HomeMy Public PortalAbout4800 TEMPLE CITY BLVD_Electrical__ WORKERS CI have COMPENSATIONDECLARATION
of corse ,loomvovvar°7 APPLICATION FOR ELECTRICAL PERMIT O
I hereby affirm that I have a certificate of consent to self '��
msura or a certificate of Workers Compensation Insurance I COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS
a et certified copy thereof Y
thereof(Sec 3800, Lab C )Policy No'j
FF57ny °-Comport ef:�d0 FOR APPLICANT TO FILL IN JOB r-^
❑Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE ADDRESS ,
(�Certified copy is filed with the county building mWec 1 8 2 Family, Sq Ft $ = $ LOCALITY
tf2 tion department Multi family Sq Ft NEAREST
CROSSST
Dote !i-i-7-3 Q4 Appbcant Residential Swimming Pools OWNER OR
^ FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec d� Ught_Sw— MAIL
COMPENSATION INSURANCE First 20 O ADDRESS
(This section need not be completed N the work Immlin d by CITY Tel No IN
the Permit Is for a"hundred dollars ($100)or less ) Total No Additional
PIAN CHECK(
I certify that in the performance of the work for which this APPLICANT o
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
Additional
Date Applicant Total No CITY Tel Noftwy
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—DW — APPLICATION
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 Hood — Fan —Other_ CITY Tel No
LICENSED CONTRACTORS DECLARATION LICENSE OR
Disp _ Room Air Cond — REG NUMBER CIO°°
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO �i SSED BY d
and Professions Code and my license is in full force and effect Size 8 Type HP, KW, KVA, Or KVAR
se DQ G
^� LicenNumber J7 gSyr] Uc Claes �0 Up to 1 Incl FINAL U
cr
Over 1 to 10 Incl DATE 7 —/^� VALIDATION
FP, O
Oar, � etelJ Over 10 to 50 Incl
❑ I am exempt under Sec Over 50 to 100 Inc By ULIU
B 8P C for this reason Over 100 Q-
Services, Swbd, MCC 8 Ponelboards - Z
Date z
0 200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V
❑ Over 1000 Amp or Over 600 V
Exemption for Reg Maim Elect
SINGLE FAMILY Temp Power Pole 8 Appurtenances
HOME OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor s License Sign with One Branch Circuit - r.jt( T.
Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits �sC7
Professions Code)
❑ 1, as owner of the property, will do the work and the Misc Conduits 8 Conductors 1 1 IEP1�
structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)— TOTAL .34 8��
Business and Professions Code) ` 7�
CONSTRUCTION LENDING AGENCY L HECK4.
I hereby affirm that there is a construction lending agency for (_ ,( •l41
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) 01/ Q
(Sec 3097, Civ C )
PLAN CHECKING FEE iJl]I}I]-IJQI]1 - j/y"JY1
Lenders Name PERMIT ISSUING FEE �3 711+ 1 { G•
Lender's Address v•i.
I certify that I have read this application and state that The TOTAL FEE d - 8119
,y
above information is correct 1 agree to comply with all County ` Q
ordinances and State laws regulating Electricalty t wrongauthorize and
�j•J 0 ��(� •�5 �, ) r��� HD C V P
hereby authorize representatives of this County to enter upon l��'• /
the above mentioned property for inspection purposes
SEE/RE�V'y�E�R�SE FOR EXPLANATORY LAN" GE 11
��l S' 2`� g/ �ti Cy 1�T(tOA wM� 5ihili ( �°^ "', g/ SDs
Signature of Permittee Date w tip/' i
0 '1 a ' �r� w 1 z wain, as t
WORKERS COMPENSATION DECLARATION 0-001 8AM DPW(1291) APPLICATION FOR ELECTRICAL PERMIT
]
I hereby affirm that I have a certificate of consent to self insure 7
or a certificate of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy thereof(Sec 3800 Lab IC) C it ;
P❑o1Ky No 4 Company FOR APPLICAIR TO FILL IN AJOB
DDRESS
L/O�
'Certified copk 11y Is hereby furnished New Reaidenbal BWpe 8 Pools NO EACH FEE LOCALITY
❑ Certified copy is filed with the county building inspection 1 d 2 Family Sq Ft — i $
department Multi family Sq Ft — NEAREST
_ - CROSS ST
Date Applicant Residential Swimming Pools ASSESSOR
MAP ROOK PAGE PMCEL
` CERTIFICATE OF EXEMPTION FROM WORKERS Ouaets Rec —Light_Sw OWNER O
COMPENSATION INSURANCE RR '
r I • c' - F First 20 MAR
AI NAA
(This ls'fon need not be completed the work Involved by the Total No Additional ADDRESS
permile�for one hundred dollars(11000)or leu)
I certify that in the performance of the work for which this permit - CITY _ TN No
is issued I shall not employ any person in any manner so as to
become subject to the Workers Compensation Laws I I Lighting Fixtures First 20 PAPPLICArC
CK
x
Date Applicant
Total No Additional ADDRESS
NOTICE 70 APPLICANT if after making this Certificate APPLIANCES NOT OVER 3 HPele of CITY TN No
Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP
provisions of the Labor Code Mm
p you must forthwith comply with such - PUCAM
provisions or this permitehell'be deemed revoked Power Apparatus 8 Large Appliances
` LICENSED CONTRACTORS DECLARATION Sue&Type HP KW KVA or KVAR ADDRESS
I hereby afhrin'Ihatil am licensed under provisions of Chapter a Over 3 to 101nc1
(commencing with Section 7000) of Division 3 of the Business and CITY Tel NO
Professions Code and my license is in full force and effect Over 10 to 50 loll }
Over 5010 100'not REO NUMO ER CIs 11
License Number L¢ Clews
Over 100 DISTRICT NO P D BY 0
X
S"evs Swbd MCC a Panelboards ,p� Q
Contractor Date 0 398 Amp Under 600 V FINAL 0
DAM
400 1000 Amp Under 800 V yAL�D�7I�� W
❑ am exempt under Sec Over 1000 Amp or O+er 600 V RNaL _ ACG — Ll
B&P C for this reason- - BRANCH CIRCUIT FEES BY ,_O ¢�•�Z
Dare 15A or 20A 120V Lighting or Rece t
1 To 10 Branch Circuits 1 ITFtlS
Signature 11 To 40 Branch Circuits
El '- Exemption for Rep Meant Elect - 15A 20A 208V To 41 Or More rarLighting Br C CircuitsTQTI'aL 4 7�
CCY1 45.
SINGLE FAMILY Tamp PoPole&Appurtenances,
HOME OWNER BUILDER DECLARATION Sign with Ona Branch Circuit - CHIME •IM
I hereby affirm that I am exempt from the Contractor a License Law
for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits
Code)
❑ Mix Conduds&Conductors ��-0001 6/30/93,
I ee 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 J 1 AN 9:533
and Professions Code) 110
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 3087 PERMIT FEE (Sub Total)
Civ C) - -
PLAN CHECKING FEE
Landera Name - - -
PERMIT ISSUING FEE
Landera Address
I cemty that I have read this application and under penelty of purlury state TOTAL FEE
that the above mformaion is correct I agree to comply with all County
Ordinances,and State laws regulating Electrical wnnng and hereby authonze
representabv of this County to enter upon the above mentioned property - owe
for in°peel Pu E REV, fOR ZATORY LANGUAGE
ru P
IV ti b
WORKER S COMPENSATION DECLARATION DOO19 PW BA663 D (12 a„ APPLICATION FOR ELECTRICAL PERMIT IJ
I hereby alhrrrl lhflt I hate a certificate of consent to sell insure 7
or a certificate of Worker s Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDIN N SAFETY DIV
copy Ihareol Sec 3,WO Lab
{�.�� O
Polley NO CORlpany „L\ �'�,[��� F(NI APPLICANT TO FlLL IM - JOB
ADDRESS
ElCertified copy Is hereby furnishedNew Residential Bldga 8 Poole NO EACH _ FEE _
l $ $ LOCALITY
d rti copy ie filed.nth Ne county buiidinp inspection 1 E 2 Fm[y F SFt
—
1 Multi lernity Sq Fl — CROSS S
Date ApfNicen —RUPenuel Swimming Poole MAP BSOR.
NAP BOOK-IL PAGE PARCEL
I,v TI ICATE OF EXEM ION FROM WORKERS Oblate Rec —Ught Sw ONNER OR
I COMPENSATION INSURANCE Fest 20
(This motion need not be completed If the work Involved by the NAIL
permit is for one hundred dollen($100)or lees)
Total No Additional AOIXiE
I certify that in the performance of the work for Which this permit CI + Tel
is issued I shall not employ any person in any manner so as to
become,sublecl to the Workers,Compensation Laws Lighting Fixtures First 20 APPLICANT
I I Total No Additional
ADDRESS
Data Applicam RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICE TO APPLICANT-II after making this Certificate of CITY - tel No
Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP
PERMIT
provisions of the Labor Coda you must forthwith comply with such APPLICANT
provisions or this permit shall be deemed revoked Power Apparatus 8 Large Appliances
loco 5QWrQ%!
` - LICENSED CONTRACTORS DECLARATION ` Size 8-Type HP KW KVA or KVAR ADDRESS
f
I hereby affirm1that 1 em licensed7000) under n 3 of the of Chapter d Over 3 to 10 Ind(commenting with Sechon 7000) of Division 3 of the Business end CITY Tel No
Professions Code and my license ie in lull force and effect Over 10 to 50 Ind
Over 50 to 100 IMI Q LGE E �s 0 a.
REO NUMBER
Licertae Number Lic CC Over 100 DISTWCT NO IP O ESSED BV O
Servic eq vpdS1 M C ds
��.�'_�'� ??�� /f �//�"punTM nde DATE 0
❑tract em exempt u errs Sec is 400 1000 Arne Under BW V //— �— VALIDATION V
Over 1000 Amp or Over 800 V UJ
-B 8P C for this reason BRANCH CIRCUIT FEES BY
Date ISA or 20A 120V Lighting or Recept r Z
Signature 1 To 10 Branch Circuits
11 To 40 Branch Circuits -
❑ Exe _ 41 Or More Branch Cucuea
mptwn for Reg Maint Elect- 15A 20A 209V To 277V Lghling Br Grcui[e i
SINGLE FAMILY Temp Power Polo 8 Appunenancae Y
HOME OWNER BUILDER DECLARATION _ CT.AT
I hereby affirm that I am exempt from the Contractor a 4cense Law Sign with One Branch Circuit
for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits 3M I't.5.7,
Code) ' i
1 ITE11
F1I as awirer of the property will do the work and the structure Mise Conduits 8 Contlreucto _
is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule)_ , TOTAL 145 . 35
and Professions Code) _
CHECK
CONSTRUCTIONLENDING AGENCY
I hereby affirm that therehereisie aa construction lending agency /or the /
performance of the work for which this permit is issued (Sec 3087 PERMIT FEE (Sub-Toto
Civ C)
I I PLAN CHECKING FEE 13COO-0001 11/22/930
Lender a Name -
PERMIT ISSUING FEE 768`2 1 PM 7;CI7
Lentler a Address
I tarhly,that I have read this application and under penalty of purjury state TOTAL FEE
that the above information is correct I agree to comply with all County
Ordinances and State laws regulating Electrical wrong and hereby authonze `
representatives of this County to enter upon the abovamentioned property - l
r wlm � SEE REVERSE FOR EXPLANATORY LANGUAGE
LA
'h1GtU OF PERU DATE
WORKER SCOMPENSATION DECLARATION ,9DPW,t29t,- APPLICATION FOR ELECTRICAL PERMIT
I heresy affirm that I have a certificate of consent to sell Insure
or a certificate of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy thereof(SeF 3800 Lab C) ( o • `
8 P
New ResMentiel Bltlga Pools $ $ LOCALm
�ICy NO Company FOR APPDGVlT TO FILL IN DRESS M
"Ce fled'copy Is hereby furnmitetl } NO EACH FEE W
❑ ' rtl
Candied copy is filed with the county buildinginspection 1 6 2 Family Sq Ft —
department r Mulu family Sq Fl CMVT
sT Cl Zus
Dale Appll t' Resident el Swimming Paola MSP oo PKfE PnacEL
Y ,CERTIFICATE OF EXEMPTION FROM WORKERSOutlets RBC _Light_S. RPM NAME
_COMPENSATION INSURANCE First 20 r
(This section need not be completed H the work Involved by the MAIL 0 a0 a��a LI
permit is for one hundred dollars($100)or lase) Total No Additional ADDRESS U
I certdy that in the performance of the work for which this permit CITY —)J_ 1) Tel NO 5/V-2 p-/F,
to Issued I shall not employ any person in any manner so as to PLAN CHECK
become subject to the Workers Compensation Laws Lighting Fixtures Fust 20 APPUCANT
Total No Additional
ADDRESS
Dote ` Applicant
NOTICE,TO APPLICANT It alter making this Certificate of RESIDENTIAL APPLIANCES NOT OVER 3 HP CT' TN No
Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP PERMIT w
provisions of the Labor Code you must forthwith comply with such Power Illus S Lar Appliances PERMIOANT -/cNQ L�\provisions of or this permit shall be deemed revoked Apparatus 9e App ancea
LICENSED CONTRACTORS DECLARATION Sue 8 Type HP KW KVA or KVAR ADDRESS 121 S"1: LN �r«T
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Over 3 to 101na CITY N9,9-P14 Tel No 7�7j b
Professions Code and my license Is in full force and effect Over 10 W 50lncl i( M
ff-- MK;ENSE OR Over 50 to 100 Ind REO NUMBER ryZ�"� V ,eu �f� a
License NVmber � v VC Cass _� 'O Over 100 DISTRICT NO n//} PR SSED BY O
Services Swbd MCC s Panelboards (x-&,Z� I=
Contractor Date tr.7(/� rc• 0 399Amp Untler R00V OA�L 0
❑ I am exempt uncle;Sec 400 1000 Amp Untler 800 V - VALIDATION V
Over WOO Amp or Over 800 V _ FINAL LV
B 8P C for this reason BRANCH CIRCUIT FEES BY U)
Date 15A or 20A 120V Lighting or Recept Z
- - 1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits -
❑ _ 41 Or More Branch Circuits
Exemption for Reg Maint Elea 15A 20A 20 VV To 277V Lighbrigi Br Circuits
SINGLE FAMILY Temp Power Pole 8 Appurtenances y i
HOME OWNER BUILDER DECLARATION _ rlllT.,r
I hereby affirm that I am exempt from the Contractor a License Law Sign with One Branch Circuit tt'7 1(I
for the following reason (Section 7031 8 Business and Professions Additional Sign Branch Circuit 3-3033
Code) 1 ITEM
❑ I as owner of the property will do the work and the structure Misc Conduns A Condumons _
is not Intended or offered for Bale(Section 7044 Business er(See Com ate ee Sc uIs)_ T1]TpL 4,7 - 10
and Professions Code) _ I_A H 47.10
CONSTRUCTION LENDING AGENCY - CHIVE .110
I hereby affirm that there in 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 111301]-111]1]1 6,/77/;'4
Lenders Name PERMIT ISSUING FEE d7� 316 1 AM 7:4,t
Lender's Address
I certify that I have read this application and under penalty of purJury state TOTAL FEE
'0
/D
that the above mlormauon 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 posse SEE REVERSE FOR EXPLANATORY LANGUAGE
&aNATUR 'F f£ n"rFE DATE
20 0010
WORKER I haveCOMPENSATION DECLARATION 7aASW DPW(12 81) APPLICATION FOR ELECTRICAL PERMIT--
or
ERMIT-— Ll
I hereby affirm That I have a certificate of consent to self Insure 78nDB7
or a certificate of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy thereof(Sec 3800 Lab C). ,1 i, -
Policy No Company FOR APPLICANT TO RLL IN JOB
AJXBRESS L�%�O
❑ r Certified copy Tilhereby fumish4d it ' New Residential Bldgs 8 Pools NO EACH FEE T L
E] Certifiedcopy i9 filed with the county building Inspection 1 6 2 Family Sit Ft S $ LOCALfTY Q
department , I Mufti femiy Sq FI L»oBER gT
DateResidential Svnmmmg Pods ASSESWR
n N �-I r Applicant i NAP BOOK PABE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rao —Light Sw o ER aR
COMPENSATION INSURANCE ' RRIV NAME
First 20 MAIL
Is
(Thio section nand not be eompletid the work'Involved by the Total No Additional ADDRE99 QQ
- 49
permit la forr one hundred dollen(61000 se)or la )
I certify that in the performance of the won for which this permit CITY Tal No b _
is Issued I shell not employ any person any manner s0 as to
become�sU act t the Workers Com Lighting Fixtures First 20 PLAN CHECK
penes n Laws. APPLICANT
Total No Additmal ADDRESS
Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICk TO APPLICANT If aft r olio t e ertificate of CITY Tat No
Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP
p10
revisions of the Labor Code you must forthwith comply with such PERMIT
provisions or this permit shell be deemed revoked - Power Apparatus 8 Large Applierices APPLICANT 4 ,
i ` o +LICENSED CONTRACTORS DECLARATION Size S Type HP KW KVA w 2 KVAR ADDRESS OF
I hereby affirm that I am licensed under provisions of Chapter B Over 3lo 10 Incl(commencing with Section 7000) of Division 3 of the Business and CITY52A ja Tel No -yjr
Professions Code and my license is in full farce and effect Over 10 to 50 Incl -
? OR
' Over 5010 100 Ina REO NUSEMBER W
Da Y a
License Number Lic ClassC /b Over 100 DISTRICT NO n (/ SSED BY O
-Services Swbd MCC 8 Penelboards 5 U O U�
NAL
Contractor - - Date 0 399 AmP Unda 600 V _ DAM � _ 0
400 1000 Amp Under B00 V /( `` ~
❑ I am exempt oder Sec �/ �"{ VALIDATION V
Over 1000 Amp or Over 000 V ANAL _ W
- B AP C for this reason - — - - BRANCH CIRCUIT FEES BY 9L
i Date 15A or 20A 120V Lighting or Recept _ Z
1 To 10 Branch Circuits
SignatureDate
To 40 Branch Circuits— 41 Branch Circuits
-
❑ Examption for Rep Mount Elea 15A 2DA 208V To 277VLightung Or More Br Circuits
SINGLE FAMILY Temp Power Palo 8 Appurtenances CCT•i
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor a License Law �T1
for the following reason (Section 7031 5 Business and Professions Addri Sign Branch Circuits . 303 4 CG
cede) TOTAL ITEMS�7LLoF
IN
❑ I as owner of the property will do the work and the structure Mise Conduits a Cooduaors
is not intended or offered for sale (Section 7044 Business Other(Sea Complate,Fee Schedule)_ CHECK .47.�.r5
and Professions Code) CL,ECK -
CONSTRUCTION LENDING AGENCY 1d.lGVv+IE-Kv •00
I hereby affirm that there is a construction lending agency for the B UIJU(J 61 630/95
performance of the work for which this permit is Issued (Sac 3087 PERMIT FEE (Sub Total)
Civ C)
PLAN CHECKING FEE
Lender s Name PERMIT ISSUING FEE 1124 1 AN 9:07
Larder aan
Address TOTAL FEE - �S
I certify that I have read this application d under penalty of purjury state
that the above information is correct I agree to comply with all County - -
Main en s end State jaws regulating Electrical vanng and hereby authorize
reties ativee of this County)"enter upon the abovementloned property
for in action pun see 6 SEE REVERSE FOR EXPLANATORY LANGUAGE
i
NA
WORKER
tI haveCOMPENSATION DECLARATION 200019 DPW(1291) APPLICATION FOR ELECTRICAL PERMIT
D W19
I hereby affirm that I have a certificate of consent to sell insure
or a certificate of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy thereof(Sec,3800 Lab C) f
Poll"No Company FOO APPLICANT TO R IN JOB
ADORERS
Cerbhed copy Ia hereby furnished New Residential Bldgs 8 Pods NO EACH FEE
❑ de artm copy Lv M1letl with the wunry building inspection 1 8 2 Family SF Ft
$ $ LOCALITY ,[f
deperbnenl Mum family Sw Ft C6�6 ST "[<j J e.
Date Applicant Residential Swimming Poria ASSESSOR
NAP BOOK PAGE PJACEL
CERTIFICATE OF EXEMPTION FROM WORKERS Cullom Fac, —Light SW FlOaM RRrOR
COMPENSATION INSURANCE
(Thio section need not be completed If the work Involved by the First 20 MAL r
Parrett Is Tor one hundred dollars($100)or leu) Total No Additional ADDRESS
1 certify that In the performance of the work for which this permit CITYle
'
is Issued I shall not employ any person in any manner so as to
become s act t the Workers Compen Non Law Lighting Fixtures First 20IT
LMORAt
Total No Additional ADDRESS
Dflt Appllcen RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTI E T APPLICANT If a m in th a rhhcate of CITY Tel No
Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP
Provisions of the Labor Cade you must forthwith comply with such PERMIT
provisions or this permit shall be deemed revoked Power Apparatus 8 Large Appliances AI,PUCANT
LICENSED CONTRACTORS DECLARATION Sue 8 Type HP KW KVA or KVAR ADDRE
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Ind �I
(commencing with Section 7000)of Division 3 of the Business and CITY (w /.� TN No
Professions Code and my license is in full force and effect Over 10 to 50 Ind }
Over 80 IO 1001r1d LICENSE OR
♦ �� REO NUMBER 7 O
Licence Number T -10" IV
Lic Class L� Over 100 pSTRICT NO �({T PROCE _ 0
Services Swbd MCC8,Panelboards ��/ Q
Canlregor Date0 388 Amp Under 800 V MATE I F—
I am axe t r Sec 400 1000 Amp Under 000 V
E] VALIDATION
Over 1000 Amp or Over 800 V FINAL VALIDATION
B dP C for this reasonBY G'
BRANCH CIRCUIT FEES Tn
Date 15A or 20A 120V Lighting Or Racepl Z
I To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
❑ Or Exemption for Reg Ment Elect 154 211A 200V To 277V hung Br Grcurts
SINGLE FAMILY Temp Power Pole 8 Appurtenances
HOME OWNER BUILDER DECLARATION Sign with One Branch Cucuil
I hereby affirm that I am exempt from the Contractor s License Law
for the following reason (Section 7031 5 Business and Professions Additional Sign Branch ClrcurLl
Code)
❑ I as owner of the property will do the Work and the structure Misc Conduits 6 Conductors 7
is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule)
and Professions Code) A�CCCT.T
CT�}
CONSTRUCTION LENDING AGENCY `M 48.60
1 hereby affirm that there Is a construction lending agency for the 1 ITEM
performance of the work for which this permit is issued (Sec 3097 PERMIT FEE (Sub-Total)
CWC) TOTAL 48 . 60
PLAN CHECKING FEE OEM 48.60
Lenders Nemo
PERMIT ISSUING FEE a O .00
Lender e Address
1 certify that I have read this application and under penalty of pu0ury state TOTAL FEE
that the above information is correct I agree to comply with all County
ordmerlcea State Is"regulating Eleclncalwiring and herebyeuthonze 0000- 01 6/26p/96
naPrasen of this County to enter upon the ebovvimentroned property 711' 1 1 AM 8:22
for I On pu I SEE REVERSE FOR EXPLANATORY LANGUAGE
1
a TE r
WORKERS COMPENSATION DECLARATION �19�3r87 APPLICATION FOR ELECTRICAL PERMIT O
1 hereby affirm that I have a certificate of consent to self 1 80615
insure, or a certificate of Workers Compensation Insurance,I COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or a certified copy thereof (Sec 3800 LLoob/C__)�
P I y No gZLIE 1�Company ✓�1/I I FOR APPLICANT TO FILL IN JOB ��.�s•I
Minified copy is hereby furnished 1 New Residential Bldgs 8 Pools EACH NO FEE ADDRESS W
Ivl Certified ca is filed with the coun building m 1 — LOCALITY+�U PY N 9 spec- 18 2 Family Sq Ft S — S C
tion department Multi-family Sq Ft NEAREST
Date cr g rg Applicant Residential Swimming Pools COWNERROSS SOR ,
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE Outlets Rec-L _
LightSw_ MAIL
First 20 ADDRESS (_
(This stolon need not be completed If the work involved by / - CITY + Tel No
the permit Is for one hundred dollen ($100)or less )/ ( Total No Additional
I certify that in the performance of the work for which this PIAN CHECK
APPLICANT
permit is issued shall not employ any person m any manner t Lighting Fixtures First 20 ADDRESS
so as,to become subject to the Workers Compensation Laws g g
Additional
Dote Applicant Total No CIN Tel No
NOTICE TO APPLICANT Ifafter making this Certificate of Fixed Appliances Not Over 1 HP PERMIT
Exemption, you should become subject to the Workers Range— Heater—D W — APPLICATION +
Compensation Provisions of the Labor Code, you must forth- Oven — Dryer —W M _Top FAU —W H —
ADDRESS S
with comply with such provisions or this permit shall be
deemed revoked Hood — Fan —Other_ CIN + Tel No r —7d J
LICENSED CONTRACTORS DECLARATION Disp — Room Air Cond — LICENSE OR
Of
I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER ,SO Class
ld
(commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO,�
and Professions Code,and my license is in full force and effect YP PROLE D BY O
fS ^,O Size 8 Typo HP, KW, KVA or KVAR L
'License Number � Lic Class L Up to 1 Incl FINAL U
Contractor �•-��+ ��• nate Over 1 to 10 Ind DATE — CC
V DATION
❑ Over 10 to 50 Incl _ FINAL ~
I am exempt under Sec Over 50 to 100 Inc BY Ul
B 8P C fee a
this resOver 100 on d
Dote Services Swbd MCC 8 Panelboords #�e 0 3 8 oqa
e C Z
0- 200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V .( • • 1 1 2 5
❑ Over 1000 Amp or Over 600 V' Exemption fee Reg Maint Elect • • •11 1 2 5
SINGLE FAMILY Temp Power Pole 8 Appurtenances
HOME OWNER BUILDER DECLARATION 0 8 0 8-8 8
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)
❑ I, as owner of the property will do the workand the Misc Conduits 8 Conductors
structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule)—
Business
chedule)Business and Professions Code)
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a coristructicn 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
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 r
hereby authorize representatives of this County to enter upon
the above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Perminee Dote 0s
WORKERS COMPENSATION DECLARATION W6 iD,BI APPLICATION FOR ELECTRICAL PERMIT q
� CE IJ
�} hereby affirm that I have a certF¢ consent ate of coent to self, CE B06C'
insure or a certificate of.Workers Compensation Insurance N COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a ce'hffiedcopy thereof (Sec 3800 Lab C )
Policy Nap'p' (01 W-4 Company/ARG/F/C C..i M.0 FOR AP►LIGNT TO FILL IN JOB
CE—Certified copy is hereby furnished New Remdenhal Bldgs 8 Pools EACH NO FEE
ADDRESS L
❑ Certified copy is filed with the county bmldin ,n ec l 8 2 Family Sq Ft $ — $ LOCALITY
tion department Multi-family Sq Ft CROSS ST WE
Dote 9_�y_ s'L�Appl<aMIt
Residential Swimming Pools OWNER OR -Wt
'_/ ' z�
CERTIFICATE OF EXEMPTION FRO WORKERS FIRM NAME �LA'L�D
COMPENSATION INSURANCE ' Outlets Rec I Light 5w� '� /y MESS
Fuat 20 ,
(This section need not M completed d the work involved by T I No nal CITY tj Tel No 7 —
the pormtt Is for one hundred dollars ($100)or less) o/p�_g..e I't.4tl CHECK
I certify that m theperformance of the work for which this 1 j Yge...L. APPLICANT
permit Is issued I shall not employ any person In any manner �-r s
so as to become subject to the Workers'Compensotion Laws Lighting Fixtures First 20 ADDRESS
Total No I`/ Additional
Date Applicant ,,t� CITY Tel No
NOTICE TO APPLICANT If, after making this Certif o Fixed Appliances Not Over 1 HPpERMn ^ ,p
Exemption you should become subject to the Workers Range_ Heater—D W APPLICANT G/A/ .5V C.V
Compensation provisions of the Labor Cade you must forth Oven _ Dryer _ W M _ ADDRESS/it? G.�v� V,
with comply with such provisions or this permit shall be Top _ FAU _WH _
deemed revoked Hood _ Fan _Other_ CITY ,C 7 Tel No rslj
LICENSED CONTRACTORS DECLARATION uCENSE OR // '
I hereby affirm that I am licensed under provisions of Chapter 9 Dlsp _ Room Air Cond REG NUMBER 3{0 - Clair YJ
(commencing with Section 7000) of Division 3 of the Business power Apparatus 8 Large Appliances DISTRICT NO BY d
and Professwro Code and my license is In full force and effect Q
bb Size 8 T a HP KW KVA or KVAR 8
I ! 0 p
License Number Lic Class,�y/ Up to 1 Incl r1Ts'09 FINAL 0
Contract to / —0 Y Over 1 to 10 Incl DATE VALIDATION U
❑ Over 10 to 50 Incl FIN W
1 am exempt under Sec Over 50 to 100 Inc BY D-
B 8P C for this reason Over 100 i Z
Date Services Swbd, MCC 8 Ponelboards
0 -200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V
• ❑ Exemption for Rag Maint Elect Over 1000 Amp or Over 600 V
SINGLE FAMILY Temp Power Pole 8 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
Low for the following reason (Section 7031 5 Business and
Professions Code)
❑ I as owner of the property will do the work and the Mnc Conduits 8 Conductors,
structure Is not intended ar offered for sale (Section Other (See Complete Fee Schedule)_ 1101,7044 Business and Professions Code)
CONSTRUCTION LENDING AGENCY 5 4 7.3 A
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) • • • o 'L
(Sec 3097, Civ C )
PLAN CHECKING FEE 1 - - 3375
Lender s Name
PERMIT ISSUING FEE p is s - 33755
Lender s Address
I certify that I have read this application and state that the TOTAL FEE 09,19-86
above Information is correct I agree to comply with all County
ordinances and State lows regulating Electrical wiring and
hereby authorize representat as of this County to enter upon
the above mentioned p p for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
ignotuIttee �'Date re oer --
�//(P/) fro f-SY
WORKERS COMPENSATION ole of corse 7� tD,BI APPLICATION FOR ELECTRICAL PERMIT q
I hereby,offiYm that I have a cendi�ate of consent to self �� IJ
insure or a certificate of Workers' Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY
or�a//171fj�j,�ad copy thereof (Sec 3800 Lob C )
�Pd(i Nb-vlcompony FOR APPLIGM TO Rll IM JOB /
Certifmd copy is hereby furnished New Residential Bldgs 8 Pools EACH NO Fl{ ADDRESS O� k
'❑ 1 8 2 Family Ft $ — $
LOCALITY L
Certified copy is filed with the county building inspec Y Sq
tion department Multi family Sq Ft — NEAREST
Residential Swimming Pools CROSS ST
Date �7.� A6 Applicant4zi4a_� OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec�ight_Svv_ MAIL /
COMPENSATION INSURANCE First 20 ADDRESS OQ lC
(This stolon need not be completed If the work Involved by Total No 7/ CITY CITY Tel No
the Perri Is for one hundred dollars ($100)or loss) PIAN CK
OIE
I certify that in the Performance of the work for which this K
ANC
permit is issued I shall not employ any person in any manner
ANT
so as to become subject to the Workers Compensutior),la Lighting Fixtures First 20 ADDRESS
Total No Additional CITY Tel No
Dote O APPLICANT pIf ant sized Appliances Not Over 1 HP PERMIT
NOTICE TO oushol H after making this the We to of Range Heater_D W _ APPLICANT ^-/'/✓ r�"'c'
Exemption you should become subject to the Workers' g -
Compensation provisions of the Lobar Code you must forth- Oven _ Dryer _W M _ ADDRESS �E Sr
with comply with such provisions or this permit shall be Top _ FAU _WH _
deemed revoked Hood _ Fan _Other— CITY Tel No ),/(J
LICENSED CONTRACTORS DECLARATION LICENSE ORR LSO
I her affirm that I am licensed under W Dnp Room Air Cord Clan L
hereby provisions of Chapter 9 REG NUMBER
(commencing s Co Section y tic of Division nfu 3 of the Rumness Power Apparatus 8 Large Appliances DISTRICT NO O ry PROGF 0-
and Professions Code and my license is in full force and effect (/I
A -1 �� Size 8 Type HP KW KVA, or KVAR' r
License Number / Lic Class dle5ya Up to I Incl
FINAL 0:
__ZZI �J i �3U/ Over I to 10 Ind O V T10N DATE O
Contractor' cl to Over 10 to 50 InU
FI
❑ NAL W
I am exempt under Sec Over 50 to 100 Inc F +♦ n
Over 100 to.
B 8P C for This reason Z
Dote Services Swbd MCC 8 Ponelboards ,
0 -200 Amp Under 600 V
Signature 201 - IOOD Amp Under 600 V
❑
Exemption for Reg Moms Elect Over 1000 Amp or Over 600 V
SINGLE FAMILY Temp Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 14 7 3 9 A
I hereby affirm that I am exempt from the Contractor s License Additional Sign Branch Circuity
Law for the following reason (Section 7031 5 Business and q • • • • • 'L
Professions Code)
❑ I as owner of the property will do the work and the Mist: Conduits 8 Conductors
structure a not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ► ( • • � 1,rj 0
7044 Business and Professions Code)
CONSTRUCTION LENDING AGENCY is • •1 1.509
1 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) 0 5 3 0 i 8 6
(Sec 3097, Civ C )
PLAN CHECKING FEE
Lenders Name
PERMIT ISSUING FEE
Lender s Address
I certify that I hove 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
n'� s g�
Signa ure of Permrtlee Date
WORKERS COMPENSATION DECLARATION 76AW 10/131 � _ _/d
hereby affirm That I have a certificate of consent to self CE 80615 APPLICATION FOR ELECTRICAL PERMIT
' insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY
0 gert.fled cop th Of SSec 3800, Lab C )
Se�� to
O cy rtiCompo ny ^�fj(��aA7�/A.AA1•� FOR APPLICANT TO FILL IN ���
Cefied copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE
Aij At,
Certified copy is filed with the county budding mspec 18 2-Family Sq Ft $ — f LOCALITY
tion department Multi-fomdy Sq Ft — NEARE_ST
Dote V!� 29-a Applicant dJq, �� JO Is JEIa� Residential Swimming Pools OWNEROR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec�lighl_Sw_ IADDL
COMPENSATION INSURANCE F rat 20 ' - RESS
(This section need not be completed if Me work Involved by
Tota No Additional CITU Tel No
the permit Is for one hundred dollars($100)or Ins)
I certify that in the performance of the work for which this PLAN GK
PLAN CHECK
E
permit is issued 1 shall not employ any person in any manner
ANT
so as to become subject to the Workers Compensation Laws Lighting Futures First 20 ADDRESS
Total No Additional
CITY Tel No
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
TO APPLICANT If after molting this Certificate of
Exemption you should become subject to the Workers Range_ Hearer_D W _ APPLICANT
-Pilfai't It
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 _WH _
r
deemed revoked Hood _ Fan _Other_ CLTY rWaif Its
el Ol U
LICENSED CONTRACTORS DECLARATION LICENSE OR `
I hereby affirm that I am licensed under provisions of Chapter 9 Disp _ Room Au Cond REG NUMBER Class F60i
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO BY }
and Professions Code and my license is in full force and effect Power Apparatus 8 Large Appliances �`O� t
a.
til L; f I� Size 8 Type His KW KVA or KVAR J `
License Number(I "_A� ,�` ��1LL�e` L`c lass �r+'�f O/ Up to 1 Incl FI D-'
Contractor�ll+ o Dote !A^ Z Y'QF7 Over I to 10 Incl '� VALIDATION O
Over 10 to 50 Incl FIN U
❑ 1 am exempt under Sec Over 50 to 100 Inc BY d
B 8P C for this reason Over 100 Z
Dote Services, Swbd MCC& Ponelboards
0 -200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V
❑
ExemptionOver 1000 Amp or Over 600 V
for Reg Mamt Elect
SINGLE FAMILY Temp Power Pole d Appurtenances
HOME OWNER BUILDER DECLARATION Sign with One Granth Circuit
hereby affirm that I am exempt from the Contractor s License Additional Sign Branch Circuits
for the following reason (Section 7031 5 Business and
Professions Code)
❑ I 6s owner of the property will do the work and the Mise Conduits 8 Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ Poo.
7044 Business and Professions Code) t 5 7 69 A
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
a • • • 02
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) ( e e , 1.25.2 5
(Sec 3097, Gv C )
PLAN CHECKING FEE is e e 1 1.255
lender s Name
Lenders Address PERMIT ISSUING FEE AOt ( Q 2 8 e 8 6
I cenAy that I have read this application and state that the TOTAL FEE e
above mformonon is correct I agree to comply with all County 1
ordinances and State jaws regulating Electrical wiring and
hereby authorize representatives of this County to enter upon
the a ave ment�d p perry for mspec ion purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
OAU&U _ l6 — )_&--�6
Signature of Permittee Dote
wow`E!hS COMPENSATION DECLARATION 7EA863 0'81 APPLICATION FOR ELECTRICAL PERMIT
I hereby �14rm ihM Mks
a certificate of content to self insure, � �e080
o e cert lCatp`of�vbrkere Ccr)Pensahon I r or cern r COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sao 38[0�0�L'abj C) Ol G--
•Pdwy Na�FanY FOR APPLICANT TO FILL IN
❑ Certified copy.,hereby furvahed �J-�.�� New Residential Bldgs & was EACH NO _FEE LOCALITY
Certified copy Is filed with the county building mspecbon i & 2-Family SKI Ft $ —
$
dqpqrtmentr }r Multi-familySq Ft — NEAREST
CROSS ST
Residential Swimming Pools OWNER OR
Applicant c ,
FIRIVI
c CERTfFICATE OF EXEMPTION FROM WORKERS 1 ' �Sw, O` - - �.. R MAL"M'E
Outlets Rec�Lght
i COMPENSATION INSURANCE Q'� � ADDRESS
(This section not e d completed the work ImFirst 20
olwd by the
permtt Is for onsria,hundred dollen($100)or Isle) Total No Additional CITY Tel NoPLAN CHECK '
I certify that m the Performance of the work for which this permit PLANCHET -
. issued I shall not employ any person in any manner so as to ,
become subfect to the Workers Compensation Lew, Lighting Fixtures First 20 51ADDRESS
Additional r
Total No CITY i., J Tel No
Date ApplicantFxed Appliances Not Over 1 HP PERMR
NOTICE TO APPLICANT If after making this Certifioate of r
Exemption you should become subtact to the Workers Compensation Range_ Heater_ DW _ I'rT
proHenons of the Labor Code you must forthwith conpty wsth such Oven _ Dryer_ W M _ ADDRESS
provisions or the pemut shell be deemed revoked Top — FAU _ WH __
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ CRYA1111 It, Tel No S
1 hereby affirm that I am licensed under provawns of Chapter 9 Disp Room Fur Cob LICEN9
(canmencng with Sechan 7000) of Dnnsion 3 of the Business and REG NUMBER - - Cis-
Professions Code and ny license.In full force and effect Power Apparatus& Large Applances DISTRICT NO y MVKSSED BY,
LB Sae& Type HP,KW,KVA or KVAR •�O f��-N�� Q
License Number !/7 �3 Lrc Class Up to 1 Incl - FINAL - C�
Contrector���e _ Over 1 to 10 Incl DATE s-l .a VAU, yAN10ON
❑ Over 10 to 50 Ind FINAL FU-
1 am exempt under Sec Over 60 to 100 Inc BY
B&PC fa this reason Over 100 . (A
• ServK Swbd MCC & Panelboards - Poo.
0-200 Amp Under 600 V
Sgnature - 207 - 1000 Amp Under 600 V ,
❑ Exemption for Over 1000 Amp or Over 600 V
Rag Maint Elect
0
SINGLE FAMILY Temp Power Pole& Appurtenances a
HOME OWNER-BUILDER DECLARATIONSign with One french Cacuit r ' T..
I hereby affirm that 1 am exempt from the Contractor a License Lew
for the
fdbwng reason (Section 70315 Business and Professions' Additional Stn Branch Cirarits
C _• _ r 333 69.�v
❑ Mac Conduits& Conductors 1 ITEMS •W
1 as owner l the property will l the work and the Business
structure TOTAL 69 .30
' a not intended a offered for sale Section 7044, Business Other(See Complete Fes Schedule) _ , ,
and Profeeaioris Code) , DECK 69.30
CONSTRUCTION LENDING AGENCY _ .00I hereby affirm that ftro is a construction lending agency for the M
performance of the wok for which this permit..sued(Sec 3097 PERMIT FEE (SubTotel) '
Cm C)
PLAN CHECKING FEE 1 9/28/95
Lender Name
PERMIT ISSUING FEE ao - 2`,}51 1 PN 5118 '
Lenders Address '
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 aulhonae
represantatrves of this County to enter upon the above mernored ^
property property for��p�purpo ss
�_�� SEE REVERSE FOR EXPLANATORY LANGUAGE
nature of Permittee ^ Date ^
WORKER ISave a certificate
DECLARATION 260018DPY/(,2 a„ APPLICATION FOR ELECTRICAL PERMIT IJ
70MI
I hereby affirm that I have a cerlihcete of consent to sell Insure
or e2fenilicate 61 Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy
of(Sac 3800 Lab C
` 'o CLL ompany FOR APPLICANT TO RIN
P011 30B
Cenllied copy is hereby furnished NO EACH FFA
New Residential Bldgs 6 Pods LOCALITY /r
❑ .:'0A died copy Is filed with the county,building Inspection 1 3 2 Family SR Ft — 3' $ �-c•
apartment Multifamily Sci Ft — �ST f
^�lL Resldentua Swimming Poole A SESSOR
DGI AppllCanl` �^ - MAP BOOK
PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Roc Light_Sw - RRMENAME
COMPENSATION INSURANCE First4
(This section need not be AtltlitK
Total No completed If the work Involved by the Additional �ImESS AQ 22y.,f-
permit Is for one hundred dollen($100)or lees)
I certify that In the performance of the work for which this permit CITY Tel
is Issued I shall not employ any person In any manner so as to fyp FLAN CIfECK
become subject to the Workers Compensation Laws Ughting Furtures First 20 APPL1CAAlT -
Total No � Additional
ADDRESS
Date r Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICE TO APPLICANT If after making this Certificate of CITY Tw No
Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP
provisions of the Labor Code you must forthwith comply with such f
provisions or this permit shell be deemed revoked Power Apparatus 3 Large Appliances APPLICANT At, AAJ
LICENSED CONTRACTORS DECLARATION Size 3 Type HP KW KVA or KVAFi ADDRESS S
V
I hereby affirm that I am licensed under provisions of Chapter g Over 3 to 10 Incl(commencing with Section 7000) of Division 3 of the Business and CITYO O C� Tal
Professions Code and my license is in lull force and effect Over 10 to 50 Ind UCENSE OR s� /+ }
{y /+ Over 50 to 1DO Incl REO NUMBER y!+ J C� {r�� O
GJ� / Lit Clare Over 100 DISTRICT NO Efi5E0 BY U
License Number �r
[� ✓- ' Services Swbd MCC d Panelboarde
Contract o�.rAw'61� �T. '-/U Date y r _ 0 399 Amp Under 000 V o^A
❑ I am exempt under Sec 400 1000 Amp Under 600 V VALIDATION W
Over 1000 Amp or Over 600 V FINAL1
B SP C for the reason 3 BRANCH CIRCUIT FEES 90U OG 0)
Date ISA W 20A 120V Lighting or Receipt z
1 To 10 Branch Orcurts
Signature i 1 To 40 Branch Clrmft
41 EJExemption for Reg Maint Eject ISA 2aA,209V To 277VLi hting Br Brnchra» its -
` SINGLE FAMILY .w.
Temp Power Palo 8 Appunenaricea - _ y�Y ^ssL-`-T e�r to?ew
HOME NER BUILDER DECLARATION Sign wide One Branch Circuit
I hereby affirm
exempt that I em exempt Irom'ihe Contractors License Lew ,
for the following reason (Section 7031 6 Business and Professions Additional Sign Branch Orcults
Code)
2i T
❑ rec Cantlurts E Conduct "'-�T+^"'+• " ` - -
I as owner of the property will do the work and the structure < TI 1 p1��-4,O
is not Intended or offered for sale(Section 7044 Burmese Other(Sae Complete Fee Schedule)_ - INA� iV
and Professions Cade) /�yL��A�yfAA w
CONSTRUCTION LENDING AGENCY ` CKCK 107.40
I hereby a//Inco that there is a construction lending agency for the e -
performance of the wok for which this permit is issued(Sec 3057 PERMIT FEE (Subtotal) D �ss�s�� 00
Civ C) ONE
PLAN CHECKING FEE -
Lender a Name
PERMIT ISSUING FEE
Lender a Address -
I c"Ify that I have mad plus application and uiMer penalty of pur ury state TOTAL FEE 0 #0 _ MOD--MlQ/7p 4rs�
that the above information Is correct I agree to comply with all County 4 w�w 7J
ordinances and State laws regulating Electrical wiring ardherebLtlL
yauthonze - 1 Ad10:4.5
representatives of ties County to enter upon the above-mentioned property
for Inspection purp`o^ses�rr^''w_,'.''� SEE REVERSE FOR EXPLANATORY LANGUAGE
WORKER+COMPENSATION DECLARATION 260019 DPW(+29„ APPLICATION FOR ELECTRICAL PERMIT
I hereby A{hrm that I teve a Certificate cete of consort to self insure
or a certificate,,QQl Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
COPY t4Araof(SeF 3800(_aD C) _
POI Company�///� FOR APPLICANT TO FlLL IN JOB OOO
ADDRESS a
;erblied copy m hereby lurnuhed N geeld44d 0
enba'Bldgs E Poole NO EACH FEE
❑ Oerulied r 1 &2 Fatuity SR Ft _ S s LOC
department is Idad othebuing _ NEAREST
MultilemirySol Ft CROSS ST CoeDate ��L%� ApResidential Swimming Pools A66EBSOR
BOOK PAGE PARCELCERTIFICATE OF EOM S Owets Rec _Ught_Sw � �y` COMPENANCE Frst�(This eeitlon need not M ce work involved by the 1uuL n
permit Is for one hundred dollars(SIGO)or lees)
Total No Additional ADDRESS V
1 certly Ihel in the performance of the work for which this permit CRY Tr
is Issued I shall not employ any person in any manner so as to
become subject to the Workers Compensation Laws Llghbng F aurae First 20 PIAN ECK
APPLICAM
Total No Additional
ADDRESS
Date rApplicant I
RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICE,TO APPLICANT 11 alter making this Certificate o/ CITY Tel No
Exemption you should become subject to the Workers Compensation , ER APPLIANCES NOT OVER 3 HP -
Provisions of the Lapor Code you must forthwith comply with such PERMIT G
provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances
LICENSED CONTRACTORS DECLARATION Size&Type HP KW KVA or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 101nU
(commencing with Section 7000) of Division 3 of the Business and CITY Tel
Professions Code and my license is in full force and effect Over 10 to 50 Ind LICENSE OR }
Over 50 to 100 Ind REO r10Al6ER 7(/
License Number /T ✓ I /� L e Class Over 100 DISTRICT NO
P BRED BY O
p U
Serwcee Swbd MCC&Panelboard,
Cahtract D 0 399 Amp Under 800 V DA O
❑
1!r.pt er Sec 400 1000 Amp Under 800 V VALIDATION W
Over 1000 Amp or Over 600 V FlNAL G.
B&P C for this reason - BRANCH CIRCUIT FEES Z
Date 15A or 20 12DV LlgMmg or Rwept
Signature 1 To 10 Branch Orwas 0
1 I To 40 Branch Cecuas
41 Or❑ 20
Exemption for Reg Maint Elect 15A 204 BV To 2M L More B Circuits
2
SINGLHOME OWNER BLE FAMILY DER DECLARATION Temp Power Pole&Appurtenances ACCT.i
I hereby affirm that I am exempt from the Contractor a Llcans r La Sign with One Branch Circuit =J)�T 7a.03
for the following reason (Section 7031 5 Business and ProfoslloqviaN Addhtional SW Brarwih Cucuns
Code)
1 ITEt15
❑ I as owner of the property will do the work and the structure Misc Condurtn&Conductors - TOTAL '�
is not intended or offered for sale (Section 7044 Business Other(Sae Complete Fee Schedule)
and Professions Code) , - CACKA 75.4[1
CONSTRUCTION LENDING AGENCY CHANK .13n
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 TOIQ V ff
Civ C)
PLAN CHECKING FEE
Lander a Name PERMIT ISSUING FEE '101 1 AM10:42
Lender a Address '
I comfy that I have read this application and under penalty of purlury state TOTAL FEE - 6,
that ft above information is correct I agree to Comply with all County A...�.E
andStemlewaregulau Elecbrcal win and hereby authorZervea f ihW unry k er upon thmemioned propertybn o SEE REVERSE FOR EXPLANATORY LANGUAGE
F PEf0I4 / PATE I
ION
Wm that
I have
a certificate
of consent
to 7sAees ,g,a, APPLICATION FOR ELECTRICAL PERMIT {�
I hereby.ffihrm the[ I have a certAxate ol consent to self insure �soeO LJ
or a certdicath of Vkrkers Compensation Insurance or a oobfed COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof 3800 Lab )
Policy No Fe' //r / M/w✓/ FOR APPDCAR7 TO FILL IN ' JOB
❑ erADORE •'�'}b/"v ///Chf&d copy is hereby furnished New Residential Bldgs 8 Roots EACH NO FEE SS
❑ ^14ertdec600py is filed with thebuildig inspection 1 & 2-Famiy So Ft 3 — $ LOCALITY
7045
/gp/srt��e� NEAREST
yt ` Mulb-lemilY Sq Ft — CROSS S7
Date_1,-[�[�_ Residential Swimming Pools OWNER OR
Applicant
- -
FIRM NAME c7%LAAPd CM,to
�p
CERTIFICATE OF EXEMPTION FROM WORKE Outlets Rec— Light — Sw MAL
i COMPENSATION INSURANCE ADDRESS
(This section need not be competed If the work Involved by the First 20 ,
permt to for one hundred dollars($100)or lase 1 I Total No Adddxxlal - CITY Tel No
I cerbfy that In the performance of the work for which thisPLAN CHECK
e
pBfrrto ARRJCANT,D.9lied I shell not employ ren m
y anY peoarty manner so as to ,
become sublett to the Workers Compensation Laws Lighting FixtureFest 20 ADDRESS
A2 1h. Additional
Date Appticent Total No CITY Tel No
NOTICE-TO APPLICANT If atter making the Certificate of Fued Appliances Not Over 1 HP , PERMIT
_ i
ExamphDn you should become subject to the Y.brkere CorrpensataRange_ HeaterDW _ APPLICANTn
p �// ��• '
ovrsiona o of the Labor Code you must forthnth campy with such Oven _ Dryer _ W M _ ADDRESS bT • / ' ,
provisions or this permit shell be deemed revoked Top — FAU _ WH _
,LK:ENSED CONTRACTORS DECLARATION Hood — Fen OtherCITY Tel No
_
I hereby affirm that I am licensed under pro'neions of Chapter 9 Drsp — Room Air Gond UCENSE OR Clw&
(commencing with Sechon 7000) of DNlslon 3 of the Business and REG NUMBER
Professions Code and my Icerise a In full force and effect Power Apparatus& Large Appliances pSTR9,7 NO ED QED ' Lr✓ O
JJ//�� Sae &Type HP KW,KVA o KVAR O U
Lcense Number-491(J982— //''��
Lc CILe n� Up to 1 Ind - - FINAL
Contractor �.�'I�er�6Q _Date �Q d / d Over 1 to 10 lrxi DAA Ir
3'I --9 VAUDAnO - O
Over 10 to 50 Ind FINAL
❑ I am exempt under Sac Over 50 to 100 Inc BY _ d
B&PC for the on Over 100
mas
Date Services Swbd MCC& Penelboards ► Z
0-200 Amp Under 000 V ,
Signature 201 - 1000 Amp Under 800 V '
❑ Exemption for Reg Maim Elect Ova 1000 Amp or Over 800 V - _- • -
SINGLE FAMILY Temp Power Pole& Appurtenances- kcm -
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I em "empt from the Contractor a License Law
fo the following reason(Secbon 7031 5 Business and Prolesslons Additional Sign Branch Circuits -
Cade)
Mec Condab& Conductors - 32% 1 11615
❑ I as owner of the property will do the wok and the structure Other(See Complete Fee Schedule) _
m net intended or offered for sale (Section 7044 Business lop.
and Prefesexxis 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) -
CN C)
PLAN CHECKING FEE
Larder a Name ,
PERMIT ISSUING FEE
Lerida a Address I certify that I have reed the applcatwn and state that the ahove TOTAL FEE ;4j�,62
'inlomaboi is correct I agree to comply with all County ordinances '
and State laws regulating Electrical wring and hereby authorize
represent trves of the County to enter upon the ebo mantcned
=Z mepeotwn p poses SEE REVERSE FOR EXPLANATORY LANGUAGE - - -
Sonature of Permdt Date
1
COUNTY OF LOS ANGELES TEMPLE CITY / 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9802050028
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE (818) 285-0488 EXT
LEGAL ID: fttS IAil? BUILDING ADDRESS
TR: 14467 1 4800 TEMPLE CITY BL
FEE DESCRIPTION QUANTITY LION AMOUNT TEMP CA 91780
ASSESSOR INFORRUTOW-RUFM NEAREST CROSS STREET L-
AI PERMIT ISSUANCE FEE 27 75� TH011AS PAGE GRID LOCALITY TEMPLE CITY
F1 120V, 15/20A BR CKTS 1 00 BR 17 40
TENANT TOTAL FEES 45 15 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
02/05/98 UT 02/05
OWNER TEL NO FINAL DATEi
7 ELEVEN 000 - /
NEW BRANCH CIRCUIT FOR NEW MACHIN
APPLICANT --ME No
J GROTHE ELECTRIC (909) 590-7090-
SPECIAL CONDITIONS
CONTRACTOR TEL NO5 PNGELES Co APPROVALS DATE INSPECTOR SIGNATURE
J G ELECTRIC (909) 590-7090- V� �TY
4075 SCHAEFER AVE LIC NO TEMPORARY POWER POLE
CHINO, CA 91710 492927C10
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEEF- TEL NO Rua-
LIC NO 1111117
ROUGH WIRING
{ vim' MAIN WATER LINE
11 r Q L P 0 VA 0�K 3 PLASTIC Y/N METAL Y/N
C\\\ O r '
ServiceThi
REPORT ID DPR265 ROUTE TO 850508
COUNTY OF LOS ANGELES TEMPLE CITY R 0508 IELECTRIGL' PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS SEL_0508.9707290008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY G
PHONE. (818) 285-0488 EXT: -
LEGAL ID FEES PAID ZUUI LD ING.ADUR 0
TR 14467 1 - 4800-TEMPLE CITY,9L -
FEE DESCRIPTION: QUANTITY: Udl: AMOUNT: 'ITEmp,reguso—
ASSESSOR INFORMATION NUMBER:
NEAREST CROSS STREET: LOVER AZUSA
Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE GRID LOCALITY TEMPLE CITY
G1 OUTLETS-LGT,SN,RECP 6 00 OUT 11 70
TOTAL FEES 39 45
ISSUED ON: PROCESSED BY. PLAN BY EXMT99-6F—
SEVEN ELEVEN 07/29/97 TC 07/29/98
OWNER TEL NO FINAL DATE
SOUTHLAND CORP (714) 255-0711-
CHANGE FRONT OSALES COUNTERS RE-I STALL OUTLETS NO NEN ,
CIRCUITS
APP ICANT TEL NO
NEST COAST CONSTRUCTION SERVICES (909) 982-6979-
SPECIAL CONDITIONS:
CONTRACTOR ��ELES CO
APPROVALS DATE INSPECTOR SIGRATURF--
WEST INDUSTRY
WAY
CONSTRUCTION SERVICES (909) 982-6979- O^
264 INDUSTRY Y LIC. NO TEMPORARY POWER PULE
UPLAND, G 91786 B i C-10
AARCHITECT OR ENGINEER TEL. NO .L
LIC. N0:
ROUGH WIRING
MAIN WATER LIKE
PUBLIC tl O O S PLASTIC Y/N METAL Y/N
L h UTILITY COMPANY NOTIFIED
f^
/ 0 ^ � " �
6crvice
• ADDITIONAL DATA ON FILE
REPORT ID DPR265 ROUTE TO- BS0508
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS I 9701 LAS TUNAS EL 0508 1006090029
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 -
PHONE (626) 285-0468 ENT
LEGAL ID FEES PAID BUILDING ADDRESS
TR 14467 1 1 4800 TEMPLE CITY BL
I . FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 91780
ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET LOWER AZUSA
8589-015-002 Al PERMIT ISSUANCE F86 27 75 THOMAS PAGE 597 GRID A5 LOCALITY TEMPLE CITY
D3 BOOTH LGT SYSTEM 1 00 BOO 16 20
TENANT TOTAL FEES 43 95 ISSUED ON PROCESSED BY PIAN BY +
TEMPLE STATION SHERIFF EXPLORER _ _ - 06/10/10 SR_
1OWNUR7-BLE 4) NO N D7�TEFI�PiA CODE
I]-ELEVRI INC (714) 674-4458- 'L�//JJ� /"`.VVV/ nv
1330 W LAMBERT RD
IBREA CA 92622 ' DESCRIPTION OF WORK _
I FIREWORKS STAND LIGHTING 2010 (PLUG-IN)
I
APPLICANT TEL NO
ITNT FIRE140"S BRAD HUDSON (714) 738-1002-159
555 N GILBERT ST SPECIAL CONDITIONS
FULLERTON, CA 92833
t
CONTRACTOR TEL NO I APPROVALS DATE INSPECTOR SIGNATURE
K C ELECTRIC (562) 867-4447- + -
6509 GLORYWHITE ST LIC NO - TEMPORARY POWER POLE
LAKEWOOD CA 90713 699521 C10
(UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER TEL NO ' UFER GROUND
LIC NO �I ROUGH CONDUIT
ROUCA WIRING _
MAIN WATER'LINE
PLASTIC_Y/N .METAL YIN
UTILITY COMPANY NOTIFI®I
I I -
I I I
I I '
I
- I
I I
I I
I I
;(
REPORT ID DPR265 ROUTE 70 890508 ' �
s COUNTY OF IAS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 IAS TUNAS EL 0508 0806200007
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID I FEES PAID BUILDING ADDRESS
ITR 14467 1 _ 1 4800 TEMPLE CITY BL
(FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 91780 -
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LOWER MUSA
8589-015-002 IA1 PERMIT ISSUANCE FEE
27 75 THOMAS PAGE 597 GRID AS LOCALITY TEMPLE CITY
I D3 BOOTH LGT SYSTEM 1 00 BOO 16 20 I
TENANT TOTAL FEES 43 95 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
TEMPLE STATION SHERIFF EXPLORER 106/20/08 _ _ SR 12/17/08
(OWNER TEL NO IFIttC�]�WIALLL DATE FINpy gY CODE
+1CITY AYSO (626) 574-7246-
148004600 T TEMPLE CITY BL
ITEMPLE CITY CA 91780
IDESCRYPTIOIT OF MURK
(BOOTH LIGHTING FOR FIREWORKS STAND-2008 (PLUG-IN) I
1APPLICANT TEL NO
IK C ELECTRIC (562) 867-4447-
16509 GLARY WHITE ST (SPECIAL CONDITIONS
LAKEWOOD CA 90713
I
1 CONTRAC-IOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE I
IK C ELECTRIC (310) 505-0444- _
16509 GLARY WHITE ST LIC NO iI I
LAKEWOOD CA 90713 ' 699521 C10 TEMPORARY POWER POLE
1
(UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER TEL NO LIFER GROUND
LIC NO ROUGH CONDUIT I I
ROVCH WIRING
I I 1NE
_1 .- PLASTIMAIN ICCTY/ L
NMETAL YIN
(UTILITY COMPANY NOTIFIEDI I
I
I I I I I
I I
I I { I I I I I
1 I I I
I I I
I I I I I I I
1 REPORT ID DPR265 ROUTE TO BS0508
1
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0906080034
BUILDING AND SAFETY I LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ITR 14467 1 1 4800 TEMPLE CITY BL 1
FEE DESCRIPTION QUANTITY DOM AMOUNT I TEMP CA 91780 1
1ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LOWER AZUSA 1
18589-015-002 IA1 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID A5 LOCALITY TEMPLE CITY ' I
D3 BOOTH LOT SYSTEM 1 00 BOO 16 20 I
(TENANT TOTAL FEES 43 95 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON 1
TEMPLE STATION SHERIFF EXPLORER 06/0 /09 SR 12/05/09
IFI
OWNER TEL NO )){{AALL QQAA A
7-ELEVEN INC (719) 679-4301- j C,__oTE FINAL Y CODE
I
330 W LAMBERT RD
1BREA CA 92622 1 IDESfRIFFION CXF WORK u1
I IB00TH LIGHTING FOR FIREWORKS STAND-2009 (PLUG-IN)
APPLICANT TEL NO
K C ELECTRIC (714) 738-1002- 1
1555 N GILBERT ST 1 1SPECIAL CONDITIONS 1
FULLERTON CA 92833
CONTRACTOR TEL NO 1APPPOVALS DATE INSPECTOR SIGNATURE
K C ELECTRIC - (310) 505-0444- _ 1
6509 GLORY WHITE ST LIC NO _ ITEMPORARY POWER POLE
LAKEWOOD CA 90713 699521 C10 I I
I UNDERGROUND CONDUIT I I
ARCHITECT OR ENGINEER TEL NO UFER GROUND
LIC NO ROUGH CONDUIT -
(ROUGH WIRING
I I (MAIN WATER LINE
(PLASTIC YIN METAL YIN
IUTIjITY COMPANY NOTIFIED(
I 1 I I I
I 1 I 1 1
I '
I I
I I I I
I I I
' I I
I I I I I I
I
�IREPORT ID DPR265 ROUTE TO BS0509
• COUNTY OF IAS ANGELES TEMPLE CITY p 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WRRS 9701 LAS TUNAS '
EL 0508 1205290057
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE 1626) 285-0488 EXT
LEGAL ID ` FEES PAID ) BUILDING ADDRESS
4800 TEMPLE CITY BL
TR 14467 1 FEE DESCRIPTION OUANTITY UOM AMOUNT TEMP CA 91780
ASSESSORINFORMATION NUMBER I I - �� NEAREST CROSS STREET LOWER AZUSA
8589-015-002 Al PERMIT ISSUANCE FEE 27 60 THOMAS PAGE 597 GRID AS LOCALITY TEMPLE CITY
D3 BOOTH LOT SYSTEM 1 00 BOO 16 15
(TENANT TDTAL FEES 43 95 ISSUED ON PROCESS® BY PLAN BY
TEMPLE STATION SHERIFF EXPLORER 05/29/12 SR
OWNER TEL NO ' �FI L TE a FS Y CODE
17—ELEVEN INC (714) 674-4458— 1
330 W LAMBERT RD
BREA, CA 92622 IDESCRIPT OF YAR$
(FIREWORKS STAND LIGHTING 2012 (PLUG-IN)
APPLICANT TEL NO '
TNT FIREWORKS, BRAD HUDSON (714) 738-1002-159
1555 N GILBERT ST SPECIAL CONDITIONS
FULLERTION, CA 92833
i
(CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE
IK C ELECTRIC (714) 699-0106— t 1_ 1
14440 CRARLEMAGNE AVE LIC NO I TEMPORARY P(1WER POLE
LONG BEACH CA 90808 699521 C10UNDERGROUND CONDOIT
(ARCHITECT OR ENGINEER TEL NO IUFER GROUND
LSC NO ROUGH CONDUIT
ROUGH HIRING
MAIN WATER LINE
PLASTIC YIN METAL YIN
UTILITY COMPANY NOTIFIED
REPORT ID DPR265 ROUTE TO SS0508
f
COUNTY OF IAS ANGELES TEMPLE CITY , # 0508 �1 1 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0706120032
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 295-0488 EXT
LEGAL ID FEES PAID F BUILDING ADDRESS
ITR 14467 1 I 1 4800 TEMPLE CITY BL
FEE DESCRIPTION QUANTITY UOM AMOUNT I TEMP CA 91780 1
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LOWER AZUSA
Al PERMIT ISSUANCE FEE 27 75 1 THOMAS PAGE GRID LOCALITY TEMPLE CITY
D3 BOOTH LOT, SYSTEM 1 00 BOO 16 20
ITENANT TOTAL FEES 43 95 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
TEMPLE STATION SHERIFF EXPLORER 1 06/13/07 SR 12/10/07
I I (
I OMRIEA TEL NO F�_ BY CODE
1TEMPLE CITY AYSO (626) 574-7246-
4800 TEMPLE CITY BL
TEMPLE CITY CA 91780 I DESCRIPTION F WORK 1
BOOM LIGHTING FOR FIREWORKS STAND-2007 (PLUG-IN)
APPLICANT TEL NO I
IK C ELECTRIC (562) 867-4447-
16509 GLORY WLHITE ST I SPECIAL CONDITIONS
LAKEWOOD, CA 90713
CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE I
IK C ELECTRIC (310) 505-0444- I
16509 GLARY WHITE ST LIC NO I TEMPORARY POWER POLE
IAKEWGOD, CA 90713 699521 CIO
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER TEL NO IUFEA GROUND
LIC NO ROUGH CONDUIT 1
ROTOH WIRING
I I
MAIN WATER LINE
IPLASTIC YIN METAL YIN
I IUT_LITY COMPANY NOTIFIED
I
I
I I
I � I
I 11 I I
I k �
I
I
I I
IRBPORT ID DPR265 ROUTE TO 850508
I I I I I
1
II �,
COUNTY OF LOS ANGELES TEMPLE CITY N 0508 ELECTRICAL=PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 US TUNAS EL-050 9706240014
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY G
PHONE (818) 285-0488 EXT
LEGAL ID: ftt:5 PAID BUILDING ADDRESS
TR 14467 1 14800'TEMPLE'C'TY BL
FEE DESCRIPTION QUANTITY UIOM AMOUNT: TEMP'G191780
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE GRID LOCALITY TEMPLE CITY
E3 TEMP XMAS TREE, ADOT 1.00 TEM 21.60
TENANT TOTAL FEES 49.35 ISSUED ON PROCESSED BY PLAN BY: wwlxhS UN
TEMPLE CITY YOUTH FOOTBALL LEAGUE _ 06/24/97 - .TC _ 06/24/98
OWNER TEL NO FINAL DATE FINAL BY;jj��CODE-
SEVEN ELEVEN (000) D00-0000- 6-Z(,-g7 -
EESCI m
U BOOTH LIGHTING FOR FIREWORKS STANLY
APPLICANT: TEL NO
RICHARD RAFFAELLI (717) 218-2741-
SPECIAL CONDITIONS:
LES CO
CONTRACTOR: TEL RICHARD RAFFAELLI (714) 218-2741- '
5681 KATELU 0828 LIC NO ' C� ` �+� _ TYPOWER
STANTON, G 90680 417812 C10 .�,J _ �A
ARCHITECT OR ENGINEER TEL NOUFER' GROUMD
LIC NO I � � H CONDUIT'
I i u i
MAIN WATER LINF
� `Ip`I J
I P U B LI C V tl C PLASTIC Y/N METAL YIN
Co
UTILrTYC O �O\
Service
I
REPORT ID DPR265 ROUTE TO BS0508
I.
COUNTY OF LOS ANGELES TEMPLE CITY A 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0306100023
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
ADDRESS-
TR- 14467 1 4800 TEMPLE CITY BL
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 91780
ASSESSOR INFORKATION NUMBER NEAREST CROSS STREET LOWER AZUSA
Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE. GRID LOCALITY TEMPLE CITY
D3 BOOTH LGT, SYSTEM 1 00 BOO 16 20
TENANT JI GENERATORS +3-10HP 1 00 GEN 19 65 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
TEMPLE STATION SHERIFF EXPLORER TOTAL FEES 63 60 06/10/03 JK 12/07/03
OWNER TEL NO TnOrWTE F I CODE
7-ELEVEN CONVENENCE STORES - (r _G ?'j I(I'1
6ESERIRTTU6F WORKv
ELECTRICAL FOR FIREWORKS STAND - 2003
APPLICANT TEL NO
K C ELECTRIC (562) 972-2706-
6509 GLORYWHITE SPECIAL CONDITIONS
LAKEWOOD 90713
CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE
K C ELECTRIC (310) 867-4447-
/ '�� �!'��
Q T�\
TE14PORARY POWER POLE
6509 GLORYWHITE ST LIC NO /� �.jfL
LAKEWOOD CA 90713 699521 C10 \`
\\ UNDERGROLAID CONDUIT
ARCHITECT OR ENGINEER TEL NO UFER GROUND
LIC NO�� Ill -� '�� V���
`.� �
RGUGH CONDUIT
R(JUGH WIRING
- MAIN WATER LINE
PLASTIC Y/M METAL Y/N
L UTILITY COMPANY NOTIFIED
i I
i
REPORT ID DPR265 ROUTE TO BS0508
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0006230034
BUILDING AND SAFETY / LAND DEVELOPMENT i TEMPLE CITY CA 91780 j
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
TR 14467 1 4800 TEMPLE CITY BL
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 91780
ASSESSOR INFORMATION NUMBERu NEAREST CROSS STREET LONER AZUSA
Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE GRID LOCALITY TEMPLE CITY
D3 BOOTH LGT, SYSTEM 1 00 BOO 16 20
TENANT TOTAL FEES 43 95 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
06/23/00 UT 12/20/00
OWNER DE
SEVEN ELEVEN -
FINAL DATE FINAL BY CODE
t>�R�na�rG��C L
BOOTH LIGHTING FOR FIREWORKS STAND V
APPLICANT TEL No
KIM DELTIEMPO - AYSO (626) 285-3555-
CONTRACTOR TEL NO co PT4GELES CO APPROVAL-S DATE INSPECTOR SIGNATURE
KIM DELTIEMPO - AYSO �0 ONTy
LIC NO 'iTEMPORARY POWER POLE
NONE
UNDERGROUND MUM-
11:1. NU UFER GROUND
LIC
UM —
LIC N0� / ROUGH CONDUIT
(� � (�j �(O '1 11 11 1,
11 III�SU _ W01FRI l Al I ROUGH WIRING
WATER LINE
PLASTIC Y/N METAL Y/N
Clll!l11��1 LLL�����!-0 lY IIIUI' UUU O C4.1
0 0 (`-F
TTi �
o 1 �y
Service Thai
r
I
REPORT ID DPR265 ROUTE TO OS0508
,
i
COUNTY OF LOS ANGELES TEMPLE CITY N 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0005190006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
TR 14467 1 4800 TEMPLE CITY BL
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 91780
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LOWER AZUSA
Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE GRID LOCALITY TEMPLE CITY
JK MOTORS, LT 3 HP 1 00 NOT 15 30
TENANT TOTAL FEES 43 OS ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
7 ELEVEN D5/19/00 UT 11/15/00
OWNER TEL NO FINAL DATE FINAL BY
7 ELEVENMTM4- Z�
ELECTRICAL FOR NEW REFRIGERATION CASE
APPLICANT TEL NO
EDISON SOURCE (714) 578-2300-
800 E ORANGETHORPE SPECIAL CONDITIONS
ANAHEIM, CA
CONTRACTOR TEL NO p�1GELES CO
APPROVALS DATE INSPEZr5ff-§rdWATUffE—
EDISON SOURCE (714) 278-0521- ,0 U�Ay
800 E ORANGETHORPE AVE LIC NO TEMPORARY POWER POLE
ANAHEIM CA 728778 A/B% (j
ARCHITECT OR ENGTWnIF- TEL NO-- UNDERGROUND CONDUIT
uftK GROUNDLIC N0 / / l� lllll
ROUGH WIRING
U B��u TV0 1 N(' PLASTIC Y/N METAL Y/N
COMPANY NOTIFIED
U /
o ��Jil
� `Service Tha
• ADDITIONAL DATA ON FILE
REPORT ID DPR265 ROUTE TO BS0508
r 1
COUNTY OF LOS ANGELES TEMPLE CITY $ 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS 1 EL 0508 9906170024
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID- FEES PAID BUILDING ADDRESS
TR 14467 1 4800 TEMPLE CITY BL
FEE DESCRIPTION WANTITY LION AMOUNT: TEMP CA 91780
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET
Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE GRID- LOCALITY TEMPLE CITY
D3 BOOTH LOT, SYSTEM 1 00 B00 16 20 I
TENANT TOTAL FEES 43 95 ISSUED ON PROCESSED BY PLAN BY EXMIW�
TEMPLE CITY YOUTH SOCCER ASSO 06/17/99 UT 12/14/99
OWNER TEL NO Fl L DATE Fl!�� CODE:
SEVEN ELEVEN (000) 000-0000-
UE 1,76
BOOTH LIGHTING FOR FIREWORKS STAND
APPLICANT
SAME AS OWNERCONTRACTOR TEL NO -
SPECIAL CONDITIONS
PNGELES CO APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER - �5
LIC NO TEMPORARY POWER POLE
UNDER GROUND MUM—
ARCHITFrT OR ENGINEER' LIFER GROUND
/ ROUGH CONDUIT
I
LIC NO� J ,_ - 1111111
1 f ROUGH WIRING
I
RAI NWATLK LINE
UL 0 m V PLASTIC Y/N METAL Y/N
urrEffy-EMPANY NOTIFIED
Service Tha'L�o(
i
i
I
1
f
I
REPORT ID DPR265 ROUTE TO BS0508
i
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT_
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL_0508_98070100041
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE (818) 285-0488 EXT
LEGAL ID --TnlrMI5 BUILDING ADDRESS
TR 14467 1 £4800 TEMPLE CITY_BL
FEE DESCRIPTION QUANTITY DOM AMOUNT TEMP-CA-91780
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET
Al PERMIT ISSUANCE FEE 28.05 THOMAS PAGE GRID LOCALITY TEMPLE CITY
D3 BOOTH LGT, SYSTEM 1 00 BOO 16 50
TENANT TOTAL FEES 44 55 ISSUED ON PROCESSED BY PLAN BY EXRAM�
TEMPLE CITY YOUTH SOCCER ASSO 07/01/98 In 07/01/99
OWNER
SEVEN ELEVEN (000) 000-0000- FINAL TE F ABY- CODE
n �.
6ESLR16TT�0
BOOTH-LI GHT I NG FOR FIR S_STAND
APPLICANT. TEL No-
SAME AS OWNERCONTRACTOR TEL NO -
SPECIAL CONDITIONS
NC,ELES ls CO,j APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER - / V� QTY
LIC NO UNDERGROUND CMUgTT-\ TEMPORARY POWER POLE
UFER GROUND/
LIC NO r , 1111 ll 1ROUGH CONDUIT
L U ' LL, 0 ��\1GRU U PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFTO
O o
c/ Q
rl \L
46/�c Se'Vice -fthl t
- REPORT ID DPR265 ROUTE TO BS0508
COUNTY OF LOS ANGELES TEMPLE CITY N 0508 ELECTRICAL PERMIT
DEPAPTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0106280004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE- (626) 285-0488 EXT
LEGAL 10 FEES PAID BUILDING ADDRESS
TR 14467 1 4800 TEMPLE CITY BL
FEE DESCRIPTION QUANTITY UDI AM"T TEMP CA 91780
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET LONER AZUSA
Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE GRID LOCALITY TEMPLE CITY
D3 BOOTH LGT, SYSTEM 1 00 BOO 16 20
TENANTTOTAL FEES 43 95 ISSUED ON PROCEssu sy PLAN ST EXPIRES ON
06/28/01 UT 12/25/01
TEMPLE CITY AYSO (626) 574-7246- 107,n 0�
6ESClTrlIm 6F
BOOTH LIGHTING FOR KS STAN-F-2`601 (PLUG-IN)
APPLICANT TEL NO
TEMPLE CITY AYSO (ROBERT SHONBORN) (626) 574-7246-
6365 BARELA AVE SPECIAL CONDITIONS
TEMPLE CITY CA 91780
S PNGELES Co
NONE �OCONTRACTOR ��/TY AR1zAb�AL3DATE INSPECTOR SIGNATURE
LIC. NO TEMPORARY POWER POLE
NONE
UNDERGROUND CONDUIT
ARcHITEL:T OR ENGINEER
;R GRZIT
UC NO 1111P7
ROUGH WIRING
) O L C V O�'� LI U V PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIEIF
A I� � s
vb/�C ServNCe ThaY�o�
r
r
1
REPORT ID DPR265 ROUTE TO BS0508
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0206270009
BUILDING AND SAFETY / LAND DEVELOPMENT TMPLE CITY CA(626) 2851
PHONEN0488 EXT
LEGAL ID. FEES PAID BUILDING ADDRESS:
TR 14467 1 4800 TEMPLE CITY BL
FEE DESCRIPTION QUANTITY UOM: AMOUNT TRIP CA 91780
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LOWER AZUSA
Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE: GRID LOCALITY TEMPLE CITY
D3 BOOTH LGT, SYSTEM 1 00 800 16 20
TOTAL FEES 43 95 ISSUED ON PROCESSED BY PLAN BY rRrrwffrm
06/27/02 JK 12/24/02
OWNER —m. No FINAL DATE FINAL BY OWE:
TEMPLE CITY AYSO (626) 574-7246-
l� �� -
a>•s�ata
BOOTh LIGHTING FOR FIREWORKS STAND-2002 (PLUG-IN)
APPLICANT TEL No
BRIAN CASEY (626) 309-1274-
5928 MUSCATEL AVE SPECIAL CONDITIONS
SAN GABRIEL
CONTRACTOR: TEL PNGELES CO
APPROVALS DATE INSFn7bw-MwxraT--
NONE - �0S �NTy
LIC NO / \
TEMPORARY
NONEUNDER,,
RaUND CONDUIT
ARCHITECT OR ENGINEER TEL NO LIFER aROUND
LIC. NO/I /
� L_ ROUGH CONDUIT
rr' MAIN IIATER LINE
LL��n
II �C TV K c�-) PLAST,C Y/N METAL Y/N
UTILI-,Y COMPANY NOTIFIED
jY0 Z rr�y 7 E(�G
c Servlce_That
REPORT ID DPR265 ROUTE TO RSD5O8
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC PARRS 9701 LAS TUNAS - EL 0508 1105030039
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ITR 14467 1 1 4800 TEMPLE CITY BL
I IFEE DESCRIPTION QUANTITY DOM AMOUNT I TEMP CA 91780
(ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET LOWER AZUSA 1
18589-015-002 1A1 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 597 GRID AS LOCALITY TEMPLE CITY 1
_ID3 BOOTH LUT, SYSTEM 1 00 B00 16 15 1
ITENANT I TOTAL FEES 43 95 ISSUED ON PROCESSED BY PLAN BY
(TEMPLE STATION SHERIFF EXPLORER 1 _ 05/)3/11 SR
I I
10WNER TEL F DA I FI CODE
17-ELEVEN INC (714) 674-4-4458- 1
1330 W LAMBERT RD 1
1BREA, CA 92622 1 1�CR PTION OP PORK 1
FIR]WORKS STAND LIGHTING 201 (PLUG-IN)
APPLICANT TEL NO 1
ITNT FIREWORKS, BRAD HUDSON (714) 738-1002-159
1555 N GIL.BERT ST
11 iSPEC IAL CONDITIONS
FULLERTON CA 92833 1
I
ICONLRACTOR TEL NO (APPROVALS DATE INSPECTOR SIGNATURE
IX C ELECTRIC (714) 699-0106- 1
14440 CHARLEMAGNE AVE LIC NO 1 TEMPORARY POWER POLE
ILONG BRACH CA 90808 699521 CIO
I I IUNDFRGROUND CONDUIT I I
I I_
1ARCHITECT OR ENGINEER TEL NO 1pFER GROUND I I
I -
LIC NO ROUCH CONDUIT I I
I
I ROUCH WIRING I
I (MAIN WATER LINE I
I PLASTIC Y/N METAL Y/N
I I
(UTILITY COMPANY NOTIFIED(
I I 1 I I I
I I i I
i I
I I I I I I
I I I I I
I
I I
I I I I
I f l I I I I
1 REPORT ID DPR265 ROUTE TO BS0508
1 '
COUNTY OF LOS ANGELtb TEMrL� CITY r 0508 i� ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0406170033
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EVLEGAL
i
ASSESSOR INFORMATION NUMBER
BUILDING ADDRESS
TR 14467 1 �D— 4800 TEMPLE CITY BL
FEE DESCRIPTION QUANTITY LYW AMOUNT TEtiP'CA,91780
NEAREST CROSS STREET LOWER AZUSA
Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE GRID LOCALITY TEMPLE CITY i
D3 BOOTH LCT, SYSTEM 1 00 B00 16 20
TENANT TOTAL FEES 43 95
_ 06/17/04 PROCESSED
JK 12/14/04
OWNER TEL NO FINAL DATE FINAL BY CODE
TEMPLE CITY AYSO (626) 574-7246- _'
UO OF WORK \41
BOOTH LICHTING FOR FIREWORKS STAND-2004 (PLUG-IN)
APPLICANT TEL NO
K C ELECTRIC (310) 505-0444-
L C U -
CONTRACTOR TEL NO APPROVAL . DATE INSPECTOR S G
K C ELECTRIC (310) 505-0444- I`
6509 GLORYWHITE ST LIC NO TEMP ORA RY POWER POLE
LAKEWOOD CA 00713 699521 CIO
UNDERGR"D CONDUIT
ARCHITECT 0- ENGINEtR ILL NO UM-t-EROUND
uC NO - A COWOUIT
RATA WATER LINE
PLASTIC Y/N METAL Y/N
i
i
i
IREPORT ID DPR265 ROUTE TO BS0508
�C ;
COUNTY OF LOS ANGELES TEMPLE CITY $ 050E ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9101 LAS TUNAS EL OSOB 0506170036
BUILDING AND SAFETY / LAND OCVCIAP3ffitT TBMPLH CITY CA 91780
PHONE (626) 385-0488 CRT
LEGAL ID FEES PAID BUILDING ADDRESS
TR 14467 1 4800 TEMPLE CITY SL
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 91780
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LOWER AZUSA
Al P®UfIT ISSUANCE FEE 27 75 THOMAS PAGE GRID LOCALITY TEMPLE CITY
D3 BOOTH LGT, SYSTEM 1 00 BOO 16 20
TENANT TOTAL PEES 43 95 ISSUED ON PROCESSED BY PLAN BY EKPIRES ON
06/17/05 JK 12/14/05
OWNER TEL NO FINAL BY CODE
TEMPLE CITY AYSO (626) 574-7246-
DESCRIPTION OF WORK
BOOTH LIGHTING FOR FIREWORKS STAND-2005 (PLUG-IN)
APPLICANT TEL NO !
K C HLECTBIC (310) 505-0444-
SPECIAL CONDITIONS
I
CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE
E C ELECTRIC (310) 505-0444- '
6509 GLORYWHITE ST LIC NO TEMPORARY POWER POLE
LAKEWOOD CA 90713 699521 CIO I -
UNDERGROUND CONDUIT
ARCHITECT OR ENGINEER TEL NO UPBd GROUND
LIC NO ROUGH CONDUIT
ROUGH MIRING
I
MAIV MATER LINE
PLASTIC YIN METAL YIN
I
UTILITY COMPANY NOTIFIED
I
f
I
REPORT ID DPR265 ROOTS TO BS0508
' P
COUNTY OF LOS ANGELES TEMPLE CITT 9 0508 ELECTRICAL PERMIT ,
DEPARTMZNT OF PUBLIC MORS 9701 LAS TUNAS EL 0508 0606150017
BUILDING AND SAFETY / LAND DEVELAPKENT TLTfPLE CITT CA 91780
PROM (636)285-0480 ERT
LEGAL ID _ FEES PAID BUILDING .ADDRESS
TR 14467 1 4600 TEMPLE CITY BL
FRE DESCRIPTION QUANTITY DOM AMOUNT TBNP CA 91700
ASSESSOR INFORMATION NUMBER i NEAREST CROSS STREET LAMER AZUSA
Al PERMIT ISSUANCE FRE 27 75 � THOMASa PAGE GRID LOCALITT T LB CITY
D3 BOOTH LAT, SYSTEM 1 00 BOO 16 20
TENANT _ TOTAL FEES 43 95 ISSUED ON PROCESSED By PLAN BY R[PIRRS ON
TEMPLE STATION SHERIFF R[PLARSR , 06/15/06 JR 13/13/06
OWNER TEL NO - FINA TE FINAL By CODE
TEMPLE CITY AY80 (6361 574-]346- i
4800 TEMPLE CITY SL
TEMPLE CITY CA 91780DES I IO
LI® O G FON FIREMOR[S STA®-2006,(PLUG-IN)
APPLICANT TEL NOYLvalac
,
[ C ELECTRIC (363) 867-4447-
6509 GLORYMH ITS ST SPECIAL CONDITIONS
LAKEWOOD, CA 90713
CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE
[ C ELECTRIC (310) 505-0444-
6509 GLARTMHITR ST LIC NO _ - TURPORART POWER POLE
LAKEWOOD CA 90713 699521 C10
UNDERGROUND CONDUIT
I
ARCHITECT OR ENGINEER TEL NO UFRR GROUND
LIC NO ROUGH CONDUIT
ROUE MIRING
MAIL+MATER LINE
PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTIFIYD ,
I
' I
i
, 1
REPORT ID DPR265 ROUTE TO B80508
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1405270075
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
TA 14967 1 4800 TEMPLE CITY BL
IFEE DESCRIPTION QUANTITY UDM AMOUNT TEMP CA 91780
ASSESSOR INFORMATION NUMBER I - NEAREST CROSS STREET LOWER AZUSA
8589-015-002 IA1 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 597 GRID AS LOCALITY TEMPLE CITY
103 BOOTH LGT SYSTEM 1 00 B00 _ 16 20
ITENANT I TOTAL FEES 44 00 ISSUED ON PROCESSED BY PLAN BY
TEMPLE STATION SHERIFF EXPLORER 05/27/14 SR `
TOWNER TEL NO FINAAA��� D�jTE FI�IL99U�yy BY CODE
I7-ELEVEN INC RRD 14) 674-4458- FIN
Za� / //
`
BREA CAA 922622 IDESCR PTIO OF FORK
FIRtWORKS STAND LIGHTING 2014 (PLUG-IN)
(APPLICANT TEL NO
(TNT FIREWORKS BRAD HUDSON (714) 738-1002-1159
555 N GILBERT ST ISPELIAL CONDITIONS
IFULLERTON CA 92833
JCONTRACICIA TEL NO (APPROVALS
DATE INSPECTOR SIGNATURE
K C ELECTRIC (714) 699-0106- I= I
4440 CHARLEMAGNE AVE LIC NO (TEMPORARY POWER POLE
LONG BEACH CA 90808 699521 1 1-1-
I IUNDhRGROUND CONDUIT
I I
(ARCHITECT OR ENGINEER TEL NO IUFE GGROUND
LIC NO IROUGH CONDUIT
TROUGH WIRING
' MAIN WATER LIRE I I
PLA.aTIC Y/N METAL Y/N
' UTILITY COMPANY NOTIFIEDI
I I I I I I
I I I I I
I I I I I
REPORT ID DPR265 ROUTE TO 13S0508
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 IAS TUNAS EL 0508 1306030085
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ITR 14467 1 4600 TEMPLE CITY BL
FEE DESCRIPTION QUANTITY DOM • AMOUNT TEMP CA 91780
(ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET LOWER AZUSA 1
8589-015-002 IA1 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 597 GRID AS LDCALITY TEMPLE CITY
ID3 BOOTH LGT,`SYSTEM 1 00 BOO 16 15
TENANT TOTAL FEES 43 95 ISSUED ON PROCESSED BY PLAN BY
TEMPLE STATION SHERIFF EXPLORER 06/03/13 SR
(OWNER TEL NO I F JY/1'E FIpY�.�Y CODE
7-ELEVEN INC (719) 674-4458- /,I __-/////li,')
330 W LAMBERT RD
BREA CA 92622 I IDESCRIP11ION OF WORK
FIREWORKS STAND LIGHTING 2013 (PLUG-IN)
(APPLICANT TEL NO
ITNT FIREWORKS BRAD HUDSON (714) 738-1002-159
1555 N GILBERT ST
CONDITIONS
FULLERTON CA 92833 iSPECTLi.
I I I
CONTRACTOR TEL NO (APPROVALS DATE INSPECTOR SIGNATURE
K C ELECTRIC (714) 699-0106-
14440 CHARLEMAGNE AVE LIC NO I ITEMPORARY POWER POLE
LANG BEACH CA 99608 699521 I 1 1 I 1
(UNDERGROUND CONDUIT
I I 1
ARCHITECT OR ENGINEER TEL NO i UFER GROUND
LIC NO ROUGH CONDUIT 1
I ROVGY WIRING
(MAIN WATER LINE
1 IPLASTIC YIN METAL YIN
1DTI1TTY COMPANY NOTIFIED I I
1 1 11 11
I I
1 I I I I I
I I_
I
I
, iREPORT ID DPP-265 ROUTE TO BS0508
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC FORKS 9701 LAS TUNAS EL 0508 1005170001
BUILDING AND SAFETY / IAM DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488
(LEGAL ID FEES PAID BUILDING ADDRESS -
ITR 14469 1 1 1 4800 TEMPLE CITY BL
I (FEE DESCRIPTION QUANTITY DOM AMOUNT I TEMP CA 91780 -
(ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET
18589-015-002 Al PERMIT ISSUANCE FEE 27 75 ( THOMAS PAGE 597 GRID A5 LOCALITY TEMPLE CITY C
I IIE NON-RES VENDING MACH 1 00 VIN 15 30
TENANT I TOTAL FEES 43 05 ISSUED ON PROCESSED BY PIAN BY
05/17/10 SR
OFT4ER TEL NO FINAL DATE FINAL BY CODE
7-11 SOUTHIAND CORP -
4800 TEMPLE CITY BL 1
TEMPLE CITY CA 91780 DESCRIPTION OF FORK
I - (WIRE KIOSK TO 20 AMP CIRCUIT
APPLICANT TEL NO
ELSNER ALLEN (B17) 546-3106-
BOX 638 1 SPECIAL CONDITIONS
FOX LAKE IL 60020 I
I
CON CTOR TEL NO 1APPPOVALS - DATE INSPECTOR SIGNATURE 1
-- ALL CITY ELECTRIC _ _ - (847) 546-0059-
P 0 BOX 638 LIC NO 1 TEMPORARY POWER POLE
FOXLAKE IL 60020 328054 C10 I I
I UNDERGROUND CONDUIT 1
I I'
ARCHITECT OR ENGINEER TEL NO JUFER GROUND I I
I
LIC NO ROUGH CONDUIT - -
ROUbH WIRING
MAIN WATER LINE ' 1
EXPIRED PLASTIC Y/N METAL Y/N I
(UTILITY COMPANY NOTIFIED
I I I I
{ I
I
I 11
� 1 I
ADDITIONAL DATA ON FILE I,
_
REPORT IO DPR265 ROUTE TO BS0508