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Home My Public Portal About5614 ROSEMEAD BLVD_Electrical__ ]eAe.eC- CKeeee 12/7e APPLICATION FOR ELECTRICAL PERMIT �I �l BUIL G AND SAFETY (VISION POR APPLICANT TO PILL IN / New Residential Bldgs & Pools EACH NO FEE ADDRESS, 1 &2 Finally Sq Ft $ — $ LOCALITY Multi family Sq Ft — NEAREST /A a• rV�J� X� Residential Swimming Pools CROSS ST �G- OWNAME Outlets Light,Switch& Receptacle MAIL First 20 ADDRESS Additional CITY Tel No PLA CHECK Lighting Fixtures APPL NT First 20 ADDR S Additional CITY / Tel NoPEA Fixed Appliances Not Over 1 HP APPLICANTa5fiV-*CIV&/U 'r Range_ Heater_ DW ADDRESS V VL l�N`f Oven _ Dryer W M �.� Top FAU WH CITY 1 '(X e�'Te1 No ��` ,51 2� y Hood Fan LICENSE ORn O n q b C 'O p� Drsp A C REG NUMBER /� / 7•'�/� T Claw U w Looe T HAVE n THIS APPLICATIONAND p Power Apparatus& Large lienees .Twr. THAT XT ORDINANCES CORRECT Tff we... To COMPLY v APPA g APP ALL .. wNo .TwTe Lww. REGULATING ly Size&Type HP, KW KVA or KVAR .LecTeICA�CONiwlno 0 0. N Up to 1 Incl z T I wM • ♦COUNTY .N.S ------ Over G/O. Qver 1 to 70 Ind LIc......A R THA co.w ion KGAL con NTr w o .TAB. o Cw.C.I..Iw• G THAT AM THE wL O Nen Or THE weO V. Over 10 to 50 Incl o..ca..oIwo Over 50 to 100 Incl PERMITEE Over 100 SIGNATURE Services DI TRIC';'}fB,� � PRO SSE V 0 200 Amp Under 600 V J 201 1000 Amp Under 600 VAPPROVALS DATE I ECTOR S Over 1 DOO Amp or Over 600 V SIGNATURE TEMP POWER POLE Temp Power Pole&Appurtenances U N D E HIS LAB WORK Sign with One Brandt Circuit Addltlooal 5 n Breoch C Cul ROUGH CONDUIT (Other) WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (Sub Total) UTI LITY CO NOTIFIED PLAN CHECKING FEE (One Fourth Permit Fee) FINAL ^7) PERMIT ISSUING FEE TOTALFEE NOTES PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATI CK MID CASH 6 1 2 DEC 12 2 0 9.0 0 nrb � r� 711A � M-OA 3-W APPLICATION FOR PERMIT DEPARTMENT OFNG AND SAFETY ��w�� COUNTY OFF LOS LOS ANGELES WILLIAM WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN Dmmr.T NO. GROUP I ZONE 1 PERMIT NO. ELECTRIC: � T/ ADDRESS ��/ AS = S AL RECEIVED 0Y FIRST 1INSPECTION Y FOR DAT[ ISSUED CITY, rQ � A COUNTY LICENSE �N�tO. ln IRE• BUILDING PERWIT S V � ADDRESS �4-1' d/./JG/yC/fD /dL(/D NUMBER EACH FR LOCALITY LIGHT OUTLETS NEMEST RECEPTACLES GROSS BT. 1,94S �U�a✓/Ir'S�./ WALL SWITCHES OWNER TOTAL OUTLETS Bo • MAIL. �/� ewva-D &i.1,P CLEC RANGES 25 ADDA[BB ELEC HEATERS ad CITY T <r�/r TEL- FIXTURES ELFIXTURES B 1 HEREBY ACKNOWLEDGE THAT I NAVE " THIS M19C APPLICATION AND STATE THAT THE ABOVE IB CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCE• NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING. MOTORS 1 CERTIFY THAT I POSSESS TW9 ABOVE VALID LOB NuueEq "MR POWER ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER R[ OF THE RE9IDENTI PROPERTY D RISm ABOVL N[w Mw HP RVEq INo EARN I Iva • L 98 SIGNATURE OF va 9 BO PERMITTE B B ISO INSPECTION RECORD e 18 ISO- 115 SoIB BO 98O BO 900 1500 903 BCO 1000 -1 BOG 1000 15 00 = OVER 1 ma 2000 M G MT/rRM CHANGER-HP WELDERBI AC-IEVA O GENERATORS - KW TRANSFORMERS - KVA TEMP MOTORS 78 OF ORIo MOVED MOTORS (78 w GRIgJ MIB SIGNS N4 / NO TRANS. N NO u APPROVALS FOR EACH PERMIT: DATE VOWED.M III NAME WIRING 81.00 CONDUIT FDfTURm 11111 OO I WIRINGSUPPLEMENTARY rIXTUREe POWER TOTAL FEE • UTILITYCO NOTIFIED FINAL O-)-7 y c�� TSA...0- c.eoen 1=,75 APPLICATION FOR ELECTRICAL PERMIT �1 BUILDING AND SAFETY DIVISION U FOR APPLICANT TO WILL IN New Residential Bldgs & Pools EACH NO FEE ADDRESS- / 1 &2 Fatally Sq Ft $ — $ -LOCALITY M Multi family Sq Ft — NEAREST ResldenuCROSS STal Swimming Pools OWNER OR FIRM NAME Outlets Light Switch&Receptacle MAIL First 20 0 'j ADDRESS Additional CITY Tel No PLAN CHECK Lighting Fixtures APPLICANT First 20 y0 ADDRESS Additional / i CITY Tel No PERMIT Fixed Appliances Not Over 1 HP APPLICANT eC Range_ Heatjr D W EG Oven _ %.r W M ADDRESS S, �y Top FAU WH CITY Tel No — d Hood Fen LICENSE OR Drip AC r EO NUMBER —C/o Class U wc.noW L.DD. r v. R.Ao ...AI...TIOM LI AHo T.T. TH weov. u c RR.eT w S waw.. ro eolvw i— Power Apparatus& Large Apphences WIT. wua cov.YY oeDl.w Ncu wno srwr. LAW. .acv LAYI.O LVi.i Size ype HP, KW, KVA or KVAR .L.DTRIDAL WIHIN. a v y Up to 1 Ino) S I H.w..Y c.RTIF• THAT I A. FweFULT RKGlaru.D AND/OR Z Over 1 to 101ncl 'Vf LICSNSZD A. R.Ov S.o .Y LOU A...LSE. COUNTY AND .TAT. OF CALIFORNIA THAT I Ar TH. LSOAL OWNS. .1 T.. w.ov. Over 10 to 50 Incl D.sc RI.....amS .RYv Over 50 to 100 InclPERMITRC Over 100 SIGNATURE Service; DISTRICT NO PR CE BY 0 200 Amp Under 600 V r J> S ce 201 -1000 Amp Under 600 V APPROVALS SIGNATURE Over 1000 Amp or Over 600 V TEMP POWER POLE Temp Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit ROUGH CONDUIT Additional Sign Branch Circuits (Other) WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (Sub Total) TILITYCO NOTIFIED PLAN CHECKING FEE (One Fourth Permit Fee) INAL PERMIT ISSUING FEE TOTALFEE OTES // . 334 PLAN CHECK VALIDATION CK MO CASHr/n1� PERWMALIDATION CK MO CASH 687�DEC"14 2D 1130a � Ilk ION WORKERS have a certificate of cLARATION GE 06G ,D,B, APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certdcate of consent t0 sell insure or a cerbfloete of Workers Compensation Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof fff (Sao 3800 Lab C) Policy N. /00/9A3 Company Sr 0( FOR APPLICANT TO F1LL IN JOB ❑ Certified COPY IS hereby fumiahedEACH NO FEE ADDRESS rrff�� Naw Residential Brigs 8 Pools W Cerhfied copy ,s filed with the ca builq2gsrapection 1 & 2-Family Sq FL $ — $ LO43A1JTY r department Multi-farmly Sq Ft — ST CROS$ST Data /�—23 dCApp cant Readennal Swimming Pools OWNER OR Fww CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec— Light � Sw ;ADDRESS NPl� COMPENSATION INSURANCE ADDRESS ,(This section need not be completed d the work kwoNed by the Total No FA�ctirst 2gnal fp Tel No permit Is for one hundred dollars($100)or lees) PLAN CHECK / I certify that in the performance of the work for which this permit s issued I shall not employ any person in any manner so es to become subject to the Workers Compensa on Laws Lighting Fixtures First 20 Total No _L_ Addntonsl CITY Tel No _( Date Applicant Fixed Appliances Not Over 1 HP r NOTICE TO APPLJCANT If after making the Certificate of APRAPIRMJCO �� Exemptcn you should became subject to the Workers Compensation Range— Heater_ DW prmnscrre of the Labor Code you must forthwith comply Wath such Oven _ Orw — W M _ ADDRESS 6790Z�M t provisions or this permit shall be deemed revoked Top — FAU _ WH Gly ! _ E Tel No if 43 LICENSED CONTRACTORS DECLARATION Hood _ Fan — Other_ K/ I hereby affirm that I am licensed under provia ons of Chapter 9LICENSE OR /' (commencitg vnth Section 7000) of Divsion 3 of the Buttress and Deep — Room Air Coed REG NUMBER g C�6-T Professions Code and my license is in full force and effectDISTRICT NO E D BY Waver Apparatus 8 Large Appliances Size&Type HP KW KVA or KVAR Y License Number tic Class Up to 1 Incl FINAL t rr (� Over 1 to 10 Inc] DATE �l pl�_((l/]� Contracts Date VALIDATION O Over 10 b 50 Incl FINAL ❑ I em exempt under Sec Over 50 to 1 GO Inc B1' 8 B&PC for this reason Over 100 ' Services Swbd MCC& Parelboerds iviv LP► Z N Date 0-200 Amo Under BOD V ;11266 A Signature 201 - 1DOO Amp Under 800 V Over 1000 Amp or Over 800 V # • • • e • 2 ❑ Exemption dor Reg Mount Elect SINGLE FAMILY Temp Power Pole& Appurfensnces to - 1200 HOME OWNER-BUILDER DECLARATION Sign With One Branch Circuit e • • 12005 I hereby affirm that I am exempt from the Contractors License Law for the folmwng reason(Section 70315 Business and Professions Additional Sign Branch Circuits Code) 1206-88 ❑ I as owner of the property .11 do the work and the structure Mise Conducts &Conductors is not intended or offered for sale (Section 7044 Busmoss, Ott(See Complete Fee Schedule) and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the wok for which the permit is issued(Sec 3097 PERMIT FEE (Sub-Total) Civ C) PLAN CHECKING FEE Lenders Name PERMIT ISSUING FEE Lenders Address I certify that I have read this application and state that the above TOTAL FEE information is torted I agree to comply with all CouPLY ordmenoes and State awe regulating Electrical vnnrg and hereby authonze representahves of this County o enter upon the above-mentioned ' property for t e s -23- SEE REVERSE FOR EXPLANATORY LANGUAGE /i Sgra rs(51"Perfihithata Geta