HomeMy Public PortalAbout5116 ROSEMEAD BLVD_Electrical__ 76A663-0806 8-62 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS /11
JOHN A. LAMBIE, COUNTY ENGINEER ,o
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY �+/
NEAREST
FOR APPLICANT TO FILL IN cRoss sr.
TOTAL NO. EACH FEE
REC EPT. OUTLETS FIRST 20 $20 $ OWNER G 0 A e— /V
LIGHT MAIL
ADD'L 10 ADDRESS
SWITCH. OVER 20
LIGHTING .TOTAL FIRST 201 .20 CITY TEL.NO.
FIXTURES } I ADD'L 10 ELECTRICIAN !> r,At
OV R 20
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS
GARB.DISP. STA.COOK
CITY 541' EL. NO.
DISHWASH. AUTO.-WASH. STATE 1
SPACE HTRS. -STA.APP.(l/z H.P.MAX.) 1 .501 LICENSE NO.
MOTORS: OVER NOT OVER H.P. DISTRICT ICT NO. GROUP ZONE CESSED BY
p 1 1.00 ,. � - /
1 3 1.50 INSPE TION RECORD
3 8 2.00
8 15 2.50
15 50 3.00 '-
d
50 100 5.00 .0
IG NO.TRANS- ell
NO.LAMPS O
SERVICE 0.60OV-Nor OVER 200A 1.00 U
W
SERVICE 0.60OV-OVER 200 A. 2.00 0-
H
SERVICE OVER 600V 5.00 z
MISC.
PERMIT ISSUING FEE 2.00 Z ^
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $
1 HEREBY 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 COU NTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL P PERTY. POWER
SIGNATURE _ UTILITY CO.NOTIFIED p p
OF PERMITTEE ,i�v
FINAL Y P 'YJ ,1r�P
(DATION ARTHUR C. VEIT
SUPERVISING ELECTRICAL ENGINEER
L_CK MO CASH
LA(;0.2 1 27%-o NOV 1 2 D 4.00-
,
.0ON
es
75A;63-CEBOf•4-68 - APPLICATION FOR ELECTRICPERMI
tiCUNTY OF LOS ANGELES
DEPARTOMENT OF COUNTY ENGINEER BUILDING
` BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER l
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY lze
FOR APPLICANT TO FILL IN CROSS ST.
NO. EACH FEE
RECEPT $ S OWNER O // AAS//S/
.r�_ MAIL
LIGHT TOTAL FIRST 20 G .20 ADDRESS
SWITCH oh �e.L OVER 20 3 .10_'X_57'
CITY TEL. NO.
PLAN CHECK
LIGHTING TOTAL FIRST 20 .20 APPLICANT
FIXTURES .2=&_ OVER 20 .10 ADDRESS
RANGE_DRYER—WTR.HTR._ CITY TEL. NO.
STA.COOK_DISP._F.A.U._ CONTRACTOR
SPACE HTR. AIR COND. ADDRESS Ail ��
CLOTHES WASH._DISHWASH._ C I T YMIJ A
TEL. NO.
,FAN—OTHER 1.00 LICENSE IJO. CLASS.
MOTORS,TRANSFORMERS RATING
IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING.
0 - 1 1.00
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
1 - 10 3.00 LICENSED AS RE.0 IRE. BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO Q
10 - 50 5.00
RES IOE IN, TH A8 E DESCRIIED .RESIDENTIAL PROPERTY. C:)
Cl
50 - 100 10.00 SIGNATURE O
OF PERMITTEE
100 - 500 15.00 U
DIS�IOCT I0 N =SSE a
SIGN,GAS SIGN AND ONE CIRCUIT 3.00 ,„,��ff (lJ
TUBE, OR Z
MARQUEE ADDITIONAL CIRCUITS 1.00
NOTES:
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
WIRING C,
PERMIT FEE (SUB TOTAL) FIXTURES A
o -G- Q �f`221L ,/
PLAN CHECK FEE (50% PERMIT FEE) ,q POWER AUTHORIZED
PERMIT ISSUING FEE 2.00 V L UTILITY CO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL k -e -70
TOTAL FEE
50 JOSEPH C. ROOHAN ZI
SUPERVISING*ELECTRICAL EtAGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. O'' //M. CASH
2 e -Za'� €O12 2 D 1 3.50-
ME BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE O
ppw-
76A6%CE306r/72 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER Joeue
BUILDING AND SAFETY DIVISION ADDRESS J
LOCALITY AI
NEAREST .mss
FOR APPLICANT TO FILL IN CROSS ST.
OUTLETS NO. EACHI FEE OWNER
$ s FIRM NA.E q
RECEPT._ MAIL
ADDRESS - \'`—
LIGHT TOTAL FIRST 20 .25
CITY ,',�� , � % TEL. NO. y i r
SWITCH OVER 20 .10
` PLAN CHECK
LIGHTING r FIRST 20 25 APPLICANT
Jy TOTAL ADDRESS
FIXTURES OVER 20 .1p
RESIDENTIAL APPLIANCES CITYPERIT
d y TEL. N0.
RANGE DRYER_WTR. HTR. APPLI ANTjOO/��y L7#ZWAIC� - _
STA. COOK DISP. F.A.U. ADDRESS/�; 2'S(J Aee"�y4t q ii/_
SPACE HTR. AIR COND. CI TY�` ';yr• TEL. N0. 'J
CLOTHES WASH. DISHWASH. LICENSE OR /`�+, CLASS.
REG. NUMBER Ly
FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING W IT ALL COUNTY DINANCES AND STATE LAWS REGULATING
IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING
SIZE & TYPE OVER TO
I HEREBY CERT Y THAT I AM ROPERLY REGISTERED AND/OR
0 — 1 1.00 LICENSED AS REQ IRED BY LOS GELES COUNTY AND STATE OF
,�.,r� CALIFORNIA OR HA I AM T LEGAL OWNER OF THE ABOVE
/ 1 — 1 O 3.00 �« c,� v
DESCRI BED RES DE TIAL PR ERT Y. CD
V
PERMI TEE
,t -
10 - 50 5.00 SIGNATURE p�
F-
50 - 100 10.00 LL'
DISTRICT N0. PR ESSED BY W
d
100 - 500 15.00 J � z
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE
SERVI CENOTOVER 600 VOLTS OR 200 AMP 3.00 UNDERSLAB WORK
SERVI CEOVER 600 VOLTS OR 200 AMP 10.00 ROUGH CONDUIT
TEMP SERVICE,POLE, &APPURTENANCES 5.00 WIRING
TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES
POWER AUTHORIZED n�E�'� +>✓•
UTILITY CO. NOTIFIED � 1, i'i fe
FINAL r �.
PERMIT FEE (SUB TOTAL) NOTES:
PLAN CHECK FEE
PERMIT ISSUING FEE 3.00
TOTAL FEE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT A IDATION CK. M.O. CASH
r
AP_ 2 8 4 873 AUG 2 ? a 6.0 0 `
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE '
COUNTY OF LOS ANGELES _ APPLICATION FOR PERMIT
.�
DEPARTMENT OF COUNTY ENGINES$ ELECTRIC 1
DIVISION OF BUILDING & SAFETY
� WILLIAM J. FOX, COUNTY ENGINEER
FOR APP CA 4T0 FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN f -
ADDRESS a RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
CITY <.t_:,,t.-o € - —,11,1, dARL. NO
COUNTY LICENSE NO. EXPIRE BUILDING
PERMIT ADDRESS
FEE
NUMBER EACH LOCALITY AA� A J E
LIGHT OUTLETS NEAREST
RECEPTACLES R SS SIT.
WALL SWITCHES OWNE
TOTAL OUTLETS Sc s
-MA41r"
ELEC. RANGES 25
ELEC. HEATERS 25
FIXTURES 5 CITY TEL. NO.
MISC. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I 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. EAcrl OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
1/2&LESS $ .215
SIGNATURE OF //"f�j f
1/2 2 .50 PERMITTEE
2 5 1.00 INSPECTION MCORD
5 15 1.50
15 50 2.50 l J�
50 200 5.00
200 500 10.00 J
500 1000 15.00 Z
OVER 1000 20.00 —
M.G. SET/FREQ. CHANGER-HP
WELDERS: AC-KVA O
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 CONDUIT
FIXTURES $1.00 WIRING
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE $ �, UTILITY CO. NOTIFIED
FINAL
7GA 889 DBS IIA. 4-52, 1 /, �
COUNTY OF LOS ANGELES APPLICATION FOR PERBUT
'DEPARTMENT OF COUNTY ENGINEE$ ELECTRIC
ti DIVISION OF BUILDING IS SAFETY
WILLIAM J. FOX, COUNTY ENGINEER
FOR APPLICANT TO.,FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN
ADDRE 8 `y, RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
A
CITY EL. NO..
COUNTY LICENS O. EXPIRES BUILDING
PERM ADDRESS
FEE
NUMBEft EACH LOCALITY
LIGHT OUTLETS NEAREST
RECEPTACLES ROS T
WALL SWITCHESr /
OWNER '
TOTAL OUTLETS 5c $ ZQA�
ELEC. RANGES 25
ELEC. HEATERS 28
FIXTURES 5 CITY 'lQ-'^'s�+A. TEL. NO.
FI
FIC. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
MIS
NUMBER OF LIGHT CIRCUITS Q APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWER FEE ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
NEw MVD. HP OVER I INC. EACH OF THE RESIDENTIAL PROPERTY
PROPERTYDE8 RIBED ABOVE.
_ I/ a LESS $ .25 SIGNI
.r q[+1'1 R
1/2 2 .50
PERM= -
2 5 1.00 INSPECTION RECORD
5 15 1.50
15 1 50 2.50 , i6 I i Ijj
50 200 5.00 - .y o
200 500 10.00
500 1000 15.00 (( 4` Q
OVER1000 20.00 �' 1� E Inut1F'f � UR`s�- Z
M.G. SET/FREQ. CHANGER-HP 0
WELDERS: AC-KVA _ Imo.,-�- �, t, O
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 CONDUIT
FIXTURES $1.00 WIRING 1 O
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE $ /� UTILITY CO. NOTIFIED " �I
o 1 AL
73A 888 DBS.( 3A. 4-32 ///o o
WORKER'S COMPENSATION DECLARATION 20-0019 DPW'(12-91) APPLICATION 1=0R ELECTRICAL PERMIT L1
I hereby affirm that I have a certificate of consent to self insure, 76A663
or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec. 3800 Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
ADDRESS-5'I6 M� 150
Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY
1 &2-Family,Sq.Ft. _ $ $ �"'P 15 l
Certified copy is filed with the county building inspection NEAREST /����^� ` p e
department. Multi-family Sq. Ft. caoss sT. Y�v� Tt 6.! It-
Date Applicant Residential Swimming Pools ASS BOOK
66 PAGE /2 PARCEL 42-
CERTIFICATE
ZCERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec.%��
LightSw. OWNER OR
COMPENSATION INSURANCE _4 /Z,�� 440 FIRM NAME 64 ok A65c.. 1-ot20 . MAILL^In �� �}CACI� S(This section need not be completed if the work Involved by the Total No. itional / ADDRESS ✓ (�
permit is for one hundred dollars($100)or less.) / `1 //�� /► _
I certify that in the performance of the work for which this permit `6y CITY SAS L7ty�1���1.. TeI.No g18 /
bissued, I shall not employ any person in any manner so as to L+p �r PLAN CHECK Q eFSil ) . 1-IOVS�S O
become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT fft#�4C�J/ j/ J( N f•t �[ )"
Total No. Additional I v. CK
�9LC A✓�
ADDRESS ,4
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITYG�NDA Tel.N .tl O P JY��Q�
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. C I
provisions of the Labor Code, you must forthwith comply with such PERMIT
py Power Apparatus&Large Appliances APPLICAN
provisions or this permit shall be deemed revoked.
LICENSED CONTRACTORS'DECLARATION Size&Type HP,KW,KVA,or KVAR Gj O ADDRESS
Thereby affirm that I am licensed under provisions of Chapter 9 _ Over 3 to 10 Incl.
(commencing with Section 7000) of Division 3 of the Business and CITYGI��C Tel.
f
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR >'
Over 50 to 100 Incl. REG.NUMBER Class. d
Over 100 DISTRICT NO. PROCaSSED BY O
License Number Lic.Class y� CFif�
Services,Swbd.,MCC&Panelboards 70
Cc
Contractor Date 0-399 Amp.Under 600 V �`� FINAL
DATE O
F-1I am exempt under Sec. 1 `400-1000 Amp.Under 600 V D / _1 .G�
VALIDATION W
Over 1000 Amp.or Over 600 V FINAL 0.
B.&P.C.for this reason BRANCH CIRCUIT FEES BY co
Date: 15A,or 20A,120V,Lighting or Recept. z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits h�/
r-141 Or More Branch Circuits ACCT o�
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits ��•yy t
SINGLE FAMILY Temp.Power Pale&Appurtenances 3303 791.60
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law `3
for the following reason (Section 7031,5, Business and Professions Additional Sign Branch Circuits `w
Code): ACCT.a
RA I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors E 3303 753.20
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) I
' !.r
and Professions Code). 2 ITEMS
CONSTRUCTION LENDING AGENCY TOTAL 1544.80
1 hereby affirm that there is a construction lending agency for theC'HEGK v 1• o80
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) o c44 t X
Civ.C.) �3 CHANGE .00
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE 417L7 0000-0001 3/13146
Lender's Address iy.0
TOTAL FEE 0 5`84 1 AM 9'34
I certify that I have read this application and under penalty of purjury state .
that the above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring,and hereby authorize
represe tatives of this County to enter upon the above-mentioned property
for ins a do pur ses. SEE REVERSE FOR EXPLANATORY LANGUAGE
t3 ��
SIGNATOR OF PERMITTEE DATE
WORKERS'COMPENSATION DECLARATION EA663 io/at APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that C
I have a certificate of consent to self insure, CE-Bose
or`'a certificate of Workers' Compensation Insurance, or a certified. COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thf:reof(Sec.3800.Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
ADDRESS • �} I���J +
❑ Certified copy is hereby-furnished. New Residential Bldgs.& Pools EACH NO. FEE r
LOCALITY
❑ ri
Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ _ $ G
department. Multi-family Sq.Ft. NEAREST
CROSS ST. Z"
Date A licant Residential Swimming Pools OWNER OR
pP �
yn� �,+1, FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec v Light — Sw. T MAIL
COMPENSATION INSURANCE ADDRESS
This section need not be completed if the work involved by the // First 20
( p Total No.T� Additional CITY j � Tel.No.
permit is for one hundred dollars($100)or less.)
PLAN CHECK
I certify that in the performance of the-work for which this permit APPLICANT
is issued, I shall not employ any person in any manner so as to
become subject,to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
i 4^ Total No. Additional CITY Tel.No.
Date 1 e&4^9I Applicant. 1�7�'-C l m- Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT W•—L TE "— TALC,
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. R
provisions of the Labor Code, you must forthwith comply with such Oven _ Dryer _ W.M.:_ ADDRESS k!-j l tt4
provisions or this permit.shall be deemed revoked. Top _ FAU _ W.H. _ CITY - L,6, �)v�-�N1-e Tel.No:a3o=-�)F
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_
I hereby affirm that I am licensed under provisions of Chapter 9Disp. Room Air Cond. Class.C+V
LICENSE OR q
.
(commencing with Section 7000) of Division 3 of the Business and REGNUMBER' a
Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESS
pQ4^ � QST Size& Type HP,KW,KVA,or KVAR Q
License Number �j �C$ Com+ Lic.Class ~� Up to 1 Incl. FINAL U
` L � � �' Over 1 to 10 Incl. DATE `
N V' �� •LU�C-1� Date VALIDATION
Contractor Over 10 to 50 Incl.
FINAL V
❑ I am exempt under Sec. Over 50 to 100 Inc. BY W
B.&P.C.for this reason Over 100 U'
Services,Swbd.,MCC&Panelboards , 7—
Date:-
Date:- 0- 200 Amp.Under 600 V
Signature 201 - 1000 Amp.Under 600 V
s�
❑ Over 1000 Amp.or Over 600 V a
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole& Appurtenances _ ,. Esc Via:
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit + _
I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits )p[!1
for the following reason(Section 7031.5, Business and Professions
Code): T [�_A"L
6' 8
❑ Misc.Conduits& Conductors
I,as owner of the property,will do the work and the structure
Other(See Complete Fee Schedule)
is not intended or offered for sale (Section 7044, Business
4i('
+' f
'and Professions Code). ij�'I�h=,7w
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
performance of the work for which thisermit is issued(Sec.3097,
P PERMIT FEE (Sub-Total)! !
Civ. C.).
PLAN CHECKING FEE �� � '` '�`� ��'z r.
Lender's Name
PERMIT ISSUING FEE ��
Lender's Address
certify that I have read this application and state that the above TOTAL FEE 6 /'
ormation is correct. I agree to comply with all County ordinances
State laws regulating Electrical wiring, and hereby'authorize
sentatives of this County to enter upon the above-mentioned
urposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Date
ORKERS',COMPENSATION DECLARATION 76A868 10/81
CF,-806GAPPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure, j' t VVV `7 '
or a certif.cate of Workers'-Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY 'ul
gopy thereof(Sec.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 6 fl C Q s eM
tla
F11 & 2-Family, Sq.Ft. $ _ $ LOCALITY �' C �
Certified copy is filed with the count building inspection
NEART
depar ent. Multi-family Sq.Ft. CROSS ST. 0,17
Date Applicant Residential Swimming Pools OWNER OR
FIRM NAME ,`Z
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec— Light — Sw.�v� / MAIL C/f
COMPENSATION INSURANCE J ADDRESS
This section need not be completed if the work involved b the First 20
( P Y CITY -S r Tel.No.
permit is for one hundred dollars($100)or less.). Total�No. ,Additional
I certify that in the performance of the work for which this permit PLAN CHECK
is issued, I shall not employ any person in any manner so as to APPLICANT
become sub'ect to.the Workers'Compensation L ws. Lighting Fixtures First 20 ADDRESS
t Additional
Total No. CITY Tel.No. 001,
Date ( Applicant Fixed Appliances Not Over'1 HP
NOTICE TO A LICANT: If, after making this Certificate of PERMIT
Exemption,you should become subject to the Workers'Compensation 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 _ Other_ CITY Tel.No.
I hereby affirm that I am licensed under provisions of Chapter 9LICENSE OR.
(commencing with Section 7000) of Division 3 of the Business and Disp. — Room Air Cond. REG.NUMBER Class.
Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. PROCESS D e
Size & Type HP,KW,KVA,or KVAR
License Number Lic.Class Up to 1 Incl. FINAL V
Over 1 to 10 Incl. DATE (' VALIDATION
Contractor Date Over 10 to 50❑ Incl. 1 17-
FINAL
I am exempt under Sec. Over 50 to 100 Inc. I BY ^ W
f
B.&P.C.for this reason Over 100 IL
to
Services,Swbd.,MCC& Panelboards O� ® ZZs
Date: 0- 200 Amp.Under 600 V
Signature 201 - 1000 Amp.Under 600 V _
.........
Over 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 f�lgrl s
for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits
Code): ..._.. ._ ...._.•
73d s JIJ,
V Misc.Conduits& Conductors I +
I� I,as owner of the property,will do the work and the structure •. •�..... • �
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) .i
i f Cdt�
- --- Al...
and Professions Code). t_"-""'•""" _ rAru
CONSTRUCTION LENDING AGENCY �aril
I hereby affirm that there is a construction lending agency for the
4ltTA'E •00
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) -
Civ.C.). __._ . ..._..__... . .
PLAN CHECKING FEE - 7/ g
Lender's Name PERMIT ISSUING FEE 03Q, 409 f AMIP 11
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�inspectionp rpsses. '7 g� SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee / Date
WORKERS'COMPENSATION DECLARATION 76A66310/8110/st
CE-806G APPLICATION FOR ELECTRICAL PERMIT
I hereby-affirm that I have a certificate of consent to self insure,
or a c6rtific6te of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
"fl
copy thereof(Sec.3800,Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB } '❑ R Certified copy is hereby furnished. EACH NO. FEE ADDRESS ( OS2
New Residential Bldgs.& Pools
❑ Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ _ $
LOCALITY 'e
department: Multi-family Sq.Ft. NEAREST
CROSS ST.
Date Applicant Residential Swimming Pools OWNER OR --7TL nn
FIRM NAME /
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec_ Light _ Sw. — MAIL
COMPENSATION INSURANCE ADDRESS '
This section need not be completed if the work involved b the first 20
( py Additional +' CITY Tel No.
Total No. :
permit is for one hundred dollars ($100)or less.) PLAN CHECK
I certify that in the performance of the work for which this permit APPLICANT
Js 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 PERMIT
NOTICE TO APPLICANT: If,. after making this Certificate of APPLICANT
Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W.
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. Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY
Size&Type HP,KW,KVA,or KVAR 1::�/ O
License Number Lic.Class Up to 1 Incl." FINAL
Over 1 to 10 Incl. DATE &7-Z_7-'"6/1 j VALIDATION Q
-Contractor Date Over 10 to 50 Incl. FINAL (~j
❑ I am exempt under Sec. Over 50 to 100 Inc. BY W
• B.&P.C.for this reason Over 100 Cn�
Date: 0- 200 Amp.Under 600 V
Services, Swbd.,MCC& Panelboards
Signature 201 - 1000 Amp.Under 600 V
ElOver 1000 Amp. or Over 600 V
Exemption for Reg.Maint.Elect. �
SINGLE FAMILY -TeIE&Power Pole& Appurtenances c^ s
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit rlrITEMS 76.10
1 hereby affirm that I am exempt from the Contractor's License Law �.701101for the following reason (Section 7031.5,Business and Professions Additional Sign Branch Circuits, W74
Code): "
Misc.Conduits & Conductors
1,as owner of the property,will do the work and the structure
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) , A
and Professions Code). GHAIdGE
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.). 0000—OD01 9/18/95
PLAN CHECKING FEE
Lender's Name D
PERMIT ISSUING FEE
Lender's Address 2321 A ,,
1 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
pro"inspposes. QSEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee" J Date
WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure, 76A663
or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec. 3800 Lab. C.) A I
/
Policy No. Company FOR APPLICANT TO FILL IN JOB ADDRESS -o
Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY �Cc
❑ Certified co Is filed with the count building inspection 1 &2-Family,Sq.Ft. _ $ $
PY Y 9 P NEAREST �C
department. Multi-family Sq.Ft. CROSS sT. -
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec._Light Sw. FOWNERIRM OR
COMPENSATION INSURANCE
ME
This section need not be completed if the work involved by the First 20 MAIL
permit is for one hundred dollars($100)or less.) Total No. Additional ADDRESS
I certify that in the performance of the work for which this permit CITY Tel.No.
is issued, I shall not employ any person in any manner so as to PLAN CHECK
become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT
Total No. Additional
ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No.
Exemption,you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Code, you must forthwith comply with such PERMIT
provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANT
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl.
(commencing with Section 7000) of Division 3 of the Business and CITY Tel.No.
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl.
LICENSEClass. }
Over 50 t0 100 Incl. REG.NUMBB ER a
Over 100 DISTRICT NO. M410.
BY Q
License Number Lic.Class V
Services,Swbd.,MCC&Panelboards L/O � T-
0-399 Amp.Under 600 V FINAL 0
Contractor Date DATE
❑ 400-1000 Amp.Under 600 V Z
I am exempt under Sec. — VALIDATION LU
_ Over 1000 Amp.or Over 600 V FINAL
B.&P.C.for this reasonBRANCH CIRCUIT FEES BY CD
a
Date: 15A,or 20A,120V,Lighting or Recept. Z_
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
❑ 41 Or More BranchCircuits `e
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits �I�-{-r r g i t y
SINGLE FAMILY Temp.Power Pole&Appurtenances7f�3y47010
HOME OWNER-BUILDER DECLARATION 3303
1 hereby affirm that I am exempt from the Contractor's License Law Sign with One Branch Circuit 1 ITEMS
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits
Code): TOTAL 70 _ 10
1,as owner of the property, will do the work and the structure Misc.Conduits&Conductors r 70.10
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) CHECK
and Professions Code). , CHANGE s00
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the tf �Sn4 ']/�;�iz
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) r 0000—1.�1001
96
civ. C.) 4846 1 AM 9*43
PLAN CHECKING FEE
Lender's Name y
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and under penalty of purjury state TOTAL FEE Q
that the above 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-mentionel property
for inspec'on urp ses. I SEE REVERSE FOR EXPLANATORY LANGUAGE
n
SIGNATURE OF PERMITTEE DATE
• WORKER'S COMPENSATION DECLARATION 20-0019 DPW(12-91)
76A663 APPLICATION FOR ELECTRICAL PERMIT
Ihereby affirm=that I have a certificate of consent to self insure,
ar-a certificate of worker's Compens&tion Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Sec. 3800 Lab. C.) 1�' //1
Policy No. Company FOR APPLICANT TO FILL IN ADDRESS
Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY
Certified copy is filed wit the county building inspection 1 &2-Family,Sq.Ft. NEAREST
Wtrt. - Multi-family Sq.Ft.caoss ST.
Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFI TE OF EXEMPTION FROM WORKERS' Outlets:Rec.A4Light 1-a Sw.-5— FOWNER I P.M NAME
OR
COMPENSATION INSURANCE (,
e Rrst 20 MAIL
(This section need not be completed if the work involved by the Total No. Additional ADDRESS
permit is for one hundred dollars($100)or less.)
I certify that in the performance of the work for which this permit CITY Tel.No.
is issued, I shall not employ any person in any manner so as to PLAN CHECK
become subject to the Workers'Compensation Laws. Lighting Fixtures ,n First 20 APPLICANT
Total No. ,5( Additional
" ��r� -L� � ADDRESS
Date 11 U K. Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of / CITY Tel.No.
Exemption, you should become subject to the Workers' Compensation OTHER APPLIANCES NOT OVER 3 HP.
PERMIT
provisions of the Labor Code, you must forthwith comply with such power Apparatus&Large Appliances APPLICANT 13 L)- LI -IV- 1,LV L—.. iG
provisions or this permit shall be deemed revoked.
LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS ►39'`l-L{
t
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl.
(commencing with Section 7000) of Division 3 of the Business and CITY L/�. 7vj t I}'X'V- Tel.No.
Professions Code, and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR
Over 50 to 100 Incl. REG.NUMBER `i Class.C VC) d
o
�j (fit Over 100 DISTRICT NO. PROCESSED BY 0
License Number Lic.Class C'— 0
S.ervvic'ess,,SSwwbd., CC&Pane oards top
41D,
Contractor kjU -Ll-A-e- Date I -ZV n i5-39 mp. nder 600 V FINALDATE
El 400-1000 Amp. Under 600 V __Q-4,' V
I am exempt under Sec. Over 1000 Amp.or Over 600 V FINAL VALIDATION W
B.&P.C.for this reasonBY BRANCH CIRCUIT FEES (n
Date: 15A,or 20A,120V,Lighting or Recept. Z_
1 To 10 Branch Circuits
11 To 40 Branch Circuits
El Exemption
Or More Branch Circuits ")
Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits '�
SINGLE FAMILY Temp.Power Pole&Appurtenances ACCT...Ir
HOME OWNER-BUILDER DECLARATION """'
Sign with One Branch Circuit 330 15 ±9
I hereby affirm that I am exempt from the Contractor's License Law �.s07 1_f�.o.�.
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits -
Code): 1 ITEMS
Gf gYCM tv
❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors T 1'TAL 1=e 1.39
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) "" " " -'t:CHECK1 151.39 l
and Professions Code). ov�
A . .........
CONSTRUCTION LENDING AGENCY CHANGE .011
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) �a
Civ. C.) 0000-0001 12/28/92
PLAN CHECKING FEE
Lender's Name
7253 1 PM 12'-U
PERMIT ISSUING FEE ...... - -
Lender's Address
I certify that I have read this application and under penalty of purjury state TOTAL FEE
that the above 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
SIGNATURE OF PERMITTEE DATE
_ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
_ DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1212130033
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 -
PHONE: (626) 285-0488 EXT:
(LEGAL ID: i FEES PAID I BUILDING ADDRESS: I
ON FILE I I 5116 ROSEMEAD BL 1
1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 00000 1
(ASSESSOR INFORMATION NUMBER: r I NEAREST CROSS STREET: 1
15388-019-030 IA1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY, Cl
I ILB 200 AMP PANELS, MCC 1.00 PAN 38.90 I
(TENANT: I TOTAL FEES 66.70 (ISSUED ON: PROCESSED BY: PLAN BY:
1 112/13/12 SR
(OWNER: TEL. NO: (FINAL DATE FINAL BY: CODE:
ISEVENTH DAY ADVENTIST CHURCH, JESUS (951) 892-4243- Ie�/
15116 ROSEMEAD BLVD. I I
ISAN GABRIEL CA 91776 1 (DESCRIPTION OF WORK
1 (INSTALLATION OF 200 AMP MAIN PANEL
(APPLICANT: TEL. NO: I I
IRA, DANIEL (310) 530-5130-
12148 W 237TH ST 1 (SPECIAL CONDITIONS: I
ITORRANCE CA 90501 I I
(CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE I
(DANIEL SUNCHO HA (310) 530-5130- I I I
12148 W 237TH STREET LIC. NO ITEMPORARY POWER POLE I I
ITORRANCE CA 90501 628877 1 I 1 I I
I I (UNDERGROUND CONDUIT I I I
(ARCHITECT OR ENGINEER: TEL. NO: 1 IUFER GROUND I I
I LIC. NO: (ROUGH CONDUIT I
I (ROUGH WIRING I I
IMAIN WATER LINE
1 (PLASTIC Y/N METAL Y/N I
I 1UTILITY COMPANY NOTIFIED 1
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
1 I I I I I
I I I I I I
I IREPORT ID: DPR265 ROUTE TO: BS0508 I I