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TSA02 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
• DEPARTMENT OF COUNTY ENGINEERBUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OR BUILD IND LOCALITY city
NEAREST
FOR APPUCA O FIL CROSS ST
RECEPr Z1 TOTAL No EACH FE[
OUTLETS FIRST 20 $20 t (` OWNER abam
LIGHT 1. MAIL
SWITCH 11 41 OVFR 20 21 10 Z l0 ADDRESS
TOTAL CITY TEL NO
LIGHTING p FiRei20 9 IID 1 8D
FIXTURES 9 ADD'{. 10 ELECTRICIAN
OV R 2D
EANGEE CIA ORTOtB WTR WAS ?Do ADDRESS 8940 3. Valley Blvd,
p 1.
CAIN DISP STA COOK CITY Rosemead TEL NO At 8-41 1
DISKWASIH ALTO W"N 3 STATE
EPACE NIRS 1 STA APP (VR M F MN( ) 1 SO 1 LICENSE NO 1 1
Mg
MOTORS' ovER NOT ovu HP DI ICT NO GROUP 86
AZO E P ED BY
O 1 100 • �
I — a 150 INSPECTION RECORD
II B •Ir 100 raI '
nm ,
111.
e tG 250 a
O
15 So 300 V
SO 100 Soo
SIGNS NO TRANR
NO LAM"
6
M H
SERVICE O SOOV Nm ovEw 200A 100 1 W Z
SERVICE D SDOV OVER 200 A 2DID
SERVICE OVER SOOV 5040
MISC
PERMIT ISSUING PEE 20011 2 11
SUPPLEMENTARY PERMIT ISSUING FEE tool I 1
TOTAL FEE s 12 1 4WD
I HENmY ACKNOWLEDGE THAT 1 HAVE READ THIS AFPLICATJON APPROVALS Vw DATE O
INE O ' I E
AHD RATE THAT THE ABOVE a CORRECT AND AGRo TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCV AND RATE LAWR REGULATING
11"CTIOCAL WIRING WIRING14 IK
1 HEREOY CERTIFY THAT I AM PROPERLY REGIST[IQD AND/OR
LICENSED AS IROUIREA GY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DuaHIBEo IanotNTl oPERrr POWER
SIGNATURE UTILITYCO NOTIPI D
OF PBRMITTB ���
FINAL
--VALIDATION A HUS C VE
AL]
IX MO GSH SUPERVISING ELECTRICAL ENGINEER
L'I�o 7 2 4 2 t; JUL 9 2 D 1 2.4 0, €'
76A669A-CE&DBA &/T2 APPL TIS -IZN. OR ELE RICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGIHCROSSST
BUILDING
BUILDING AND SAFETY DIVISIADDRESS ,3 q µ„
LOCALITY
NEAREST
FOR APPLICANT TO FILL OUTLETS NOWNER �1RECEPTSMAIL
LIGHT_ TOTAL FIRST 20ADDRESS W
SWITCH_
OVER 20 CITY C �. TEL NO
PLAN CHECK
FIRST 20 APPLICANT
LIGHTING i TOTAL d
FIXTURES 1( _19' OVER 20 AGGRESS
RESIDENTIAL APPLIANCES CITY TEL NO
RANGE—DRYER WTR HTR_ PERMIT
APPLICANT
STA COOK_DISP _F A U _ ADDRESS
SPACE HTR AIR GOND CITY TEL NO
CLOTHES WASH DISHWASH _ LICENSE NO CLASS
FAN_OTHER 1 HEREBY ACI(MOW LEOOE THAT NAVE HEAD THIS APPLICATION
AND !TATE TXAT THE ABOVE IS CORRECT AND AGREE TO COMPLY C
MOTORS TRANSFORMER! "TING WITH ALL COUNTY ORDINANCES AND !TATE LAWS REGULATING [)
IND HEATERS ETC HP NW FVA ELECTRICAL WIRING
912E & TYPE OVER TO
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AMD/OR
D — 1 LICENSED A9 REQUIRED By LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT AM THE LEGAL OWNER OF AND INTEND TO Lj.l
1 — 10 REIIOE IN THE ABOVE DESCRIPED RESIDENTIAL PRO ERTY wZ+yd
10 - $0 SIGNATURE
OF PERMITTEE
50 - 100
DISTRICToNO IttASS ZONE P O ESSED BY
100 - Soo (J L
SIGN GAS SIGN AND ONE CIRCUIT NOTES
TUBE OR
MARQUEE ADDITIONAL CIRCUITS
SERVI CENOTOVER 600 VOLTS OR 200 AMP
SERVICE OVER 600 VOLTS OR200AMP APPROVAL! DATE INSPECT01PS BKDLATURE
TEMP POWER POLE
TEMP SERVICE,POLE &APPURTENANCES
UNDERSLAB WORK
TEMP LIGHT OR RECEPT SYSTEM
ROUGH CONDIUT
WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (SUB TOTAL)
UTILITY CO NOTI FIEO
PLAN CHECK FEE
PERMIT ISSUING FEE FINAL D—�� �Z�j
TOTAL FEE
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION cX M D CASH
692�1MT 14 2 D 6.10A`z
1
COUNTY OF LOS ANGELES TEMPLE CITY p 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0502030017
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID ftt:5 PAID BUILDING ADDRESS
ON FILE 5335 SULTANA AV
FEE DESCRIPTION. QUANTITY UOM AMOUDIT: TEMP CA 917803050
ASSESSOR INFORMATION NUMBER: NEAREST CRDSS STREET. OLIVE
5388-006-017
Al PERMIT ISSAINCE FEE 27 75 THOMAS PAGE: 596 GRID: H4 LOCALITY. TEMPLE CITY, C
F1 12OV, 15/20A BR CKTS 1.00 BR 17 25
TENANT: F2 208, 277V LGT BR CKT - 1.00 BR 27 30 ISSUED ON PROCESSED BY PLAN BY EKPIRES ON
G1 OUTLETS-LGT,SW RECP 2.00 OUT 3 90 02/03/05 JK 08/02/05
G2 LIGHTING FIXTaES 1.00 LGT 1.95
OWNER: TEL. NO HA FAU LESS 3HP 1.00 FAU 10.95
COFFEY, KARREN (626) 285-9455- JB AC UNITS +3.10HP 1.00 AC 19.65 V
5335 SULTANA AV LB 200 AMP PANELS, MCC 1.00 PAN 38.85
TERP 917803050 TOTAL FEES 147.60 utscRLPTiON OF WORK
UPGRADE SERVICE TO 200 AMPS AND ELECTRICAL FOR HVAC
SYSTEM
APPLICANT TEL NO:
SAME AS OWNERCONTRACTOR. APPROVALS DATE INSPECTOR SIGNATURE
-
SPECIAL CONDITIONS
SAME AS OWNER -
LIC. NO TEMPORARY POWER POLE
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER TEL. NO' UFER GROUND
LIC. N0: ROUGH CONDUIT
ROUGH WIRING
MAIN WATER LINE
PLASTIC Y/N METAL YIN
UTILITY COMPANY NDTITM
REPORT ID DPR265 ROUTE TO: BSO508