HomeMy Public PortalAbout6022-6024 TEMPLE CITY BLVD_Electrical__ 76A663-CE60612-65 APPLICATION FOR E.LECTRICALfPERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY 'ENGINEER rt
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING, LOCALITY
NEREST '
FOR APPLICANT TO FILL IN CROSSAST.
RECEPT. TOTAL NO. XACH FEE
LIGHT
OUTLETS I FIRST 20 $.20 $ OWNER
DSWITCHADD'L 10 ADDRESS
OVER 20
TOTAL FIRST 211-- .20 ® CITY T NO. Ir
LIGHTING I
FIXTURES
FIXTURES ADD'L OVER 20 10 CONTRACTOR
RANGES DRYERS NRR.HTRB. 1.00 ADDRESS-
GARB.DISP. STA.COOK
CITY TEL.N
DISHWASH. AUTO.-WASH. STATE
SPACE HTRB. STA. APPL. ,SO
LICENSE NO.
MOTORS: OVER NOT OVER H.P. DIS RICT G 7ANIT PR
O 1 1.00 er
I 3 1.50 INSPECTION RECORD
3 S 2.00
s is .2.50 m
O
is so 3.00 b
W
50 100 5.00 O.
In
Z
SIGNS: NO.TRANS.
NO.LAMPS
SERVICE 0.600V-NOT OVER 200A 1.00.
SERVICE 0.600V-OvER 200 A. 2.00
SERVICE OVER 600V 5.00
OTHER (SEE COMPLETE FEE SCHEDULE)
PERMIT ISSUING FEE 2.00 Q
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TOTAL FEE S
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLIC TION UNDERSLAB WORK
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
A�w
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF;AND INTEND TO POWER
RESIDE IN.THE ABOVE SCRIBED R IDEN IAL PROPERTY.
SIGNATURE UTILITY CO.NOTIFIED w
OF PERMITTEE s
FINAL s /I
VALIDAIJON�, JOSEPH C. ROOHAN
CK MC( ___I_ SUPERVISING ELECTRICAL ENGINEER
L6679% 12 2 u 460- 4
FOAS63-CESOS-7-36 APPLICATION FOR ELECTRIC PERM-. T ],
BUILDING AND SAFETY DIVISION
Department of County Engineer BUILDING hgA&V/Z1 V C Q
County of Los Angeles ADDRESS
JOHN A.LAMBIE. COUNTY ENGINEER /
GASSATT D.GRIFFIN,SUPIr OF BUILDING LOCALITY /
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
PERM FEES �ir�
NUMBER OWNER / , At-wen
LIGHT OUTLETS MAIL
ADDRESS
RECEPTACLES
WALL SWITCHES FEE CITY TEL.NO.
TOTAL OUTLETS 0 Be $ ELECTRICIAN d tj Cdlll',m SE
ELEC.RANGES 28 ADDRESS Q It Pi , t
ELEC.HEATERS 28 CITY /� TEL.NO p
KW EA STATE w�
FIXTURES g LICENSE NO. V
MOTORS DIST T NO. IGROUPI7 NE 10
I READY FOR INSPECTION
NUMBER HORSEPOWERFEE
NEW MVD. HP OVER INC. EACH
Ih&LESS $ .25 INSPECTION BECORD
36 2 .s0
2 s Loo
s 1s 1.so AlIs s0 2.50 �A11--Y 0 /" Or,
50 200 5.00 LL :
MISC. 1/.11 [AK
Ser r i c TiYEIT AgweH T>?/P
-R Y JAIL .7�,r gyri
NO.SIGNS NO.TRANS. ' /V ,QY0k-fM"�Z2,0AIaR
NO.SIGNS NO.LAMPS I.E Age 4LL"a �iPrd)r, -I EQ
FOR EACH PERMIT:
WIRING PERMIT $1.00
FIXTURE PERMIT $1.00 Y4/ )/ fis �u4ff
SUPPLEMENTARY .50 y� APPROVALS )))041 if /ff
TOTAL FEE g Cid DATE INSPECTORS SIGNATURE
1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING'
ELECTRICAL WIRING. FIXTURES
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL OPE T/!. P UTILITY CO.NOTIFIED
SIGNATURE / d /
OF PERMITTEE-19FINAL a :✓cf
JOHN UN A.LAMBIE VALIDATIQ�, ARTHUR C.VETT,
.OUNTY ENGINEER CK NO H SUPERVISING ELECTRICAL ENGINEER
LC0 5 6 8 8., MAR 1 2 1 .0 0 M
76AS63 SA SSM BETS 7-48 •1fE1* CATWN FOR p
DEPARTA+IENT Or str�nnvG AND sA�rY A�E�La�eaEasva�C:T�ty IC �
COUNTY OF LOS ANGELES
M FO CHISF NGIN A
_� NAME _ P AZ ® �qi�?- DISTRICT NO. GROUP ZONE PERMIT NO.
U ADDRESS r �_ 3 C:�9
CITY TEL,—NO, �!f READY FOR DATE!SS ED
FIRST INSPECTION
J COUNTY /z7—
M LICENSE NO. EXPIRES
APPLICANT FILL IN UP-AV"Y'OiMLNM PORTIO)qONLY
JOB
1DESCHEMON OF WORK ADDRESS
NUMBER OF OUTLETS ON CIRCUITS LOCALITY � .rF
LOCATION BY ROOMS rs
NEAREST L_
LIGHT OUTLETS SW. PLUGS Fl7LT CROSS ST
F
CIRCUIT A B C I D E F IG I H S NAME
a MAIL
O
CITYT - TEL NOS
1 AM THE LEG4L POSSESS OF THE -ABOVE LOS
ANQIW= COUNTY CERTIFICATE OF QUALIFICATION..
_ ELECTRICIAN.
AI AM BOVB TII6 A* OWNER O RO DESC�
OWNER.
CORRECTBONS
J
Q
• Z
- p
TOTAL
NO. OF OUTLETS G ffi 3 b . APPROVALS
' NO. OF FIXTURES ffi 1 - DATE INSPECTOR'S NAME
NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. ffi WIRING
• r
LNO. OF RANGES OR HEATERS $ FIXTURES r
SCELLANEOUS $ POWER G n ('.p
RMIT FEE ffi UTILITY CO.NOTIFIED
T FEE FINAL I vvv
:=... P ORKERS'COMPENSATION,DECLARATION 176A663 10/81 E L E
I, .ereby� f�firm.tha>!I have..a certificate of consent to self !CE-8066 , APPLICATION ,FO.. I.CAL PE.RM;IT
}� p I R : CTR
in§ure,
or' certificate of\A(Sec rs'Compensation Insurance.,
COUNTY OF LOS ANGELES BUI.LDING,AND SAFETY V
ono certifiecLcopy thereof (S'ec. 3800, Lab. C.) j }
FOR..APPLICANT TO FILL-IN JOB
• P�oliey No.. ' _� Company _ _
Certified co is.hereby furnished. I' EACH NO. FEE ADDRESS
PY Y I, New•Residential'Bldgs. &Pools
t _ $. .. LOCALITY
Certified copy i.s filed with the county building inspec- 1. &2-Family;.Sq. Ft.: .
tion department. Multkfa.mily Sq. Ft. — NEAREST
I �Y`/ /
or
Res'ident'ial Swimming;Pools CROSS ST: J/.
Date, Applicant FIRM OWNER OR
NAME ^ �. 7lLLJGYJ
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:'Ree�Light Sw.!. i fL
COMPENSATION INSURANCE ADDRESS ge-sp d
{ Firdt 20 >
{
(This section need not be completed If the work involved by f Total No. CITY Tel, N'o.
the permit is for one hundred dollars(51.0.0)or;lass.) Additional 4
PLAN CHEC
I'certify that in the performance of the�work for which this APPLICANT
permit is,issued,,I shall not employ any person in any manner I' +
so as to become.subject to the Workers'Compensation Laws. Lighting'Fixtures� First 20 Z ADDRESS
l Total No.
Additional CITY Tol. No.'
Date applicant A '
Fixed poliances.Not Over 1 HP
NOTICE TO APPLICANT: If, after making this Certificate of PE
RMIT ., -
Eketnption, you should become`subject to the Workers' ;L Range_ Heater_.D.W. — APPLICANT' p-v- :Qat u►�
Compensation provisions.of the Labor Code, you must forth- Oven —Dryer _W.M. AbDRESS >7~ �
with comply•with such provisions or this permit shall :be Top _ FAU W.H. — ` r
deemed revoked. CiTY Tel. IVo.:
LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ O 35�7.33�5
'Disp. Room Air Cond. LICENSE OR Class.
1
I hereby affirm that I arra licensed under provisions of Chapter 9 REG.NUMBER .
(commencing with Section 9000)of Division 3 of the Business' DISTRICT NO. PROC ED BY '.
ond'Professions Code,and my license it;in full.force and.effect. Power Apparatus&'Large Appliances O
Size&Type HP; KW, KVA, or WAR' �.
License.Number Lic. Class. Up to 1 Incl. DNA L•
Contractor Over'1 to 10'lncl. E �z DATION
A
Date V`
Over 1:0 to 50 incl'.
ElI am.exempt under:Sec. Over 50 to 100.Irtc. ......... B ` d
B.&P.C: for this reason Over 100
Date:.. Services, Swbd.,MCC&Panelboards ']
0 -200 A00m.p. Under 6 V v
Signature 201 - 1000 Amp. Under'600 V
Over 1000 Amp.,of Over 600 V
❑' Exemption for-Reg. Mairlt..ElecC r
SINGLE'FAMILY Temp. Power Pole&Appurtenances '
HOME OWNER-BUILDER DECLARATION Sign with OneBranch Circuit :1.5 O 4,4 A
I hereby affirm that I am exempt from the Contractor's License + ti
Law for tAe following reason.,(Section 703'1.5, Business and Additional.Sign Branch Circuits j
Professions Code):
f # 0000,o2
li as owner.of the:property, will do the.work.and the € Misc. Conduits&Conductors I . • 4 a - 33,75
structure ,is not intended or offered for•safe (Section I Other(See Complete Fee,Schedul.e:)_ I
7044, Business and Professions Code). , o o,o .3 3 7 5 v
CONSTRUCTION-LENDING AGENCY r g{s
0
I hereby affirm that there is a construction lending.a,geney for 7, 15=r86
i I
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 j '1
PERMIT ISSUING FEE (J
Lender's Address
I 2
I certify that I have read this application and state that the iR TOTAL FEE
above information is correct. 1 agree to-comply with all.County i
ordinances and State laws regulating Electrical wiring, and
hereby authorize.representatives of this County to enter upon. '
the above-mentioned property for inspection purpos S. , SEE REVERSE'FOR EXPLANATORY LANGUAGE
c
Signatof Permitt ate
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