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Home My Public Portal About6250 TEMPLE CITY BLVD_Electrical__ /� M L1 C /-r(/ {� 76#669 CE8069-64 APPLICATION FOR ELECTRICAL PERMIT f.l COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRHDe JOHN A LAMBIE, COUNTY ENGINEER COLEMAN W JENKINS SUP T OF BUILDING LOCALI NEAREST 1 PPLICAN FIL IN CROSS 8T RECEPT 1 TOTAL LIGHT 11 OUTLETS FIRST 20 •20 t OWNER MAIL ADD'L f0 ADORE88 SWITCH OVER 20 w TOTAL CITY TEL NO LIGHTING I FIRST 20 20 FIXTURES ADD'L 1O ELECTRICIA OV R 20 RANO" CLO DRYERS WTR HT" I DO AD GARB OI4 STA (DOOR Q CI NO DISHWASX AUTO WASH STATE SPACE HTItS STA API (W N P MAX ) 80 LICENSE NO MOTORS' OVER NOT OVER NP DISTRI NO 6R P ZONE P rL BY O 1 100 1 — a 750 INSPECTION R ORD 8 8 200 0 B 16 250 u IS SO SDID O SO too 800 W SIGNBl NO TRANS R NO LA1VS H Z SERVICED SOOV NOT mm 200A too SERVICE D SOW OVER 200 A 200 SERVICE OVER SOW 500 M18C 7 r I Q/ PERMIT ISSUING PEG 2010 ^ 8UPPLEMENTARY PERMIT ISSUING FEE 100 $ TOTAL FEE 4' 1 "WHEY ACRNOVIL[OOE THAT 1 HAVE R[AD THIS APPLHGTJPO:WIER FP PATE IM OR' •ONA ANO RAT[ THAT THS: AOOVS: IS CORRECT AND AGREE TO COMCONDUIT WITH ALL COUNTY ORDINANCES AND AND LAWS REGOLAT tL[CTIIICAL WIRING WIRING I NUEEr CERTIFY THAT I AM PROP IIRLY R¢GIFr a GD ANDFIXTURES uc"SEC A. REQUIRE. ¢T LOS ANO EL EF COUNTr Ax0 ITAT¢ CA LIPS RNu oR TNAr I TH¢ L¢GAL ¢R oP AND INTEND TO ft. 91 IN THE AEDV¢ Rle¢D REn uL ROPER r SIGNATURE TYCO NOTIFIED .�II� OF PERMITTEE VALEC ROO LEC CK M< H SUGSSUPERR VISING ELECTRICAL ENGINEER LAC88 9 5 9z2 JAN 20 2 0 3.00" a TEMPLE CITY 76A66!-CEW6 8.62 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER euILDINa BUILDING AND SAFETY DIVISION ADDRESS o .Ei+f L JOHN A LAMBIE COUNTY ENGINEER .v WILLIAM A JENSEN,YUP T OF SUILDING LOCALITY /'1 ling MMMMMMMONEAREST IRO P N FI N CROSH H'T RECEPT I TOTAL NO RACH MR I OUTLETS FIR T 20 S IIO S OWNER LIGHT MAIL awlTtx ADD'L 10 ADDRESS OVER 2O LIGHTING TOTAL pIR[T 20 20 CITY TEL NO At/ 4z�46 FIXTURES ADD'L 1p ELECTRICIAN OV R 2O RANGYY CLO DRYLRY wTR IITR[ 100 ADDRESS a2340 Al W. GARY OUIP [TA COOK CITY NO DIMWAYN AUTO WARN STATE PAC[HTRR STA APP (V HP MAK) So LICENSE NO �IO MOTORS. OY[R NOTOWR HP DISTRICT NO GROUP 2 E PROCESSE BY o 1 foo 1 — a 1 e0 INSPECTION RECORD S S 200 Y — is leo 1e — eO SOD a eO — 100 500 v0 SIGNS. NO TRANS D{ NO urro r� SOtVICE O SOOV NOT D 200A AAAW& 0 SERVICE O e00Y ovu IIOO A 300 w SERVICE OVER GOOV 500 Z MISC PERMIT ISSUING FEE 2 00 SUPPLEMENTARY PERMIT ISSUING FEE too TOTAL FEE d 1 MLIY[[Y AG NOWL[DOL THAT I HAV[ BRAD THIS APPLICATIONAPPROVALS DAT[ INP[ OR Y AND RAT[ THAT TNL AYOV[ I[ COXAXCT AND AOR[[ TO COMPLY CGNDUIT WITH All COUNT ORDINANCES AND STATE LAW[ REGULATING [L[CTRICAL WIRING WIRING 1 H[FQY QRryIY THAT 1 AM PROPERLY I�GIYT[IRO ANO/OR LIC[MQO AS 1COOIRLD BY lD[ AMG[LI[ COUNTY AND [TAT[ 0I FIXTURED , CALIFORNIA OR M THE "GAL OWNER OF TNL ABOVE DLKIO[[p IR[I uL POWER SIGNATURE F UTILITY CO NOTIFIED OR PlRMITTE FINAL 4VAJIDATION ARTHUR C VER CK NO CASH SUPERVISING ELECTRICAL ENGINEER JuL22 2 0 4.00- WORKERS Ihave COMPENSATION cafeDECLARATION corse 7&M63 ID,B, APPLICATION FOR ELECTRICAL PERMIT � I hereby affirm that I have a certificate of consent to self �'� 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 !OB y r >✓' // Certrftedc is furnished ADDRESS ) Y 'spY Y New Residential Bldgs 8 Pools �� NO v ❑ Certified copy is filed with the county building inspaa- 1 8 2 Family Sol Ft f — 2 LOCALITY _!•,,w.,'uF'd-,�% ('�/ t tion deportment Multi family Sal Ft — NEAREST Residential Swimming Pools CROSS ST Dote Applicant OWNER OR FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec_Li ht_Sw_ MAIL _ -�+•' COMPENSATION INSURANCE g ADDRESS (ThIs sectlon need stat be completed N tiro work Involved First 20 � P by Total No Additional CIN •,..c f.c ..L-' Tel No the petTnit b n for ort*hundred dollars($100)or less) I certify that in the performance of the work for which this CK AP�PLI ANTT permit is issued I shall not employ any person in any manner so ce to become subject to the Workers'Compensation lots Lighting Fixtures First 20 ADDRESS rt t. f7 ''r /r ^ Addhhonol 1 Ti +eft Total No CITY Tel Na Dote f" ^'APPLcont z k Fixed Appliances Not Over 1 HP jRILAT NOTICE TO APPLICANT If after making ilii Certificate of APPLICANT „•,Lt >!•� '��, Exemption you should become subject to the Workers Range_ Heater_D W — Compensation Provisions of the Labor Code you must forth Oven _ Dryer _W M _ ADDRESS 77 •`�` '� a; L+^ with comply with such provisions or this permit shall be Top — FAU —W H — deemed revoked Hood _ Fan _Other— CITY 1. Class No �•- � LICENSED CONTRACTORS DECLARATION ^ ....a — RNUMBER 'r,'_ "f J L /4 I hereby affirm toot I am licensed under provisions of Chapter 9 Dap Room Au Cond CE } (commenting with Section 7000) of Division 3 of the Business PC`wer Apparatus 8 Large Appliances DISTRICT NO PROCESSED BY jy and Profess,oro Code and my license is in full force and effect _ Q t Size 8 Type HP, KW, KVA or KVAR // ,� ,/' '' V License Number ��TLtc Class f �c7 U to 1 Incl FINAL J W _ 'J r _ I Over 1 to 101nd DAA �® _Iel;2 VALIDATION W Connector ` ' C` �'¢ Date / r '�❑ Over 10 to 50 Incl FINAL oil- I am exempt under Sec Over 50 to 100 Inc BY � st B 8P C for this reaOver 100 K reason Over Services Swbd MCC 8 Panelboards 0. �_ d Dote 0 200 Amp Under 600 V 4XI Signature 201 IODD Amp Under 600 V ❑ Exemption for Reg MaOver 1000 Amp or Over 600 V mt Elect SINGLE FAMILY Tem le HOME OWNER BUILDER DECLARATION P Power Po8 Appurtenances Sign with One Branch Cucmt I hereby affirm that I exempt from the Connectors License Addnionol Sign Branch Circuits Law for the followingg r reason (Section 7031 S, Buvneu and -P A', 7 Professions Code) t t, ❑ I as owner of the property will do the work and the Misc Conduits 8 Conductor structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ fi 704 Business and Professions Code) ► ) 's • j� t , CONSTRUCTION LENDING AGENCY I hereby off um that there is a construction lending agency for ' atj t1 rJ t1 the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec 3047, Civ C ) PLAN CHECKING FEE Lender's Name JJ PERMIT ISSUING FEE Lender's Address I certify that I have read this application and stab that the TOTAL FEE above information is correct I agree to comply with all County ord'nor)ces and State laws regulating Electrical wiring, and hereby authorize representah'ves of this County to enter upon the abbve-m$ntianed property far }pechon purposes r s s� s SEE REVERSE FOR EXPLANATORY LANGUAGE r signature of Pe r, tee t�0 Date