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HomeMy Public PortalAbout6332 ROSEMEAD BLVD_Electrical__ � 3 76A688•CE808 7.88 •..� -m. APPLICATION FOR ELECTRIC PERMIT 1 COUNTY OF LOS ANGELES ` DEPARTMENT OF COUNTY ENGINEER BUILDING 6 2- JOHN Kf--<Cc•yv.r_ BUILDING AND SAFETY DIVISION - 3r� JOHN A. LAMBIE, COUNTY ENGINEER G. igleCASSATT D. GRIFFIN, 5UP'T OF BUILDING E •v.r FOR APPLICANT TO FILL IN NEAREST . EARESCROSS T. L U+^ G1 a v. PERNIIT FEES /� {- I T E M NUMBER EACH FEE OWNER G.%#q L Ap 'S !3V T T I 4° -A SBR�C 3 OUTLET r ` _ / LIGHT ,. RECEPT. SW. I $.1 $ �• _ ADDRESS `� 5 o S `�^�'6j LIGH ING FIXTURES �_ / .10 CITY'-7-Q w �e C.�F TEL. NO. ELEC. RANGES CLO. PERS ELECTRICIAN Ivlco SS G-el7s WATER H EATERS .50 ELEC.SPACE HTRS. DISHWASHERS ADDREASSa O Z AS. � I"QOss- CITY M C5 N 6Z.t V`✓'+ TEL. N0. �L-�Z{f0� STATE LL WASHERS STA. COOKING UNITS .25 LICENSE NO. MOTORS: OVER INC. H.P. 0— +/i .25 DISTRILQT NO. G OUP ZONE i PROCESSED BY � 1/2— z so INSPBtnON RECORD 2— 5 1.00 5— 15 1.50 Is— 50 2.50 50-2005.00 n//�� 6A SIGNS: NO. TRANS. L NO. LAMPS SERVICE 0-600V 1.00 SERVICE OVER 600V 5.00 - MISC. WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 TOTAL FEE $`l =� APPROVALS 1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES r NTY AND STATE OF FIXTURES CALIFORNIA OR THAT I A THE LEGAL WNER OF ABOVE POWER DESCRIBED RESIDENTIAL p//''''TI'Y. SIGN APEURERMITTEE '&4 C UTILITY CO.NOTIFIED y� � XWARTHUR C. V EIT. l`c�Jlci/ Moo CASK CASH SUPERVISING ELECTRICAL ENGINEER �`� 4226u; ��R30 2 A 2.00 DEC TION •WORKERS'that t I have a certificate cafe of corse 76A663 DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT O I hereby affirm that I have a certificate of consent to self cE eobG insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS or a certified copy thereof (Sec. 3800, Lob. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB �� ❑Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS (p C_ �J'ICa u� + t. ❑Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY75 Q tion department. Multi-family Sq. Ft. — NEAREST CROSS ST. O vli e–iU- Residential Swimming Pools Date Applicant WNER OR FFIIRM NAME M (Zilf� L Ga CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec L Light SW.— MAIL COMPENSATION INSURANCE j S ADDRESS 633-L DS HLI P-ID N—u (This section need not be completed if the work involved b l First 20 y C y Total No. CITY Tel. No. the permit is for one hundred dollars (;100)or less.) Additional � �.C- ' 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 Laws. Lighting Fixtures First 20 ✓G ADDRESS /� Additional CITY Tel. No. Total No._J Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT � Exemption, you should become subject to the Workers' Range— Heater—D.W. — APPLICATION C Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS D 1G �, u � with comply with such provisions or this permit shall be Top — FAU —W.H. — p deemed revoked. Hood — Fan —Other CITY M Tel. No LICENSED CONTRACTORS DECLARATION Dis — Room Air Cond. LICENSE OR (� I hereby affirm that I am licensed under provisions of Chapter 9 p REG. NUMBER 363 /Sb Class. 0 (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. P SED BY and Professions Code,and my license is in full force and effect. Size &Type HP, KW, KVA, or KVAR 7 T> Q License Number Lic. Class Up to 1 Incl. FINAL U Contractor Date —� Over 1 to 10 Incl. 1 DATE VALIDATION 0 ❑ Over 10 to 50 Incl. NAL ~ I am exempt under Sec. Over 50 to 100 Inc. FIFIY W B.&P.C. for this reason Over 100 d i Date: Services, Swbd., MCC & Panelboards ® / Z 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 HOME OWNER-BUILDER DECLARATION Temp. Power Pole &Appurtenances 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): Ell, 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). �.6 A CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for #.0 0.0 0 0 2 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). 'I, °.° 3 3 2 5 PLAN CHECKING FEE Lender's Name ° ° ° 3 3 2 5 Lender's Address PERMIT ISSUING FEE 008. 18-88 ✓ I certify that I have read this application and state that the TOTAL FEE 3-3 Atli 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 Signature of Permittee Date , ©s WORKERS'COMPENSATION DECLARATION 76- M10/81 APPLICATION FOR ELECTRICAL PERMIT {� I hereby affirm that I have a certificate of consent to self insure, CE-806G LI or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec. 3800,Lab. C.) 34 Policy No. - Company f`'°'� FOR APPLICANT TO FILL'IN JOB Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE. ADDRESS 1 & 2-Family, S Ft. $ — $ LOCALITY Certified copy is filed with the county building inspection y q NEAREST C department. Q� Multi-family Sq. Ft. CROSS ST. / (y Date Z� pfd Applicant, ✓ Residential Swimming Pools OWNER CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec— Light Sw. MAIL p 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 CITYC�PLAN CHECK Tel.No. ?3 l vL �y I certify that in the performance of the work for which this permit APPLICANT hev is issued, I shall not employ any person in any manner so as to �j become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS ( 7_3t,44y "rv� Y S Total No. Additional CITY -T"' -� ,�l4 w Tel.N , Date Applicant Fixed Appliances Not Over 1 HP / IT 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._ ADDRES /'Z: 'S5 provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. _ CITY Tel.No '�� 7 J LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR Disp. Room Air Cond. REG.NUMBER �Tl5 & Class. q(commencing with Section 7000) of Division 3 of the Business and Professions Code,and my license is in full force and effect. DISTRICT NO. PROC S D BY Power Apparatus& Large Appliances Size& Type HP,KW,KVA,or KVAR e d License Number Lic.Class ^� Y L Up to 1 Inc]. FINAL U Contractor ft f e �/ " '� Date 2 J'�p Over 1 to 10 Incl. DAT VALIDATION El Over 10 to 50 Incl. FINAL U I am exempt under Sec. Over 50 to 100 Inc. BY :s BAP.C.for this reason Over 100 3-1307 v'=, i Services,Swbd.,MCC& Panelboards 1.ITEMS, Z Date: 0- 200 Amp.Under 600 V Signature 201 - 1000 Amp.Under 600 V ® TOTAL 33 =00 ❑ Over 1000 Amp. or Over 600 V �.� 33.!I�; Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole& Appurtenances CHANGE .00 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits for the followingreason Section 7031.5, Business and Professions i� r Code): ( W000-0f 10 3 7/'X!4/?(! Misc.Conduits & Conductors 2026 1 Aid 10 a 49 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). 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 Address ,�• y 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 "Si at emit ee Date