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HomeMy Public PortalAbout5200, 5202, 5204 ROSEMEAD BLVD_Electrical__ ' y WORKERS'COMPENSATION DECLARATION76A66vDPw3,87 APPLICATION FOR ELECTRICAL'`PERMIT O I -hereby affirm that I have a certificate of consent to self '.CE 8006G insure,,or a certificate.of WorkeYs' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy 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 ❑Certified co is filed with the count building ins ec- 1 & 2-Family, S Ft. $ — $ LOCALITY PY Y. g P Y 9 tion department. Multi-family Sq. Ft. — NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec 7 Light Sw._ MAIL COMPENSATION INSURANCE First 20 ADDRESS y SMD (This section need not be completed if the work involved by Total No. Additional CITY /tit Tel. No.� the permit is for one hundred dollars ($100)or less.) PLAN CHECK 1 certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner Lighting Fixtures First 20 ADDRESS so as to become subject to the Workers'.Compensation Laws. Additional Q .c�o�/n y f Total No, CITY Tel. No. Date—a612' Applicant_ ��/✓ Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION Exemption, you should become subject to the Workers' Range— Heater—D.W. _ Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M._ ADDRESS,:: with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. Hood — Fan —Other_ CITY G Tel. No._ Z LICENSED CONTRACTORS DECLARATION LICEN E OR ' Disp. — Room Air Cond. — REG. NUMBER // Class.�Z) I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PR OC >" and Professions Code,and my license is in full force and effect. d Size&Type HP, KW, KVA, or KVAR � O License Number l�/l` 1 Lic. Class C' Z U Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE ,ZVALIDATION Contractor Ane! _• Z��CDate_/�/�Y� 0 ® Over 10 to 50 Incl. F_ FINAL U I am exempt under Sec. Over 50 to 100 Inc. BY Q LLJ B.&P.C. for this reasonOver 100 ILServices, Swbd., MCC& Panelboords U) Date: Z 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 - I hereby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors �= - structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— Business and Professions Code). ,.4y s;Jly 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 PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE .ZV Lender's Address I certify that I have read this application and state that the11 TOTAL FEE (Ry 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 —� ©s ignA'ure of Permittee Dat 18 WORKERS'COMPENSATION DECLARATION 76A663 10/81 L �/ 1 �� I hereby'affirm that I have a certificate of consent to self insure, CE-806G APPLICATA FOR ELECTRICAL PERMI {� or.a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY u copy thereof(Sec.3800,Lab. C.) Policy No// 1 �ompany ' '1`6l FOR APPLICANT TO FILL IN JOB e L ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&'Pools EACH NO. FEE ❑ 1 & 2-Family,Sq.Ft. $ — $ LOCALITY Certified copy is filed with the county building inspection department. Multi-family Sq.Ft. — NEAREST CROSS ST. Date Applicant Residential Swimming Pools OWNER OR FIRM NAME , 4110• �- - ��q - CERTIFICATE OF EXEMPTION FROM WORKERS' J— MAIL Outlets:Rec— Light Sw. COMPENSATION INSURANCE ADDRESS (This section need not be completed if the work involved.by the First 20 FLO s permit.is for one hundred dollars($100) or I Total No, Additional CITY Tel.Nq�/ � Y I certify that in the performance of the for which this permit PLAN CHECK Y p APPLICANT is issued, I shall not employ any p n in any manner so;as to become subject to.the Workers' mpensation Laws. Lighting Fixtures First 20 ADDRESS Additional Total No. CITY Tel.No. } Date Applicant Fixed Appliances Not Over 1 HP NOTICE 'TO PLICANT: If, ,after making this Certificate of PERMIT u Exemptio ou should become subject to the Workers'Compensation Range— Heater_ D.W. APPLICANT ,provi ' s 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. _ CITY LICENSED CONTRACTORS DECLARATION Hood Fan _ Other_ Tel.No. ,) C� I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. LICENSE OR (commencing with Section 7000).of Division 3 of the Business and REG.NUMBER' Class. IL Professions Code,and my license is in full force and effect. DISTRICT NO. PROCESSED BY Power Apparatus& Large Appliances 7 Size& Type HP,KW,KVA,or KVAR License Number Lic:Class /'�-1 Up to 1 Incl. FINAL p/ Over 1 to 10 Incl. DATE - O Contractor ' ' Date / Z� �I !` �l�l V�ALI ATION ❑ Over 10 to 50 Incl. FINA V I-- am exempt under Sec., Over 50 to 100 Inc. BY W BAP.C. for this reason Over 100 04� ' Q„ Services,Swbd.,MCC& Paneiboards Z Date: 0- 200 Amp.Under 600 V Signature _ ZWit^ 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 DECLARATI Sign with One Branch Circuit I hereby affirm that I am exempt from the Cont r or's License Law for the following reason (Section 7031.5, Bu ' ess and Professions Additional Sign Branch Circuits 8 8 3 O A Code): v 0 0 0 0 0 2 Misc.Conduits&Conductors I,as owner of the property,w' do the work and the structure is not intended or offere or sale (Section 7044, Business Other(See Complete Fee Schedule) _ ► ° °J 4,2,5 and Professions Code �° ° °,1 425 CONST CTION LENDING AGENCY I hereby affirm t there is a construction lending agency for the 1.25,-88 performance he work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) Civ.C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE 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. ,/// p p SEE REVERSE FOR EXPLANATORY LANGUAGE Cn CSP / eL, Sig ature of Permitteq Date WORKERS'COMPENSATION DECLARATION 7Eass3 10/81 APPLICATION FOR ELECTRICAL PERMIT I het•eby affiY-n that I have a certificate of consent to self insure, C -9osG or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab. C.) -72 Policy No. • Company �•' / '^"`" - FOR.APPLICANT TO FILL IN JOB ❑ EACH NO. FEE ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools , ❑ 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY Certified copy is filed with the county building inspection department. Multi-family Sq.Ft. NEAREST 7 CROSS ST. f;f Date %�' 2'�/ Applicant /� Residential,Swimming Pools OWNER OR FIRM NAME (j CERTIFICATE OF EXEMPTION F OM W RKERS' Outlets:Rec Light — Sw. AMAIL DDRESS COMPENSATION INSURANCE (This section need not be completed if the work involved by the First 20 permit is for one hundred dollars($100)or less.) Total No. Additional PLAN CITY Tel.No. I certify that in the performance of the work for which this permit APPLICHECK. CANT 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 ," o Additional Total No. CITY 10 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_ 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. / CITY Tel.No. r (�b LICENSED CONTRACTORS DECLARATION. Hood — Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9 — Room Air Cond. LICENSE OR Disp. (commencing with Section 7000) of Division 3 of the Business and REG.NUMBER Class. Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances DISTRICT NO. rPSSED BY Size& Type HP,KW,KVA,or KVARG/ / 0 License Number ti�.l C1 Lic.Class Up to 1 Incl. FINAL ���ryryry U Over 1 to 10 Incl. DATE Contractork Date ��' �' Over 10 to 50 Incl. FINAL, (/ VALIDATIO Q. ❑ 1 am exempt under Sea Over 50 to 100 Inc. gY / 7 W BAP.C.for this reason Over 100 / N Services,Swbd.,MCC&'Panelboards Z 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. # o o o o o SINGLE FAMILY Temp.Power Pole& Appurtenances b 0 o25505, HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit hereby affirm that I am exempt from the Contractor's License Law 1 2 03-87 for the following reason (Section 7031.5,Business and Professions Additional Sign Branch Circuits Code): o ❑ Misc.Conduits&Conductors 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) poll. Professions Code). 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.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address 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 Signatu,Vdf Pe ittee Date y , iNORKERS;ICOMPENSATION DECLARATION 76A663to/St CE-B06G APPLICATION FOR ELECTRICAL PERMIT Y I hereby affirm that I have a certificate of consent to self insure,. E-aos. �. or a.certlfioate of Workers' Comp sation Insurance; or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY cipy thePeof(Sec.3�OQJJr. ' PolicyFOR APPLICANT TO FILL IN' JOB ADDRESS .26 ,AlJ Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE pol ❑ 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY Certified copy is filed with county building inspection department. Multi-family Sq.Ft. NEAREST CROSS ST. LA J r /S� Residential Swimming Pools OWNER ORDate 2 Applican FIRM NAMECERTIFICATE OF EXEMP N FROM WO Outlets:Rec— Light — Sw. MAIL �^ COMPENSATI INSURANCE First 20 ADDRESS 4ck (This section need not be completed if the work involved by the CITY o. p /20 permit is for one hundred dollars($100).or less.) Total No. Additional I 2 Q2 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 l 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 C 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 J. / 1 ' A provisions or this permit shall be deemed revoked. Top — FAU _ W.H. LICENSED CONTRACTORS DECLARATION Hood — Fan A— Other_ CIT fY Tel.No.10 I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR �`' Disp. Room Air Cond. REG.NUMBER .�O J 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 S— �' L U Size & Type HP,KW,KVA,or KVAR v License Number J— Lic.Class G— 3 -Up to 1 Incl FINAL / V /,c,{/� Over 1 to 10 Incl. DATE �/ V LIDATION 00 Contractor�l/��M�z E�P�A� ��^�Z Over 10 to 50 Incl. C/ 17— ❑E] FINAL I am exempt under Sec. Over 50 to 100 Inc. BY 1.1 B.&P.C,for this reason Over 100 C.. Services,Swbd.,MCC& Panelboards , Z 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 8 4 7 A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law #'o 0 0 0,0 2 for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits I 0 - 2 G 5 0 Code): ❑ Misc.Conduits & Conductors 0 0 0 2 (�5 Q tzi 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) _ and Professions Code). pool. Q`s$7 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.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address — I certify that I have read this application and state that the above TOTAL,FEE v 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 Iproperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Per tee , Date I WORKERS'COMPENSATION DECLARATION CEasss loisf APPI�ICA�I® FOR ELECTRICAL PERMIT I,herdby.affirm that I have a certificate of consent to self insure, CE-806G or a Certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy 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 ❑ 1 & 2-Family,Sq.Ft. $ — $ LOCALITY Certified copy is filed with the'Bounty building inspection department. Multi-family Sq.Ft. — NEAREST CROSS ST. Residential Swimming Pools OWNER OR . Date, Applicant =ER r/�H L� + GG�.1 d r CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec— Light Sw. — MAIL COMPENSATION INSURANCE ADDRESS (This section need not be completed-if the work involved by the First 20 permit is for one hundred dollars($100)or less.) Total No. Additional CITY Tel.No. I certify that in the performance of the work for which this permit PLAN CHECK 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 ' Additional Total No. CITY Tel.No. Date '� � Applicant Fixed Appliances Not Over 1 HP NOTICE TO AP (CANT: If, after maki t s Certificate of PERMIT Exemption,you should become subject to the orkers'Compensation Range_ Heater_ D.W. _ APPLICANT provisions of the Labor.,Code, you must forthwith comply with such Oven Dryer W.M._ ADDRESS S S provisions or this permit shall be deemed revoked. Top FAU- W.H. _ CITY - Tel.No. // LICENSED CONTRACTORS DECLARATION Hood Fan Other_ � .e �C I hereby affirm that I am licensed under provisions of Chapter 9 •Disp. Room Air Cond. LICENSE O (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER D�{j Class [ f� Professions Code,and my license is in full force and effect. DISTRICT NO. PROCES BY Power Apparatus& Large Appliances y, / Size& Type HP,KW,KVA,or KVAR © CL . O License Number b Lic.Class C?�lhr Up to 1 Incl. FINAL V Over 1 to 10 Inc[. DATE Contractor Date �`(p VALIDATION O Over 10 to 50 Incl. FINAL f.1 ❑_ I am exempt der Sec. Over 50 to 100 Inc. BY W B.&P.C.for this reason Over 100 � Date: Services,.Swbd„MCC& Panelboards ® Z 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 I Sign with One Branch Circuit I hereby affirm that I am-exempt from the Contractor's License Law' PC ri`•, ,i a; for the fol lowing reason(Section 7031.5,Business and Professions IAdditional.Sign Branch Circuits Code): ? - -�c I,as owner of the property,will do the work andMisc.Conduits& Conductors ,the structure is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) za_ a and Professions Code). ® OTAL =s ��5. CONSTRUCTION LENDING AGENCY - �k I hereby affirm that.there is a construction lending agengy for the CH erformance of the work for which this permit is issued Sec.3097, t• +GE p P ( PERMIT FEE (Sub Totaq` p Civ.C.). PLAN CHECKING FEE' Lender's Name .ol 14 f PERMIT ISSUING FEE74 - Lender's Address �v �3.5 i4 €� f :°J.=• 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 Signature of Permit e Date ' ,"WORKER'S COMPENSATION DECLARATION 20-0019 DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT i'"ir 76A663 I hsreby affirm that I have a certificate of consent to self insure, 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. o.� Company :M� FOR APPLICANT TO FILL IN DDRESSy_ Certified copy is hereby furnished. New Residential Bldgs.&Pools PEACH. NO. FEE_ $ LOCALITY Q� C Certified co Is filed with the c nt build inspection 1 &2-Family,Sq.Ft. PY Y P — NEAREST teparM - Multi-family Sq.Ft. CROSS ST. Date�t Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM ORKERS' Outlets:Rec._Light Sw. OWNER OR COMPENSATION INSURANCE FIRM NAME First 20 (This MAIL section need not be completed if the work involved by the ADDRESS ' 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 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 15 OR 20A,120V BRANCH CIRCUITS NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMAPPLICANT provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH LICENSED CONTRACTORS DECLARATION ADDRESS CL I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH � � O (commencing with Section 7000) of Division 3 of the Business and CITY Tel.No. }�-3 U Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR Power Apparatus&Large Appliances REG.NUMBER Class.C 0 License NumberLic.Class `�� Size&Type HP,KW,KVA,Or KVAR DISTRICT NO. p PROCESSED BY Up to 3 Incl. �Qp W Contractor Q Date �( Over 3 to 10 Incl. PANTECO Over 10 to 50 Incl. ( CO ❑ 1 am exempt under Sec. Over 50 to 100 Incl. `(` VALIDATION Over 100 FINAL B.&P.C.for this reason BY Services,Swbd.,MCC&Panelboards 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 >;- for the following reason (Section 7031.5, Business and Professions Additional-Sign Branch Circuits 'k»= -� Code): - ❑ C i Conduts&Conductors I,as owner of the property,will do the work and the structureMisc: ---"'h{ -•� �' �e is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) j'31 's- `' - 45 and Professions Code). CHECK CONSTRUCTION LENDING AGENCY _ Li 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.) PLAN CHECKING FEE } ,I[J- ' I?r s.1 �'t '''t Lender's Name j D 9 �:_N 6 PERMIT ISSUING FEE (G, •J• • 1 Lender's Address I certify that I have read this application and state that the above TOTAL FEE information is corr t. I agree to comply with all County ordinances and State laws r ulating Electrical wiring, and hereby authorize represe tatives of is County to enter upon the above-mentioned propert for in a do urposes. Q SEE REVERSE FOR EXPLANATORY LANGUAGE (' � / SIGNATOR OF APPLI NT OR AGENT DAT WORKERS' COMPENSATION DECLARATION 766663 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT O I hereby<afNrm that I have a certificate of consent to self CE-806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified cop thereof (Sec. 3800, Lab. C.) r - Policy No. 76_ Company5���a� { u, FOR APPLICANT TO FILL IN JOB 5-10js -ted_ g L . ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY ' tion department. Multi-family Sq. Ft. — NEAREST - CROSS p / S T. Date C Residential Swimming Pools OWNER 'J'--Applicant OR FIRM NAME U� U ✓� / CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ AMAI DDRESS f� PDQ-a L COMPENSATION INSURANCE First 20 p� (This section need not be completed if the work involved by Total No.. Additional CITY C, Tel. No. the permit is for one hundred dollars ($100)or less.) PLAN CHECK I certify that in ',he performance of the work for which this APPLICANT (/ permit is issued, I shall not employ any person in any manner 20 First ADDRESS t Fixures rst Lighting so as to become subject to the Workers'Compensation Laws. Additional Total No. CITYTel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICATION t r7 9�t4µ Exemption, you should become subject to the Workers' Range— Heater—D.W. — Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS R44,ry-- 4Ve, with comply with such provisions or this permit shall be Top — FAU —W.H. — deemed revoked. CITY C / /Y"f Tel.Hood — Fan —Other— No.� 4 LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. NUMBER Class. C (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. PROC ED d and Professions Code,and my license is in full force and effect. ,`� pp�y'I` Size &Type HP, KW, KVA, or KVAR 130 O License Number 6P Lic. Class GW Up to 1 Incl. FINAL U �'p�7Usi s 2� 31— Y, VALIDATION Over 1 to 10 Incl. �-1 0 DATE _ Contractor Date Over 10 to 50 Incl. ❑ FINAL I am exempt under Seo. Over 50 to 100 Inc. BY 0 U W B.BP.C. for this reason Over 100 t1 Services, Swbd., MCC& Panelboords , Date: Z 0- 200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Mainz. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Tem Power Pole &Appurtenances HOME OWNER-BUILDER DECLARATION p' 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 Additional Sign Branch Circuits Professions Code): 4 ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)_ , h'•.} ;_ ' Business and Professions Code). •t CONSTRUCTION LENDING AGENCY - hj. Ji- the ,. I hereby affirm that there is a construction lending agency for -;r ''�- "'- the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE :'i? i'•-°i_l ._, Lender's Name PERMIT ISSUING FEE Z } ,. fir: Lender's Address - 1 certify that I have read this application and state that the TOTAL FEE 5 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 4 Signature of Permittee Date' Y• ©s 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 certific to of 1)Vorkerls Compensation Insurance. or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab. C.) .im�2LT�L'1 d. P❑ copy . New Residential Bldgs. Pools OIICy NO.��� a Company FOR APPLICANT 70 FILL IN JOB P .,�• 14 ki (v Certified cois hereby furnished. &PNO. EACH FEE ADDRESS _ $ $ LOCALITY F-1 Certified copy is filed with the co u ty building spec'or 1 &2-Family,Sq.Ft. department. Multi-familyS Ft. NEAREST q CROSS ST. Date 111 fpplic nt,,,VSF Residential Swimming Pools ASR BOOK MAPPAGE PARCEL NER OR CERTIFI ATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Light 32_Gw.'i2 FIRM NAME (-\,% COMPENSATION INSURANCE (J First 20 MAIL (This section need not be completed if the work involved by the permit is for one hundred dollars($100)or less.) Total No. Additional ADDRESS �- I certify that in the performance of the work for which this permit CITY Tel.No. is issued, I shall not employ any person in any manner so as toB-O Lf 0 PLAN CHECK become subject to the Workers' Compensation Laws. Lighting Fixtured ,; First 20 APPLICANT Total No. Additional G'' ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP. provisions of the Labor Code, you must forthwith comply with such P PLICNT A ( r(� provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS 1 hereby affirm that I am licensed under provisions of Chapter 9 _ Over 3 to 10 Incl. Z (commencing with Section 7000) of Division 3 of the Business and CITY Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR License Number (• Class. a Over 50 to 100 Incl. REG.NUMBER \j 41 7 Lic.Class Over 100 DISTRICT NO. R ESSED BY Q �1 Services,Swbd.,MCC&Panelboards �/ c/'�,� Contractor !�L�gl a��dsex Ctc I ii, S S 0-399 Amp.Under 600 V DATE O ❑ 400-1000 Amp.Under 600 V I am exempt under Sec. ( f'J /� VALIDATION V Over 1000 Amp.or Over 600 VWFINAL B.&P.C.for this reasonBY BRANCH CIRCUIT FEES Date: 15A,or 20A,120V,Lighting or Recept. Z_ 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits El 41 Or More Branch Circuits Exemption for Reg. Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits SINGLE FAMILY Temp.Power Pole&AppurtenancesI$Tyr-` 229.90 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit a 1 1 LI 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): TOTAL. 229 m 90 ❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) CHECK and Professions Code). 229.90 CONSTRUCTION LENDING AGENCY Lt I hereby affirm that there is a construction lending agency for the CHANGE n00 performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ. C.) PLAN CHECKING FEE Lender's Name 0000-0001 9/1`1/95 PERMIT ISSUING FEE Lender's Address t t I certify that I have read this application and under penalty of purjury state TOTAL FEE 2244 1 AN $b09 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 or in ction purp ses. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF PERMITTE TE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 9904130002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: BK: 62 PG: 74 PC: 1 5200 ROSEMEAD.BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB CA 917762279 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 5388-019-031 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 10.00 OUT 19.50 TENANT: G2 LIGHTING FIXTURES 6.00 LGT 11.70 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: HOLLY YOUNG LANG. CLASS & BOOK CENT TOTAL FEES 58.95 04/13/99 UT 04/13/00 OWNER: TEL. NO: FINAL DATE FINAL CODE: CHEN I CHANG;SHIU H (818) 441-4698- 2700 MONTEREY RD SMAR 911081730 DESCRIPTION OF WORK ELECTRICAL FOR T.I. IMPROVEMENT APPLICANT: TEL. NO: C M ELECTRIC CO. (626) 309-0745- 9435 DAINES DR.. _-_ SPECIAL CONDITIONS: TEMPLE CITY, CA GEL S Co CONTRACTOR: TEL. NO: ®� ��(y� APPROVALS DATE INSPECTOR SIGNATURE C M ELECTRIC CO. (818) 309-0745- d 9435 DAINES DR LIC. NO TEMPORARY POWER POLE TEMPLE CITY, CA. 91780 519987 C10 G UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. N0: / llllill ROUGH CONDUIT ROUGH WIRING d `t r P��� MAIN WATER LINE I�fr U PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED 0 0 ,� O 0a� O CJ � tom. � Svmplf90;(B REPORT ID: DPR265 ROUTE TO: BS0508 ,. COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0710170024 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: 1 ON FILE 5220 E ROSEMEAD BL (FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB CA 917762279 ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 15388-019-007 1A1 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: HS LOCALITY: TEMPLE CITY, Cl IK1 SIGNS, OUTLINE LGT 1.00 SIG 38.85 TENANT: I TOTAL FEES 66.60 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: POSTAL PRO 1 110/17/07 SR 04/14/08 1OWNER: TEL. NO: I 1FINAL DATE I BY: CODE: ICHEN I CHANG;SHIU H (818) 441-4698- 1 1 I 12700 MONTEREY RD I I I ISMAR 911081730 1 (DESCRIPTION OF WORK I (ILLUMINATED CHANNEL LETTERS I I I I (APPLICANT: TEL. NO: IJ & H SIGN INC. (626) 448-1166- 1 19441 VALLEY BLVD. I 1SPECIAL CONDITIONS: 1 IROSEMEAD, CA 91770 I 1 I I I 1CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IJ AND H SIGN (626) 448-1166- I 19441 VALLEY BLVD. LIC. NO 1 (TEMPORARY POWER POLE IROSEMEAD, CA 91770 873439 C45 ( I I I I (UNDERGROUND CONDUIT I I I (ARCHITECT OR ENGINEER: TEL. NO: I 1UFER GROUND I _ I I I I LIC. NO: I (ROUGH CONDUIT I I I I I (ROUGH WIRING I I I I I I I I IMAIN WATER LINE I I (PLASTIC Y/N METAL Y/N I I I I I (UTILITY COMPANY NOTIFIED( 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 I I I I I I I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 I I I I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0101080016 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 5220 E ROSEMEAD BL 16"- FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB CA 917762279 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 5388-019-007 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY G2 LIGHTING FIXTURES 2.00 LGT 3.90 TENANT: TOTAL FEES 31.65 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 01/08/01 UT 07/07/01 OWNER: TEL. NO: FINAL DATE FINAL BY: / CODE: CHEN I CHANG;SHIU H (818) 441-4698- 2700 MONTEREY RD d`�� fl� SMAR 911081730 DESCRIPTION OF WORK INSTALLATION OF TWO NEW LIGHTING FIXTURES APPLICANT: TEL. NO: BOB CHAN ELECTRIC 626285888 8321 E. DUARTE RD. SPECIAL CONDITIONS: SAN GABRIEL, CA CONTRACTOR: TEL. N0: - APPROVALS DATE INSPECTOR SIGNATURE BOB CHAN ELECTRIC (818) 285-8888- 8321 E. DUARTE RD. LIC. NO TEMPORARY POWER POLE SAN GABRIEL, CA 91775 485022-C10 _ UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: _ -,,f LIFER GROUND LIC. N0. _ i i -- ROUGX CONDUIT I I I i I ROUGE! WIRING MAIN WATER LINE. PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0212300027 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: BK: 62 PG: 74 PC: 1 5200 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB CA 917762279 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BROADWAY 5388-019-031 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 3.00 OUT 5.85 TENANT: G2 LIGHTING FIXTURES 1.00 LGT 1.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: OLYMPIA IA N-RES EX FANS LT 3HP 1.00 EX 15.30 05/22/03 JK 11/18/03 TOTAL FEES 50.85 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: CHEN I CHANG;SHIU H (818) 441-4698- 6Gt"-tLL,-_.l:.�t�c� 2700 MONTEREY RD SMAR 911081730 DESCRIPTION OF WORK T.I.- ADD RESTRM;NEW STOREFRONT;REMOVE EXISTING STAIRCASE DONE W/O PERMITS APPLICANT: TEL. NO: SAM STEPHENSON (626) 652-0409- 2207 W MERCED SPECIAL CONDITIONS: WEST COVINA 91790 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE LEDFORD SERVICES (909) 765-5557- 41082 TAVA LN. LIC. NO TEMPORARY POWER POLE HEMET, CA 92544 429636 A UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC YIN METAL YIN UTILITY COMPANY NOTIFIED * ADDITIONAL DATA ON FILE REPORT ID: DPR265 ROUTE TO: BS0508 - COUNTY OF LOS ANGELES , TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC'WORKS ' 9701 LAS TUNAS EL 0508 0703290019 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0468 EXT: LEGAL ID: - FEES PAID BUILDING ADDRESS: ON FILE 5214 ROSEMEAD BL IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( SGAB CA 917762279 ASSESSOR INFORMATION NUMBER: I I _NEAREST CROSS STREET: - I5388-019-007 IA1 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY, Cl I IK1 SIGNS, OUTLINE LGT 1.00 SIG 38.85 I (TENANT: - - I TOTAL FEES 66.60 JISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I 103/29/07 JK 09/25/07 I OWNER: TEL. NO: IFINALDAT X BY: CODE: I CHEN I CHANG;SHIU H (626) 441-4698- I 1PIRD I 2700 MONTEREY RD ISMAR 911081730 1DESCRIPTION OF-WO E 1 I 11NTERNALLY ILLUMNINTED LED CHANNEL LETTERS I (APPLICANT: TEL. NO: 1WU (626) 444-8181- 12812 PECK ROAD ISPECIAL CONDITIONS: IEL MONTE - (CONTRACTOR: TEL. NO: - (APPROVALS DATE INSPECTOR SIGNATURE SUCCESS SIGN AND AWNING, INC. (626) 444-8181- 1 12812 PECK ROAD LIC. NO I ITEMPORARY POWER POLE I I IEL MONTE CA 91731 739177 C45 I I (UNDERGROUND CONDUIT (ARCHITECT OR ENGINEER: TEL. NO: IUFER GROUND I I I - I 11 I LIC. NO: I IROUGH CONDUIT I IROUGH WIRING I I 1 I I I I I I I IMAIN WATER LINE I I 1 IPLASTIC YIN METAL YIN I I 1 I I I I I I (UTILITY COMPANY NOTIFIED( 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 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 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 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 (REPORT ID: DPR265 ROUTE TO: BS0508 I I I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1201240041 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 5200 ROSEMEAD BL IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( SGAB CA 917762279 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: BROADWAY 15388-019-007 1A1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY, Cl I IK1 SIGNS, OUTLINE LGT 1.00 SIG 38.80 1 1 ITENANT: ITOTAL FEES 66.60 (ISSUED ON: PROCESSED BY: PLAN BY: 1 101/24/12 SR I 1OWNER: TEL. NO: IFINAL/D/FATE FIN`AAIl�yyBY: CODE: 1 CHEN, JUDY /��-�", / - �1 5220 N. ROSEMEAD BL. ITEMPLE CITY CA 91780 ID,SCRIPTION OF WORK 1 I I 11 WALL SIGN CHANNEL LETTERS I (APPLICANT: TEL. NO: ISIERRA'S SIGNS (626) 401-2544- 11930 N. ROSEMEAD BL. ( ISPECIAL CONDITIONS: 1 IS. EL MONTE CA 91733 1 I I I I I I ICONTRACTOR: TEL. NO: 1P.PPROVALS DATE INSPECTOR SIGNATURE 1 (SIERRA'S SIGNS INC. (626) 401-2544- 1- 11930 N. ROSEMEAD BLVD. LIC. NO ITF.MPORARY POWER POLE IS. EL MONTE, CA 91733 939544-C45 I I (UNDERGROUND CONDUIT 1ARCHITECT OR ENGINEER: TEL. NO: I IUr'ER GROUND 1 1 LIC. NO: 1 IROUGH CONDUIT I 1 I I I 1 I IROUGH WIRING I 1 1 I IMAIN WATER LINE I (PLASTIC Y/N METAL Y/N I I (UTILITY COMPANY NOTIFIEDI 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 I * ADDITIONAL DATA ON FILE I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 I 1 I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0211070021 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 5214 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB CA 917762279 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 5388-019-007 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY K1 SIGNS, OUTLINE LGT 1.00 SIG 38.85 TENANT: TOTAL FEES 66.60 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: MP VIDEO 11/07/02 JK 05/06/03 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: CHEN I CHANG;SHIU H (626) 441-4698- 2700 MONTEREY RD SMAR 911081730 DESCRIPTION OF WORK ONE SET INDIVIDUAL ILLUMINATED CHANNEL LETTER SIGN APPLICANT: TEL. N0: SUCCESS SIGN PRINTING (626) 444-8181- 2812 PECK RD #A SPECIAL CONDITIONS: EL MONTE 91731 CONTRACTOR: TEL. NO: j APPROVALS DATE INSPECTOR SIGNATURE SUCCESS SIGN PRINTING INC. (626) 444-8181- I 9363 VALLEY BLVD, #A LIC. NO I TEMPORARY POWER POLE EL MONTE CA 91731 739177C45 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0212300027 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 DUPLICATE PHONE: (626) 285-0488 EXT: iLEGAL ID: FEES PAID BUILDING ADDRESS: MBK: 62 PG: 74 PC: 1 5200 ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB CA 917762279 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BROADWAY 5388-019-031 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID:..HS._. ,LOCAL_ITY: TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 3.00 OUT 5.85 TENANT: G2 LIGHTING FIXTURES 1.00 LGT .1.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: OLYMPIA IA N-RES EX FANS LT 3HP 1.00 EX 15.30 05/22/03 JK 11/18/03 TOTAL FEES 50.85 OWNER: TEL. NO: FINAL DATE FI BY: CODE: CHEN I CHANG;SHIU H (818) 441-4698- ��O-0[� 2700 MONTEREY RD T SMAR 911081730 D SCRIPTION OF WORK T.I.- ADD RESTRM;NEW STOREFRONT;REMOVE EXISTING STAIRCASE DONE W/O PERMITS APPLICANT: TEL. NO: SAM STEPHENSON (626) 652-0409- 2207 W MERCED SPECIAL CONDITIONS: WEST COVINA 91790 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE LEDFORD SERVICES (909) 765-5557- 41082 TAVA LN. LIC. NO TEMPORARY POWER POLE HEMET, CA 92544 429636 A UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: LIFER GROUND LIC. NO:' ROUGH CONDUIT ROUGH WIRING `1c3`�✓ MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED 1 * ADDITIONAL DATA ON FILE REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0103090012 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ON FILE 5220 E ROSEMEAD BL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB CA 917762279 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BROADWAY 5388-019-007 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPEL CITY G2 LIGHTING FIXTURES 1.00 LGT 1.95 TENANT: TOTAL FEES 29.70 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 03/09/01 LS 09/05/01 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: 2700 MONTEREYSRDU H (818) 441-4698- SMAR 911081730 DESCRIPTION WORK LIGHT FIXTURE FOR "EXIT" LIGHT W/BATTERY BACK-UP APPLICANT: TEL. NO: HI HO ELECTRIC (626) 827-1493- P.O. BOX 1425 SPECIAL CONDITIONS: SAN GABRIEL CA 91776 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE HI HO ELECTRIC (818) 287-1493- P.O. BOX 1425 LIC. NO TEMPORARY POWER POLE SAN GABRIEL, CA 670353 C10 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: LIFER GROUND LIC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1002220060 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ; ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I ON FILE I I 5200 ROSEMEAD BL I (FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( SGAB CA 917762279 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: BROADWAY _ I 15388-019-007 1Al PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY, Cl I IK1 SIGNS, OUTLINE LGT 1.00 SIG 38.85 I 1 (TENANT: I TOTAL FEES 66.60 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I I 102/22/10 SR 02/22/11 1 I I I I (OWNER: TEL. NO: IFINAL DATE FINAL BY: CODE: 1 ICHEN, JUDY - 1 _ I I 15220 N. ROSEMEAD BL. _ I I ITEMPLE CITY CA 91780 - 1 (DESCRIPTION OF WORK 1 I IELECTRICAL FOR SIGN CHANNEL LETTERS 1 I I I I (APPLICANT: TEL. N0: 1 I ISIERRA'S SIGNS (626) 401-2544- 1 11930 N. ROSEMEAD BL. ISPECIAL CONDITIONS: IS. EL MONTE CA 91733 1 1 I I I I (CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE (SIERRA'S SIGNS INC. (626) 401-2544- 1 1 11930 N. ROSEMEAD BLVD. LIC. NO (TEMPORARY POWER POLE IS. EL MONTE, CA 91733 939455 C45 1 I 1 I I (UNDERGROUND CONDUIT I 1 I I I I I I (ARCHITECT OR ENGINEER: TEL. NO: I IUFER GROUND I I I I - I I I I I I LIC. NO: I - IROUGH CONDUIT I I 1 I I I I I I IROUGH WIRING I I I I I I I I I IMAIN WATER LINE I I I I IPLASTIC Y/N METAL Y/N 1 I I I I I I I I I (UTILITY COMPANY NOTIFIEDI I - I I I I I I I I I I I I I EXPIRED ,�?,OJD 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 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 I I I I I I I I I I I I I I I I f I I I I I I I I I I I I IREPORT ID: DPR265 ROUTE TO: BS0508 I I I 1 I I I I I I 76A663-CE806 9-64 APPLICATION FOR ELECT IC�4L!�MIT COUNTY OF LOS ANGELES DEBPUILDI�NG AND SAFETY DIVISIONENT OF COUNTY NAD_,_SS Z — r+v JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUP'T. OF BUILDING LOCALITY f.. �. l ✓ c1 I e NEAREST FOR APPLICANT TO FILL IN CROSS ST. r/A-&e REC EP T. TOTAL N0. EACH FEE OUTLETS FIRST 20 $20 $ �/� OWNER '�� C ; C. /}-� b c.,LIGHT I r to MAIL A DO'L f0 ADDRESS SWITCH. - OVER 20 6 �, LIGHTING � r IF1Rsr20 _01 .20 CITY TEL. NO. FIXTURES ADD'L TOTAL OVER 20 10 ELECTRICIAN q (l RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK CITY r > i e- ,,(' TEL.NO. :2� DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(+/x H.P.MAX.) ,50 LICENSE NO. 3-7)- 36 MOTORS: OVER NOT OVER H.P. DISTRICT NO. RO ZONE P �$ESSED BY O 1 1.00 t J 1 3 1.50 x IN yPECTION RECORD ^ ^ �1./,�Jx v� yd _ 3 8 2.00 /d•cF'G - yaNvo"t0 8 15 2.50 15 50 3.00 - c%� ' 0 so 100 5.00 u W SIGNS: NO.TRANS- IL NO.LAMPS N Z SERVICE 0.600V-Nor OVER 200A 1.00 SERVICE 0-60OV-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 M i SC. .�Lr' ,L•'�.,,� 1 iQ- 130 PERMIT ISSUING FEE 2.00 00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE Is 00 1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVEl,IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING ,✓,� ..$a HEREBY .CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LII CENSED AS REQUIRED BY L05 ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN, THE ABOVE DESCRIBED (DENT L PR PERTY. POWER SIGNATURE UTILITY CO.NOTIFIED OF PERMITTEE FINAL - VALIDATI JOSEOH C. ROOHAN CK MO CASH SUPERVISING ELECTRICAL ENGINEER 1GO 3 3 2 1 LIS jUL 2 2 D 5,0 0,., 76A&6 CE-806(11 /78) PLI ATI N FOR ELECT OCAL.P -IT ... _. . . . COUNTY OF LOSANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN JOB New R6sidential Bldgs.&.Pools EACH NO, FEE ADDRESS U /,?elS'I do 1 &2:Family,Sq. Ft: $ .025 — $ LOCALITY Multi-family Sq. Ft. ,.02 NEAREST Residential Swimming Pools 25.00 CROSS ST. OWNER OR' /�— FIRM NAME Pef � Vf Outlets: Rec Light st 2 ADDRESS /' First 20 S0ZSK Total No. Additional ' .30 CITY.r—� el. No. PLAN CHECK APPLICANT lighting Fixtures First 20 .50 ADDRESS .30 Total No. Additional CITY Tel. No 1 Fized:Appliances Not Olen 1 HP PERMIT- APPLICANT Range_Heater_D.W. ADDRESS Oven'_'Dryer`—W.,M:— Top FAU. —W.H._ CITY Tel. No. Hood,Fan _'Other_ LICENSE OR ` Dis Room_Air Cond. 2.5� REG. NUMBERf�d..f Class; P _. — I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA- Power Apparatus&Large.Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO Size&T COMPLY WITH"ALL'"COUNTY. ORDINANCES 'AND STATE LAWS ?� ype HP, KW, KVA,or KVAR 2 50 REGULATING ELECTRICAL WIRING Up to'] Incl I HEREBY.CERTIFY THAT-I AM PROPERLY'REGIST DAN / R Over 1 to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY DST O 93 Over 10 to-50lnd. •• 12.50 CALIFORNIA,OR THAT I THE LEGAL_OWNE -- _•,THE 0 1 2.00 DESCRIBED RESIDENTIA R PERTY. S Over SQ to 100 lnc. PERMUEE 40.00 ' . Over 100 SIGNATURE Services "DISTRICT NO., P ESSED 0-200 Amp.Under 600 V 2.50 201•-1000 Amp. Under 600 V 25.00 X Over 1000 Amp.or Over 600 V 50.00 O Temp. Power Pole&Appurtenances 10.00 Sign with One Branch Circuit 10.00 z2 7 2 A S-A Additional Sign Branch Circuits 2'00 INSPECTION > 0 0 0•o o:'�' INFORMATION Misc Conduits&Conductors 10.00 W 17.d 0 Other(See Complete Fee Schedule) ON REVERSE u 2'0 0 SIDE.. .Q 'oaa1700 fO � 6' 79 PERMIT FEE (Sub-Total) PLAN CHECKING FEE (One-Fourth Permit Feel O PERMIT ISSUING FEE $7.00 . a i G TOTAL FEE . r INSPECTION FINALED ae date: By � ©s all AE7 IL 76A663 CE-60616/78) APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN• JOB s� FRed ial Bldgs.&Pools EACH. NO. FEE ADDRESS T2 0 ily,Sq. Ft. $ .025 — •$ LOCALITY 7"0 C17— Multi-family 1T ily Sq.Ft. .02 — NEAREST 25.00 CROSS ST. Swimming Pools OWNER OR g��/ FIRM NAME C d/Y/'�� G Light First 2 MAIL S3 First 20 .50 ADDRESS Additional .30 CITY Tel. No. PLAN CHECK D APPLICANT ° Lighting Fixtures First 20 .50 ADDRESS s %Q Additional. .30 Total No. CITY Tel. No.' Fixed Appliances Not Over 1 HP PERMIT Range—Heater— D.W. _ APPLICANT Oven—Dryer W.M. ADDRESS Top _FAU — W.H:_ CITY Tel. No. Hood_Fan —Other— LICENSE OR ry Disp.—Room Air Cond. 2'50 REG.NUMBER .3j�� O d3 g Class.6��� I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA- Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO Type HP, KW, KVA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS Size&T YP REGULATING ELECTRICAL WIRING. d 2.50 Up to 1 Incl. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF W Over 10 to 50 Incl. 1250 DESCRIBED RESIDE OR2 THAT I AM THE LEGA W ER THE ABOVE IAL PROPE TY. Over 50 to 100 Inc. 25.00 PERMIT Over 100 40.00 S.ERMI Services DISTRICT NO ESSE Y 0-200 Amp. Under 600 V 12.50 201-1000 Amp. Under 600 V 25.00 Over 1000 Amp.,or Over 600 V 50.00 Temp. Power Pole&Appurtenances 10.00 1 Sign with One Branch Circuit 0.00 Additional Sign Branch Circuits 2'00 INSPECTION > INFORMATION u Misc.Conduits&Conductors 10.00 ON REVERSE s ;9,4,6 1.7 R Other(See Complete Fee Schedule) SIDE v Q # o a a o 0 2 J 2 a 031,00 PERMIT FEE (Sub-Total) o o o 3 1,Q Q v PLAN CHECKING FEE )One-Fourth Permit Fee) O 0x29* 79 a PERMIT ISSUING FEE •$7:00 J TOTAL FEE G > It= INSPECTION FINALED W date: �..�/2q Byf OOs 1 t 76A663 C1=-806 16/7111 .APPLICATION FOR ELECTRICAL PERMIT -- COUNTY.OF LOS ANGELES BUILDING AND SAFETY,. .. FOR APPLICANTTO FILLIN JCB i� k t� 41 .� ` to fA0 . �v^ New Residential Bldgs.&Pools EACH NO. FEE ADDRESS -N, G• `�-,b Y 1 al 1 &2-Fomlly,Sq. Ft. $ .025 — $ LOCALITY L1 Lv C�(T Multi-family Sq. Ft. .'02 — NEAREST. Residential Swimming Pools 25.00 CROSS ST. OWNER OR I FIRM NAME M 1 L, CAI- (Z IR"Ii- Outlets: Rec Light Sw. MAIL First 20 .50 ADDRESS '�' QiOS= G 1JJILQID Total No. Additional .30 CITYk_f��tj L C ' Tel. No.28 2 PLAN'CHECK APPLICANT Lighting Fixtures First 20 .50 ADDRESS Additional .30 t Total No. CITY Tel. No. Fixed Appliances Not Over 1 HP PERMIT \ 7 Range_Heater— D.W. _ APPLICANT L—A I C Oven_Dryer_W.M. ADDRES-,4( [„L Prl d+�I• d�VL Top _FAU _ W.H._ CITY `)L [jUj Hood_Fan _Other_ LICENSE OR Disp.—Room Air Cond. 2'50 REG.NUMBER Class. IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA- Power Apparatus&Large Appliances TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO Size&Type HP, KW, KVA,or KVAR COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS YP REGULATING ELECTRICAL WIRING. Up to 1 Inc. 2.500 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl. 5.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 9 Over 10 to 50 Incl. 12.50 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE Over 50 to 100 Inc. 25.00 DESCRIBEIDtLENITIAL.PPVPERT.Y. PERMITEE Over 100 40.00 SIGNATURE t Ar--aA� Services DISTRICT NO. PROCESSEDBY g 0-200 Amp. Under 600 V 12.50 25.00 c- 201-1000 Amp. Under 600 V \w ' Over 1000 Amp.or Over 600 V 50.00 Z U -710.00 t Temp. Power Pole&Appurtenances Q Sign with One Branch Circuit 10.00 G Additional Sign Branch Circuits 2.00 INSPECTION > INFORMATION v Misc.Conduits&Conductors 10.00 ON REVERSE i 1 Other(See Complete Fee Schedule) SIDE v `- Z CLQ J PERMIT FEE (Sub-Total) Z PLAN CHECKING FEE (One-Fourth Permit Fee) O r PERMIT ISSUING FEE $7.00 7 c TOTAL FEE /, e-0 > INSPECTION FINALED W /date: �Q _ By y` ©s 76A663 CIL806R 1A,77 APPLICATION FOR ELECTRICAL PER 11 •� COUNTY OF LOS ANGELES ` 'DEPARTMENT OF COUNTY ENGINEER JOB BUILDING AND SAFETY DIVISION ADDRESSj:400 Lb)� � - -e_a ) FOR APPLICANT TO FILL IN LOCALITY rNeResidential Bldgs.&Pools EACH NO. FEE NEAREST 2-Family,Sq. Ft. .025 — $ CROSS ST.OWNER ORulti-family Sq. Ft. 02 FIRM NAMEsidential Swimming Pools 25.00 MAIL ll� ADDRESS ts: Rec_L�Light,CSw. J-6 CITY Tel. No. First 20 .50 o PLAN CHECK Total No.--,1/3- Additional .30 19,4 APPLICANT ADDRESS Lighting Fixtures First 20 .50 CITY Tel.No. Additional .30 v PERMIT Total No. �b APPLICANT /V Fixed Appliances Not Over 1 HP ADDRESS A Range—Heater_D.W.— CITY �j Tel.N .Xl Oven _Dryer_W.M.— LICENSE OR Top- �FAU —W.H. REG.NUMBER �-' r� Class. Hood—Fan _Other— I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Disp. — Room Air Cond. 2'50 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN- ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. Power Apparatus&Large Appliances Size&Type HP, KW, KVA,Or KVAR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS �` REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM 3" Up to 1 Incl. 2.50 E f THE LEGAL OWNER OF T E ABOVE DESCRIBED RESIDENTIAL PROPERTY. �O Over 1 to 101nc1. 5.00 v Over 10 to 50 Incl. 12.50 PERMIT r rY Over 50 to 100 Inc. 25.00 SIGNATURE Over 100 40.00 DISTRICT NO. _ PROCMED BY N Services 0- 200 Amp.Under 600 V 12.50 INSPECTOR'S 201-1000 Amp.Under 600 V 25.00 % APPROVALS DATE SIGNATURE n Over 1000 Amp.or Over 600 V 50.00 tTEMP. POWER POLE j DERSLAB WORKTemp. Power Pole&Appurtenances 10.00Sign with One Branch Circuit 10.00 UGH CONDUIT Additional Sign Branch Circuits 2.00 WIRING Misc.Conduits&Conductors 10.00 FIXTURES Other(See Complete Fee Schedule) POWER AUTHORIZED UTILITY CO.NOTIFIED ]FINAL 1 7 NOTES 412-1-79 , �JL�P�f. C�sDv�i PERMIT FEE (Sub-Total) � 5 yo­ PLAN CHECKING FEE (One-Fourth Permit Feel PERMIT ISSUING FEE $7.00 +, .. TOTAL FEE t J `" 'r o 0 ro :m PLAN CHECK VALIDATION CK. M.O. CASH 0,PERMIT YALIDATION CK. M.O. CASH CD CU © o r. 1, 'N N o ¢0 o IV -O CD O N .� SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE CH WORKERS' COMPENSATION DECLARATION C-663 10/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, CE-806G � f or a cert cat,kof Workers' Compensation Insurance, or a certified COUNTY'OF LOS ANGELES BUILDING AND SAFETY U copy. f(S c.3800,Lab.C.)' Poli No. Company - qAc FOR APPLICANT•TO FILL IN JOB' ADDRESS Ly Certified copy is hereby furnished. New Residential Bldgs:& Pools NO. FEE e EACH ❑ 1 & 2-Family,Sq.Ft. $ — $ LOCALITY !'–✓ C.�U Certified copy is Wed'with with"the 'county buil ng inspection _ NEAREST d partme t. Multi-family Sq.Ft. ul-lubti 61. Date � Applicant' Residential Swimming Pools OwN R OR / ., FIRM NAME. © GGA CERTIFICATE OF EXEMPTION FROM WQR ERS' MAIL COMPENSATION"INSURANCE / Outlets:Rec Light — Sw. ADDRESS [CIYl�S (This section need not be completed.if the work involved-by the First 20 permit is for one hundred dollars($100) or less.) Total No. Additional CITY Tel.No. _ I certify that in the performance,of the'.work for which this permit PLAN CHECK 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 Additional Total.No. CITY11 Tel.No Date Applicant Fixed Appliances Not Over 1 HIP NOTICE TO APPLICANT: 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. 'Tops- — FAU _ W.H. _ ' LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ CITY Te I.No.' I.hereby affirm that I,am licensed under, provisions of Chapter 9 Ds — Room Air Cond. LICENSE Class. S (commencing with Section 7000) of Division 3 of the Business and REG.NUMBB ER Professions Code,and my license is in full force and effect. DISTRICT NO. PROCESSED BY Power Apparatus& Large Appliances 0 Size& Type HP,KW,KVA,or KVAR ®� License Number Lia Classc4c Up to 1 Incl. FINAL V Over 1 to 10 Incl. . DATE VALIDATION Q Contractor (/�� Date f 1 Over 10 to 50 Incl FINAL L 0 ❑ . lam elpt under ea Over 50 to 100 Inc. BY W BAP.C.for this reason Over 100 p' Services,Swbd.,MCC& Panelboards Dater 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' IL /�/'/+ 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACCT 'Ir I hereby affirm that I am exempt from the Contractor's License Law 5q Additional Sign Branch Circuits �n t� to�y for the following reason(Section 7031.5, Business and Professions JJV3 eg p JnU Code): _. 1 ITEMS ❑ Misc.Conduits&Conductors, I,as owner of the property;will the work and the structure pop- TOTAL 6. 60 is not intended or offered for salal e (Section 7044, Business Other(See Complete Fee Schedule) and Professions Code). CHECK . 65.60 CONSTRUCTION LENDING AGENCY CHANGE o 00 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) d.L Civ.C.). ,t n PLAN CHECKING FEE MO-0001 11/28/95 Lender's Name PERMIT ISSUING FEE– d 3459 1 PM 684"06 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 re ulating Electrical wiring, and hereby authorize represe tatives o is County to enter upon the above-mentioned propert for in e tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signaturb of Per V ee Dat 76A663 CE 806R 1077 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB ;7/ti1 ,*�.,r -»1/yln BUILDING AND SAFETY DIVISION ADDRESS t3;W Ko—ce—I G/(Y f' FOR APPLICANT TO FILL IN LOCALITY New Residential Bldgs.&Pools EACH NO, FEE CNEAREST ROSS ST. 1 &2-Family,Sq. Ft. $ '025 — $ OWNER OR Multi-family Sq. Ft. 02 — FIRM NAME BO cM0:511/4/) �6CM Residential Swimming Pools 25.00 AMAIL DDRESS P,o- �� 1�8 77 NE Outlets: RecLight�Sw. . / CITY A&0J,4 Tel. No. L12-//Go First 20 '`�' PLAN CHECK '`/y Total No. Additional .30 APPLICANT U ;S'// ADDRESS 1f9 ` Lighting Fixtures First 20 .50 CITY ATel. No. Additional .30 PERMIT Total No. APPLICANT Fixed Appliances Not Over 1 HP ADDRESS ✓r- 3 Range_Heater_D.W.— CITY157_ Tel. N 4 [� 3 S / 100 Oven _Dryer_W.M. [� Top —FAU —W.H._ LICENSE G.NUMBER ,7� a �{ 3 class. Hood_Fan _Other— 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Disp. — Room Air Cond. 2'50 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDIN ANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. Power Apparatus&Large Appliances Size&Type HP, KW, KVA,or KVAR HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQ UI RED BY LOS ANGE S COUNTY AND STATE OF CALIFORNIA OR THAT I AM > Up to 1 Incl. 2.50 THE LEGAL OWNER ABOVE DESCRIB IDE TIAL PROPERTY. p Over 1 to 10 Inc] 5.00 v Over 10 to 50 Incl. 12.50 PERMITTEE Ct�J Over 50 to 100 Inc. 25.00 SIGNATURE G Over 100 40.00 DISTRICT O. P CESSED BY d Services 0-200 Amp.Under 600 V 12.50 INSPECTOR'S 201-1000 Amp.Under 600 V 25.00 APPROVALS D SIGNATURE Over 1000 Amp.or Over 600 V 50.00 "'L TEMP. POWER POLE Temp. Power Pole&Appurtenances 10.00 UNDERSLAB WORK Sign with One Branch Circuit 10.00 ROUGH CONDUIT Additional Sign Branch Circuits 2.00 WIRING Misc.Conduits&Conductors 10.00 FIXTURES Other(See Complete Fee Schedulei POWER AUTHORIZED d - - -_ UTILITY CO.NOTIFIED }} FINAL �._ 5` --- PERMIT FEE (Sub-Total) NOTES PLAN CHECKING FEE (One-Fourth Permit Fee). .r PERMIT ISSUING FEE ffr7 66' TOTAL FEE ! d� PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK: M.O. CASH `J i 9cr-_DEc, 7 2 D 1: 6.0 0 d3t's3 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE