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Home My Public Portal About6119 TEMPLE CITY BLVD_Electrical__ �E a TEA , cEBDB 468 APPLICATION FOR ELECTRICAL PERMIT U COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS e' r �' • JOHN A. LAMBIE. COUNTY ENGINEER L COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY '�yPl NEAREST FOR APPLICANT TO FILL IN CROSS ST. NO. EACH FE $ S E OWNER 1C RECEPT._ MAIL LIGHT TOTAL FIRST 20 .20 ADDRESS SWITCH_ OVER 20 .10 CITY TEL. NO. PLAN,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 SPACE HTR. AIR COND. ADDRESS '9Z 1�. CLOTHES WASH._DISHWASH._ CIT TEL. Q FAN--:OTHER 1.00 s� ^ f"' 1� LICENSE IJO. /�� CLASS. �� v MOTORS,TRANSFORMERS RATING IND. HEATERS, ETC. HP. KW. KVA, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SIZE TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. 0 - 1 1.00 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR 1 - 10 3.00 LICENSED'AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO 10 - 50 5.00 RESIDE THE ABOVE' DESCRIBED ESIDENTIAL PROPERTY. SIGNA E a 50 - 100 10.00 OF PERMI V too - soo 15.00 DIS. NO UP' NE PR ESSED BY � SIGN,GAS C TUBE, OR SIGN AND ONE CIRCUIT 3.00 t Ea MARQUEE ADDITIONAL CIRCUITS 9.00 NOTES: SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00 Z O- ? SERVICE OVER 600 VOLTS OR 200 AMP 5.00 TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE TEMP. POWER POLE UNDERSLAS WORK ROUGH CONDUIT PERMIT FEE (SUB TOTAL) WIRING FIXTURES PLAN CHECK FEE (50% PERMIT FEE) r/ POWER AUTHORIZED - Z PERMIT ISSUING FEE 12.00 OR UTILITY CO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL 9A A TOTAL FEE JOSEPH C. ROOHAN SUPERVISING ELEC CAL ENGINEER ATION CK.. PLAN CHECK VALIDATION CK.. M.O.. CASH PERMIT VALIDM.O. nCASH EE BACK OF;APPLICATION FOR COMPLETE FEE SCHEDULE �� ' `r/ ofal Cl 7",Y 7SA66 -CE606 4-613 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER fBUILDINGBUILDING AND SAFETY DIVISION DDRESSJOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDINGOCALITY e EAREST FOR APPLICANT TO FILL IN ROSS ST. NO. EACH FEE RECEPT.s_ S S OWNER UG�/L/itJ MAIL �+ LIGHT TOTAL FIRST 20 .20 ADDRESS J�Pj7� SWITCH_ 422 OVER 20 .10 CITY TEL. NO. PLAN CHECK Olt LIGHTING TOTAL FIRST 20 .20 APPLICANT FIXTURES OVER 20 .10 ADDRESS RANGE—DRYER—WTR.HTR.— CITY TEL. NO. CI STA.COOK_DISP._F.A.U._ CONTRACTOR , W, RJ c7- U SPACE HTR. AIR COND. ADDRESS CLOTHES WASH._DISHWASH._ a CITY a TEL. NO. — j FAN—OTHER 1.00 LICENSE 1-40. J CLASS. C MOTORS,TRANSFORMERS RATING ,I IND. HEATERS, ETC. HP. KW. KVA. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION TO AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY SIZE & TYPE OVER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 0 — 1 1.00 ELECTRICAL WIRING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 1 — 10 3.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND IN END TO . 10 — 50 5.00 RESIDE IN, THE A OVE D CRIP.ED RESIDENTIAL PERTY. CL CL U 50 — 100 10.00 SIGNATURE C OF PERMITTEE 100 — 500 15.00 I" SIGN,GAS DIST,QIc GROUP Z N PROCESS D BY w SIGN AND ONE CIRCUIT 3.00 3 CL TUBE, OR Z 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 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE r/�fI�QL,E el7y It le, TEMP. POWER POLE UNDERSLAB WORK ROUGH CONDUIT PERMIT FEE (SUB TOTAL) WIRING FIXTURES PLAN CHECK FEE (50% PERMIT FEE) ++�� POWER AUTHORIZED PERMIT ISSUING FEE 2.00 p? D� UTILITYCO.NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL TOTAL FEE JOSEPH C. ROOHAN SUPERVISING ELE AL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 4' EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 0A J 76A668{E806 12/75 APPLICATION OR EL CTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER fNEA7REST BUILDING AND SAFETY DIVISION ADDRESS FOR PP C F Y C New Residential Bldgs& Pools EACH NO. FEE 1 & 2-Family,Sq. Ft. $ .025 — $ .Multi-famil S Ft. .0P — ER M Y q• FIRM NAME Residential Swimming Pools 20.00• MAIL ADDRESS W 11T Outlets: Light,Switch & Receptacle CITY No. 1 First 20 •50 PLAN CHECK Additional .30 APPLICANT ADDRESS Lighting Fixtures First 20 .50 CITY TBI.No. Additional .30 PERMIT �— APPLICANT Fixed Appliances Not Over 1 HP ADDRESS r Range_Heater. D.W.L CITY Gel Oven_Dryer_W.M._ LICENSE OR Top_ FAU _W.H._ REG.NUMBER U,5_ 1 Class. Hood_ Fan _ I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION DISp_A.G. 2.00 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING Power Apparatus& Large Appliances ELECTRICAL WIRING. Size&Type HP, KW, KVA,or KVAR I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF Up to 1 Incl. 2.00 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE Over 1 to 10 Incl. 5.00 DESCRIBED RESIDENTIAL PROPERTY. 0 Over 10 to 50 Incl. 10.00 PERMITEE Over 50 to 100 Incl. 20.00 SIGNATURE2-2;d; 5 ff! Over 100 30.00 DISTRICT NO..� PROCESSED BY 0 Services S� 7� !/r r U 0- 200 Amp. Under 600 V 12.50 INSPECTOR'S IL 201-1000 Amp. Under 600 V 25.00 APPROVALS DATE SIGNATURE g Over 1000 Amp. or Over 600 V 50.00 TEMP.POWER POLE Temp. Power Pole&A UNDERSLAB WORK ppurtenances 10.00 . Sign with One Branch Circuit 10.00 ROUGH CONDUIT Additional Sign Branch Circuits 2.00 WIRING (Other) FIXTURES POWER AUTHORIZED UTILITY CO.NOTIFIED FINAL 15I f`%7 w PERMIT FEE (Sub-Total) NOTES l0 PLAN CHECKING FEE (One-Fourth Permit Fee) PERMIT ISSUING FEE $6.00 TOTAL FEE !0-To PLAN CHECK VALIDATION,yk',J'nK' -EN9APERMIT VALIDATION CK. MO. CASH 3 2 61r--1 OCT 7 2 G 1 0,5 0 e�?; _. :Y HIOLDER. SEE ielrl947 ftOR nMPLETi 2HE"OU .E l WORKERS'COMPENSATIONDECLARATION llCE-8ofiG (2-80.)- APPLICATION FOR ELECTRICAL PERMIT I -hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure,or a certificate of Workers'Compensation Insurance,or f +✓ .. a certified copy thereof(Sec.3800,Lab.C.) f ` Policy No. Com any FOR'APPLICANT TO FILL IN JOB P Ir New Residential Bldgs.&Pools EACH N.O. FEE ADDRESS / k. C, C1 Certified copy is hereby furnished. 1 &2-Family.Sq.Ft.—_.—_- =�__ $ — $ LOCALITY eii1 se— a Multi-family Sq. Ft. — NEAREST r Certified copy is filed with the county building inspection CROSS ST department. Residential Swimming Pools , OWNER OR t �/ FIRM NAME a-lu-'A '`` /'�!A Date Applicant I Outlets: Rec/ fight� Sw.� I'ADDRESS j+ P.ivinl& CERTIFICATE OF EXEMPTION FROM WORKERS' First 20 COMPENSATION INSURANCE i Total No. Additional CITY• d �„ Tel No. $[ PLAN CHECK" tl APPLICANT O (This section need not be completed if the,work involved `0 by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First:20 ADDRESS Total No.)13 Additional O I certify that in the performance of the work for which this + CITY Tel No. � ermit'is issued I shall not employ an Fixed Appliances Not Over 1 HP p p y y person in any manner I PERMIT J rII ��/ W so;as to become subject to the Workers Compensation Laws. Range_Heater D.W._ APPLICANT a li!7k 41 a Oven' _Dryer_W.M._ ca ADDRESS ' �lQ7p /� C� �� Date Applicant r Top _ FAU•_W.H. , Hood — Fan _Other_ CITY �"�,. `.j r.�',.� Tel No. g6..d-991 NOTICE TO APPLICANT: If, after making this Certificate of Disp. _Room Air Condom LICENSE OR Exemption, you. should become subject to the Workers' REG.NUMBER Class Compensation provisions of the Labor Code,you must forth- •I Power Apparatus&Large Appliances DISTRICTAa. ,:✓ PPRFEID BY with comply with such provisions or this permit shall be deemed revoked. Size&Type HP,KW,KVA,or KVAR /vim U� Up to 1 Incl. FINAL LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl_. DATE — /� VALIDATION ' Over 10 to 50 Incl. I hereby affirm that I am licensed under provisions of Chapter I Over 50 to 100 Inc. FAL 9 (commencing with Section 7000)of Division 3 of the.Busi- Over 100 ness and Professions.Code, and my license is-in full force and effect. r Services License Number Lic.Class 0-200 Amp.Under 600 V 201-1000 Amp.Under 600 V Contractor Date Over 1000 Amp.or Over 600 V ' HOME OWNER-BUILDER DECLARATION. Temp.Power Pole&Appurtenances I hereby affirm that I' am exempt from the Contractor's I Sign with One Branch Circuit F License Law for the following reason (Section 7031.5., Busi- Additional Sign Branch Circuits ness and Professions Code): ' Misc.Conduits&•Conductors I, as owner of the property, will do the work and the Other(See Complete Fee Schedule)— ' , 0 0 0 0.0 2 structure is not,intended or offered for sale (Section 7044,Business and Professions Code).•. 2 0 0 2 9 7 0 CONSTRUCTION LENDING AGENCY i I hereby affirm that there is a construction lending agency ) 0 0 ° 2 9.7 0 U for the .performance of the work for which this permit is issued(Sec.3097,Civ.C.). + PERMIT FEE (Sub-Total) I r 2, 1 Lender's Name I 0=81 PLAN CHECKING FEE (One-Fourth Permit Fee) Lender's'Address PERMIT ISSUING FEE I certify that I have read this application and state that the I.TOTAL FEE aboveinformation 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 fins action purposes:.. SEE'REVERSE FOR EXPLANATORY LANGUAGE , r Signature of Permitt a Date. t