HomeMy Public PortalAbout6207 A & B TEMPLE CITY BLVD_Electrical__ 76A663-CESO6 4-68 APPLICATION FOR UIECTRICAPERIMITd'
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER 'BUILDING
BUILDING AND SAFETY DIVISION ADDRESS Ci C5 -rem,
JOHN A. LAMBIE. COUNTY ENGINEER = Z 'b
COLEMAN W. JENKINS, SUPERINTENDENT air BUILDING F=A LITY
1 "EAREST
FOR APPLICANT TO FILL IN 'ROSS ST.
7 NO, EAC _FEll
I S $ 6WNER 14
RECEPT.— MAIL
...........
LIGHT TOTAL FIRST 20 .20 ADDRESS
SWITCH OVER 20 .10 CITY TEL. NO.
PLAN CHECK
LIGHTING ITOTAL FIRST 20 .20 . APPLICANT
A
FIXTURES OVER 20 .10 ADDRESS
RANGE—DRYER—WTR.HTR.— CITY TEL. NO.
STA.COOK—DISP.—F.A.U.— CONTRAC-TOR
SPACE HTR., AIR CON-D.— 40DRESS
CLOTHES WASHDISHWASH CT N <\Vqp,Ull-
CLASS.TEL. N
0
FAN—OTHER 1. -01 1 EN S Erell—
I TC
MOTORS,TRANSFORMERS RATING
lHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
IND. HEATERS, ETC. HP. KW. KVA. L.. STATE THAT THE A86YE IS CORRECT AND AGREE TO COMPLY
SIZE ac TYPE OVER to IWITH ALL COUNTY ORDINANCES AND-STATE LAWS REGULATING
.SE LECTRICAO WIRING.
0 - t 1.00 f PROPERLY REGISTERED AND/OR HERESY CERTIFY THAT I AM PROP
I ES COUNTY
TY AND STATE OF
L'CE HSEAS
CALIFORNIA OOR THAT I AM THE LEGAL OWNER OF,'AND INTEND TO
1 - 1.0 3.00 REQUIRED BY LOS ANGEL
.E IN, ABOVE DESCRIBED R)EIIRENTIAL PROPERTY.
10 - 50 5.001 1 3
so - 100 10.001 SIGNATUR
OF PERMIT
BY 100 - Soo 15.001 D 1,51 R ZONE �ESSE D B
SIGN,GAS O.
TUBE. OR SIGN,.AND ONE CIRCUIT 3.00 1 1 ow!!�_� L
MARQUEE ADOf TIONAL CIRCUITS 1.00 NOTES:
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2,00. :2
JR �ASQVF DEIG"ll
S
PERMIT E
14
SERVICE OVER 600 VOLTS OR 200 AMP 5.00
TEMP*SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSLAG WORK
ROUGH CONDUIT
WIRING
!PERMIT FEE (SUB TOTAL)
ROUGH
PLAN CHECK FEE (50% PERMIT FEE) EPOWER AUTHORIZED
IPERMIT ISSUING FEE 2.00 UTILITY CO.NOTIFIED
SUPPLEMENTARY PERMIT ISSUI NG FEE_1.001_ FINAL
dv JOSEP14'la. ROOHAN
,TOTAL FEE SUPERVISING ELEC ICAL ENGINEER
PLAN CHECK VALIDATION CK. m.0. 1 CASH PERMIT VALIDATION nCK. M.O. CASH
1 0 8 5 7v jlL 9 D 4,10'0"°' ov'
L
PE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
{
I
I
70AE38-CEBOU-11-sy,APPLICATION FOR ELECTRIC PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING o1s O�y
BUILDING AND SAFETY DIVISION ADDRESS 6- C
rrOFIII�A.LfiN18IS.Couat� �
CASSATP D. GBIFFIM.SYp t of S LOCALITY
NEAREST
FOR APPLICANT TO FILL INF:CROSSPERNIIT FEES
ITEM NUMBER EACH FEE OUTLETS• qq R $ $LIGHTS ARECEPT. O BW / 2— .10 2•�LIGHTING FIXTURES .2Q .10 O TEL.NO.ELEC.RANGES CLO.DRYERS AN � r
WATER HEATERS .50 6 fiLEC.SPACE HTR3. DISHWASHERSy�•g�GARBAGE DISPOSERS AUTO.- TEL.NO. 6 9WASHERS STA.COOKING UNITS .2s �� ¢�
LICENSE NO. .
MOTORS.: OVER INC. H.P.
o— I/2 2g DISTR C O. JGROUPI NB READY FOR INSPECTION'
k 1/2 — 2 .$O
r 2 — s 1.00INSPECTION RECORD
s — 1s 1.50 jl
p
is — s0 2.150
3 50— 200 15.00
I
SIGNS: NO.TRANS. I '
i NO.LAMPS ,
SERVICE 0.600V 1.00 0d1l dJ i
{ SERVICE OVER 1500V 5.00 19 -� NFA' •S'Q
MISC. 'trrl J t A
r `I � • i�i�
WIRING PERMIT 1.00
FIXTURE PERMIT 1.00 0
SUPPLEMENTARY PERMIT 50'
TOTAL FEE $ ,� APPROVALS
I HEREBY CKNOWLEDGE THAT I HAVE READ THIS APPLICATION DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT 2-Z•
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. " WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES n4 f tlllhXt
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIA ROPE
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTE } y�
:e FINAL ✓ l�e�•',� .,r%i.,`�;T/-� ..
VALIDATION ARTHUR C.V/IEIT.
K No CASH SUPERVISING ELECrRICAL.ENGINMR
1
LACO2 4. 9 4 S 4 2 2 A 12.45
' WORKERS'COMPENSATION DECLARATION ,D,B, APPLICATION FOR ELECTRICAL PERMIT
L Herebyby affirm that I have a certificate of consent to self cE-BM CE-806G
insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof(Sec. 3800, Lab. C..)
Policy No. Company FOR APPLICANT TO-FILL IN JOB. `
Certified copy is hereby furnished. New Residential Bldgs. &Pools
EACH NO. FEE ADDRESS
❑ Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ LOCALITY
tion department. Multi-family Sq. Ft. — 'NEAREST
Residential Swimming Pools CROSS ST.OWNER OR
Date. Applicant FIRM NAME
CERTIFICATE.OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAfL
COMPENSATION INSURANCE First'20 ADDRESS
(This section need not be completed if the work Involved by Total No. Additional CITY Tel. No.
the permit is for one hundred dollars(;100)or less.) PLAN CHECK
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
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
~� Total No. Additional� CITY Tel. No.
Do Fixed Appliances Not Over 1HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICAN
Exemption, you should. become subject to the Workers' Range_ Heater_D.W. — G`
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. C Tel.�d����
LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_
R Room Air Cond. NSE M
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ REG. NUMBE l; Class.', Z O
(commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROCE ED BY
and Professions Code,and my license is in full force and effect. Power Apparatus 8 Large.Appliances -r�
�y Size&Type HP, KW, KVA, or KVAR' U
License.Num -• Lic. Class- Up i"o 1 Incl. FINAL
.��?� Over 1 to 10 Incl. DATE —�` VALI ATION
Date Over 10 to 50 Incl. 0
FINAL
❑ I am exempt under Se . Over 50 To 100 Inc.. BY
B.&P.C. for this reason Over 100 �
Date: Services, Swbd., MCC&Panelboards ►
0 -200 Amp: Under 600 V
Signature 201 -1000 Amp. Under 600 V ;11 4 5 1 A
❑ Exemption.for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V # o 6 e o 62
SINGLE FAMILY Temp. Power Pole&.Appurtenances .1 o o 1 (L,5 0
HOME OWNER-BUILDER DECLARATION Sign with One.Branch Circuit :
I hereby affirm that I am exempt from the Contractor's License n Branch Circuits 0 0 1 4.5 0 5 o =
,
Law for the following reason (Section 7031'.5, Business and Additional Sig •
Professions.Code): Q 1,3 1 —8 5
ElI, 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 fdr
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
q.
above information is correct. I agree to cgmply 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
Signature of Permittee Date