The URL can be used to link to this page

Home My Public Portal About6011-6015 ROSEMEAD BLVD_Electrical__ 7GA663-CESOB 10/72 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER 1013 BUILDING AND SAFETY DIVISION ADDRESS LOCALITY t.. C, NEAREST FOR APPLICANT TO FILL IN CROSS ST. L: M 0 , OUTLETS NO. EACH FEE OWNER OR aa-- ! FIRM NAME W t RECEPT.� $ 5 MAIL ^] i 'LIGHT TOTAL FIRST 20 25 ADDRESS / .5 c IM V Q+s tet R-A- SWITCH OVER 20 to CITY dL Q TEL. NO. PLAN CHECK LIGHTING 1FIRST 20 25 APPLICANT )} TOTAL ADDRESS FIXTURES OVER 20 1p RESIDENTIAL APPLIANCES CITY TEL. NO. PERMIT RANGE DRYER_WTR. HTR._ APPLICANT C. STA. COOK DISP. F.A.U. ADDRESS111 0 (r oIJ SPACE HTR. AIR COND. CITY a U 6jj TEL. N0. CLOTHES WASH. DISHWASH. LICENSE OR CLASS. REG. NUMBER FAN OTHER 1.00 1 HENEBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING. S1ZE & TYPE OVER TO I HEREBY CERTIFY TH AM PROPERLY REG TE ED AND/OR 0 — 1 100 LICENSED AS REQUIRE Y L S ANGELES COUNT STATE OF CALIFORNIA OR THAI I A HE EG AL,/ OHNE TN ABOVE 1 — 10 300 OESf.RIf ED SIDEN 1 ROP TY /f/i/ O PERMITEE C.3 10 - 50 5.001 SIGNATUR Cr O 50 - 100 10.00 DISTRICT N0. EO BY t3 V I N W 100 - 500 15.00 '5—, (507! SIGN. GAS SIGN AND ONE CIRCUIT 5.00 APPROVALSL/ DATE INSPEC SSIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE SERVICE NOTOVER 600 VOLTS OR 200 AMP 3.00 Sar/ UNDERSLAB WORK SERVICEOVER 600 VOLTS OR 200AMP 10.00 ROUGH CONDUIT TEMP SERVICE,POLE, &APPURTENANCES 5.00 WIRING TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED UTILITY CO. NOTIFIED FINAL ? PERMIT FEE (SUB TOTAL) NOTES: PLAN CHECK FEE PERMIT ISSUING FEE 3.00 _31U TOTAL FEE 9-s-0 PLAN CHECK VALIDATION CK, M. CASH PERMIT VALIDATION CK. M.O. CASH 0 6.5 0 ,&r- SEE 0r„SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE WgRKFPS'COMPENSATION DECLARATION 20AD19DPW 3/87 APPLICATIONFOR ELECTRICAL PERMIT •I '�rel�yIll,fin that I have a certificate of consent to self 7E_8M CE-806G I1 `insJlre, .1 a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS L or a certified coy thereof(Sec. 3800, Lob. C.) Policy No Company TCi C ^� FOR APPLICANT TO FILL IN JOB ` ❑Certi ied c py i ereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS 06 ❑Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ —is LOCALITY tion departme �� Multi-family Sq. Ft. / l , Residential Swimming Pools CR SE SpR Date l4( Applicant- ✓ I L—� FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ AMAIL DDRESS I COMPENSATION INSURANCE (This section need not be completed If the work involved by Total No. AddiFirst tional CITY Tel. No,.J �— the permit is for one hundred dollars($100)or loss.) PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation s. Lighting Fixtures First 20 ADDRESS / Additional Date—A//O/ Applicant ! v Total No. CITY T o. NOTICE h6 A PLICANT: If, after making this Certificate kf Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Work s' Range— Heater—D.W. APPLICATION Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS with comply with such provisions or this permit shall be ITop — FAU —W.H. — deemed revoked. Hood — Fan —Other— CITY Tel No. LICENSED CONTRACTORS DECLARATION LICENSE OR — I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG.NUMBER Class. (commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. PROCESSED a IL Professions Code,and my license is in full force and effect. Size&Type HP, KW, KVA, or KVAR —, O License Number Lic. Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DAT V ID ION Ir Contractor Date Over 10 to 50 Incl. FIN O ❑ I am exempt under Sec. Over 50 to 100 Inc. BY 7 8 i A LU B.&P.C. for this reason Over 100 1? 0 0 0 0 o L a- Date: Services, Swbd., MCC&Panelboards Z 0-200 Amp. Under 600 V ; 5. v Signature 201 - 1000 Amp. Under 600 V ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Mainf. Elect. SINGLE FAMILY T=Po-erAppurtenances 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 Additional Sign Branch Circuits Profess' ns 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). 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.). J `/\ PLAN CHECKING FEE Lender's Name CI Lender's Address, A-��, ScCJ" / 1H PERMIT ISSUING FEE (J V- / 6 � � 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 authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ( �L/1 1 L=gEz 6/V XL '47d! Signature of Permittee Date 1,wm I at I COMPENSATION DECLARATION CE806G'� /81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm yat have a certificate of consent to self insure, - or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec.3800,Lab.C.) [� ,Q JOB Policy No. Company FOR AP LICANT FILL IN ADDRESS Ste' i[J Certified copy is hereby furnished. New Residential Bldgs.& EACH NO. FEE ❑ 1 & 2-Family,Sq.Ft. $ — $ LOCALITY /P Certified copy is filed with the county building inspection department. Multi-family Sq.Ft. NEAREST CROSS ST. Date Applicant Residential Swimming Pools CROSS T. FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets:Rec—Light — t 2 — ADDRESS This section need not be completed if the work involved by the First 20 ( P CITY Tel.No. permit is for-one hundred dollars($100)or less.) Total No. Additional G14ti1 ,/�� I certify that in the performance of the work fo which this permit PLAN CHECK Is issued, I shall not employ an APPLICANT p y y person in a manner so to become subject to the Workers'Compensati aws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel.No. Date.' Applicant Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, after making this Certific of PERMIT Exemption,you should become subject to the Workers'Compensation Range— Heater— D.W. — APPLICANT provisions of the Labor Code,you must forthwith comply with such Oven — Dryer— W.M.— ADDRESS provisions or this permit shall be deemed revoked. Top — FAU — W.H. — LICENSED CONTRACTORS DECLARATIONCITY i S�,2 Tel,No. Hood — Fan Other— 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. Professions Code,and my license is in full force and effect. DISTRICT NO. PROCESSED Y > Power Apparatus&Large Appliances r�j nwel Size&Type HP,KW,KVA,or KVAR /r V D.C9License Number Lip.Class Up to 1 Incl. FINAL Over 1 to 10 Incl. DATE®r / Qom' ContractorZfi ��g�..te Over 10 to 50 Incl. VA ID TION O ❑ FINAL I am exempt under Sec. Over 50 to 100 Inc. BY W BAP.C.for this reason Over 100 N Services,Swbd.,MCC&Panelboards Date: 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V ❑ Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ;3. 1 A I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits .. for the following reason(Section 7031.5,Business and Professions ; v 0 o o u2 Code): Misc.Conduits&Conductors i c o 9 1, '-4 El I,as owner of the property,will do the work and the structure See Complete is not intended or offered for sale (Section 7044, Business Other( Fee Schedule) — ® c o c �,.r(j and Professions Code). CONSTRUCTION LENDING AGENCY J ;• ,•- 1 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 So 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 representativo of this Count o enter upon the above-mentioned property fo spection r SEE REVERSE FOR EXPLANATORY LANGUAGE C,ftnature of Permittee VDate /� ry y WORKERS'COMPENSATION DECLARATION 78A863 10/81 APPLICATION PPLIC/iTION FOR ELECTRICAL P ` 1Y 9 I hereby affirm Khat I have a certificate of consent to self Insure, CE-808G /"1r i�/^�1 A V t+ AP 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 ❑ AV EACH NO. FEE ADDRESS r Certified copy is hereby furnished. New Residential Bldgs.& ❑ 1 &2-Family,Sq.Ft� $ — $ LOCALITY Certified copy is filed with the county building inspection NEAREST department. Multi-family Sq.Ft. CROSS ST. Date Applicant Residential Swimming Pools OWNER OR a, FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL ��/ COMPENSATION INSURANCE Outlets:Rao— g — — ADDRESS 00 (This section need not be completed If the work involved by the Firstt 2 20 q permit is for one hundred dollars($100)or less.) Total No. Additional CITY , P� Tel.No. HECK I certify that in the performance of the work for which this permit PLAN APPLICANT is issued, I shall not employ any person in any nner so as tD become subject to the Workers'Compensation L Lighting Fixtures First 20 ADDRESS � Additional Total No. CITY Tel.No. Date —jaApplicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT. Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. _ provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. CITY % el.No. LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Room Air Cond. RELICG.N OR Class: (commencing with Section 7000)of Division 3 of the Business and REG.NUMBER 7_ Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. I, PROCESSED U Size& Type HP,KW,KVA,or KVAR 0 License Number Lic.Class G Up to 1 Incl. FINAL ` 0 Over,1 to 10 Incl. DATE r VAL •ATION Q Contractor 4 Date Over 10 to 50 Incl. FINA V ❑ I am exempt under Sec. Over 50 to 100 Inc. B LLI Over 100 B.&P.C.for this reason Services,Swbd.,MCC&Panelboards Date: 0-200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V ❑ Exemption for Reg.Maint,Elect. Over 1000 Amp.or Over 600 V SINGLE FAMILY Temp.Power Pole&Appurtenances 13 3,2 A HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ; 0 0 0 0 0 2 1 hereby affirm that I am exempt from.the Contractor's License Law Additional Sign Branch Circuits for the following reason(Section 7031.5,Business and Professions I 0 o39.62 Code): ❑ Misc.Conduits&Conductors 0 0 0 69.6 2 I,as owner of the property,will do the work and the structure l h F S Other(See Complete Fee Schedule) _ is not intended or offered for sale (Section 7044, Business G I 5-88 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 Lender's Address 1 certify that I have read this application and state that the above TOTAL FEE r information is correct.I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representati s of this County to enter upon the above-mentioned property f inspection poses. SEE REVERSE FOR EXPLANATORY LANGUAGE � Signature of Permittee I Date