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Home My Public Portal About5723 ROWLAND AVE_Electrical__ T _vl"� 78A8.68-CEB0g468 APPLICATION FOR ME& RICAL PERM COUNTY OF LOS ANGELES r DEPARTMENT BUILD NG AND SAFETY ENGINEER ER BUILDING n Lei�AQ JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS o� COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY ` NEAREST FOR APPLICANT TO FILL IN CROSS ST. ✓ NO. EACH FEE RECEPT.� S S OWNER MAIL LIGHT TOTAL FIRST 20 .2 ADDRESS SWITCH OVER 20 .10 CITY TEL. NO. PLAN CHECK LIGHTING TOTAL FIRST 20 APPLICANT FIXTURES OVER 20 .10 ADDRESS RANGE_DRYER_WTR.HTR._ CITY TEL. NO. STA..COOK_DISP.-F.A.U._ CONTRACTOR /- SPACE HTR. AIR COND. ADDRESS G CLOTHES WASH._DISHWASH._ CITY Ar TEL. NO. �f-3)0 FAN.-OTHER 1.00 LICENSE NO. lQ�7G CLASS.-C MOTORS,TRANSFORMERS RATING IND. HEATERS, ETC. HP. KW. KVA. 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SIZE & TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 0 - 1 1.00 ELECTRICAL WIRING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1 - 10 3.00 LICENSED AS REQUIRED BY .LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LE141U. OWNER OF, AND INTEND TO 10 - 50 5.00 RESIDE. IN, THE ABOVE DE SC .E RESIDENTIAL PROPERTY. 50 - 100 10.00 SIGNATURE d OF PERMITTEE V 100 - 500 15.00 DIST IT GR P ZON PR E GAS 0 TUBE, OR SIGN AND ONE CIRCUIT 3.00 CCD MARQUEE ADDITIONAL CIRCUITS 1.00y NOTES: SERVICE NOT OVER 600 VOLTS OR 200 AMP 1-1-00 00 f 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 PERMIT FEE (SUB TOTAL) WIRING. FIXTURES PLAN CHECK FEE (50% PERMIT FEE) 2POWER AUTHORIZED PERMIT ISSUING FEE 00 3 �� UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL TOTAL FEE JOSEPH ROOHAN SUPERVISI G ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDAT O ••GK M.O. CASH t . ?E BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE WORKERS'COMPENSATION DECLARATION CE-8066 10i81 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have o certificate of consent to self CE-806 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 ADDRESS Certified co is hereby furnished. EACH NO, FEE PY Y New Residential Bldgs. & Pools ❑ $ _ $ LOCALITY Certified copy is filed with the county building inspec- 1 8 2-family, Sq. Ft. tion department. Multi-family Sq. Ft. — NEAREST Residential Swimming Pools CROSS ST. Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw. MAIL COMPENSATION INSURANCE ADDRESS First 20 (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.) 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 ADDRESS ' Total No. Additional 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 with comply with such provisions or this permit shall be Top _ FAU —W.H. — deemed revoked. CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_ Disp. _ Room Air Cond. LICENSE OR Class. I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER (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 8 Large Appliances O Size & Type HP, KW, KVA, or KVAR u License Number Lic. Class U to 1 Incl. FINAL W Over 1 to 10 In . DATE LL cl VALIDATION Contractor Date Over 10 to 50 Incl. G>C F-1 FINAL I am exempt under Sec. Over 50 to 100 Inc. BY Q B.&P.C. for this reason Over 100 O Services, Swbd., MCC & Ponelboards pop. 0- Date: 0 - 200 Amp. Under 600 V W Signature 201 - 1000 Amp. Under 600 V +. F– ❑ Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect. K. s j w SINGLE FAMILY 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 Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and a t ((Professions Code): " L�.l. I, as owner of the property, will do the work and the Misc. Conduits&Conductors s. 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 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 .r• 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 authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. { SEE REVERSE FOR EXPLANATORY LANGUAGE r Signature of Permittee Date WORKERS'COMPENSATIONDECLARATION CE43066 (2.80) • APPLICATION FOR ELECTRICAL PERMIT ' CE-8.06 I hereby,affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof.(Sec.3800,Lab;C.) FOR APPLICANT TO FILL IN JOB ROWLAND' AVE.- 1, 31 02060762 EMP.01F WAUSAU o y o. Company NADDRESS 'New Residential Bldgs.&Pools EACH O. FEE Q Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY TEMPLE CITY Multi-family Sq. Ft. NEAREST ® Certified copy is filed with t county building inspec ' CROSS ST department. Residential Swimming Pools OWNER OF j� MICHELE Date Applicant FIRM NAME t Outlets: Rec.^Light—First MAIL ��M7�{� First 20 ADDRESS SAM. CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CITY Tel N986_3278 } COMPENSATION INSURANCE PLAN CHECK CL APPLICANT (This sectipn need not be completed if the work involved 0 by the permit is for one hundred dollars ($100) or less:) Lighting Fixtures First 20 ADDRESS Total No. Additional 0 I certify that in the performance of the work for Which this CITY Tel No. permit is issued, I shall'not em Fixed Appliances Not Over 1 HP p employ y an y person in any manner PERMIT TWE HCC so,as to become subject to the Workers'Compensation Laws. Range_Heater D.W._ APPLICANT Oven _ Dryer W.M. ADDRESS 20,34 N, PECK RD. Z. Date-'Applicant Top _ FAU "KW.H. e Hood — Fan _Other_ CITYF-T. MpNTpTel Nor _7g NOTICE TO APPLICANT: If, after making this Certificate of Disp. _Room Air Cond._ 2 50 LICENSE R Exemption, you should become subject to the Workers' REG.NUMBER Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PRO.0 SED'BY with comply with such provisions or this permit shall be Size&Type HP,.KW,KVA,or KVAR deemed revoked., Up to-1 Incl. FINAL 3 �Ip Over 1 to 1.0 Incl. 5 DATE LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl•. ( '-V�^ 1 VALIDATION I hereby affirm that I.am.licensed under provisions of Chapter Over 50 to 100 Inc. FINAL M ,r 9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 ness and Professions,Code, and my license is in full force and, BY effect. Services ' License Number 265094 Lic.Class C-�10 '• 0-200 Amp.Under 600 V 201-1000 Amp.Under 600 V Contractor TRANS H Date 10-.9.-80 Over 1000 Amp.or Over 600 V �a 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): Misc.Conduits&Conductors I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— g 2'5 4 3 A structure is not'intended or offered for sale (Section 7044,Business and Professions Code). t 0 0 0 0 0 2 CONSTRUCTION LENDING AGENCY I hereby affirm that there is.a construction lending agency 2 0 0 1 4,5 0 for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). PERMIT FEE (Sub-Total) 7 50 0 0 o 1 4,5 0.35, Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) fQ09-80 Lender's Address PERMIT ISSUING FEE 7 00 I certify that I have.read this application and state that the TOTAL FEE . 14 SO above information is correct.I agree to comply with all County ,ordinances and State laws regulating Electrical wiring, and -hereby a orize representativesof is County to enter upon mentioned property f pection p osea. „ SEE'REVERSE FOR EXPLANATORY-LANGUAGE J Signature of Permittee Date