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Home My Public Portal About5675 ROSEMEAD BLVD_Electrical__ i8A663 CE 606R ,o,» APPLICATION FOR ELECTRICAL PERMIT �L.I COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN LOCALITY C/ Q New Residential Bldgs.&Pools $EACOH25 NO. $ FEE CROSS ST.S 1 &2-Family,Sq.Ft. OWNER OR Multi-family Sq.Ft. .02 — FIRM NAMEAl Elft Residential Swimming Pools 25.00 ADDRESS 40 AeFAMAIC S� Outlets:Rec_ Light—Sw. CITY Tel.No. First 20 .50 PLAN CHECK Total No. Additional .30 APPLICANT. ADDRESS Lighting Fixtures First 20 .50 CITY Tel.No. Additional 30 PERMIT `�'t eL o JV�C ss ed. Total No. APPLICANT Fixed Appliances Not Over 1 HP ADDRESS VAO��6�C A104,14-14ili r Range_Heater_D.W.— CITY Z.,I4, , Tel.No.Z.K 10 /O Oven_Dryer—W.M LICENSE OR. Top —FAU —W.H._ REG:NUMBER Class.(i" Q 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 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 Up to 1 Incl. 2.50. THE LEGAL OWNER OF THE ABOVEDESCRIBEDRESIDENTIAL PROPERTY. CD Over 1 to 1"0 Incl. 5.00 v Over 10 to 50Ind12.50 y PERMITTEE Over 50 to 100 Inc. 25.00 SIGNATURE Over 100 40.00 DISTRICT NO. PROCESSED f Y oW. J`'. Dig z z Services 0-200 Amp.Under 600 V 12.50 INSPECTOR'S 201-1000 Amp.Under 600 V 125.00 APPROVALS DATE SIGNATURE Over 1000 Amp.or Over 600 V 50.00. TEMP.POWER POLE UNDERSLAB WORK. Temp.Power Pole&Appurtenances 10.00 Sign with One Branch Circuit 10.00 ROUGH'CONDUIT AdditionalSign'Branch Circuits 2.00 WIRING Misc.Conduits&Conductors 10.00 FIXTURES Other(See Complete Fee Schedule) POWER AUTHORIZED UTILITY CO.NOTIFIED FINAL �,Z -x/72 Z--1,5^rte", PERMIT FEE (Sub-Total) NOTES PLAN CHECKING.-FEE (One-Fourth Permit Feel PERMIT ISSUING FEE $7.00 TOTAL FEE AID— PLAN CHECK VALIDATION CK. M.O. CASH a ° PERMIVVALIDATION M.O. CASH " N o o o. OD N N o ' ul I• 57 Q 0- 4 4 O O o -+ OD O O r\)' 7v SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE CH 76AG63C- CEa061B 12/75 APPLIC' TION FOR ELECTRICAL PERMIT BUILDI AND SAFETY, VISION/ N FOR APPLICANT TO FILL IN JOB ADDRESS' (� New Residential Bldgs.&Pools EACH NO. FEE 1 &2 Finaily Sq. Ft. $ — $ LOCALITY Multi-family Sq. Ft. — NEAREST Gr9s7,ellvl Residential Swimming Pools CROSS ST.OWNER OR FIRM NAME Outlets: Light,Switch&Receptacle MAIL First 20 ADDRESS Add itibnal. CITY. . 4405 S Tel. No. PLAN CHECK: Lighting Fixtures APPLICANT First 20 ADDRESS Additional CITY Tel.No. p rr Fixed Appliances Not Over 1 HP APPLICANT ,� . _ &A" 6 GE` RO Range_ Heater_ D.W. p Oven Dryer _ W.M. ADDRESS 9�63 /QG[� OP,� �jLVSJ Top _ FAU _ W.H. _ CITY Q Tel.No. �J l Hood Fan LICENSE EG NNU OR /71 /16 Class. d Q raj Disp. A.C. _ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION O� CD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY Power Apparatus& Large Appliances WITH, ALL COUNTY ORDINANCES AND STATE LAWS REGULATING V Size&Type HP,.KW,KVA,or KVAR ELECTRICAL WIRING. y Up to 1 Incl. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Over 1 to 10 Incl. LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT AM THE LEGAL OWNER OF THE ABOVE Over 10 to 50 Incl. DESCRIBED RESIDEN OPERTY. Over 50 to 1.00 Incl. PERMITEE Over 100 SIGNATUR DISTRICT SED BY Services 0-200 Amp:Under 600 V . 0 Cl 201 -1000 Amp.Under 600 V APPROVALS DATE / I E RE Over 1000 Amp.or Over 600 V "SIGNATURE TEMP.POWER POLE Temp. Power Pole&Appurtenances UNDERSLAB WORK Sign with One Branch Circuit Additional Sign Branch Cir uits ROUGH CONDUIT (Other) y WIRING FIXTURES POWER.AUTHORIZED PERMIT FEE (Sub-Total) UTI LITY CO.NOTIFIED PLAN CHECKING FEE (One-Fourth Permit Fee) FINAL Z' 13'77 PERMIT ISSUING FEE TOTAL FETE NOTES Qd PLAN CHECK VALIDATION CK. M.O. CASH PE T MALIDATION CK. M.O. CASH _ r' 76A66SA-CES06A 4/72 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING UILDING AND SAFETY DIVISION ADDRESS ' Q � O LOCALITY NEAREST C OR APPLICANT TO FILL IN CROSS S. OUTLETS NO. EACH FEE7 �p $ $ OWNER bN ew AA/ AJ!/ RECEPT._ MAIL ADDRESS LIGHT TOTAL FIRST 20 CITY ��/�. TEL. NO.�S - j 6 SWITCH_ OVER 20 PLAN CHECK LIGHTINGTOTAL FIRST 20 APPLICANT FIXTURES OVER 20 ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO. APPARANGE DRYER_WTR. HTR. L-5 STA. COOK DISP. F.A.U. ADDRESS xs' Rc;CK SPACE HTR. AIR COND. CITY [ I�n TEL. N0.a CLOTHES WASH. DISHWASH. LICENSE N0. ' I !Zle, CLASS.G FAN OTHER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION a AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY p MOTORS, TRANSFORMERS RATING WITH ALL COUNTY OPOINANCES AND STATE LAWS REGULATING CJI IND HEATERS, ETC. HP. KW.KVA. ELECTRICAL WIRING. a SIZE & TYPE OVER TO p I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR i-- 0 - 1 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF W CALIFORNIA OR THAT IAM THE LEGAL OWNER OF, AND INTEND TO O. 1 - 10 RESIDE. IN, THE ABO! DESCRIBED RESIDENTIAL PROPERTY. y / Z SIGNATURE 10 - 50 OF PERMITTEE 49 50 - 100 DISTRICTNO. CL.AS ZONE ROLE ED BY 100 - 500 6. 45 I I SIGN, GAS SIGN AND ONE CIRCUIT NOTES: f 2 Cg7�� fjT' TUBE, OR MARQUEE ADDITIONAL CIRCUITS SERVI CENOT OVER 600 VOLTS OR 200 AMP APPROVALS DATE INSPECTOR'S SIGNATURE SERVI CE OVER 600 VOLTS OR 200 AMP TEMP.POWER POLE TEMP SERVICE,POLE, &APPURTENANCES ZI TEMP LIGHT OR RECEPT. SYSTEM UNDERSLAB WORK ROUGH CONDIUT WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (SUB TOTAL) i � UTILITY CO. NOTIFIED PLAN CHECK FEE � FINAL PERMIT ISSUING FEE TOTAL FEE 2 PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. LASH 5 3 9r/--'DEG 1 2 U 1 6.5 0 ,&�> S (? V" _ND SAFhl COUNTY OF LOS ANGELES ELECTRIC WM. J. FOX, CHIEF ENGINEER NATURE OF INSTAL�L�ATION DISTRICT NO. GROUP ZONyE/ PERW-[ No. WIRING I FIXTURES I a's"' SERVICE , I ` J �� i i- .e READY FOR RECEIVED 5,Y DATE ISSUED RANGE I I HEATER I POWER FIRST INSPECTION ^ `. _ SIGNS I I MISCELLANEOUS �r ,'4 I L SIIV APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY .t+ JOB Q NAM L (� ✓ _ F� � '.riff _ ADDRESS U «^ ADDRESS ._ r^=. LOCALITY -..� •¢•.� !r t �a! JU CITY J , NEAREST CITY ,� !�_'L Y TEL No. CROSS ST. COUNTY W REG•NO - ,.'/ EXPIRES 6S NAME ..� '�� "� DESCRIPTION OF WORK � 3 MAIL NUMBER OF OUTLETS ON CIRCUITS ADDRESS� O LOCATION BY ROOMS CITY TEL No. LIGHT II OUTLETS I SW.I PLUGS IFIXT. CORRECTIONS CIRCUIT A I B I C I D I E I F G H LIVING ROOM I �— DINING ROOM BRFST. RM. BATH �—_—i i ILI — ENT. HALL HALL NO. FRONT PORCH I� IL OUTSIDE I J_F KITCHEN SERV. PCH. I_) kBDRM. NO. I IOSERM. NO. 1 S� p APPROVALS F\Vi 0(1.i I I DATE INSPECTOR'S NAME Cv Y1 o I �� CONDUIT �_ 4_ � ' 'WIRING TOTAL � � FIXTURES NO. OF OUTLETS ;z 7 _ $_ ,3 51 POWER NO. OF FIXTURE%, UTILITY CO. NOTIFIED NO. OF MOTORS I H. P.1 /'^.'��" $ dC FINAL NO. OF SIGNS TRANS. $ � I AM THE LEGAL,QWNER OF THE ABOVE LOS ANGELES COUNTY REGISTRATION NUMBER: NO. OF RANGES OR HEATERS $ $ _ rp � MISCELLANEOUSELECTRICIAN.!' $ 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED PERMIT FEE $ I ABOVE. TOTAL FEE 1 $ ✓ OWNER. WORKERS'COMPENSATION DECLARATION 76A663 10/81 I 1 hereby affirm that I have a certificate of consent to self CE-806G APPLICATION FOR ELECTRICAL PERMIT insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof(Sec. 3800, Lab. C.) I Policy No. Company FOR APPLICANT TO FILL IN JOB Certified co is hereby furnished. ADDRESS PY Y New Residential Bldgs. 8 Pools EACH NO. FEE ❑ 1 &2-Family, S Ft. $ — S LOCALITY p , Certified copy is filed with the county building inspec- Y� q• tion department. Multi-family Sq. Ft. — NEAREST �c�� / Residential Swimming Pools CROSS ST. OZ–At / Date Applicant OWNER ORCC FIRM NAMEJOS;rr I;L6 0 TWO NV CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL �� % _ Outlets: Rec Light Sw._ COMPENSATION INSURANCE First 20 ADDREss (This section need not be completed if the work involved by Total No. Additional CITY � v 7 fr T the permit is for one hundred dollars(;.100)or less.) I certifythat in the of the work for which this PLAN CHECK e performance APPLICANT permit is issued, I shall not employ any person in any manner so as to becomLi— Ican the Workers'Co pe ation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional Date rt CITYTel. No. NOTICE TO APPLICANT: If, after making this Certificate.o Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater_D.W. _ APPLICANT S PdC Compensation provisions of the Labor Code, you must forth- Oven —Dryer —W.M.— ADDRESS NdiA, with comply with such provisions or this permit shall be Top _ FAU —W.H. — CITY Tel. No. �� `�� deemed revoked. Hood — Fan —Other— LICENSED CONTRACTORS DECLARATION LICENSE OR ! p I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER 2 i02 b Class_" O (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PR SED BY and Professions Code,and m license is in full force and effect. Power Apparatus&Large Appliances y y Size&Type HP, KW, KVA, or KVAR O License Number Lic. Class Up to 1 Incl. FINAL �, Over 1 to 10 Incl. DATE VALIDATION 0 Contractor Date Over 10 to 50 Incl. ® FIN I am exempt under Sec. Over 50 to 100 Inc. BY IL B.&P.C. for this reason Over 100 Services, Swbd.,MCC&Panelboords D te: Serv0 -200 Amp. Under 600 V - O 8 7 A Signature 201 -1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V # o 0 o a o 2 Exemption for Reg. Maint. Elect. SINGLE FAMILY Temp. Power Pole&Appurtenances 1 - 1550 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits o 0 0 1j rj 9 Law for the following reason (Section 7031.5, Business and ( 1,19-8 5 4 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 (SectionOt er(See Complete Fee Sc h dul )_ Poo7044, Business and Professions Code). ' CONSTRUCTION LENDING AGENCY S 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 ` Lender's Address I certify that I have read this application and state that the TOTAL FEE 'So 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 upor; the e Tcl property for inspection purposes.. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date I WORKERS'COMPENSATIONDECLARATION h6-806G (2•BO)A663 APPLICATION FOR ELECTRICAL PERMIT E f I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES .� CBUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or + ��a��c++ertified copy thereof(Sec.3800,Lab.C.� // w-- y?C. Oal73ompan FOR APPLICANT TO FILL IN gDDRESS�O ��/��/S �l CJ �LL s Policy o. Company New Residential Bldgs.&Pools EACH NO. FEE Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY �� / Multi-family Sq. Ft. NEAREST �1 Certified copy is filed with the county building inspection CROSS ST department. G �r Residential Swimming Pools /� ® �� /` w�� NEROR FIRM NAME /1;��elT .S, Dated Applicant utlets: Rec..--_Light Sw. MAIL p a/ / �1 ' First 20 ADDRESS C S 2- G_Av4 AV, CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional _,W COMPENSATION INSURANCE CITY ��r Tel No.� . 03Z7 PLAN CHECK a l/�i Co.V E ,$ (This section need not be completed if the work involved APPLICANT U by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS ��Z Gf(S� ��/ Total No. Additionalcc I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CI Y � /Pf I No. . (— permit is issued, I shall not employ any person in any manner PERMITW so as to become subject to the Workers'Compensation Laws. Range_HeaterD.W. _ APPLICANT CL Oven _ Dryer_W.M._ ADDRESS8 S'7 . Z Date Applicant Top _ FAU _W.H.._ Q Hood _ Fan _Other— CITY�`G"� COVJN,JTeI No. 2L LICENSE OR ExOempt nO you should become I after subject totire Workers s Certificate of Disp. _Room Air Cond._ REG.NUMER 76 less C-10 Compensation provisions of the Labor Code, you must forth- Power Apparatus&Large Appliances DISTRICT NO. PROC SSED BY with comply with such provisions or this permit shall be Size&Type HP,KW,KVA,or KVAR Up to 1 Incl. Lie deemed revoked. FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE VALIDATION Over 10 to 50 Incl. SS--�" I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 BY �. ness and Professions Code, and my license is in full force and effect. Services .tC� License Number 27621 Lic.Class C-/O 0-200 Amp.Under 600 V G 05 y 201-1000 Amp.Under 600 V ContractorlJdl"5s 61415C.Data Over 1000 Amp.or Over 600 V HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ness and Professions Code): r, Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— j. r a a 9 a �• structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AO CY o o ' 2 (� I hereby affirm that there is a construct' n Ajending agency a I. for the performance of the work,f r is this permit is PERMIT FEE (Sub-Total) issued(Sec.3097,Civ.C.). ' G 1 _4 Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's Address 4-1 (a PERMIT ISSUING FEE t3v I certify that I have read this application and state that the T07AL FEE 3a C) 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 1 the above-me Toned perty for inspection purposes. SEE'REVERSE FOR.EXPLANATORY LANGUAGE Signature of l`dliffittee /Date WORKERS t I have cerci irate of cons PE-863 10ie1 APPLICATION FOR ELI CTRICAL PERMIT I hereby affirm that I. have a certificate of consent to self + PE-806G. - insure, or a certificate of Woikers'Compensation Insurance, COUNTY OF LOS ANG or a certified copy thereof(Sec:3800,:Lab. C.) ELES BUILDING AND SAFETY� Policy No. Company FOR•APPLICANT_TO.FILL IN . I JOB, ❑ Certified co is hereb� furnished. EACH NO. FEE 'I ADDffESS . PY Y New Residential Bldgs. &Pools � ❑ Certified copy is,filed with the county building inspec- 1 &2-Family, Sq. Ft. $ $ LOCALITY tion department. Multi-family Sq. Ft. — `NEAREST 1 Residential Swtmming Pools OWNER OR Date• Applicant FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL � Outlets.: Rec Light Sw._ • COMPENSATION INSURANCE 1 °• ADDRESS-' Thls section need not be completed if the work involved b First'20 a. I+ ( p y CITY Tel. No. Total No. Additional the permit is for one hundred dollars($100)or less,): I certify that in'the'performance of the work for which this PLAN CHECK 4, • fY, P � .APPLICANT permit is issued,I shall not employ any person in any,manner so as to become•subject'to the Worker'•Come cation Laws. Lighting Fixtures First 20 ADDRESS � Additional 1 - ' A&A�� Total No. CITY Tel. No. ' Date, ppli ant - p F � � � '•Piked Appliances Not�O.ver l'4 _ I PERMIT ' I• NOTICE TO APPLICANT:-1 •'after making is Certificate'of ! APPLICANT j Exemption, you should become• subject to the Workers' Range_ Heater_D.W.,— r Compensation provisions of the Labor Cod'e,.yoif-must forth- Oven —Dryer' —W.M. + ADDRESS with, comply with such provisions or ;this permit shall be Top —•FAU —.W.H'. = e 9 1, CITY Tel.'No.. + ,. deemed revoked.• .• � � Hood _ Fan '_Other_ ' LICENSED CONTRACTORS DECLARATION, LICENSE OR E Disp. — Room Air Cond. REG.NUMBER Class. Q ' 1 1 hereby affirm.that I-arA licensed under provisions of Chapter 9 - (. (commencing with Section 7000.)of Division'3.of the Business ' DISTRICT-NO. PROCESSED BY Power Apparatus&Large Appliances I, and Professions Code,and my license is in full force and.effect. �- I @ D '.Size&Type HP,KW, KVA, or KVAR' J ��7 License Number Lic.Class ~� Up'to'1 Incl. `•I FINAL.' � '� e e ATE ,p • A Over 1 to 10 Incl. ,�.D G VALIDATION is • Contractor. Date < . Over 10 to 50 Incl. FINAL I am exempt under Sec. Over 50 to 100:1nc, BY _ LU Over 100 U) BAP.C.,for this•reason i Services; Swld.;MCC&Panelboards. t ! t ate: 0.-200 Amp. Under 600 V (� ( FT tignature ''. 201 : 1000.Amp. Under.-600•V ' ❑' + Over 1000 Amp. or;Over 606 t0741 Exemption for Reg. Maim. Elect, ' SINGLE FAMILY '}Temp. Power, Pole&Appurtenances I ' 1 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit' + ' I hereby affirm that I am exempt from the Contractor's License i 1 y P (Additional Sign;Branch Circuits. I Law for the following reason.(Section.,7031..5, Business and n �; ✓1 Professions.Code.): } ❑ Mtsc. Conduits&Conductors ;+ n ° 0 0 ' I, 6s.owner of the property, will do the work.and the - structure, is not intended or-offered for sole {Sectiori •�ther(See Complete Fees Schheedulej_ 7044, Business and Professions Code). % ° I 1 �..o I, CONSTRUCTION'LENDING,AGENCY ( v n o 7 I hereby affirm.that there is a constructionf lending agency for' /! the performance of the work for which this permit is issued' "PERMIT FEE (Sub-Total). ( (Sec. 3097,,-Civ. C.). ;) 1 PLAN CHECKING FEE rZ Lender's Name PERMIT ISSUING FEE -Lender's.Address ( j A 7, . 1 certify that'I.have read this application and state that the TOTAL FEE 6 above information is correct. I agree to'comply with all County�11 ordinances and'..State laws regu;lating'Electrical wiring,'and hereby authoriz •representatives of this County to enter upon d t bov en on property r in purposes. I' SEE REVERSE-FOR EXPLANATORY LANGUAGE s Signature of Permittee acite :� WORKERS'COMPENSATION DECLARATION610/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self -806-806 G insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified.copy thereof(Sec. 3800, Lab. C.) J 6, ' Policy No. Company FOR APPLICANT TO.FILL IN JOB ADDRESS%ZY C.?/ r► ✓(1�,��/�if<^ G . 4 Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE LOCALITY Z-/�f qq ❑ Certified copy is filed with the county building inspec- tion department. Multi-family Sq. Ft. 'NEAREST Les �V e /A. Residential Swimming Pools CROSS ST. II .4 6 ,A B r Date Applicant. FOONER OR NAME V��L 1 Cd A)-r/,CP i CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS3362 P—LVE -O V 6 01 (This section need not be completed If the work involved by First 20 V32A I the permit is for one hundred dollars($100)or less.) Total No. Additional CITY ��$�f L Tel. No. S ' P I certify that in the performance of the work for which this APPLICANT CHECK CANT permit is issued, I shall not employ any person in any manner so as to become subject to the Work s'C pensati0. Laws. Lighting.Fixtures First 20 ADDRESS I,v ` Total'No. Additional. .CITY Tel. No. Date r pplicant Fixed Appliances Not Over 1 HP PERMIT / CC C NOTICE TO APPLICANT: If, after maki g this Certificate of APPLICANT L6J EI�LT IG Exemption., you should become subject to the Workers' Range— Heater_D.W. — [ Q Compensation provisions of the Labor Code, you must forth- Oven .—Dryer —W.M.— ADDRESS ,64 h S with comply with such provisions or this permit shall be Top- _ FAU —W.H. — / deemed revoked. CITY �v`A,�j �v�AITel. No j68 Hood _ Fan _Other_ LICENSED CONTRACTORS DECLARATION LICENSE OR ` I hereby affirm that I am licensed under provisions of Chapter 9Disp. — Room Air Cond. REG.NUMBER 6� Class—IO (commencing with Section 7000)of Division 3 of the Business . DISTRICT NO, FIR ED BY - Power Apparatus&Large Appliances and Professions Code,and my license is in full.force and effect. Y n Size&Type HP, KW, KVA, or KVAR' J ✓ � License Number / Lic. Class �^� /D Up to 1 Incl. FINAL. DATE Over 1 to TO Incl. 0 C- VALIDATION 0 Contractor Date �V Over 10 to 50 Incl. � ❑ FINAL I am exempt under Sec. Over 50 to 100.Inc. BY �r-- LU B.&PX. for this reason Over 100 Services, Swbd.,MCC&Panelboards i ► 099 A" ate' 0 -200 Amp. Linder 600 V Signature 201 - 1000 Amp. Under 600 V4 ❑ 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 Circuith I hereby affirm that I.am exempt from the Contractor's License Q. Low for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits ff o u o 0 o i Professions Code); ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors 7 o ° 1 L,w Q structure is not intended or offeied for sale (Section Other(See Complete Fee Schedule)— , o. o o 1 7 5 C 7044, Business 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 PERMIT FEE (Sub-Total-) (Sec. 3097, 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 TOTAL FEE „ above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and ! hereby authorizer presentatives of this County to enter upon the ve ti proper or inspection purposes.. SEE REVERSE FOREXPLANATORY LANGUAGE . i i ignature o Per. ittee Date i WORKERS'COMPENSATION DECLARATION 7.6A863 10/81 + reby affirm that I have a certificate of consent to self insure, CE-808G APPLICATION FOR ELECTRICAL PERMIT or"a certificate of Workers'Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDINGAND.SAFETCd r copy thereof(Sec.3800,Lab.C.) 01 /�IGJ /y Policy N�� Company FOR APPLICANT TO FILL IN ADDRESS J00f%V W411i6 ❑ Certlfled copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE 1 &2-Family,Sq.Ft. $ — $ LOCALITY ❑ ;ertified copy is filed with the county buil ' g inspectla — depar ent. Multi-family Sq.Ft. E ,q..� Residential Swimming Pools CROS •1 7 /(/nJ Date `w Applicant FIRMOWNER OR 9 4AN.,,_ y FIRM NAME /;I� •irse<+i�ilC/ CERTIFICATE OF EXEMPTION FROM WORK S' Outlets.'Rec Light_Sw. MAIL COMPENSATION INSURANCE ADDRESS.:rA (This section need not be completed If the work Involved by the Fist 20 permit is for one hundred dollars($100)or less.) Total No. Additional CITY C Tel PLAN CHECK I certify that in the performance of the work for which this permit ,is issued, I shall not employ any, person in.any manner so as to APPLICANT become subject to the Workers'Compensation Laws. lighting Fixtures First 20DRESS Addition Total No. CI el.No. Date Applicant Fixed.Appliances Not Over 1 HP NOTICE TO APPLICANT- If,. after making, this Certificate of I PERM 69 Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. APPLI provisions of the,Labor Code,you must forthwith.comply with such Qven_ Dryef_ W.M._. ADDRESS provisions or this permit shall be deemed revoked.. Top FAU _ W.H. _ GITYm Tel. -LICENSED-CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 8. LICENSE OR Disp. Room Air Cond. REG.NUMBER Claw• (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full fon and effect. Power Apparatus&Large Appliances DISTRICT NO. PROCESSE BY p Size& KW;KVA,or KVAR ' License-Numb �0 Lic..Classle Up to.1 In pAAL '• ' /_�,�P� Over 1 to 1.0 Inc. VA 1 TION O Contractor Date / Q Over 10 to 50 Incl. FINAL + ❑ lam exe.pt.under Sec. , Over 50 to 100 Inc. BY LLI B&P.C:for this reason Over 100 Z • Date ervices,Swbd•,MCC&Panelboards. 0-200 Amp.Under 600 V pop- Signature.. 1 -1000 Amp.Under 600 V u ❑ O 1000 Amp.or'Over 600 V Exemption for Reg..Maint.Elect. SINGLE FAMILY Temp.Power &Appurtenances HOME OWNER-BUILDER DECLARATION Sign with.One Bran. 'rouit I hereby affirm that I am exempt from the Contractor's Li na.Law . Additional Sign Branch Chou for the following reason(Section.7031.5,Business and Pro- sions Code): 'Mise.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 and Professions Code). Poo. 'CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of# c for which this permit is issued(Sec.3097,. PERMI EE r (Sub-otal) Civ:C.). PLAN CHEC G FEE Lender's Names' CEb y ERMIT ISSUING F Lender's'Address 'I certify :that I have read this application and state that the above TOTAL FEE 2, 1'+y qAM information is correct:I agree to comply with all County ordinancesA. and State laws regulating Electrical -wiring, and hereby authorize I F rr1 representativ4epurooses ' ounty to enter upon the above-mentioned property r 4' SEE REVERSE FOR EXPLANATORY LANGUAGE S_i atu s Date WORKER'S COMPENSATION DECLARATION 20=0019 DPW 9/89 APPLICATION: ELECTRICAL PERMIT u Thereby affirm' tiat°Ishave a certificate of consent to self Insure, 76A863 1': , or*4 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 'GNY�� n.1ft`-'9.>f d; FOR APPLICANT TO FILL IN JOB �ee� . ESS, Certified.copy is hereby furnished. 41• EACH IVO. FEE ADBRL New Resldemlal.Bldgs.&Pools — IT1( 1 . LOCAL , �' . Certified copy Is-filed,with the coun�bullins on 1&2-Family,Sq.Ft. de artm nt. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools ASSESSOR . MAP BOOK PAGE PARC0. CERTIFICATE OF EXEMPTION/FROM WORKERS' OWNER OR .I COMPENSATION INSURANCE Outletsy Rec.=Light Sw. FIRM NAME .0• ' First 20 MAIL nI�q (This section need:not tie.completed:if the workAnvolvefi by the. Total No. Additional I • , ADDRESS .& `U J permit le for one hundred dollars Oio0j'or lese.j , �1a certify,that in the•performance of the work for,which this permit �; l : CITY Tel.-No V is'# ssued; 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'•. 7 15 R 20A,120V BRANCH CIRGUITS• - CITY Tel.No. NOTICE TO-APPLICANT: If, after making this Certificate of 1 T01101 ' Exemption,you should become subject to the Workers'Compensation NCLUSIVE EACH provisions of the Labor,Gode, you must forthwith comply,with.such 1.1 TO 40 INCLUSIVE-EACH PERMIT, provisions or this permit,shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH i LICENSED CONTRACTORS DECLARATION - • ADDRESS 184 a I hereby affirm that I.am licensed under provisions of Chapter 8 15 OR 20A,208V TO 277V LIGHTING EACH (commencing with Section 70.00)of Division 3 of the-9uslhds's and �- CITY wtt/I�+ �� Tel,No. a,ZCIO•L Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP T0.3HP LICENSE OR %( 'J Q ll Power Apparatus&Large Appliances RES.NUMBER Z �SZ Class' C—1 Q D License.Number 2 g2 L'ic..Class L Size&Type HP.,KW,KVA,or KVAR DISTRICT NO. p P b SEED BY I' Up to 3 Incl. O u N $7y6O2 7 2 ` Over 3'to 10 Incl. FINAL n Contractor Date Zi - .. DATE p U, T-- •• •• Over 10 to 50 Incl.� ,,.Contractor 1 am exempt under Sec. - 1: - Over 50 to 100 Incl.• VALIDATION AL B.&P.C.for th#s;reason Over 100 _ Y Services Swbd.,MCC&Paneiboards. ( !% I' ate: - ,. 0-;200 Amp.Under 600 V.- i1 Signature 201=1000 Amp:Under 600 V.•-•.- �- g ❑ _.. _.. Over'1000 Amp.or Over 000 V Exemption for Reg.Maint.Elect. 7:1 ,. SINGLE FAMILY Temp.Power Pole&Appurtenances M HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit --- ;- I hereby affirm that.I.am exempt'from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits =`: •. •- - ` Code): L.• r r.E . E] ;' 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). ► �' `=''-' a'. and Professions Code). • CONSTRUCTION LENDING AGENCY • _ - _ #'I•l�:a_i��f i� I hereby affirm that there is a construction lending'agency for.the performance-of the work for which this permit is Issued(Sec.3087, .PERMITI,FEE _ ,(Sub Total) , krf; l 3 r 2 ' Civ.C.) i PLAN CHECKING FEE Lender's Name I" PERMIT'ISSUING FEE p`Al Lender's Address TOTAL FEE I certify that I have read this application and state.that the above information is correct. I agree to comply with all County ordinances and State 11. aws.regulating Electrical wiring, and hereby authorize r- representativ of this ounty to enter upon the above-mentioned property for nspecti urpos SEE REVERSE FOR EXPLANATORY LANGUAGE SIONA; E OF PPLICANT OR AGENT DATE i WORKERS'COMPENSATION DECLARATION I 76AtD/81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to.self CE-806G insure; or a.certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a'certified copy thereof(Sec. 3800, Lab. C.) I: PARKING LO PolicyNo. CoI' FOR APPLICANT TO FILL IN .108 E] Certified m pan y � ADDRESS N/W CORNER LAS TUNAS 8c Certified copy is hereby furnished. ' New Residential Bldgs. &Pools EACH NO. FEE 1 .&2-Family, S Ft: $ _ $ LOCALITY R C+J � • . Certified copy is filed with the county building inspec- y� q` 'NEAREST ] tion department. Multi-family Sq. Ft. USCF (✓ �l Residential Swimming Pools CROSS ST. Date Applicant OWNER OR �v� FIRM NAME EXPLORER POST.4191 CERTIFICATE OF EXEMPTION FROM WORKERS' MAfL i, Outlets: Rec Light Sw._ COMPENSATION INSURANCE First 20 ADDRESS 9150 E (This.section need not be completed if the work involved by Total No. Additional CIN P�+' CITY Tel. No.286— 08� the permit is for one hundred.dollars(;100)or less.) i I certify that in the performance of the work for which this PLAN P LICANTK permit is issued,•I shall not employ any person in any manner :so as to become'subject to the Workws. Co. pe s tion Laws. Lighting Fixtures First 20 DDRESS Total No. Additional 6--6-86 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' Range_ Heater_D.W. Compensation provisions of the Labor Code, you must forth- Oven _'Dryer —W.M.— ADDRESS P.0 BU 1+29 with comply with such provisions or this permit shall be Top _ FAU —W.H. — deemed revoked. CITY BAN GAIIRIEL Tel. No-287-196 . LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG..NUMBER Class. (fir•. (commencing.with Section 7000) of Division 3 of the BusinessDISTRICT NO. PROCESSED BY y and Professions Code,and m license is in full force and effect.ALI Power Apparatus&Large Appliances ,,qq-'- � ,�( Size&Type HP, KW, KVA, or KVAR• y ✓t✓ u License Number 4 Lic. Class6 Up.to 1 Incl. FINAL �p f I 19 Over 1 to 1.0 Incl. DATE 11 �(0 JUDATION O Contractor,o ^� Date❑ Over 10 to 50 Incl. FIBYNAL 11— LU I am exempt under Sec. Over 50 to 100 Inc: LU B.&P.C. for this reason Over 100 A 4 8 7j•2 A #A? Services, Swbd.,MCC&Panelboards Date: 0 -200 Amp. Under 600 V # 000'002 Signature o` 201 - 1000 Amp. Under 600 V I ( o'0,1 5;5 IF❑ Exemption for Reg. Maint. ElectOver 1000 Amp. or Over 600 V. 0.0 .0 5 _ SINGLE FAMILY Temp. Power Pole&Appurtenances 0 6 1 U HOME OWNER-BUILDER DECLARATION Sign with:One Branch Circuit , I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031,5, Business and Professions Code): ❑ I, as owner of the property, will do the work and the I Misc. Conduits&Conductors structure is not intended or offered for sate (Section Other See Complete Fee Schedule)- 7044, Business and Professions Code). TEMPORARY STA" W CONSTRUCTION LENDING AGENCY FIRE I hereby affirm that.there is a construction lending agency for I the performance of the work for which this permit is issued i PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). j PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE U �Q Lender's Address I certify that I have read this application and state that the TOTAL FEE S S 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 Bove ntioned propertyb foy—binsppectSxx'oyb purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE JVI � Signature of Permittee Date I, WORKERS'COMPENSATION DECLARATION � I��BI APPLICATION FOR E �ECTRICAL PERMIT l ereb�-nffirm that I have a certificate of consent to.self insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof(Sec. 3800, Lab. C.) Policy No. Company �. FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. F New Residential Bldgs. &Pools EACH NO. FEE 1 ADDRESS 5675 N. ROSEMEAD BLVD 1 &2-Famil S Ft. $ — $ I LOCALITY TEMPLE CITY Certified copy is filed with the county building inspec- y� q' NEAREST tion department. Multi-family Sq. Ft. — Residential Swimming Pools I CROSS ST. _ CiMPTER Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' IMAIL COMPENSATION INSURANCE I Outlets:.Rec Light Sw.— ADDRESS 9523 E. LAB TUNAS DRO .(This sectionj, Total No. Additional CITY �j'v�P�+' CITY Tel. No c7 .need not completed if the work Involved by First 20 286 -6)+82' the permit is for one hundred dollars($100)or less.) 4 I certify that in the performance of the work for which this I APPNCANTK permit.is issued, I shall notemploy any person in any manner i ! so as to become subject to the Work mpens ti Laws. Lighting Fixtures First 20 ADDRESS / Additional 6-13-85 Total No. CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP _ NOTICE TO APPLICANT: If, after=this Certificate of PERMIT Exemption, you should become subject to the Workers' Range_ Heater_D.W. _ I APPLICANT DALES ELECTRIC Compensation provisions of the Labor Code, you must forth- Oven —Dryer _W.M.— I ADDRESS P.O. .BOX 4.29 with comply with such provisions or this ,permit shall be Top — FAU —W..H. — deemed revoked. CITY Tel. IVo. • LICENSED CONTRACTORS DECLARATION Hood — Fan —Other— SAN GABRIEL 2 Dis — Room Air Cond. LICENSE OR Class. I hereby affirm that I am licensed under provisions of Chapter 9 p' I REG.NUMBER 2762.18 C_10 (commencing with Section 7000).of Division 3 of.the..Business DISTRICT NO.. PROCESSED BY and Professions Code;and my license is in full force and effect. Power Apparatus&Large.Appliances 0. rJ Size&Type HP, KW, KVA, or KVAR5.05 License Number 2/621 8 Lic. Class C�1 O Up to T Incl. FINALU Contractor Date Over 1 to 10 Incl. i DATE VALIDATION M I Over 10 to'50 Incl. I FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc, I BY B.BP,C, for this reason Over 1;00 tH iDaServices, Swbd., MCC&Panelboards ► Z te 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V I . ;2'2 2 9.6.A ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp, or Over 600 V I # 0 0 0 0 0 2 SINGLE FAMILY Temp,Power Pole&Appurtenances 'I o 0 1550 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License , r o o o 1 55010 Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): 06,20-85 IDMisc. Conduits&Conductors I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section OthgL(See Complete Fee Schedule)_ 7044, Business and Professions Code.). leM Orar CONSTRUCTION LENDING AGENCY Fireworks Stand I hereby affirm that there is a construction lending agency for f the performance of the work for which this permit is issued I PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). f PLAN CHECKING FEE Lender's Name I C3 j PERMIT ISSUING FEE Lender's Address I certify that 1 have read this application and state that the I TOTAL FEE above information is correct. I agree to comply with all County I ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon theovsft7b,led pro ty for inspection purposes. ' SEE REVERSE FOR EXPLANATORY LANGUAGE 6-13-85 'SignaiMm of Permittee Dote .A0'..'S COMPENSATION DECLARATION 7D�DS0639 DM(12-91) APPLICATION FOR ELECTRICAL PERMIT I herAdNfff"ir_m 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, i. BUILDING AND SAFETY DIV. copy Wof (Sec.3800 Lab.C.) Z poily2Compan FOR APPLICANT To FILL IN JOB � 4). ALCertified copy is hereby furnished. New Residential Bldgs.&Pools NO: EACH FEE ADDRESSLOCALITY' 1&12-Family,Sq.Ft. — $ $ Certified copy Is filed with the ounty building inspection NEAREST department. Multi-family Sq.Ft. CROSS ST. Date ZJ-1757_! Applican Residential Swimming Pools RADDRESS SESSOR AP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION ROM WORKE Outlets:Rec._Light Sw. WNER OR COMPENSATION INSURANCE ® RM NAME' ' (This section need not be completed if,the.work Involved by the First 20 permit is for one hundred doffers(570 0)or less:) Total No. Additional I.certify that in the performance of the work for which this permit �' ' 7�' Tel.No. is issued, I shall not employ any person in any manner so as toAN CHECK 'become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 PLICANT L ` Total No. Additional ADDRESS 9 27?2•_ Date 'Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP. �� ` AE 40 1Z NOTICE.TO.APPLICANT: If, after making,this,Certificate of CITY 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 jVtr• / provisions or this permit shall be deemed revoked. Power Apparatus&Large Appliances APPLICANTL -.LICENSED CONTRACTORS DECLARATION Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that Lam licensed under provisions of Chapter 9 �7Z (commencing with Section 7000)of Division 3 of the Business and Over 3 to 10 Incl.• CITY�� ' (T Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. f/N k \ (�Nor S��!`� I //9 '1 Over 50 to 100 Incl. LICENSE OR ER �L.! g class' d License Number'�`r;X 3 Lie.Class Over 100 DISTRICT NO. p PROCESSED BY Q Services,Swbd.,MCC&Panelboards j Z-�f�'�`� 0-399 Amp.Under 600 V 'FINAL 0 Ontractor Date DATE 1-_400-1000 Amp.Under 600 V 2-2Z, ,� I am exempt under Sec. VALIDATION V Over 1000 Amp.or Over 600 VIIIFINAL B.&P.C.for this reasonBRANCH CIRCUIT FEES BY i coi' Date: 1.5A,or 20A,120V,.Lighting or Recept. ;4 Z L. 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits ❑ 41 Or More Branch Circuits Exemption for Reg.Maint.Elect. 15A,20A,208V To 277V Lighting Br.Circuits rF SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION it O CTA— I hereby affirm that I am exempt from the Contractor's License Law 1 1 ., for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 3-70-4v1e,F• Code): Misc.Conduits&Conductors ITEMS I,as owner of the property,will do the work and the-structure .�,.�, -•-e .is not Intended or offered-for sale(Section 7044, Business Other(See Complete Fee Schedule) - ; TA} 3'I•-'_35 and'Professions Code). CHECK CONSTRUCTION LENDING AGENCY CHANGE arr I hereby affirm that there Is a construction lending agency for the S performance of the work for which this permit is issued(Sec. 3097, PERMIT FEE (Sub-Total) Civ.,C.) 1 PLAN CHECKING FEE 1_1 0 7131I 0C,IJ1 12 Lender's Name "'7-n., '`l3 Oe PERMIT ISSUING FEE 1p 7.171 25 Lender's Address 0 � 3 I certify that I have read this application and under penalty of purjury state TOTAL FEE 0 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 n action urpos . SEE REVERSE FOR EXPLANATORY LANGUAGE i SIGNATU OF PERMITTEE DATE { I � WORKERS'COMPENSATION DECLARATION 7BA663 1.0%81 r CE-806G ' ECTRICAL PERMIT {� I hereby affirm that I have a certificate of consent to self insure, APPLICATION FOREL � •• LI or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES r BUILDING AND SAFETY ' copy thereof(Sec.3800,Lab.C.) policyAld&O b3. Company sw* r-uM- - I FOR APPLICANT TO FILL IN ' JOB ❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS New Residential Bldgs.&Pools � 4 ' A. 1 &2-Family,Sq.Ft.' $ LOCALITY( — $ .. ❑ Certified copy is filed with the county building ine;ction _ NEAREST departmen Multi-family Sq.Ft. CROSS ST JA Date �' Applicaht. Residential Swimming Pools OWNER OR i ;. FIRM4NAME 0- CERTIFICATE OF EXEMPTION FRO WORKERS' f MAIL Outlets:Roo—Light_ Sw.— COMPENSATION INSURANCE I � ADDRESS}7� (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 CIT�� Tel.No. I certify that PLAN CHECK in the performance of the work for which this permit { APPUCANT 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 ' ) on i Total No. Additional ' CIT 1�. or Date Applicant Fixed Appliances Not Over 1 HP �' PERMIT' NOTICE TO APPLICANT: .if, after making this Certificate of i APPLICA $p Exemption,.you should become subject to the Workers'Compensatidn Range,_ Heater D.W. j provisions of the Labor.Code,you must forthwith comply with such j; Oven,_ Dryer_ W.M:_ ADDRESS"' provisions or this permit shall be deemed revoked.. Top _ FAU' _ W.H. _ CIV LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ , FJ + ID 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. i Power Apparatus&Large Appliances DISTRICT NO. PROCESV. }� /�� Size&Type HP,KW,KVA,or KVAR . p' Licens`�Number A LLica Class Up to 1 Incl. '• FINAL (8 � i►�tllr ,. Over-1 to 10 Incl. DATE (� ��V. ha VALIDATION Q G�`�o``�bf�ra �h3t Over 10 to 50 Incl. FINAL ;I� (�•� ❑ I am:exempt:under.Sec. . Over.50 to 100.Inc. c BY W Over 100' B.&P.C.for this reason er es,Sw6d.,MCC,&Panelboards Date: 200 Amp.Under 600 V Signature 201 - 'I OOO Amp.Under.600 V ❑ Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V SINGLE-FAMILY F Tempp,Power Pole A Appurtenances , HOME OWNER-BUILDER DECLARATION I Sign with One Branch Circuit /�/+ I hereby affirm that I om exempt from the Contractor's License Law ACCT.V for the following reason(Section 7031.5.;Business and Professions Additional Sign Branch Circuits 65 6 Code): I -•' Misc.Conduits&Conductors i 1 ITE ❑ '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) _ TOTAL . 65.610 ' and Professions Code): CONSTRUCTION LENDING AGENCY f '' f+, CHECK 65°60 I hereby'affirm that there is a construction lending agency for the CHANGE °00 ,performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) 3R 301 Civ.C.). �+ PLAN CHECKING FEE 0001 Lender's Name ��S 1 1 '13 PERMIT ISSUING FEE Eii :?.b11I Lender's Address �certify that I have read this application and state that the above ,I TOTAL FEE Lb information is correct.I agree.to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize .L. representatives of this County to enter upon the.above-mentioned 'property for in coon purposes. } SEE REVERSE FOR EXPLANATORY LANGUAGE J-A-- J 1400� i 7--2-0-c- S!4mure of Permitte C Date WORKS. 'COMPENSATION DECLARATION CE- 63 ,D.BI APPLICATION FOR ELECTRICAL .PERMIT I rFieiebjr affirm that I have a certificate of consent to self CE-8066 Ansure.0 a'"certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY if p sir ed copy thereof(Sec. 3800, Lab. C.) Gd oy Poli-y Np372-157'-'• Company FOR APPLICANT TO FILL IN JOB Certified,copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS ❑ $ _ $ LOCALITY Certified copy is filed with;the county buildinginspec-` 1 &2-Family, Sq. Ft. tion department. a Multi-family Sq. Ft. — NEARESTff 10--1Residential Swimming Pools CROSS ST. ,• Date 6o '� Applicant Lam':"°O ""-ax • OWNER OR //' C FIRM NAME lA• �IS. • CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets: Rec Light Sw._ .r � e, . First'20. � J� ADDRESS (This section need not.be completed if the work involved by Total No. Additional CITY Tel. No: + the permit is for one hundred dollars($.100)or less.) I. certify that in the performance of the work for which this PLAN CHECK permit is'issued, I shall not employ any person in any manner APPLICANTG. so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 �� ADDRESS Total No. Additional Date Applicant CITY Tel, N.W. -&V4765Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certificate of PERMIT Exemption, you should become subject to the Workers' Range_ Heater_D.W. APPLICANT JVWe?% k Compensation provisions of the Labor Code, you must forth- Oven _'Dryer —W.M. ADDRES c with comply with such provisions or this permit shall be Top _ FAU —W.H. pafe deemed revoked. Hood _ Fan _Other CITY Ida 72 LICENSED CONTRACTORS DECLARATION .$'li ./ LICENSE R Dis _ Room Air Cond. LICENSE affirm that I am licensed under provisions of Chapter 9 p' REG. NUMBER Class. (commencing with Section 7000)of.Division 3 of the Business'. DISTRICT NO. OC ED BY Com. and Professions Code.,and my license is in full force and effect. Power Apparatus&Large Appliances O „ �9 Size&Type HP, KW, KVA, or KVAR' c (7p C� Lice u �r// Lic. Class Up to 1 Incl. 'ri7-°° P FINAL --0� Over 1 to 10•Incl. 7 o v DATE VALIDATION Con r%F AN a 1P.. r con aY Date _V6 Over 10 to 50 Incl. FIN W I am exempt under Sec. Over 50 to 100 Inc. . BY .� n B.&P.C. for this reason Over 100 Z+ Services, Swbd., MCC&Ponelboards Date: 0 -200 Amp. Under 600 V a Signature 201 - 1.000 Amp. Under 600-V .3�d Oo ;0 5 6 a,l A ' ❑ Over 1000 Amp. or Over 600 V Exemption.for Reg. Maint. Elect. # 0 0 0 0 19 • f�i SINGLE FAMILY Temp. Power Pole&Appurtenances CD I 0-103,00 HOME OWNER-BUILDER DECLARATION Sign with One'Branch Circuit I hereby affirm that I am exempt from the Contractor's License o o z Low for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits .00 1 O.3O 0,= Professions Code): I Q-1 6-86 i86 El .I, as owner of the property, will do the work and the ' Misr. Conduits&Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ , 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for ;1 5 6 a 2 A the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) # o 0 0 0 0 2 (Sec. 3097,-Civ. C.). Lenders Name PLAN CHECKING FEE I ° 21 6 5 0 - PERMIT ISSUING FEE Lender's Address C o 0 2 1 65 Q v z I certify that I have read this application and state that the TOTAL FEE above information is correct. I agree to comply with all County I Q 16 8 6 rdinances and State laws regulating Electrical wiring, and h eby author' entatives of this County to enter upon th above entioned op ty for inspection purposes. / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permit Date WORKERS'COMPENSATION DECLARATION 7&46010/81 APPLICATIONFOR ELECTRICAL PERMIT �,6hereby affirmCE-806G that I have a certificate of consent to self CE-806G igsure,'bfcertific�gfe of Workers'-Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certifiea d copy thereof (Sec. 3800, Lab. C.1 Policy No Company i FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. 'FEE 1.}- Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY tion department. Multi-family Sq. Ft. — NEAREST L ^ CROSS ST. Residential Swimming Pools OWNER OR �N / /t��f ,N 1 .N! Date Applicant v FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS't Outlets: Rec Light Sw._ MAIL ^� /� CO.MFENSATION INSURANCE First 20 ADDRESS1TV1 (This section need not be completed If the work involved by Total No. Additional CITY �� Tel. No. the permit Is for one hundred dollars($100)or ass.) PLAN CHECK I certify that in the performance of the work f r which thi APPLICANT permit is issued; I shall not em any p i any mann so as to ecore subject to the rkers' .tion La Lighting Fixtures First 20 ADDRESS Additional Total No. CITY Tel. No. Date pplic Fixed Appliances Not Over 1 HP PERMIT p NOTICE T A�LICANT: If, after in is icate of APPLICANT r(°CfSI(�,� P Exemption, yo should become subj t To the Work Range_ Heater_D.W. _ ` 'Compensation provisions of the Labor C e, yyu must fo th- Oven —Dryer —W.M.— ADDRESS (l lz with comply with such provisions or th. rmit shall Top — FAU —W.H:— deemed revoked. Hood _Fan _Other_ CITY LA Tel. No.2sP3 r . LICENSED CONTRACTORS DECLARATION LICENSE OR 1 hereby affirm that I am licensed under provisions of Chapter9;. Disp. _ Room Air Cond. REG.NUMBER D Class "f(� } (commencing with Section 7000) of Division 3 offtcl' Bsiness ' DISTRICT NO. PROCESS Y ° d- Power Apparatus&Large Appliances i and Professions C ,an my license is in full forc effect. �^ �j O Size&Type HP, KW, KVA, or KVAR �/L�/ ® V License N er Lic. Class 0 Up to 1 Incl. FINAL O jl Over 1 to 10 Incl. DATE I VALID TION 1� Contractor P Date. Over 10 to 50 Incl. FINAL W InI am exempt under Sec. Over 50 to 100 Inc. BY W B.&P.C. for this reaso I Over 100 _ Z Date: Services,Swbd.,MCC&Panelboards ► ' 0 -200 Amp. Under 600 V Signature AIM201 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V Exemption for Reg. rit. Eect. SINGLE FAMILY Temp. Power Pole 8 Appurtenan4es ® ;P 3 5 3 2 A HOME OWNER-BUILDER DECLARAT Sign with One Branch Circuit I.hereby affirm that I am exempt from the Contractor's License # 0 0 0 0 0 2 Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits Professions Code): 10.0.30.50 a = I, as owner of the property, will do the work and the Misc. Conduits&Conductors o 0 0 3 Q 5 0 v structure is not intended -or offered for sale (Section Other See Com I�te Fee Schedule)_ 7044, Business and Professions Code). C E A.& o a 2 2—8 5 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 IJ Lender's Address I S5PPrtify that I hav read this application and state that the TOTAL FEE is f alio a infor, ation i correct. I , r to comply with all County o dnance St to laws citing Electrical wiring, and hereby a th r e resentativ sof this County to enter upon abov - en'o d propertyo.inspectio pur ses. SEE REVERSE FOR EXPLANATORY LANGUAGE , Signature o er 1 e Datil/ COUNTY OF LOS ANGELES TEMPLE C11'Y' # 05`c'_8 '" ELECT CAL_MMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS 8-9/04080032 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL 10: FEES PAID B IL "DDRESS�' TR: 3623 LT: 41 EMEAD—BF_ S ES ORINFORMATION MB R: FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 'E�ECROSS STREET: LAS TUNAS 5387-031-065 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY F1 120V, 15/20A BR CKTS 4.00 BR 69.60 TENANT: JX MOTORS, LT 3 HP 4.00 MOT 61.80 ISSUEO ON: PROCESSED BY: PLAN XPIRES ON: CHEVRON TOTAL FEES 159.15 04/08/97 TC 04/08/98 OWNER: TEL. N0: FINAL DATE FINAL B CODE: CHEVRON U S A INC (000) 000-0000- 1 1300 S. BEACH BL. LA HABRA, CA 90632 DESCRI TION OF WORK DISCONNECT & RECONNECT DISPENSOR , TANKS AND MONITORING SYSTEM DUE TO MODIFICATIONS TO CONTAINMENT TANKS APPLICANT: L. PETROLEUM BUSINESS SYSTEMS (714) 680-3885- SPECIAL CONDITIONS: CONTRACTOR: TEL. O: APPROVALS DATE INSPECTOR SIGNATURE PETROLEUM BUSINESS SYSTEMS (714) 680-3885- 251 IMPERIAL HWY STE 420 LIC. NO TEMPORARY POWER POLE FULLERTON CA 92635 674513 C10 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: E 0: U•ER GROUND LIC. NO: ROUGH CONDUIT sO ROUGH WIRING WAUN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508