HomeMy Public PortalAbout5703 ROWLAND AVE_Electrical__ 76A663-CE806,9-67 APPLICATION FOR ELECTRICAL PERMIT /J
~ COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS Q
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. Las Tunas
NO. EACH FEE
$ $ OWNER Ho RoofRECEPT._ MAIL
LIGHT TOTAL FIRST 20 .20 ADDRESS5703 Rowland
SWITCH_ OVER 20 .10 CITY Temple city TEL. NO. 2-5
LIGHTING ITOTAL, FIRST 20 .20 CONTRACTOR p i 'j
FIXTURES OVER 20 .10 ADDRESS 10920 E. Grand.
RANGE—DRYER—WTR.HTR.— CITY Temnlp rit TEL. NO.
STA.COOK_DISP.—F.A.U._ LICENSE NO. 2118
SPACE HTR. AIR COND. 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
CLOTHES WASH._DISHWAS H._ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING.
FAN-OTHER 1.00 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
MOTORS,TRANSFORMERS RATINGCALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
IND. HEATERS, ETC. HP. KW. KVA. RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY.
SIZE & TYPE OVER TO SIGNATURE
0 - 1 1.00 C0 PERMITTEE
1 - 10 3.00 DISTJS.CTnNO. GRaUP ZONE P 40 ESSED B 0V
10 - 50 5.00 • / .09
O
50 - 100 10.00 NOTES: F-
W
100 - 500 15.00 CS.
N
TUBE, A [SIGN AND ONE CIRCUIT 3.00MARQUEE DDITIONAL CIRCUITS 1.00
SERVICE NOT OVER 600 VOI3S-OA 200 AMP 2.00
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP SERVICE, POLE, &APPURTENANCES 3.00
APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
• UNDERSLAB WORK
ROUGH CONDUIT V !
WIRING i
ISSUING FEE 2.00
FIXTURES
SUPPLEMENTARY ISSUING FEE 1.00
POWER AUTHORIZED
PERMIT FEE UTILITYCO.NOTIFIED
PLAN CHECK FEE (50% PERMIT FEE) FINAL
TOTAL FEE JOSEPH C. ROOHAN
SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIOI(::: ml
CK. M.O. CASH
.Ao 7 4 2 a -NOV 26 2 D 4.00- a
-E BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
WORKERS'COMPENSATION DECLARATION E-BOGG (2.80)
CE-806APPLICATION FOR ELECTRICAL PERMIT
tb C
jl`hereby'affirm that I have a certificate, of consent to self COUNTY OF LOS ANGELES ND SAFETY
insure,or a certificate of Workers'Compensation Insurance,or '
a certified copy th eof(Sec.3800,. ab.C.)
31_33_al, (JS.�N los FOR APPLICANT TO FILL IN JOB
Policy N Company , a
New Residential Bldgs.&Pools EACH NO. FE ADDRESS d 3
Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITYE-.Ake C-1'Nl
Multi-family Sq.Ft. NEAREST
Certified copy is filed with the c. ui ng i e on CROSS ST t�1 r7
de artment. Residential Swimming Pools .OWNER OR
p c
RM NAME
14 PL �S 4N `(IV) 0
DafeJ Vu Applic Outlets: Re .._,_Light Sw.3
0' MAIL , �p ��'
First 20 ADDRESS (y
CERT OF E MPTION FROM O ERS' Total No. Additional CITY• APLa Gv%f Tel N $' -
COMPENS .TION INSURANC .
+ PLAN CHECK /� �^C. tl
PPLICANT' FU I� o_&$J3r O
(This section need not be completed if the work involved V
Lighting Fixtures First 20
by the permit is for -one hundred dollars ($100) or less.). Total No. ADDRESS1&,1d4
� AdditionalO
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITYJPZ(dAfjf //7 Tel No. a—116 R
permit is issued, I shall not employ any person In any manner PERMIT .p� �+ �`� � W
so as to become subject to the Workers'Compensation Laws. Range_Heater.D.W._ APPLICANT 2ct+ F �,a 0113 t a
Oven _ Dryer_W.M._ ADDRESS' Iu& p12dU! (� ti1a�A,� U)
Date Applicant Top _ FAU _W.H..._. CITY kU41/jDME 011l66.Tel No. &.—�
Hood _ Fan —Other
NOTICE TO APPLICANT: If, after making this Certificate of Disp. _Room Air Cond. LICENSE OR
Exemption, you should become subject .to the Workers' REG.NUMBER q^ p 0. Class I�
Compensation provisions of the )abor Code, you must:forth- Power Apparatus&Large Appliances DISTRICT NO. PROCE E.D BY
with comply with such provisions or this permit shall be Size&Type HP,KW,KVA,or K.VAR
deemed revoked. Up to 1 Incl.
�j
FINAL I
I LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE VALIDATION.
Over 10 to 50 Incl.
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-
ness,•and Professions Code,and my license is in full force and
effect. Services
ense Number �Lk.Class ^ 0-200 Amp.Under 600 V A
.r,,G�ffP �l 201-1000 Amp.Under 600 V
ontractor Date Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appu'rtenances
I hereby affirm that I am exempt from the Contractor's Sign with One Branch.Circuit t , 0 1 3 A
License Law for the following reason (Section 7031'.5, Busi- Additional Sign Branch Circuits
Hess and Professions Code):•
a,o o a a 2
Misc.Conduits&Conductors a c
`I1 as owner of the property, will do the work and the Other,(See Complete Fee Schedule)— 2 2 55 0'0
Structure is not intended or offered for sale (Section ^ ,- y
71044,Business and Professions Code). o a o G, G r!c)
CONSTRUCTION LENDING AGENCY 1 0-81
I her affirm that there is a construction lending.agency, '
for the,performance of the work for,which this permit is PERIV.IT FEE (Sub-Total)• `
issued i(Sec.3097,.Civ.C.).
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) -
I
-Lender's Address PERMIT ISSUING FEE
I certify that I have read this application and state that the TOTAL FEE +
above.informati. n is correct.I agree to comply with all County ;
ordinances- so State laws regu ting Electrical wiring, and _
hereby aulb6ri esenta "Ce f this.County' enter upon
the abov me pro rty insp ction pur ses.
SEE'REVERSE FOR EXPLANATORY LANGUAGE
Signa ure of Pe. tte ate '