D GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORIG.) MOVED MOTORS (75% OF BRIG.) MISC. SIGNS NO. NO.TRANS. APPROVALS N0. NO. LAMPS FOR EACH PERMIT: DATE INSPECTOR'S NAME WIRING $1.00 B CONDUIT FIXTURES $1.00 WIRING SUPPLEMENTARY .50 FIXTURES POWER r' TOTAL FEE $ ® UTILITY CO.NOTIFIED Ybjcv FINAL j `'.`^'�'.'.� ry/,-r WORKERS'.COMPENSATION DECLARATION 76-663 10/81 CE-806G APPLICATION FOR ELECTRICAL PERMIT I bereby'affirm that I have a certificate of consent to self insure, or-a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.338000,LLab,.C.) (_ }') Policy NjI _ Company✓�' — —y .FOR APPLICANT TO FILL IN JOB ADDRESS �f,J /a N� � V°'�GJ"1' ❑ Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE IIGY1 & 2-Family,Sq.Ft. $ _ $ LOCALITY TEA•QLE C,`1 TV 6CI� Certified copy is'filed with the ounty building inspection department:' r Multi-family Sq.Ft. NEARESTT ,J9"'[ niD �] CROSS Sf� Date �`� [—� Applicant Residential Swimming Pools OWNER OR - G�i�� l� FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec l„L Light;c--r--- Sw.� MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved'by the First 20 CITY l.No.3� permit is for one hundred dollars($100)or less.) Total No. Additional' ® PA-5^10 ,.V _ Te ' I'certify that in the performance of the work for which this permit APPLICANT CHECKPLAN 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 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 subject to the Workers'Compensation Range Heater_s D.W.. J— APPLICANT provisions of the Labor Code, you must forthwith comply with such Oven Dryer J W.M.J ADDRESS provisions or.this permit,shall be deemed revoked. Top FAU W.H. — LICENSED CONTRACTORS DECLARATIONCITY Tel.No. Hood � Fan � Other_ I hereby affirm that I am licensed under provisions of,Chapter 9 Disp. Room Air Cond. O �r� • LICENSE OR Class. (commencing with Section 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. PROCE SED”BY " Size&Type HP,KW,KVA,or KVAR License Numb """ Lic.Class Up to 1 Incl. FINAL U J� �_ Over 1 to 10 Inc[.�,;� O DATE /Z'y'�� VALIDATION 0 Contractor Date ��' Over 10 to 50 Incl. / U FINAL I am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C.for this reason Over 100 iLfn Services Swbd. MCC&Panelboards p p Z 4 ofDate: 0- 200 Amp. nder 600 V P /n �a` �a 0 Signature 201 - mp.Under 600 V !" ElOver 1000 Amp.or Over 600 V Exemption-for Reg.Maint.Elect. • SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 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): �+•_ { �c','yi3_5 ❑ e T .•'r:Misc.Conduits & Conductors _ TEMS, 1,as owner of the property,will do the work and the structure l d h F Complete omplete ee Schedule)is not intended or offered for sale (Section 7044, Business Other , •t O!,I;L �, G..� and Professions Code). pp s•�f r.rj 4.00 CONSTRUCTION LENDING AGENCY r•ssC#•i at F'I B1, e_L tP I hereby affirm that there is a construction lending agency for the ti•s s;`st�� =-G_ p . performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) �� 0-0 Civ.C.). PLAN CHECKING FEEi7sli� l—sifi E s i Lender's Name PERMIT ISSUING FEE Hr Lender's Address I certify that I have read this application and state that the above TOTAL FEE / T 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 f inspection purpo s. SEE REVERSE FOR EXPLANATORY LANGUAGE . _ 917-9/ Signature of Permittee Date