HomeMy Public PortalAbout4335 TEMPLE CITY BLVD_Electrical__ 70Aeu
DEe VA 395 APPLICATtPN FOR ELECTRIC PERMIT 1
DIMON OF BUILDING SAFETY _
Deportment of Counts EnglaiNa
County OZ LOS Anes BUILDING
WM J FO COUNTY NGINRER ADDRESS
C:AS•ATT D GRIFFIN eu.roF eu1LGINoOr
LOCALITY
FOR APPLICANTPFTO FILL INPERNEAREST
EES
CR088 8T
NUMBER EACH FEE
LIGHT OUTLETS OWNER
RECEPTACLES MAIL
ADDRESS
WALL SWITCHES -
TOTALOUTLETS 54 • ITrO
ELEC RANGES 25 ELECTRICIAN
_ELEC HEATERS 2S ADDRE88
KW EA CITY rOiC- TEL N
FIXTURES S LICENSE NO
NUMBER OF LIGHT CIRCUITS
DISTRICTJO GROUP AUPY FOR INnecr mK
NUMBER OF RECEPTACLE CIRCUITS ✓!. 2
MOTORS
NuMe6R HORSEPOWER FEE INSPECTION RECORD
NEW MVI, HP QV.. INc "CH
•LEGG 8 29
2 00
S .3 2 S 100 Op
3 IS 1 SO
16 SO 250
e0 200 500
f� Vw
MISC
NO SIGNS - NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING •100 O
FIXTURES •t 00
SUPPLEMENTARY SO APPROVALS
TOTAL FEE • O DATE INSPECTOR S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT
AMD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND "ATE LAWS REGULATING WIRING I em
ELECTRICAL WIRING
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THA 1 AN THE LEGAL 0 NE OF THE ABOVE POWER
DESCRIBED RESIDENT PRrR
SIGNATURE
(L UTILITY CO NOTIFIED
OF PERMITTfi FINAL
WILLIAM J FbrX. COUNTY ENGINEER VALIDATION A C VEIT,CHIEF ELRCT.INSPECTOR
UiLO2008Zi JIM 18 2 450 0
Gea6AB Bl APPLICATION FOR ELECTRIC PERMIT I
DIVISION OF BUILDING AI►� SAFEfY
Dayortmaut of County En�lnear
Comty of Loa Raqelea BUILDING S
WM J FOX COUNTY ENGINKER ADORESg
CASSATT D GRIFFIN SUP T OP BUILDING t /J
LOCALITY (ate
FOR APPLICANT TO FILL IN NEAREST
PERNIIT FM NEAREST ST
NUMBER EACH FEE 1
����
LIGHT OUTLHTB OWNER
RECEPTACLES MAIL `
ADDRESS
WALL SWITCHES - — - -
TOTALOUTLETS S
ELEC RANGES 2N ELECTRICIAN
ELEC HEATERS 2S ADDREfiB
NW EA CITY 1welof TEL NO
FIXTURES E (CENSE N
NUMBER OF LIGHT CIRCUITS
DISTRICT NO GROUP ZONE euor FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS ✓
MOTORS J
NUMBER HORSEPOWER FEE INSPECTION RECORD
N¢W MYy HP Ho INC EACH
/ Ih e LRRG S 2E
2 So
2 S too
S 15 1130
IS SO 250
SO 200 Soo
MISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING gl OO
FIXTURES 41 00
SUPPLEMENTARY BO APPROVALS
TOTAL FEES DATE INSPECTOR S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APP ICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COYPLT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING t ZS
ELECTRICAL WINING
1 HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR FIXTURES '
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWN eR OF T E ABOVE POWER
DESCRIBED RESIDENT PROPE TY
SIGNATUREUTILITY CO NOTIFIED
OF PERMITTEE INAL 1 '7
WILLIAM J F4).COUNTY ENGINEER VALIDATION A C VEIT.GHIEa ELLE= INYPECTOR
ro xcv8
p21 90A JM24 2 1 o6
�p _ m
ION
L WORKERS have
a certificate
of consent
to 7aA993 10,61 APPLICATION FOR ELECTRICAL PERMIT {�
Ip ee 66S L J
I hereby affirm that I have a ceNfcate of consent to self assure
or a certificate at Workers Compensation Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec 3800"ab C)
Policy No Company FOR APPLICANT TO FILL IN JOB �j �• R/
❑ Certified copy is hereby funnsFed _ New Residential Bldgs d Pods EACH NO FEE_ ADDRESS ,7 C?
❑ Certified copy Is filed with the county bukhrg inspection 1 8 2-Family Sq Ft $ — $ LOCAUTY
department Multi-family Sq Ft NEAREST
CROSS STDate Applicant Residential Swimming Peale OWNER OR • , ksA
FIRM NAME bvwsere D i
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec_ Light Sw MNL
COMPENSATION INSURANCE ADDRESS loweeL A
(TMs section need not be completed d the work Involved try the First 20
permit is for one hundred dollars ($100)or lase) Total No Additional - CITY Tel No
I certify that in the performance of the work for which this permit CIA
'APPLtt'.AIJT
rs Issued I shell not empty are person in any manner so as N
become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS
Total No Additional CITY Tel No
Date Applicant
NOTICE TO APPLICANT If after making this Certtioate of Fixed Appliances Net Over 1 HP PERNLT
Exemption you should become subject to the Workers Compensation Range_ Heater_ DW _ � Nrr19.04il • /0i
provisions of the Labor Code you must forthwith comply with such Oven Dryer — W M _ ADDRESS 8 O w e R z&S'A
Ixonsions ori tins permit shall he deemed revoked Top — FAU _ W H
LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_ CRY Q Tel No
I hereby affirm that I am licensed under provisions d Chapter 9 Disp — Room Air Cond UCG OR Class
(cm
omencing with Section 7000) of Division 3 of the Business and REG NUMBER'
Professions Code and my license s in full force and effect Power Apparatus 8 Large Appliances DISTRICT NO PROC D B
Size 8 Type HP,KW KVA or KVAR
Licenee Number Lie Class Up to 1 Inc! FINAL
Contractor ii Over 1 to 10 Incl DATE VALIDATION Q
Date Over 10 to 50 Incl FINAL
❑ I am exempt under Sec Over 50 to 100 Inc BY 1,1
B&PC for this reason Over 100 N
Date S'ione Swbd MCC 8 Panelboards Z
0- 200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V
❑
Exemption for Reg Wirt Elect Over 1000 Amp or Over 600 V -
IW
SINGLE FAMILY Temp Power Pole 8 Appurtenances 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circus
1 hereby affirm that I am exempt from the Contractors License Law +
for the following reason (Section rofessions 7031 5 Business and PAdditional Sign Branch Circuits ACCTS
code) 3307 31.00
❑ 1 as owner of the property will do the work and the structure Misc Conduits 8 Conductors 1 ITEMS
riot intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule)
and Professions Code) 1. - TOTAL 31 - 00 r�vrrl
CONSTRUCTION LENDING AGENCY 31.Vl
I hereby affirm that there is a construction larding agency, for the HECK
Performance of the work for which this permit s casted(Sec 3097 PERMIT FEE (Sub-Total) CF AHE '00
Cry C)
PLAN CHECKING FEE -
Lenders Name DD0p—�01 6/20/Wl
PERMIT ISSUING FEE bV
Larder Address 1376 1 AM 8:53
1 certify that 1 have read the application and state that the above TOTAL FEE
information s correct I agree to comply with all County, ordinances
and State laws regulating Electrical wining and hereby authonze
repro ativss of unty to enter upon the above-mentioned
ty for ins
p es
- SEE REVERSE FOR EXPLANATORY LANGUAGE
6 �o ya
Sig re o Perm tee Date
;/0
W_RKERS COMPENSATION DECLARATK)N CE 863 iD/Bl APPLICATION FOR ELECTRICAL PERMIT
�I hdreby offirm that I have a certificate of consent to self
insure ore copy the of Workers Compensation Insurance , COUNTY OF LOS ANGELES BUILDING AND SAFETY
ora certified copy thereof (Sec 3800 Lab C )
Pol icy No Compony FOR APPLICANT TO FILL IN JOB /u�
❑ Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE ADDRESS `
Certified copy a filed with the county building inspec- I & 2-Family Sq Ft S = S LOCALITY
tion department Multi-family Sq Ft NEAREST
Date�z 7 i J t D/S Residential Swimming Pools CROSSST �Tl
Applican, OWNER OR ysr '
FIRM NAME 10 W
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec_Lght_Sw_ MAtI Y
COMPENSATION INSURANCE ADDRESS 355— r
(This section need not be comploNd H the arork Involved by First 20
Total No Addmonol CITY -`j Tel No"
the permit Is for one hundred dollars ($100)or Iwo ) RAN CHECK '7 0�
I certify that in the performance of the work for which this PLAN AM L
permit is issued 1 shall not employ any person in any manner
so as to become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS
I I Addnnonol
Total No CITY Tel No
Dote Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT If after making this Certificate of 7
Exemption you should become subject to the Workers' Range_ Heater_D W _ APPLICANT ED d
Compensation provisions of the Labor Code you must forth- Oven _ Dryer _W M — ADDRESS A z 2
with comply with such provisions or this permit shall be Top' _ FAU —W H Q
deemed revoked Hood _ Fan _ Other— CITY F Tel No
LICENSED CONTRACTORS DECLARATION LICErISE OR �// py
I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Art Cond REG NUMBER 7 V �o / Class 9
(commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO P ED BY y
and Professions Code and my license is in full force and effect d
( Size 8 Type HP KW KVA or KVAR O O
License Number FL¢ Class Up to 1 Incl FINAL – V
sO/SO r� Over 1 to IO Incl DATE
if
Contractor Data VALfDATION - O
❑ Over 10 to 50 Incl FINAL _ C
1 am exempt under Sec Over 50 to 100 Inc By to
d
B BP C for this reason Over 100 N
Services Swbd MCC 8 Panelboards - Z
Date 0 21X1 Amp Under 600 V O -
i Signature 201 1000 Amp Under 600V
Over 1 ODO Amp or Over 600 V
❑ Exemption for Reg Maint Elect � ;91 1 21 A
SINGLE FAMILY Temp Power Pole&Appurtenances _ t # e to e e is 2
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor s License I e • 2 S 5 0
Low for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits
Professions Code)
❑ 1 as owner of the property will do the work and the Misc Conduits 8 Conductors t
structure n not intended or offered for sole (Section Other (See Complete Fee Schedule)_ ►
7044 Business and Profewons 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 I /
PLAN CHECKING FEE
Larder s Nome
PERMIT ISSUING FEE
Lenders 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 lows regulating Electrical wiring and ,
hereby authorize res toeves of this County to enter upon
the above menti operty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
-Z7
Sig Lure oT Permittee Dote
. h -fiWO ERS C'I have a serif DECLARATION CE 806 ID,Bt APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self �BD6G
,more 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 `
Certified copy is hereby furnishedNew Residential Bldgs 8 Pools EACH NO FEE ADDRESS
1 8 2-Family, f — f LOCALITY
Certified copy a fled with the county"ding spec- Y' S9 Ft ' I
tion department Mule NEAREST-family Sq Ft phCROSS ST
Residential Swimming Poole
Date cant OWNER
FIRM NAME C
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec�.Light_Sw_ MAIL
COMPENSATION INSURANCE 'JJ ADDRESS `
(This section need not be completed IF the work Imrolved by _ __ First 20
the permit li for one hundred dollars($100)-or
or lose) Tocol No- Addmonal ' CITY i, el"No -� 7
I certify that the performance the work for mRAN CHECK
IF
h this APPLICANT
perms m resume a shall not employ any person m anyy manner
_ so as to become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS
Total No-Z±-- Additional
CITY Tel No
Date v ) Applicant Fixed Appliances Not Over I HP PERMIT
NOTICE TO APPLICANT If after making this Certificate of -APPLICANT /' /Sd
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 ROXIIII with comply with such provisions or this permit sholl be Top _ FAU —W H r �Lf/p
deemed revoked Hood _ Fan _Other_ CITY Tel No
LICENSED CONTRACTORS DECLARATION affirm Room Au Cond LICENSE OR l� Ca-�-�x��J
I hereby arm that I am licensed under provisions of Chapter 9 Disp _ REG NUMBER 6 W 't'7
(commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO P D BY
and Professions Code and my license is in full force and effect` (�
�'yl/, Size 8 Typo HP KW KVA or KVAR s e
License Number�f Uc Up to I Ind FINAL tJ
/ Over I to 10 Incl O
ATE
Contractor �� Q�S pore /�- Z�^�y Over 10 to 50 Incl FINAL VAUDA N 0
❑ I am exempt under Sec Over 50 to 100 Inc BY _ su
B 8P C for this reason Over 100
-Dote Z
Services Swbd , MCC 8 Ponelboards ,
0 -200 Amp Under 600 V r
Signature 201 - 1000 Amp Under 600 V
❑ Over 1000 Amp or Over 600 V
125A
Exemption for Reg Maint Elect # e • • • • 2
SINGLE FAMILY ' Temp Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I is - 5325
1 hereby off um that I am exempt from the Contractor s License Additional Sign Branch Circuits
• 5 2 5�i
Law for the following reason (Section 7031 5, Business and
Professions Code)
❑ I as owner-of the property will do thework and the Mist Conduih 8 Conductors I ,1 2 7-84
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 )
.CFS PLAN CHECKING FEE _
Lender s Name _
PERMIT ISSUING FEE
Lenders 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 r
ordinances and State la regulating Electrical wiring and
hereby authorize repres nt 1, of this County to enter upon
the above me o r or inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
Skacttufe of Permmee Date i