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Home My Public Portal About5628-5628 1/2-5632-5632 1/2 ROSEMEAD BLVD_Electrical__ 76.0663-CE806 11/70 APPLICATION FOR ELECTRICAL PERM! �- COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS �(p Z y COLEMAN W. JENKINS. SUPERINTENDENT OF BUILDING LOCALITY L; �` NEAREST FOR APPLICANT TO FILL-IN CROSS ST. �, \{✓ V OUTLETS NO. EACH I FEE e OWNER 1l1 RECEPT._ $ $ MAIL LIGHT TOTAL FIRST 20 25 ADDRESS CITY TEL. NO. SWITCH OVER 20 610 PLAN CHECK LIGHTING TOTAL FIRST 20 .25 APPLICANT FIXTURES •10 ' OVER 20 ADDRESS ' APPLIANCES CITY TEL, No, PERMIT RANGE DRYER_WTR. HTR. APPLICANT Q Z STA. COOK DISP. F.A.U. ADDRESS 7 -7 G® SPACE HTR. AIR COND. CITY iF*VW -T23 CLOTHES WASH.• DISHWASH. LICENSE N0. CLASS 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 WIT ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS,,ETC. HP. KW.KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR 0 — 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF p �• CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO }. l—a`Aj 1 — 10 3,00 RESIDE IN, TH AS E DESC ED RESIDE TIAL PRO RTY. O SIGNATURE V 10 - 50 5.00 OF PERMITTEE 50 - 100 10.00 0 DIS•�_�T��J.CTfJO. JkL�Ayfi ZOIJ PROLE BY NJ 100 - 500 '15.00 4V• V a SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES: ktX(2 N Z TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 SERVICENOTOVER 600 VOLTS OR 200AMP 3.00 �OO APPROVALS DATE INSPECTOR'S SIGNATURE S ERVI CE OVER 600 VOLTS OR 200 AM P 10.00 TEMP.POWER POLE TEMP SERVICE,POLE, &APPURTENANCES 5.00 UNDERSLAB WORK TEMP LIGHT OR RECEPT. SYSTEM 3.00 ROUGH CONDIUT WIRING FIXTUR r POWER AUTHORI7EO l PERMIT FEE (SUB TOTAL) f UTILITY CO. NOTIFIED G� PLAN CHECK FEE i� :3100 FINAL �L PERMIT ISSUING FEE 3.00• JOS EP ROOHAN . TOTAL FEE i SB�Q SUFERVI IN ELECTRICAL ENGINEER. • r PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDA I CK. M.O. CASH AoInoG7N DO& 7 2 •p 1 .5.0 ON SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE - TEMPLE CITY. IA665-CE9O6 10=61 APPLICATION ,FOR AECTRICAL PERMIT . COUNTY OF LOS ANGELES ' DEPARTMENT OF COUNTY ENGINEER .-BUILDING BUILDING AND SAFETY DIVISION ADDRESS �� Ap JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A.JENSEN,.SUPT OF BUILDING LOCALITY NEAREST .s i) FOR APPLICANT TO FILL IN ' ' CROSS ST. I T E M NO. EACH FEE _ OUTLET - ( RST 20) g�EO ;• Oa OWNER r, LIGHTS RECEPT. SW. MAIL OUTLETS-- (ADOPL UNIT 10 ADDRESS ' LIGHTS RECEPT. SW. O LIGHTING FIXTURESe (FIRST 20.) U 20 Q CITY TEL.NO. LIGHTING FIXTURES: (ADDITIONAL) .1011 ELECTRICIAN RANGES CLO.DRYERS WTR:HTRS: . 1.00 ADDRES S" LJ 1,[�J'` GARB.LISP. STA.COOK CITYNO.TJ( 2& D18HWA8H. AUTO.-WASH. STATIE SPACE HTRS. STA.APP.(Ve H.P.MAX.) .50 - LICENSE NO.-, MOTORSe OVER NOT OVER H.P: DISTR T G UP Zr- PROCESSED BY O 1 1.00 7i 1 5 1.50 INSPECTION RECORD sAl 5 s 2.00 ez O s 1s 2.50 �y � �- o _ Is 50 5.00 SO 100 5.00 77, �✓,� W 11 SIGNS: NO.TRANS. NO.LAMPS. ' ) SERVICE 0.600V-NOT OVER 200A 1.00 SERVICE 0.600V•OVBR 200 A. 2.00 }� J •'A �� F` �� 4 SERVICE OVER SOOV 5.00 MISC. - M PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE ffi I HEREBY ACKNOWLEDGE THAT I HAVE•READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ;WITH ALL COUNTY ORDINANCES AND STATE TAWS REGULATING CONDUIT /. ELECTRICAL WIRING. - WIRING /v--V! �, �9�w'F�• - .I HEREBY CERTIFY THAT I' AM PROPERLY REGISTERED AND/OR f j LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES' CALIFORNIA OR THAT 1 AM THE LEGA WNER OF THE ABOVE - DESCRIBED RESIDENTIA PE Y POWER SIGNATURE UTILITY CO.NOTIFIED OF PERMITTE FINAL t LIDATION ARTHUR C. VEIT MO CASH SUPERVISING ELECTRICAL ENGINEER :2� 8 3 0% AUG-1 0 2 'D 1 3.0-0' Q f WORKER'S COMPENSATION DECLARATION 20.0019 DPW(12-91) LI I hereby affirm that I have a certificate of consent to self insure, 764663 APPLICATION FOR ELECTRICAL PERMIT_ or'3lcertifla6fdf Worker's Compensation Insurance, or a certified' C6UNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS B SAFETY DIV. copjf thereof(Sec.�.3800�b.,C.),� r S-_'� S;rATL� r� cY No.- 2 Company FOR APPLICANT TO FILL IN' JOB _ ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY ~ Certified copy is filed with the county building Inspection 1&2-Family,Sq.Ft. _ $ $ NEAREST department. Multl-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR f MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTI FRO S. OWNER OR COMPENSATION INSURANCE Outlets:Rec. Light Sw. pO ®� a FIRM NAME First 20 O �f� MAIL (Th'I•s.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 First 20 APPLICANT Total No. Additional ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT. If,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. Power Apparatus&Large Appliances APPLICANT, you must forthwith comply with such PERMIT ow,09 /V provisions or this permiYshall be deemed revoked. �O,S6�rj�,,�. �Vp; LICENSED CONTRACTORS DECLARATION Size&Type..HP,KW,KVA,or KVAR ADDRESS �� Y`-� I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 1D.Incl. (commencing with Section 7000)of Division 3 of the Business and CITY Tel.N Ctl Q-7 14 Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR Class ////..� l�J�CL��J Over 50 to 100 Incl. REG.NUMBER O License Number 63 "� Lic.Class I Over 100 DISTRICT NO. PI&PESSED BY Services,Swbd.,MCC&Panelboards 0 Yom (2- ,f1 0-399 Amp.Under 600 V FINAL Contractor {��N -DateDATE I:k•r s u m 400-1000 Amp.Under 600 V ❑ I am exempt under Sec. — _VALIDATION (y( Over 1000 Amp.or Over 600 V FINAL 5�,, la. BRANCH'CIRCUIT FEES B.&P.C.for this reason BY CO) s Date: 15A,or 20A,12oV,Lighting or Recept. j• f Ib Z Signature 1 To 10 Branch Circuits i'( AIL 5 ') 60 11 To 40 Branch Circuits C.4i+^• ,^F r�it 9 4.1 Or More Branch Circuits +•ti'#s.:�.• �.L n 6 0 Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits , _ SINGLE FAMILY ll L r IL t, 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 .E ;J—r.�L a ;yl 03i Code): q 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) and 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 Vol 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 regulati ectrical wiring,and hereby authorize representatives of this Co enter upon the above-mentioned property for Inspergon p SEE REVERSE FOR EXPLANATORY LANGUAGE �SIGNAP R OF PE DATE l%mli=vlf9 GUT, of 7GA663-CES06 6-62 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER =BUILDING �B !v BUILDING AND,SAFETY DIVISION ADDRESS J L. .0 JOHN A. LAMIPIE. COUNTY ENGINEER ILE GI IT WILLIAM A..IENSEN,SUP-T OF BUILDING LOCALITY NEAREST FO APPLICANT TO FILL IN CROSS ST. S 7&&A S RECEPT. TOTAL NO. EACH FEE LIGHT OUTLETS FIRST 20 $20 $ OWNER ay Q, SV/fy� )� SWITCH. �-L=�- OVER L .10 ADDRESS � 6 �y �7►G Fa 2V D TOTAL O CITY EJ7 lr lr// TEL.NO. LIGHTING FIRST 20 .20 FIXTURES ADD'L 10 ELECTRICIAN OVER 20 r RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS 57 J, '} /_ / A Q ^� GARB.019!1. STA.COOK CITY CIt_Z TEL.NO./// /�� '• DISHWASH. AUTO.-WASH.. STATE SPACE HTRS. STA.AFP..(Vs M.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER M.P. DIST��gT GROUP Z NE P CESSED BY O 1 1.00 .� (J I s 1.50 INSPECTION RECORD s s 2•.00 8 15 2.50 .15 SO 8.00 } D. so too 5.00 - O SIGNS: NO.TRAMS. a NO.LAMPS rO SERVICE,0.600V-Nor oVER 200A 1.00 v W SERVICE 0.600V-OVER 200 A. 2.00 d h SERVICE OVER 600V 5.00 ? MISC. PERMIT ISSUING FEE E-00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE $ AA 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS PATIC INSPECTOR-9 SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT 7 WITH ALL•COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING'-=. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE \ �nq DESCRIBED RESIDENTIAL PR POWER / / 17 SIGNATURE / UTILITY CO.NOTIFIED �/!iI • �/ OF PERMITTEE 93 FINAL �! OLIDATION AR HU It C. VETT CKMO CASH SUPERVISING ELECTRICAL ENGINEER �r iso 70 6 I-LIR 5 2 D 6.4 0 N