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Home My Public Portal About5816 TEMPLE CITY BLVD_Electrical__ 7GA663-CE506 3-68 APPLICATION FOR ELECTRICAL PERMlir COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS at ifl&tlp JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NO. EACH FEE RECEIPT. $ $ OWNER MAIL LIGHT 15' TOTAL FIRST 20 ,20 �C ADDRESS CA SWITCH OVER 20 .10 J,, CITY TEL.Ng! 'PLAN CHECK LIGHTING TOTAL FIRST 20 ,20 d APPLICANT FIXTURES I-L.5-- OVER 20 ,10 ADDRESS RANGE_DRYER_WTR. HTR. CITY TEL.NO. STA. COOK_DISP._F.A.U. CONTRACTOR / SPACE HTR. AIR COND.. ADDRESS IV CLOTHES WASH._DISHWASH. CITY llqxA4.A TEL.NO. (y FAN_OTHER 1.00 LICENSE Ne CLASS. MOTORS,TRANSFORMERS RATING I HEREBY 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 WIRING. 0---- 1 1.00 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR , C LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATEOF 1 — 1O 3.00 CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN, THE ABOVE DESCRIBED RESID IAL PROPERTY. 10 - 50 15.00 SIGNATURE / F 50 - 100 10A0 OF PERMITTEE l� u 100 — 500 15.00 DISTRICT NO� GROUP ZONE PRO C SIGN,GAS SIGN AND ONE CIRCUIT 3.00 D � 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, IN APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT / WIRING PERMIT FEE (SUB TOTAL) FIXTURES PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED PERMIT ISSUING FEE 2.00 d UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL 7/f TOTAL FEE � � JOSEPH C. ROOHAN SUPERVISING ELECTRICAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH lAr,,54670 =18 2 D 14.50 4 SEE BACK OF APPI IPATInN FnR COMPI ETE FEE SCHEDULE /�� WORKERS'COMPENSATION DECLARATION 76,663 10/81 APPLICATION PPLIC p TION FOR ELECTRICAL PERMIT�.I het'eb4 affirm that I have a certificate of consent to self CE•BO6G �'°'i 9'1! 1�1 1� 9�GiI� 1 insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lob. C.) Policy No. Compony 37W [//o FOR APPLICANT TO FILL IN JOB ❑ Certified copy is hereby furnished. New Residential Bidgs. &Pools EACH NO. FEE ADDRESS 1 &2-Family, S Ft. $ _ $ LOCALITY y� Certified copy is filed with the county building inspec- q' NEAREST /10 tion department. Multi-family Sq. Ft. Residential Swimming Pools CROSS ST. Date Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION [(YM WORKERS' Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE First 20 ADDRESS (This section neod not bo completod If the work involvod by Total No. Additional CITY T Tel. No. the ormlt is for one hundred dollars($1100)or less.) I cify that in the performance of the work for which this APPLICANTK e t per it is issued, I shall not employ any person in any manner so aq to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS 1; Total No. Additional Date Applicant Qj CITY Tel. No. Fixed Appliances Not Over 1 HP PERMIT NOTIE TO PPLICANT: If, after r 9 Sg this Certificate of APPLICANT Exemption, you should become �tbject to the Workers' Range_ Heater_D.W. Compensation provisions of the Labor Code, you must forth- Oven —Dryer —W.M. ADDRESS 1,C with comply with such provisions oe this permit shall be Top _ FAU —W.H. — deemed revoked. CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ Disp. _ Room Air Cond. LICENSE O C Class —v I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER 7 (comm ncing with Section 7000)of Division 3 of the Business DISTRICT NO. PROC D and Prg fessions Code,and my license is in full force and effect. Power Apparatus&Large Appliances /} p� I Size&Type HP, KW, KVA, or KVAR ense N ber Lic. Class��o Up to 1 Incl. FINAL r Over 1 to 10 Incl. DATE 7 _Z VALIDATION! 0 Con'fractor Date �❑ Over 10 to 50 Incl. v l FIN, W I am exempt under Sec. Over 50 to 100 Inc. BY O: B.&P.C. for this reason Over 100g 6 �'J A Z Date Services, Swbd., MCC&Ponelboards 0 -200 Amp. Under 600 V # 0 0 0 0 o 2 Signature 201 - 1000 Amp. Under 600 V❑ ( 0 - 255-0 Over 1000 Amp. or Over 600 V Exemption for Reg. Maint. Elect, o 0 0 2� � 0Z SINGLE FAMILY Temp. Power Pole&Appurtenances 216—, . HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ( 2 1 6"i 7 1 hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits Law for the following reason (Section 7031.5, Business and Professions Code): ❑ 1, as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Address .. I certify that I have read this application and state that the TOTAL FEE above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 710e, Apno Si re of Permittee to