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HomeMy Public PortalAbout4805 TEMPLE CITY BLVD_Electrical__ 7BA6:3-CE306 f BB APPLICATION FORI I ELECTRI E 01TSU COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING /i 0 S 2?:A ? C/71' 6Ll'�j JOHN A LAMBIE COUNTY ENGINEER ADDRESS T COLEMAN IN JENKINS, SUHRINTENDLNTOV BUILDING LOCALITY C EAREST FOR APPLICANT TO FILL IN CROSS ST Lo�l.r.v ,d l&S/ /,o NO EACH FEE RECEPT $ OWNER TAST f AA!W- MAIL LIGHT ;//1qq TOTALE /�AL FIRST 20 20 Q ADDRSS ,/ SWITCHIL2{Q OVER 20 4<1A 1 10 CITY LX TEL NO PLAN CHECK LIGHTING TOTAL FIRST 20 20 O APPLICANT FIXTURES 32 OVER 20 10 ADDRESS RANGE—DRYER—/ nWTR HTR CITY TEL NO STA COOK_DISP LF A U — CONTRACTOR ��/c OI 4er SPACE HTR /AIR COND ADDRESS �� X 1*,Ed1OiV CLOTHES WASH _DISHWASH _ / CITY 0/j".lOVIQ TEL NO k5-? S' 2 FAN OTHER 6 1 00 Me, LICENSE NO JSZ 3 CLASS e-ll MOTORS TRANSFORMERS RATING IND HEATERS ETC HP KW KVA I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SIZE & TYPE OVER TO AMD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING Wily -244,11p 0 - 1 1 OO O ELECTRICAL WIRING -3//0 ��-2ND 1 - 10 3 DO LICE MSCO BAB CREQUIRED THAT LOR 05 AN ELES COUNTY BAND ESTATE/Of CALIFORNIA OR THAT 1 AM THE LEO AL OWNER OF AND INTEND TO 10 50 5 00 RESIDE IN THE ABOVE DESCRYED RESIDENTIAL PROPERTY O SIGNATURE �f�El AA's � ME 50 - 100 10 00 OF PERMITTEE DB 100 - S00 1S 00 O SIGN GAS DIS�fitICT O POUP ISLE CESSED BY rj TUBE OR SIGN AND ONE CIRCUIT 300 J F L MARQUEE- ADDITIONAL CIRCUITS 1 00 NOTES Z SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00 SQ lCE OVER 600 VOLTS OR 200 AMP 6 00 r TEMP SERVICE POLE &APPURTENANCES 3 00 APPROVALS DATE INSPECTOR S SIGNATURE TEMP POWER POLE UNDERSLAB WORK ROUGH CONDUIT PERMIT FEE (SUB TOTAL) WIRING FIXTURES PLAN CHECK FEE ISO% PERMIT FEE) POWER AUTHORIZED PERMIT ISSUING FEE 2 00 Z UTILITY CO NOTIFIED Q SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL TOTAL FEE JOSEPH C ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION 0 D CASH LAC„4 2 2 61z K%R 2 5 2 D 3 6.8 0;- I EE IEE SACK OF APPLICATION FOR COMPLETE FEE SCHEDULE {& Bea-c_lleoa a-eG T�,`{ pL,E �/ T� • APPLICATION FOR ELE - ICAL PERMIT COUNTY OK LOS ANGELES DEPA9tTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A LAMBIE, COUNTY ENGINEER COLEMAN W JENKINS, SUPERINTENDENT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS S NO EACH I[[ S $ OWNEae RECEIPT MAIL LIGHT_ TOTAL FIRST 20 20 ADDRESS CITY TEL NO SWITCH_ OVER 20 10 PLAN CHECK LIGHTING TOTAL FIRST 20 20 APPLICANT FI%TURES } OVER 20 10 ADDRESS RANGE_DRYER_WTR HTR CITY 17 TEL NO STA COOK_DISP _F A U CONTRACTOR SPACE HTR _AIR COND ADDRESS CLOTHES WASH _DISHWASH _ CITY Z TELT FAN OTHER 1 00 LICENSE NO CLASS ..t MOTORS TRANSFORMERS RATING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION IND HEATERS, ETC HP KW KVA AND STATE THAT THE ABOVE Ia CORRECT AND AGREE TO COMPLY SIZE 6 TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAW9 REGULATING [L EC TRICAL WIRING D - I 1 DD 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED IND/OR d LICENSED AS REQUIRED BY LOS ANGELES COUNTY AN ATEOF O I - 10 3 OO CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND END TO V RESIDE IN THE ABOVE DESCRIBED BI D. L PRO 10 — SO S 00 CIC SIGNATURE V 60 - 100 IODO OF PERMITTEE W 100 — SDD 1500 DISTRICT NO q GROUP ZONE PRoc[asED Rr CL SIGN GAS SIGN AND ONE CIRCUIT 3 00 S,�o F Z L �« ��� Z TUBe, OR MARQUEE ADDITIONAL CIRCUITS 1 00 NOTES SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 00 SERVICE OVER 600 VOLTS OR 200 AMP 5 00 TEMP SERVICE, POLE. &APPURTENANCES 300 Q APPROVALS DATE aDPECTOR% .p TU,L TEMP POWER POLE IFIXTURES LAB WORK CONDUIT UIT PERMIT FEE (SUB TOTAL)PLAN CHECK FEE (50% PERMIT FEE) AUTHORIZEDPERMIT ISSUING FEE 2 00 � CO NOTIFIEDSUPPLEMENTARY PERMIT ISSUING FEE 100 t;t TOTAL FEE JOSEPH C ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION C. M Q CASH PERMIT VALIDATION © M O GAB. I d{',. 4 1 3 2 MAR 17 2 D 5,0 0'" EEE BAC. OR API.II.TION IO. CDMP1 rT[ REE SCHEDULE �T&Ase!-CLeOb a-RG 7.__ __ _ �/Ne � , APPLICATIOONN/ FOR ELECTRICAl PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTYENGINEER AD'L N C BUILDING AND SAFETY DIVISIONIdud JOHN A LAMBIE, COUNTY ENGINEER COLEMAN W JENKINS, SUPERINTENDENT OF BUILDING LGCA L ITT N FOR APPLICANT TO FILL IN CflEOSARSE STT T MO iACN •CC _ RECEIPT MAIL LIGHT TOTAL FIRST 20 pp ADORES SWITCH— OVER 20 10 CITY TEL NOPLAN CHECK LIGHTING TOTAL FIRST 20 20 APPLICANT FIXTURES } OVER 20 10 ADDRESS RANGE_DRYER_WTR HTR CITY TEL NO STA COOK_DISP _F A U CONTRACTOR Fa SPACE HTR —AIR COND ADDRESS lv� CLOTHES WASH _DISHWASH CITYLA &A isEAx>& TEL NO — (� FAN_OTHER 1 GO LICENSE NO CLASS MOTORS TRANSFORMERS RATING I NERDY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION IND HEATERS, ETC HP KW KVA AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WINING 0 — 1 1 00 1 MEREST CERTIFY THAT I AM PROPERLY REGISTERED MO/OR �ICCM SED AS RCOUIRED SY LOS ANGELES COUNTY ARO STATE OF } 1 — 10 3 00 CALIFORNIA OR THAT M TN EGAL OW N[N OF AMD INTEND TO LL RESIDE IN THE ASOV E6CR RCSI4EHTIAL PROPERTY O 10 — 50 S00 U S IGNATUR 60 — 100 10.00 OF PERM T O� 100 — Soo 1500 IN T NO G OuPp ZONE RoC SSDD SY G SIGN,GAS SIGN ANO ONE CIRCUIT 3 00O ��" TUBE OR Z MARQUEE ADDITIONAL CIRCUITS 1 00 — SERVICE NOT OVER 600 VOLTS OR 200 AMP 2 DO SERVICE OVER 600 VOLTS OR 200 AMP 5 00 TEMP SERVICE, POLE, &APPURTENANCES 3 00APPROVALS DATE RUIPECTORD SIGNATURE POWER POLE LAB WORK CONDUIT PERMIT FEE (SUB TOTAL) ES PLAN CHECK FEE (50% PERMIT FEE) AUTHORIZED PERMIT ISSUING FEE 2 00 UTILITY CO NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL TOTAL FEE JOSEPH C ROOHAN SUPERVISING ELECTR AL ENGINEER PLAN CHECK VALIDATION CK M D -CASH PERMIT VALIDATION cK M D CASH U`t,5 2 5 6ie JRA 5 2 D 6..)00/)0_— c SEE SACK OF APPLICATION FOR COMPLETE FEC SCHEDULE • �// I,'/l/W�/V 7GA053 CIBOe 10 e0 APPLICATION FOR ELECTRICAL PERMIT 1 COUNTY OF LOS ANGELES DEPARMENT OF COUNTY ENGINEER BUILDING IA4 BUILDING AND SAFETY DIVISION ADDREBB OSJOHN A LAMBIE COUNTY E.— '--R /�WILLIAM A JENSEN SUPT OF BUILDING LOCALITY C. /NEARESTFOR APPLICANT TO FILL IN CROSS ST OLPERMIT FEES OWNER eI T E M NUMBER EACH PEE MAILOUTADDREBBTS RECEPT aw 10 CITY TEL NO LIGHTING FIXTURES 10 OEIEC RANGES CLO DRYERDELECTRICIAN O WATER HEATER• a0 ADDREBB[LEC SPACE HTRS oIYHWAEHERS CITY s� TEL NOGARBAGE DISPOSERS AUTO STATE WASHERS BTA COOKING UNITS 2a LICENSE NOMOTORS OVER INC 'NP DISTRICT UP NE 0— 1/E 25 CZ _ IA— 2 so I PECTION RECORD 2— a 100 d a— 1a 1 ao O 1a— so leo im go— 200 app O SIGNS NO TRANS NO LAMPS H SERVICED SOOV 100 Q SERVICE OVER 000V apo r MISC. � J WIRING PERMIT 1 OO FIXTURE PERMIT too e ' SUPPLEMENTARY PERMIT so TOTAL FEE f O I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THUI APPLICATION APPROVALS DATE INSPECTOR 9SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT .L I WITH ALL COUNTY ORDINANCES AND RATE LAWS REGULATING ELECTRICAL WIRING WIRING ` I Id I IMAP M RL 1 HEREBY CERTIFY THAT 1 APROPEY REGIB18NtD D AN /OR LICENSED AS REOUIRSO BY LOS AMOELES COUNTY ANO STATE OR FIXTURES 1 A CALIFORNIA OR THAT 1 AM TNl_J.4%A4 OWNEIL OF THE ABOVE DEECf1IBED REEID PR POWER L 1 SIGNATURE Ui1LlTY CO NOTIFIED I I OF PERMI FINAL _ ' JVTgl1DATION ART u N Err v c/R/ Yo CASN $UPHRVI IND ELECTRICAL ENGINEER ( (,`0 568 74 DEC 4 2 0 5-90 Q / { TeAeeD cleoa Ino APPLICATION FOR ELECTRICAL PER ` `"`"tV, COUNTY OF LOB ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADORES e JOHN A LAMBIE COUNTY ENGINKKR LOGLI COLEMAN W JENKI NS N 1 NEAREST �O FOR APPLICANT TO PILL IN CR09S ST OUTLETS OWNER RECEPT_ $ S MAIL LIGHT 3 TOTAL FIRST 20 2o ' ADDRESS SWITCH/ OVER 20 10 CITY TEL NO PLAN CHECK LIGHTING l FIRST 20 20 APPLICANT M 7-p C I TOTAL FIXTURES OVER 20 10 ADDRES eSy—,C—R APPLIANCES CITYTAYY TEL No;.9r794 RANOE_DRYER_WTR HTR PERT APPLICANT L STA COOK_DISP _F A U _ ( ADDRl�9+3 SPACE HTR AIR GOND CITY,/ GW 1 TEL NO CLOTHES WASH DISHWASH_ LICENSE NO CLASSC,- FAN—OTHER 100 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STAT[ THAT THE ABOVE I$ CORRECT AND AOR[[ TO COMPLY MOTORS TRANSFORMER$ I4 TINY WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING IND HATERS, ETC HP KW 'XVA ELECTRICAL WIRING SIZE a TYPE pVKR TO HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR D - 1 100 LICENSED AS .THAT REQUIRED BY LOS LEGAL OW COUNTY AND STATE TOF O CALIFORNIA OR.THAT SCAM DNC L[OAL OW N[R OF AND INTEND TO 1 - 10 300 Ras or IM TX! ABO V! Deeu mm R[$ID[NTIAL PROPERTY 91GNATURE 10 — 50 SOO OF PERMITTE SO — 100 IODO p. D 18 M CT NO CLASS GROUP ZONE ROCl1 BY O 100 — sDo soo Q� [t L SIGN GAS SIGN AND ONE CIRCUIT 800 NOTES TUBE, OR Z MARQUEE ADDITIONAL CIRCUITS 100 SERVICENOTOVER 600 VOLTS OR 200AMP 200 SERVICEOVER 600 VOLTS OR 200AMP SooFFRU PROVALS DATE INlLCTGIHB SImNTUR! OWER POLE TEMP SERVICE POLE, C APPURTENANCES $00 LAS WORK TEMP LIGHT OR RE EPT SYSTEM 900 -- ONDIUT Fed l4drr'llflo 1 x PERMIT FEE (SUB TOTAL) SAUTHORIZEDPLAN CHECK FEE (50% PERMIT FEE) CO NOTI FIE'PERMIT ISSUING FEE 200SUPPLEMENTARY PERMIT ISSUING FEE 100 JO EPH C ROOHAN TOTAL FEE SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION cK M D CASH PERMIT VALIDATION cK M 0 CASH IA�_ i � e2� �u�30 2 D5.00� CQ S![ SAM OF APPLICATION FOR COMPLETE SCHEDULE u 2IMPLE 09TY * 3 T6A668-C•EW6 6-62 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER r!7CAuTY BUILDING AND SAFETY DIVISION CSN �i dr JOHN A LAMBIE, COUNTY ENGINEER WILLIAM A JENSEN, BOF T OF SlI1LOIN0 N EARE6T IC N O FILLIN IRO,,ST WQ.✓ 43 RECEPT TOTALNO EACH RE OUTLETS FIRST 20 •2O 6 OWNER /Ah/ SWITLIGHMAIL ADD•L ADDRESS SwlrcH OVER 20 10 TOTAL CI H ai✓ TEL NO LIGHTING � F1RaT 20 a0 �+ FIXTURES ADO2 1O ELECTRICIAN klr /� O Q� OV R 20 _ /✓/� RANOII CLO DRYmfS WT11 w" 100 ADDRESS Z3 Ci+HalAw CAM DISP STA COOK CITY-r Cow TEL NO DISMWASH AVID WASH STATE CE HRS / SPATRA APP SYR N F MAS 1 60 LICENSE NO v MoroRe, OVER Nor ovm NFDIST ICT N UP P CE ED BY 0 I 1 00 I a ISO INSPECTION RECORD a S 200 S — IS a50 IS — So Soo SO — 100 Soo O BIaNe No TRAM. NO LAMPS 0 SERVICE 0600V NOT wa 200A 100 Q �J SERVICE 0600V OVER 200 A 200 d N SERVICE OVER GOOV Soo Z MISC PERMIT ISSUING FEE 200 SUPPLEMWTAUY PERMIT ISSUING FE[ 1001 1 TOTAL FEE [ I HERESY AC%NOWLEOGE THAT 1 NAVE RUO THIS APPLICATION APPROVALSOAT[ INEP[CTO11 •GMATURS AN STATE THAT THE ARGYE IS GORMCT AND AGRQ To CoNFLY CONDUIT WITH ALL COUNTY ORDINANCES AND RAT[ LAWS MOULATINO IDJDL gCAL WIRING WIRING 1 IOVRMY CERHTEAT AT 1 AN PROPERLY R[OISTERm AMO/OR LICANSED AS RIGUIREO ST LOS ANO[LES COUNTY AND STAT OF FIXTURES CALIFORNIA OR THAT 1 AN TI[ "CAL OWN" OF E AOOVE DESC,=D MSHDENTAL POWER SIGNATUR2 OP PERMITT ` UTILITY CON [D EE FINAL VALIDATE ARTHUR C VEIT CK MO CASX SUPERVISING ELECTRICAL ENGINEER t �0 6 8 3-w JUM30 2D 5.40- 0 76A8e3 CE80E G AA U APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING Q BUILDING AND SAFETY DIVISION ADDRESS Jq JOHN A LAMBIE. COUNTY ENGINEER Af.i T /, COLEMAN W JENKINS SUP T OF BUILDING LOCALITY KMAP � /eA1 C4 NEAREST FOR APPLICANT TO FIL IN I CROSS ST N RECEPT TOTAL No EAC" FSE LIGHT OUTLETS FIRST 20 $20 i Q OWNER �� D MAIL SWITCH /� ADD'L ADDRESS A��6 (�1Yo✓P/ OVER 20 10 LIGHTINGF/TeT AL FIRST 20110 2 CITY //LO TEL No FIXTURES — ADo'L 1O ELECTRICIAN /e F-ojs E oY R20'L RANGES CLO DRYERS WTR HTR[ 100 ADDRESS i CAI [/ / a.T GAtet DMP STA COOK N CITY TEL NO 1 T(O - SV DISHWASH AUTO WARN STATE SPACE HTRS STA APP (VR HP MAX ) Sp LICENSE NO / MOTORS. OVER NOT OVER HP DIST CT NO ZONE P EBBED Y 0 I 100 S I — s ISO INSPECTION CORD a a 200 a — la ISO — O IS BO Soo / BE 50 100 500 0 SIGNS, NO TMNS ITM NO LAMMZ SERVICH O 600V NOT ovES 200A 100SERVICE O GOOV OVER 100 A 200 SERVICE OVER BODY ao0MISCPERMIT ISSUING FEE 100SUPPLEMENTARY PERMIT ISSUING FEE 1010 TOTAL FEE MEREST ACKNOWLEDGE THAT 1 HAV[ READ TNu APPLICAnAPPROVALS GATE IMSPE oNO STATE THAT THE ABOVE IR CORRECT AND AGREE TO COMPUIT wrmALL CDUNTY ORDINANCES AND STATE LAWS REGULATIRICAL WIRING NGHEREBY CERT.FT THAT I AM PROPERLY REOIST[R[D AMD/ RHY FlIf LICENSED Af R[OUIREO RYLOf ANOELl1 COUNTY AND CTAT[CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTYR aIGNATUp! TYCO NOTIFIED OF PERMITTEE FINAL n A5 VALIDATI u JOS PH C ROOHAN CK m ,/ CAS H SUPERVISING ELECTRICAL ENGINEER LAL;0 3 3 JUL U b.0 U" d T DECLAR WORKER I havCOMPENSATION of 7�eLa°DPW„2 9„ APPLICATION FOR ELECTRICAL PERMIT I hereDq elhrm that I hnve.h certificate of,consent to self Insure or a certificate of lyyorker a Compensation Insurance or a cerutied ,COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 3800 Lob C) r - No Company FOR APPUCANT TO FILL 01 JAWRE56 L.as Cer!d"d copy a hereby furnished NO EACH FEE • f , New Resldenbal Bldgs 8 Pods $ $ LOCALITY LV- ❑ Camhed copy 6 filed with the county budding inspection 1 6 2 Family SO Ft departmentMulti family Sp Ft —' csgr Date f Applicant RnMEemial Swimming Poole A35ESSOR .i MAP BOOK L) PAGE P/pOEL CERTIFICATE OF EXEMPTION FROM WORKERS .►�L - Ow'NER OR f Outlets Ran �^�Light_Sw FIRM NAME 0 UN COMPENSATION INSURANCE First� v (Thin eintlon need not be completed If the work involved by the MAIL n permit In for one hundred dollars($100)or leas) Total No Additional AOpRE55 PeQ QLj9N I certify that in the performance of the work for which this permit CRY A Atq� Tei No L is Issued I shall not employ any person In any manner no as to Pt-AN CHECK become subject to the Workers Compensation Laws Lighting Fixtures First 20 APPucANT Total No Addmonal ADDRESS Date 7a� Applicant RESIDENTIAL APPLLWCES NOT OVER 3 HP NOTICE TO APPL ANT If after making this Certificate of CITY Tel 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 PEPAIR provisions or this permit shall be deemed revoked - Power Apparatus 8 Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Sae a Type HP KW KVA or KVAR ADDRESS 7 •& �' t I hereby affirm that I am licensed under provisions of Chapter a Over 3 to 101nd !y (commencing with Section 7000)of Division 3 of the Business and CT' Tel No G O Professions Code and my license is In full force and effect Over 10 to SO not } U 1,15E OR Over 50 to 100 Ind REG NUMBERA-16,3 Over 100 DISTRICT NO PROLE License Number Do Clens Q —"'" '- -' r Senates Swbd MCC 8 Panelboards Comractor Date 2 0 399 Amp Under 800 V FINAL _ DATE VALIDATION V _ _ 400 1000 Amp Under 800 V _ ry ❑ _am exempt_under Sec Over 1000 Amp or Over 60O V FINAL W B 8P C for this reason -' BRANCH CIRCUIT FEES BY CL Date 15A or 20A 120V Lighting M Rector Ov ? Signature 1 To 10 Branch Circuits C 11 To 40 Branch Orcwro - 41 Or More Branch Orcults Exemption for Reg Maim N Elect 15A 20A 208V To 27Br Orcuns ACC T. SINGLE FAMILY Temp Power Pole&-Appurtenances _ _ HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit - 77107 137.01 1 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 Circuits 1 ITBS Code) �--ac ❑' Misc Conduits s Conductors, T13TAL 103 . 0`' I as owner of the property will do the work end the structure - ia not intended or offered for tale (Section 7044 Business Other(See Colete Fee Schedule)_ , _ CHECK - 13.x.LIQ and Professions Code) mpCHANGE .00 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) OOC&OW 1 1/..4/55 PLAN CHECKING FEE V771 1 AN10:11 Lender s Name PERMIT ISSUING FEE Lenders Address 1 - I certlty,that I have read this application and under penalty of purlury state TOTAL FEE 33.0 that the above Information is correct !agree to comply with all County - ordinancesandStatelawnregulatingElecYncalwinng and hereby authorize representatives of unty to enter upon the above mentioned property - -for to u SEE REVERSE FOR EXPLANATORY LANGUAGE ' V DATE WORKER have a certificate DECLARATION 7BA 63 DPW(12 Bt) APPLICATION FOR ELECTRICAL PERMIT I hereby 8lhrm that I have a cerbhcata of,ponsent to sell insure ]8A883 1 or a Certificate of Worker s Compensation Insurance Or'a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 3800 Lab C I. Policy No Company FOR APPDCANT TO RLL IN JOB ORE99 Cerbfied copy is hereby fumuNew Resdenbal Bldgs hetl ' NO EACH FEE gs d Poole — LOCALITY ❑ Cerbfied copy a filed with the county building inspection 1 8 2 Family So Ft department Multi/army Sq Ft c 6T r,.reiJi �ts/Zq Dale Appllcarri Reaidenbal Swimming Pools ' ASSESSDR MAP 8001( I PACE PARCFl CERTIFICATE OF EXEMPTION FROM WORKERSOMER OR COMPENSATION INSURANCE Oialela Roc —LightSw _ _ FIRM NAME First 20 (This secllon need not be completed If the work Involved by the Total No Additional MAIL f permit le for one hundred dollars(7100)or lose) I certify that in the performance of the work for which this permit CITY r i TO No is issued I shall not employ any person in any manner so as to PLAN CHECX become subject to the Workers,,Compensauon Laws Ughting Fixtures First 20 APPUCANT Total No Additional ADDRESS Dale - 3f—sr .Appocam,(��z.1,><ct �u-+r NOTICE TO APPLICANT It alter making this Cerlrficatl of RESIDENTIAL APPLIANCES NOT OVER CITY Tel 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 Power Apparatus 8 Large Appliances APPIJrt M provisions or this permit shell be deemed revoked 7 ' LICENSED CONTRACTORS DECLARATION I Size 8 Type HP KW KVA or KVAR ADDRESS nS5 /l 4"1 A I hereby affirm that I am licensed under provisions of Chapter 0 (commencing with Section 7000) ofiDivision 3 of the Business and Over 3 to ID Incl CITY �� Tel Niii Professions Code and my license is In full force and effect Over 10 to 501=1 11 Over 50 to 100InG REG EG NU NUMBER '7eL .3r 2,T Ckn � QL 0 DISTRICT ND EBBED BY License Number LIc Clens � O+er 1 W fJ /,'� Services Swbd MCC 8 Penelboerds ��� LG�e(,��_ W Contractor PRA a CArt'$T Date 5 y4� 0 30g Amp Under fi00 V M� 0 ❑ I am exempt under Sec 400 1000 Amp Under 800 V ��p VALIDATION W Over 1DDO Amp or Over 6W V FlNAL _ .1 (L B 8P C for this reason - BRANCH CIRCUIT FEES BY ` Dale 15A or 20A 120V Lighting or ReCept _ L�, Z r 1 To 10 Branch Cimune Signature 11 To 40 Branch Grana LG) �4,.ILI ❑ Circu Exemption fu Reg Meint Elect 15A 20A 208V To 277VOLogrb"BBMore&rCrcuds its 1 ITEM SINGLE FAMILY Temp Power Poled Appurtenances TOTE 64 w D ffiHOME OWNER BUILDER DECLARATION Sign with One Branch Circuit ( ( I hereby arm that I em exempt from the Contractor s License Lew ,HECK, 64.51) for the fallowing reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits Code) — CHMIGE .Ol ❑ I as ovmar of the property will do the wok and the structure Min Conduits 8 Conductors- is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) and Professions Code) CONSTRUCTION LENDING AGENCY Li �J 1 ANIG:1G I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sac 3007 PERMIT FEE (Sub Total) Civ C) PLAN CHECKING FEE Landera Name PERMIT ISSUING FEE Lender s Address I candy that I have read this application and under penalty of purlury rnme TOTAL FEE that the above information a correct I agree to comply with all County - ordmanceaand State lam regulating Electualwinng andherebyauthonze representatives,of this County to enter upon the above mentioned property Z inepecn �osee SEE REVERSE FOR EXPLANATORY LANGUAGE , 1, : r9w u T PFAI � WTE