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HomeMy Public PortalAbout6262 TEMPLE CITY BLVD_Electrical__ Ob e-A T." uM DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES ELECTRIC NATURE OF .LNSTALLXTION DISTRICTNoGROUP TYPE PERMIT No WIRING FIXTURE! I B¢R VICE I ft V READY FOR R[C[IYDATE 1 RANGE H[AT[R POWER FIRST INSPECTION Z:- U]e[O —SIGNSMISCELLANEOUS / /� A 1L O TLI EDICTION ONLY JOB � / NAM ADDRESS 1 LOCALITY ADDR[BB b N[AR¢ST CITY ✓ TEL No CROSS ST 'l STATE COUNTY LICENSE No REG No u NAM DESCRIPTION OF WORK 2 MAIL NUMBER OF OUTLETS ON CIRCUITS 0 ADDRHBf Q •�`�( O LOCATION BY ROOMS CITY � Tr- No I LIGHTouTLEre W PLUGG nn CORRECTIONS CIRCUIT A I B I C D I E T F I H LIVING ROOM I I I I I DINING ROOMI BRFST RM I I BATH I [NT HALL HALL No FRONT PORCH I -� Z OUTBID[ KITCHEN I �� ��• C SERV PCH BORN NO CLOSET I BORN No CLOSET APPROVALS DATE IK..[CTOn 9 NAMK CONDUIT WIRING TOTAL FIXTURES NO OF OUTLETS f O POWER NO OF FIXTURES S 0 UTILITY CO NOTIFIED FINAL _11S NO OF MOTORS H P f 1 AM THE LEGAL OWNER OF THE ABOVE LOS ANGELES NO OF SIGNS TRANS i COUNTY REGISTRATION NUMBER NO OF RANGES OR HEATERS S �J/RT.11=TKC� MISCELLANEOUS f 1 AM 7H[LdOAL�� PROPER [SCRIB[D 5L:BOV[ PERMIT FEE • TOTAL FEE • ORN�n t • � i i i i Alf i : 1 . = OEM �J NUMBER OF'OUTLWM ON CIRCUITS LOCATION BY ROOMS moo 0cuman mom MMIMPS... M..■ MMORW........E . .ter■■ ■.....■ .C....... - �:::::::::: .�.....■.... .�.......... �.......... .�........... ■�........... IME .�......... ■ � .. ......... �......■... ...�■ �.............r . .� ..........� NO �............�•�� ..�...........� ■............ NOW SFE::::©:::': MMlMMMEMM TeAeeS ceeoe 11-T, APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADORES$ LOCALI FOR APNEARESTPLICANT TO FILL IN CROSS ST OUTLETS NO EAU File OWNER S FI% RECEPT_ MAIL 9 e LIGHT— TOTAL FIRST 20 26 7 ADDRESS CITU TEL NO SWITCH_ OVER 20 10 PLAN CHECK LIGHTING FIRST 20 E5 APPLICANT TOTAL OVER 20 ADDRESS TURES 10 RESIDENTIAL APPLIANCES CITY TEL NO PERMIT RANGE_DRYER_WTR HTR_ APPLICANT STA COOK_OISP_F A U _ ADDRESS SPACE HTR AIR GOND CITY TEL NO f-142 CLOTHES WASH DISHWASH_ LICENSE NO 2Y CLASS FAN_OTHER 100 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO STAT! THAT THE ABOVE IS CORRECT AND AOR[[ TO COMPLY MOTORS TRANSFORMERS RATING WITH ALL COUNTY ORDINANCE/ AND /TAT[ LAWS REGULATINS IND NEATER/ ETc HP KW KVA ELECTRICAL WIRING SIZE S TYPE OVER TO I HEREBY C[RT IFY THAT I AM PROPERLY R[OISTER[D AND/OR 0 — 1 FDO LICINSEO AS REQUIRED BY LO/ ANGLED COUNTY AND /TAT[ OI CALIFORNIA OR THAT 1 AM TNC LEGAL OW M[R OF AN INTEND TO 1 I — 10 SOD RESIDE IN TN[ ABOVE DIESCR ED R EIDENTIAL PROPERTY 0 SIGNATUR! 10 — 50 500 OF PERMITTEE Of 50 — 100 1oD0 [) DUTRICTCND MA// zoNIZ a eY 1LTLi 100 - E00 1500 E/aJ d N Z SIGN GAS SIGN AND ONE CIRCUIT 500 NOTES TUBE OR MARQUEE ADDITIONAL CIRCUITS 100 SERVI CENOTOVER 600 VOLTS OR 200 AMP SOD APPROVAL/ DAT[ NwLTUR1 SERVICE OVER 600 VOLTS QR 200 AMP / 1ppp 1!'� OIP[CiDR/ W TEMP POWER POLE TEMP SERVICE,POLE,&APPURTENANCES 500 UNDERSLAB WORK TEMP LIGHT OR RECEPT SYSTEM /00 ROUGH CONDIUT WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO NOTIFIED PLAN CHECK FEE FINAL L PERMIT ISSUING FEE 1 900 �51QQ TOTAL FEE PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION � cR M 0 CASK u. w9899�— WV24 2 u 13.60, 599 DAM or APPLICATION FOR COMPLETE SCHEDULE TanSa`-ceeoe II-TI APPLICATION FOR ELECTRICAL PERMUr COUNTY OF LOS ANGELES BEPAOTMENT OF COUNTY ENGINEER BUILDING Z 'L s e M 'A Q � • BUILDING AND SAFETY DIVISION ADDRESS ~F• LOCALITY CM P1 7- FOR APPLICANT TO FILL IN CROSS 5T oAv9,ao0eAhs-ROSe M a d OUTLETS NO EACHI Fe OWNER or O Y In s RECEPT MAIL LIGHT &D TOTAL FIRST 20 D ,b ADDRESS SWITCH �/ 4 OVER 20 10 O PLAN CHECK CITY t/h ( TEL NO LIGHTING FIRST 20 0 a t- Olv APPLICANT FI%TURES TOTAL OVER 20 10 ADDRESS RESIDENTIAL APPLIANCES CITY TEL NO PERMIT RANGE_DRYER_WTR HTR_ APPLICANT STA COOK_DISP_F A U ADDRESS 3 3 5 • r SPACE HTR AIR CONO CITY TEL NO �Q CLOTHES WASH DISHWASH_ LICENSE NO 7640 CLASS FAN I OTHER 100 /T// I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION V '� ANO fiAT! THAT THE ABOVE IS CORRECT AND AOR[[ TO COMPLY MOTORS TRANSFORMER[ RATING WITH ALL COUNTY ORDINANCES AND [TAT[ LAWS REGULATING IND HEATERS ETC HP KW RVA ELECTRICAL WIRING SIZE A TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AKOMR O - 1 100 LICE NSCD AS REQUIRED BY LOS ANGELES COUNTY AND [TAT[ 01 CALIFORNIA OR THAT I AM THE LEGAL OWNER AND INTEND TO 1 - 10 900 RESIDE IN THE ABOVE DESCRIBED RE IAL PROPEATY V SIGNATURE DE 10 - 50 500 OF PERMITTED O SO - 100 1000 IWIRING ICT MO CLASS 20M! PROC • Y 100 - SOO 1500 a C A. SIGN GAS SIGN AND ONE CIRCUIT 500 S O C TUBE OR MARQUEE ADDITIONAL CIRCUITS 100 G /J jtSERVICENOTOVER 600 VOLTS OR 200AMP 300S ERVI CE OVER 600 VOLTS OR 200 AM P 1000APPRovALB DAT[ uu1PEC10RD BIGIIATUR[ POWER POLE TEMPSERVICE POLE &APPURTENANCES 500 SLAB WORK TEMP LIGHT OR RECEPT SYSTEM 300 CONDIUT A 11/jAL A. FIXTURES POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO NOTIFIED PLAN CHECK FEE PERMIT ISSUING FEE500 _iFu FIN < TOTAL FEE O PLAN CHECK VALIDATION CK M 0 , CABxRMIT VALIDATION EK M 0 DASH p7340 4 2 D 36b0~ s {l SEE DAM OF APPLICATION FOR COMPLETE SCHEDULE '°"63 `E=°° APPLICATION FOR ELECTRICAL PERMITU COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING �! _ BUILDING AND SAFETY DIVISION ADDRESS �j-L� Al, 4PZ;N2rA,67A LOGLI NEAREST FOR APPLICANT TO FILL IN CROSS ST OUTLETS A OWNER S RECEPT_ MAIL LIGHT_ TOTAL FIRST 20 �, ADDRESS OVER 20 CITY L NO SWITCH_ 10 PLA CHECK LIGHTING FIRST 20 10 ZS APPLICANT FI%TURES TOTAL OVER 20 ADDRESS RESIDENTIAL APPLIANCES CITY TEL NO PERMIT RANGE_DRYER_WTR HTR_ APPLICANT STA COOK_DISP _F A U _ ADDRESS SPACE HTR AIR GOND CITY TEL CLOTHES WASH DISHWASH_ LICENSE NO CLAS FAN_OTHER 100 1 HEREBY AOKNOWL[DGE THAT I HAVE READ THIS APPLICATION AND [TATE THAT THE ADOVE IS CORRECT AND AGR[[ TO COMPLY MOTOR! TRANSFORMER! RATING WITH ALL COUNTY ORDINANCES AND STAT[ LAW! REGULATING IND H"TERS ETC HP NW KVA ELECTRICAL WIRING SIZE B TYPE OVER TO 1 LICENSED A CERTIFYIR THAT I AM PROPERLY REGISTERED O A K Oft OF O — 1 I00 LICENSE° A! ROUT BY LOS ANGELES CWM AND 1 END OF CALIFORNIA OR T T AM TN l OAL 0 [ AMD END TO 0 1 — 1O SOO R[SIDC IN TI Y NTIA P STY O SIGNATUR J V 10 — 50 !DO OF PERMITTEE me 50 — 100 ION r 01lTrRICT No u.Au zoxe P c6 BY 100 — S00 Ism '' D 10 �9 N SIGN GAS SIGN AND ONE CIRCUIT J00 VROUGHCONDIUT TUBE OR MARQUEE ADDITIONAL CIRCUITS 100SERVICENOTOVER 600 VOLTS OR 200AMP 300 S DAT[ WICCTOIP[IINIATURt S ERVI CE OVER 600 VOLTS OR 200 AM P 10POLETEMP SERVICE POLE, Q APPURTENANCES JDO ORKTQAP LIGHT OR RECEPT SYSTEM Soo T POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO NOTIFIED PLAN CHECK FEE FINAL 1 1111717 2-A PERMIT ISSUING FEE J00 l TOTAL FEE PLAN CHECK VALIDATION CK M o CASH PERMIT VALI IDH cK u o CAM u" 802 SEP 25 2 0 13.0O� a G[[ SAM OF APPLICATION FOR COMPLETE SCHEDULE '—' 7-AI Pz,F c ryy '°"°°' `E:°° " " APPLICATION FOR ELECTRIaL PERMIT �• COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER FADRE BUILDING AND SAFETY DIVISION Y FOR APPLICANT TO FILL IN T OUTLETS ° "CH! FEE S $ 7 RECEPT_ ._ LIGHT_ TOTAL FIRST 20 ADDRESS OVER 20 CITY O SWITCH_ 10 PLA C EC FIRST 20 2S APPLICANT LIGHTING TOTAL OVER 20 ADDRESS FIXTURES 10 RESIDENTIAL APPLIANCES CITY TEL NO MIT RANGE_ORYIR_WTR HTR PERAPPLICANT STA CODK_DISP_F A U _ ADDRESS ` SPACE HTR AIR CONO CITY'/ TEL N CLOTHES WASH OISHWASH_ LICENSE NO CLA FAN_OTHER 100 I N[R!/Y ACKNOW L[Ol[ THAT I HAVE READ THIS APPLICATION AMD STATE TNAT TN! ADOID CD[CT AMC, AGREE TO COMPLY MOTORS TMNf IORNIlR! RWITH ALL COUNTY ORDINANCES AND STATE LAW! R!/U UTI NO IND NGT[R! ETC XP KW KW K RVA ELECTRICAL WIRING SIZE D TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 — 1 IOD LICENSED AS RLOUIREO 0Y LO! ANGELES COUNTY D / OI CALI IORX IA Op TNA AM TN! L AL OWNER I D END EMO TO 1 — 10 D00 REDID! IN TX OVL D D I PITY Q SIGNATURE 10 — 50 500 OF PERMITTEE 1O SO — 100 1°D° (� 01l TRI_CTMO Alf ZOIL[ RROC[ [LLLDDD Y 00 IL 100 — 500 15 S 1 Z SIGN GAS SIGN AND ONE CIRCUIT 500 / NOT ar TUBE, OR MARQUEE I ADDITIONAL CIRCUITS 100 SERVICE NOTOVER 600 VOLTS OR 200 AMP 300 APPROVAL° DATE DIP[CTOR/fNRNTRE SERVICE OVER 600 VOLTS OR 200 AMP 1000 TEMP POWER POLE TEMP SERVICE,POLE &APPURTENANCES 5D0 UNDERSLAB WORK TEMP LIGHT OR RECEPT SYSTEM D00 ROUGH CONDIUT WIRING FIXTURES POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO NOTI FI EO PLAN CHECK FEE FINAL PERMIT ISSUING FEE 900 TOTAL FEE � PLAN CHECK VALIDATION CR M o CASH PERMIT VA ID ION c[ M o c"eX ,nw � 01 8� w25 D $.Q0- N D[[ DAM OF APPLICATION FOR COMPLETE SCHEDULE i •WORKERS Ihove COMPENSATION DECLARATIONcorse ]OODIVDVw]/61 APPLICATION FOR ELECTRICAL PERMIT Q I hereby offvm that I have a certificate of consent to self �� ipsure or a{prtificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ` or a certified copy thereof (Sec 3800, Lob C ) P I NO f 111V Company FOR APPLICAM TO FlLL IN lOB � Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE ADDREA'SS 2 "-•! (' 40 LVp ❑Cenified copy is filed with the county building mspec- 1 S 2 Family, Sq Ft $ — $ LOCALITY L µs�EN Rd SCf�f4D p VOs non department Multi-family Sq Ft — NEA T CROSS ST Date—Applicant FIRM NAME SAQT S Fog - of fuuls d Residential Swimming Pools OWNEEs CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rac_Light_Sw_ MAIL COMPENSATION INSURANCE First 20 ADDRESS ii. lOA1G IBJ Fs (This section need not be completed U the work Invoked by Total No Additional CITY /A C.4, Tel No , Qyy the permit Is for one hundred dollen($100)or less) RAN CHECK I certify that in ,he performance of the work for which this APPLICANT a E Al N N permit is issued I shall not employ any person in any manner Lighting Fixtures Fiat 20 ADDRESS LO�6 QLC� so as to o subject to the Workers Compensation Laws g g Additional Total No Dote Appbcao Fixed Appliances Not Over 1 HP PEIRMIT CA Tell�N�o�Tyy` D` NOTICE O APPLICANT If aft r making this Certi ate of Ra Heater—D W — APPLICATION /L a J0 a!:e_r/f l e— Exemption you should become subject to the workers Range— provisions of the Labor Code you must forth- Oven — Dryer —W M _ ADDRESS with comply with such provisions or this permit shall beTop FAU —W H — d �L deemed revoked Hood — Fan —Other_ CITY A UR 'I/J67 Tel No LICENSED CONTRACTORS DECLARATION Dtsp _ Room Au Cond _ RCE R OR Clan �_�a j hereby affirm that I am licensed under provisions of Chapter 9 (commencmg with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICTD Y Y and Professions Code and my license is in full force and effect d / Size 8 Type HP, KW, KVA or KVAR F Q License Number y30 'i 9 R Lic Class ` U Up to 1 Incl FINAL �REus/otJ Eck'-T Over I to 10 Ind DATE ALIDATION Q Contra o Date Over 10 to 50 Incl I am exempt under Sec Over 50 to 100 Inc BYE W B 8P C for this reason Over 100 (� d Date Services MCC 8 Panelboards `�Signature �^�q(/ Z 0- 20000 AA mp Under 600 V � ,V❑ — - 1000 Amp Under 600 V Exemption m Cover 'Exemption for Reg Mat Elect Cover 1000 Amp a Over 600 V SINGLE FAMILY Temp Power Pole 8 Appunenonces HOME OWNER BUILDER DECLARATION 2 1 hereby affirm that I am exempt from the Contractor s License Sign with One Branch Circuit CT•• Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits Professions Code) 3307 25.50 ❑ I as owner of the property will do the work and the Musc Conduits 8 Conductors 1 ITEMS structure is not intended or offered for sale(Section 7044 Other(See Complete Fee Schedule)_ , Business and Professions Code) VAA51 TOTAL 25 .50 CONSTRUCTION LENDING AGENCY �`kA 25•%l 1 hereby affirm that there is a construction lending agency f the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) - 1efBU111tL •OO (Sec 3097, Civ C ) PLAN CHECKING FEE Lenders Nome O�-'0001 11/14/N PERMIT ISSUING FEE Lender s Address 6790 1 AM11041 I certify that I have read this application and state that the TOTAL FEF above information is correct I agree to comply with all County - ordinances and State lows regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the above endo ed property for inspection furp gI es SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permmee d 1 Ddte- ms ION ` WORKERS have a certificate of consent to CE 806 pre, APPLICATION FOR ELECTRICAL PERMIT ' f Ixareby affirm that I have a certmcete d wnsem ro self rlsure �8080 or a certificate of Workers Compensation Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec 3800 Lab C) ''7 t/ /]�/� Policy No Company FOR APPLICANT TO FILL IN JOB ADDRESS6,246,2 Q O CMCJ{Q/ BL�D ❑ Certified copy a hereby furnsted New Residential Bldgs 8 Pods EACH NO FEE ADDRESWCALITY 2 CL T ❑ 1 S 2-Family Sol Ft $ _ $ L Certified copy a tiled with the county, building rrmPechon NEAREST DN6oCN ✓'�r 7- department Multi-famdy Sq Ft CROSS 3T Date Applicant Residential Swimming Pools OWNER OR �f-- L / FIRM NNAE J Off+ /Ww CERIIFICACOMPENSATION INSURANCE TE OF EXEMPTION FROM RKERS Outlets Tec—Light —Sw ADDRESS 13 "Al (TMs section need not be completed It the work Imotved by the Fust 20 v permit U for one hundred dollars($100)or less) Total No Additional CITU C,4 Tel No S7 T./07T�/� I certify that in the performance of the work for which this permit PlAfl CHECK m owed 1 shell not employ any person An arty manner so as to JFPUCANT become sub the Workers pp�r�Lewy Lighting Fixtures Fret 20 ADDRESS ECKID� �.E�-7 Date_ �% Applcam fiPANk /IE,PNAN�6 L Total No Additional CTfV Tel No NOTICE TO APPLICANT If after making this Certificate of Fired Appliances Not Over 1 HP PERMIT ��J D E I Exemption you should become subleot to the Workers Compensation Range— Heater_ D W _ A` T d provisions of the Labor Code you must forthwith comply with such Oven _ Dryer, _ W M _ ADDRESS 11'/ I 4AIM PA prows"or this permit shall be deemed revoked Top — FAU _ Wit _ CITY ps a o�11/ 9Ne Td 3S 9 IMF I D CONTRACTORS DECLARATION Hood — Fan _ Other_ I hereby affirm that I am licensed under prwaons of Chapter R _ Room Air Cud LICENSE OR ' Gene (commenarg with Section 7000) of Dnenn 3 of the Business and Ditto REG NUMBER 7 C-I Q Profession Code and my(cense is An full farce and effect DSTRICr NO PROCESSED BY 2 R9 Power Apparatus 8 Large Appliances, license Number q I I L, C� Size 8 Type HP KW KVA,or KVAR O Up to 1 Ind FINAL /Sr C�S��'lr LOeta Over 1 to 10 IndVALID DATEno I��r(�padar G Over 10 m 50 Ind 17 J ATION ISI I am exempt under Sec Over 50 to 100 Inc BY yyJJ / - BLPC for this mason Over 100 ✓ O. Services Swbd MCC 8 Panelboerds DateO- 200 Amp Urdu 600 V �{ c Signature201 - 1000 Amp Under 600 V 14 { 3 AQ.5 2 ❑ Exemption for Reg Maim Elect Over 1000 Amp u Over BOO V SINGLE FAMILY Temp Power Pole 8 Appurtenances 49925509 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 11. 16A88 1 hereby affirm that I am exempt from the Contractor a License Law Atldrtmal SW Branch Cawas for the following reason(Section 70315 Business Professions and Profesons Code) ❑ I as owner of the property will do the work and the structura Mmc Conduits 8 Cordudus is not intended jor offered for sale (Sedan 7044, &mines• (Sisa F Schedule) ► and Professions Coda) A CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lading agent' for the tomfomwice of the work for which this permit Is asued(Sec 3087 PERMIT FEE (Sub-Total) Cr, C) JAZ PLAN CHECKING FEE i Lenders Name , PERMIT ISSUING FEE LerdeYs Address W �D I certify that I rave read flus application and sora that the above TOTAL FEE information As cured I agree to comply with all County onhnarices end State laws, regulating Eactrcaf wiring and hereby auffor¢e represematrvas of this County to enter upon shows-mentpned Try, for inspectT purposes SEE REVERSE FOR EXPLANATORY LANGUAGE sture o rmrt a pate WORKERS COMPENSATION DECLARATION 209019 DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I gave a certificate of consent to self Insure ]BA983 or a certdigate.Of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 3900 Lab C) Policy NO Company FOR APPLICANT TO FlLL IN AOORESS ❑ Certified copy Is hereby furnished New Residential Bldgs 8 Pools NO EACH FEE LOCALITY _ ❑ Certified copy is hied wnh the county building Inspection 1 8 2 Family Sg Ft — $ i department MUNI family 5s, Ft CRS ST Dale Applicant Residential Swimming Poole ASSESSOR MAP BOOK PN3E PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS Outlets AM —Light_Sw FlRMER OR COMPENSATION INSURANCE First 20 MNL permME (This section for nab not be colors($tl 0 the cork Involved by the Total No AddNonal ADDRESS S permit le for one hundred dollars(1100)or lees) I certify that in the performance of the work for which this permit CITY - TN No % is issued I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers Compensation Laws Lighting Fixtures First 20 APPUC Total No Additional ADDRESS Data Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT If alter making this Certificate of CITY Tr _ Exemption you should became subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code you must forthwith comply with such Arm provisions or this permit shall be deemed revoked Power Apparatus 8 Large Appliances APPLICANT LICENSED CONTRACTORS DECLARATION Sue 9 Type HP KW KVA or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Ind (commencing with Section 7000) of Division 3 of the Business and CITY y T°I f Professions Coda and my license is m lull force and effect Over 10 to 501nc1 LICEN SI!OFF Over 50 to IGD Incl REO NUMBER O Clam C/o d License Number�� O LK Clan C Over 100 DISTRICT NO o PROCESSED BY V Serycm Swbd MCC 8 Panelboards DO 0104M Contractor Dale ] ✓u�" / 0 399 Amp Under BOO V FINAL❑ Q I am exempt under Sec 400 1000 Amp Under 800 V '� Over 1000 Amp or Over 600 V Over W B 8P C for this reasonBY d BRANCH CIRCUIT FEES BY Date 15A or 20A 120V Lghurg or Recept Z 1 To 10 Branch Circuits Signature 11 TO 40 Branch Circuits 41 Or rcuits ❑ Exemption for Reg Mamt Elect 15A 204 209V To 27TV U More Gc dss SINGLE FAMILY Temp Power Pole 9 Appurtenances, HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit A��T.i I hereby affirm that I am exempt from the Contractor a License Law for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits - ; (rc•7I: Code) rk F1 as owner of the property will do the work and the structure Mise Conduhe 8 Conductors 1 ITEMS Is not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) ' TOTAL 45 _ 75 and Professions Code) CHECK 45.75 CONSTRUCTION LENDING AGENCY CAKE •IJ� I hereby affirm that there Is a construction lending agency for the 7B9'I�G performance of the work for which this permit is issued (Sec 3097 PERMIT FEE (Suit-Total) Cly C) PLAN CHECKING FEE 0000-0001 61 7/97 Lender a Name _ PERMIT ISSUING FEE 0122 1 Ah 7%50 Lender a Address I certify that I have read this application and under penalty of purlury state TOTAL FEE that the above information is correct I agree to comply wnh all County ordmairce9 and State laws regulating Electrical wiring and hereby authonze representatives of this County to enter upon the above-mentioned property foran purposes SEE REVERSE FOR EXPLANATORY LANGUAGE in ecti NATDRE OF ME Ilezy RMRTEE DATE 1) WORKERCOMPENSATION DECLARATION 720 W196MW (12 91) APPLICATION FOR ELECTRIGIAt PERMIT I hereby affirm that I have have a certificate of consent to sell insure or a certificate of Worker s Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy tthhTrsrelol(See 3800�LLtbb IC) //� ///. Pp�Lf IW ll-11Pan� jJyJ TiGO. C.IA� FOR APPLICAM TO RLL IN JOB ' ❑ Certified copy is hereby furnished New Residential Bldgs A Pools NO EACH FEE ALAE I J�� Er _ i i LOCALITY / L•S Candied copy a Bled with the county building inspection 1 8 2 Family Sq FI tlapaart �n t Multi family Sq Fl — NEAREST, v /- --a?.f�c/16p Residential Swimming Pools ABBESSOR /( �h Date Plicant MAP DOCK PAGE PAM',EL CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec —Light Sw =q E p •( �� COMPENSATION INSURANCE(This /T / /✓ .✓~CGi First 20 MAIL s perm t Is lot need not he completed O the work Involved by the Total No Additienal ADDRESS permit Is far one hundred dollen(i10o)or leu) _ 1 certify that on the performance of the work for which this permit CITY is Issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws Ughtmg Fixtures First 20 PLAN CHECK APPLICANT Trial No Additional ADDRESS Date Applicant RESmENML APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT If, after making this Certificate of CITY Tel No Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code YOU must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked Power Apparatus 8 Large Appliances APPLICANT T C LICENSED CONTRACTORS DECLARATION Sae 8 Type HP KW KVA or KVAR ADDRESS S7- 7;iacA.0w I hereby affirm thal'l am licensed under provisions of Chapter 9 Over 3 to 10 Incl(commencing with Section 7000)of Division 3 of the Business and CITY Tel No e1 Professions Code and my license is on lull force and effect Over 10 to 50 Incl uCEHSE oR } ryI Over 50 to 100 Incl REG NUMBERS U Z69 Cmu C OL License Number ���T Lic Class ��D Over10D DISTRICTN0 P BY O o Services Swhd MCC 8 Panelboards Contractor_IL I Dere 0 399 Amp Under 800 V ALFI ❑ TE I am exempt under Sec 400 1000 Amp Under 800 V VALIDATION U Over 1000 Amp or Over 600 V FlNAL Wd B 8P C la this reason BRANCH CIRCUIT FEES BY U) Data 16A or 20A 120V Lighting or Recap) z 1 To 10 Branch Circuits Signature 11 To 40 Branch Cucuss ❑ Branch C Exemption for Reg Maont Elect 15A 20A 208V To 277VOi ghting More Br Circuilsuib y SINGLE FAMILY Temp Power Pole&Appurtenances 4• HOME OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor a License Law Sign with One Branch Circuit for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits J_UJ Ih7.Ii - Coda) 1 1TEI'('= ❑ I as owner of the property will do the work and the structure Misc Conduits&Conductors TOTAL 47 . 10 is not intended or offered for "(a(Section 7044 Business Olh (See Complete Fee Schedule) , and Professions Code) CHECK iK 47.1- it CONSTRUCTION LENDING AGENCY f HFddGE I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3087 PERMIT FEE (Sub-Total) Civ C) pinn]-+]GGI PLAN CHECKING FEE Lenders Nemo PERM � JLS97 1 AM PERMIT FEE `• Lender's Address I certify that I have read this application and under penalty of puqury Wats TOTAL FEE that the above information is correct I agree to Comply with WI County ordinances and State laws regulating Electrical wiring andherebyauthonze representatives of I"County to enter upon the ebova�mentwned property for uro ion purposes SEE REVERSE FOR EXPLANATORY LANGUAGE tUr�dF PEW1DATE WORKER I haveCOMPENSATION DECLARATION 726 8933 DPW(12 91) APR!JCATION FOR ELECTRICAL PERMIT IJ I hereby elimm that I have a certificate of consent to self insure or a certificate of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 3800 Lab C) Policy No Company FOIL APPDGNT TO FILL IN ms ❑ Certified Is her furnmhed NO EACH FEE 04 6 O s!Vri`G ooPY hereby New Ret Family Bldgs d Pods LOCALITY T(L a ❑ Cenified copy Ia filed with the county Wilding mWection 1 8 2 Family Sp R — E E department S Multi mX C J 6 Date Applicant Remdenhal Swimming Pods MPP BOOK PAGE PMCFl CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec _Light_Sw OWNER OR COMPENSATION INSURANCE MqNAr4E M G to r- OY7J Foal 20 V N MAIL w.+e perms talion need not be completer! the work Involved by the Total No Additional ADORE99 a A� d O;k_3permit a for one hundred dollars(61000)or leu) I certify that in the performance of the work for which this permit CfTV Lyy� i1p Tel NP jq8b,71 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 APPNLmCH�EOK Total No AddlWrlel ADDRESS Date Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT If after making this Certificate of CITY Tel W Exemption you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code you must forthwith comply with such PERMR provisions or this permit shall be tlaemetl revoked Power Apparatus E Large ApplueKea APPDCANT LICENSED CONTRACTORS DECLARATION Sue 8 Type HP KV/ KVA or KVAR ADDRESS I hereby affirm that I am licensed under provlslone o1 Chapter 9 Over 3 to t01rK.1 (commencing with Section 7000)of Division 3 of the Busmoss and CITY TO W Professions Code and my license is in full force and effect Over 10 to 50 Inc] Over 50 to 100 Incl DCENSE OR / /_/ _. /�O } pp,r / `l REO NUMBER /O fpb �^�°C� a License Number 6 _y S 9 / Lro Clave e l Over 1DO DISTa1Cr NO SSM BY O Services Swbd MCC a Panelboards U Contractor. l ti m,44fA Date 6 /�/ 0 399 Amp Under 800 V TE o ❑ I am exempt under Sec 400 1000 Amp Under 8DO V VALIDATION V Over 1000 Amp or Over 800 V FINAL W B eP C for this reasonA� (� BRANCH CIRCUIT FEES BY d Date m/t`I 7S 15A or 20A 120V Lighting orRecept Z Signature 1 To 10 Branch Circuits 11 To 40 Branch Grcwta 41 Of More Branch Circuits ❑ Exemption for Reg Mamt Elect 15A 20A 208V To 277V Lighting Br Circuits SINGLE FAMILY Temp Power Pole E Appurtenencres ACCT A HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I em exempt from the Contractor a License Law 3X3 (L.'7 for the following reason (Section 7031 5 Business and Professions Addlllonal Sign Branch Circuits .85 Code) TOTAL' IT 7 _ 85 ❑ I as owner of the property will do the work and the structure Mm Conduits 8 Conductors 'T is not Intended or offered for same(Section 7044 Business Other Complete Fee Schedule)— �!�Ei�__ -�7 and Professions Code) U1�7}JI�"(J Yi�j 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 (Sec 3097 PERMIT FEE (Sub Total) Civ C) PLAN CHECKING FEE Lenders Name PERMIT ISSUING FEE Lender as I cannt y thatat I have read this application and under penalry o/purlury state TOTAL FEE that the above information Is correct I agree to complY with ab County ordinances and State laws regulating Electrical wring end hereby authorize representabves of this County to enter upon the abovamentioned property for'MpBODaI purposes _ r , SEE REVERSE FOR EXPLANATORY LANGUAGE ANIm OF ./CJ DATE WORKER I haveCOMPENSATION ate ofcIARATION APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of wneent to self insure or a certificate of Worker a Compensation Insurance or a candied OS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 3800 Lab C) ./ ry Policy Nu Company rail APPLIGtM TO PLL a - MUDRESS 6 a 6oL sQ ❑ S:MOliad copy is hereby furnished New Residential Bldgs y Pools, EACH NO FEE^�✓/ 1 8 2 Family Sit Fl $ — $ LOCALITY department is Bled wM the county building Inspection NEAREST tleperiment Mule family Sq Ft (:•ROBS s1 � O Date Applicant Residential Swimming Poole ASSEeSO41 MAP BOOK PA PMCFL CERTIFICATE OF EXEMPTION FROM WORKERS pullets Rec —Light_Sw _ 22=02 DR COMPENSATION INSURANCE RM NNAE (This section mod not be completed If the work Invotved by the First 20 uu� permit is for ora hundred dollars($100)or hiss) Total No Additional ADOREss �QS I certify that In the performance of the work for which this permit CTY/G- T'I R0 o- Is Issued I shall not employ any person In any manner so as to P.AhlOHECK become subject to the Workers Compensation Laws Lighbrg Fixtures First 20 ,yB Total No Additional ADDRESS Date APpllcam CH CIRCUITSBRAN 15 Off 20A 120Y NOTICE TO APPLICANT If after making this Certificate of 1TOl01NCL0VBRANCH CITY Tal W Exemption you should become subject to the Workers Compensation provisions of the Labor Code you must forthwith comply with such 11 TO 401NCLUMVE EACH jCAHT provisions or this permit shall be deemed revoked 41 OR MORE BRANCH CIRCUITS EACH LICENSED CONTRACTORS DECLARATION 15 OR 20A 208V TO 27N LIGHTING EACH ADDRESS a� � d I hereby affirm that I em licensed under provisions of Chapter 8 OF (commencing with Section 7000) of Division 3 of the Business and CITY - TY W 8 Professions Code and my license Is In full farce and effect RESIDENTIAL APPLIANCES UP TO 3HP �m Ott Power Apparatus 6 Large Appliances RIKI WMBER r7.So 6 Mine e_10 ¢o Lwenee Number? -,S��� Lw Clore �r Sin&Type HP KW KVA or KVAR Diem T 1.10 SSeo BY f.. Up to 3 Incl �D jL COver 3 to 10 Incl RNAL d amractor e Over 10 to 50 Ind 2 VALIDATION z F1em exempt under Sec _ Over 50 to 10D Incl B AP C for this reason Over 100 R Nft Services Svbd MCC&Parnilboerda BY Date 0 200 Amp Under 600 V Signature 201 1000 Amp Under e00 V ❑ Exemption for Reg Melnt Elect over 1000 Amp or Over 600 V- SINGLE FAMILY Temp Power Pole 6 Appurtenamcae r I hereby affirm that I am exempt from the Contractor a License Law HOME OWNER BUILDER DECLARATION Sign with One Branch Orcult Aivt F.c- for the following reason (Section 7031 5 Business and Professions Addruonal Sign Branch Circuits - Code) ,),I_l L._,ILL ❑ I as owner of the property will do the work and the structure Mier Concurs;A Conductors Is not Intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule) �I�A_ 44 - 1(j and Professlons Code) I CONSTRUCTION LENDING AGENCY i. I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit Is Issued (Sec 3087 PERMIT FEE - (Sub Total) Civ C) PLAN CHECKING FEE _h]00-0I]IJ1 Lenders Name 22 PERMIT ISSUING FEE ✓' =QQG j, �l7 74L,, Lender a Address 7[ / TOTAL FEE I certify that I have read this application and elate that the above iJ 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 propert r Ins p •Io urposes SEE REVERSE FOR EXPLANATORY LANGUAGE 74 6—(07'92, agNATVf� OFMPUCN ORNJErfr DATE WORKERS COMPENSATION DECLARATION 20aaloDIV 3,67 APPLICATION FOR ELECTRICAL PERMIT O I hereby affirm that I have a certificate of consent to self � m re or a certificate of Workers'Compensation Insurance COUNTY OF LOS ANGELES DEPT Of PUBLIC WORKS orertified copy thereof (Sec 3800 Lob C ) Policy 1i, Company FOR APPLICANT TO FILL IN JOB L �s Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE ADDRESS p�C �M 6ya d Certified copy a filed with the county budding mspec 1 8 2-Family, Sq Ft $ — $ LOCALITY ; 4 Lr 1 hon department Multi-family Sq Ft — NEAREST CROSS ST Rosemead ky O?f O Residential Swimming Pools OWNER ,/ y� Date Applicant FIRM NAME t r G 7 CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec_Light_Sw_ MAIL J ^ COMPENSATION INSURANCE ADDRESS (This section nand not be completed"the work Introlvad by First Total No Additional CITY-110, Mf Tel No tT 74 70' the perm"Is for one hundred dollars ($lag)or less ) I certify that in 'he performance of the work for which this PLANT HECK permit is issued I shall not employ any person in any manner Ltitin Fixtures First 20 ADDRESS so as to become subject to the Worko i CoCory ensaLaws g 9 Date e–'3 ' 9/ Appl¢a � Total No Additional CIN Tel No NOTICE TO APPLICANT If offer making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers Range— Heater—DW _ APPLICATION }s g Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W M _ ADDRESS z1 3 4 hel 4Li: with comply with such provisions or this permit shall be _ deemed revoked Hood — Fan —Other_ CITY c177 _ C Te No frf13 ? LICENSED CONTRACTORS DECLARATION Dtsp _ Room Air Cond — REG 5E OR .� 3 Class C—�b I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO PRO ED BY > and Professions Code,and my license is in full force and effectL- v{a O R p /� Size 8 Type HP, KW, KVA, or KVAR d G Q License Number �QLic Class _/a Up to 1 Incl FINAL G� U Contractor ?t/TdMI note � el-71 Over I to 10 Incl DATE / / VALIDATION 0O ❑ Over 10 to 50 Incl FINAL 1 am exempt under Sec Over 50 to 100 Inc By W B 8P C for this reason Over 100 11 Dote Services, Swbd , MCC 8 Panelboords loop. Z 0-200 Amp Under 600 V Signature 201 - 1000 Amp Under 600 V Exemption for Reg Maim Elect Over 1000 Amp or Oyer 600 V SINGLE FAMILY Temp Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION ` I hereby affirm that I am exempt from the Contractor s License Sign with One Branch Circuit rr. 1 i Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits ,�.t Professions Code) 710_ 2 .16 El I as owner of the property will o the work and the ♦� Mix Conduits 8 Conductors j I I EN_: Bufsiness isnot intended or offered for sole(Section 7044, Other (See Complete Fee Schedule)— , T{tjny :3 OO Business and Professions Code) CONSTRUCTION LENDING AGENCY =F14 COP Ill-Oki L [K -1.1.10 I hereby affirm that there is a construction lending agency for CHANGE (j I the performance of the work for which this permit is issued PERMIT FEE (Sub Total) (Sec 3097 Civ C ) PLAN CHECKING FEE . ;J 9 I)1 -Ill-I iliQj Qr :t'71 PERMIT ISSUING FEE a- 7331 1 AM Lenders Address I certify that I have recd this application and state that the TOTAL FEE o'D above information is correct I agree to comply with all County r ordinances and State jaws regulating Electrical wiring, and hereby authorize represent as of this ounty to enter upon the�beve-mp ha ed pr er for ms rposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ms WORKERS ave a ceSATION DECLARATION to CE 803 ,p,B,' APPLICATION FOR ELECTRICAL PERMIT {� 1 hereby affirm That I have a certificate Of consent to self insure CE e0e0 u oi�a certificate of Workers Compensation Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(Sec 3800 Lab C) Policy No Company FOR APPLICANT TO FILL IN JOB ADDRE2 ❑ 41 koSf1nZA0 41 Gertifed copy rs hereby furnished New Resdennal Bldgs 8 Pools EACH NO FEE (� ❑ 1 A 2-Family So Ft $ — $ LOCAUTY de copy a bled with the county, building inspecixm department NWIh-Famiry Sq Ft — NEnnE31 CROSS ST Z8� Date Residential Swimming Pools Arxllcanl oF17R oR N 5• /11 o w CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec Light Sw Mad COMPENSATION INSURANCE ADDRESS 6773 O A K V (This sector,need not be compteted rf the work Inn olvaid by the First 20 CITU /� r / Tel No 4 permtt Is for one hundred dollars ($100)or less) Total No Pdddonel I Certify that in the performance of the wank for which this permit PLAN CHECKAPPUC� is Issued I shall not employ any person in any manner so as to _ become su lett to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS I// Date Applicant / Total No Adtldional CITY S,+ Tel No NOTICE TO APPIJCANT g after maWng the Ceridoate of Fixed Appliances Not Over 1 HP PERMIT f Exemption you should become subject to the Workers C tan Range— Heater— DW �� `r'rT Cs '�� provisions of the Labor Code you must forthwith comply, with such Oven — Dryer _ W M ADDRESS prowatons or this permit shall be deemed revoked Top — FAU — WH CITY Te LICENSED CONTRACTORS DECLARATION Hood — Fan -_ Other— ORI hereby affirm that I am licensed under prove of Chapter 9 Disp _ Roam Ann Cond LICENSEBotass Division with Section 7000)of Divisn 3 of the Business and REG NUMBER Professions Code and my license is In full force and effect DISTRICT NO PROCESSED BY bia (//'J�[(/'/\ Power Apparatus 8 Large APPllences R License m Lc Class`— `r Size 8 Type HIPKW WIA or KVAR FINAL O Over 1 to 10 Incl L. DATE 11-4 -910 VALIDATtO QF rod Contracto Date — Or 10 o 50 InclNAL U Over BY I am exempt under Sec BY Over 50 to 100 Inc ty BSPC or this reason Over 100 U) Date Services Swbd MCC 8 Panelboards , Z 0-200 Amp Under 800 V Signature 201 - 1000 Amp Under 800 V ❑ Exemption for Reg Over 1000 Amp or Over 800 V Nleint Elect SINGLE FAMILY Temp Power Pole 8 Appurtenances 90 2 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit ACCT.i I hereby affirm that I am exempt from the Contractors License Law for the following reason (Becton 7031 5 Business and Professions Additxual Sign Branch Circuits Doan) ] 43.00 ❑ I as owner of the property will do the work and the sh-cturs Mlsc Conduits 8 Conductors 1 ITERS is not Intended or offered for sale (Section 7044 Business Other (See Canplete Fee Schedule) _ TOTAL -43.00 and Professions Code) f±L1 CONSTRUCTION LENDING AGENCY T � C/�A(�SH/�I� 43.00 I hereby affirm that there Is a constructgn lending agency, for the t1aS1VG .( performance of the work for which is permit is issued(Sec 3097 PERMIT FEE (Sub-Total) Cw C) Lenders Name T1 PLAN CHECKING FEE 00 r1r1r1— —00Qi _ PERMIT ISSUING FEE ,� 3957 1 AM11:12 Lenders Address I have I our that I hese read th ppl ton and sore that the above TOTAL FEE inf at i ct I ag e o comply wdh all County ordinances tat r lah tncal wing and hereby authonze TO t 1 the Cc to enter upon the above-mentioned prone ty on our s SEE REVERSE FOR EXPLANATORY LANGUAGE Si e l WORKER I have a certificate DECLARATION X19 DPW(12 a„ APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certiliceta of consent Ko abil u)'sure or a certificate of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sac 3800 Lab C) Policy No Company FOR APPUCAMT TO FILL a1 JOB ADDRESS❑ Certified copy is hereby furnished New Reirdential Bldgs &Pods NO EACH FEE R ❑ 1&2 Family Sq `Ft — & 5 LOCALITY yf Combed Copy is filed with the county building inspection NEAREST department Multi famdy,Sq FI CROSS ST Date ApplicantRe9dentlal Swimming Pada ASSESSOR MAP BOOK( PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rea _ wRER Light_Sw OOR COMPENSATION INSURANCE FIRM NAME �O perms settlor need not be completed($1 the won First 20 MALL n Involved by the permit le for one hundred dollars(51000 bu Total No AANtianal ADOriESS)or ) o I certify that in the performance of the work for which this permit CITY G TM No IS issued I Shell not employ any person in any manner so as to become subject to the Workers Compensation Laws Lighting Fixtures First 20 E Total No Additional ADDRESS Date Applicant RESUENTUL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT If alter making this Certificate of CITY TO No Exemption you Should become Subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code you must forthwith comply with such PERMIT provisions or this permit shall be deemed revoked i Power Apparatus&Large Appliances APPLICANT L LICENSED CONTRACTORS DECLARATION Sae&Type HP KW KVA or KVAR ADDRESS I hereby affirm that I am licensed under provisions of Chapter 9Aver 3 to 10 Incl (commencing with Section 7000) of Division 3 of the Business and CITY T.I No Professions Code and my license is In full force and effect Ozer 10 to 50 Ind UCENSE OR / / ,1 } Over 50 to 100 IW REO NUMBER N` p���/ v a License Number 9-566 7 Lit Claes� ,lOver 100 OtsTRICT No BY 0 Services Swbd MCC&Penelboards �(/ Q Conhectat/"'GsC.ILI�Li C-�C 0 399 Amp Under 800 V pATE r �y y ° ❑ em exempt under Sec 4Da 1000 Amp Under 600 V 1D�2 l VALIDATION W Over 1000 Amp or Over 600 V FINAL 0- 8&P C for this mason BRANCH CIRCUIT FEES BY Z Date ISA or 20A 120V Ughting or Recept 1 To 10 Branch Circuits Signature 11 To 40 Branch Circuits - 41 More Branch Circuits ❑ Exemption for Reg Mamt Elect ISA 20A 206V To 277VLihbrg Sir Cecuro SINGLE FAMILY Temp Power Pole&Appurtenances 7 HOME OWNER BUILDER DECLARATION Son with One Branch Circuit ACCT.i I hereby affirm that I am exempt from the Contractor a License Law for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits 3M 48.60 Code) ❑ I as owner of the property will do the work and the structure Mrsc Conclurts&Conductors 1 ITEM is not intended or offered for sale (Section 7044 Bumness Other(See Complete Fee Schedule)_ , TOTAL 48 - 60 and Professions Code) CECK 48.60 CONSTRUCTION LENDING AGENCY CHAhIGE .00 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sac 3D97 PERMIT FEE (Sub Total) Civ C) PLAN CHECKING FEE 0000-0001 5/31/96 Lender s Name PERMIT ISSUING FEE 6676 1 Ali 8:03 Lenders Address I certify that I have read this application and under penalty of pugury state TOTAL FEE (��f that the above mtormauon is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring and hereby authorua representatives of fine County to enter upon the above-menlwned property for Ins pe Wrpoaee SEE REVERSE FOR EXPLANATORY LANGUAGE swNA RE aF nvrurrTEE wee ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 JELECTRICANIPERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL9050819810200057 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (818) 285-0488 EXT LEGAL ID FEES PAID BUILDING ADDRESS: TR 5904 LT 89 BL. 001 FEE DESCRIPTION QUANTITY UOM AMOUNT• �TEMPyCA-91780542 L, ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET LONGDEN 5384-005-002 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE- 596 GRID H2 LOCALITY TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 3.00 OUT 5 85 TENANT G2 LIGHTING FIXTURES 6 00 LGT 11 70 ISSUED ON PROCESSED BY. PLAN BY EX9RTrM WATERMILL EXPRESS IE NON-RES VENDING MACH 1 00 VEN 15 30 10/29/98 LIT 10/29/99 LA 100 AMP PANELS, MCC 1 00 PAN 38 85 TOTAL FEES 99 45 FINAL SNALDINO LOUIS P;DOROTHY A - 13583 WHITTIER BL �� WHIT 906051935 DESCRIR'TION'OF• �r ELECT R I CARFORIWATERlVEND I NG APPLICANT TEL NO JOE GARRETT (949) 222-0058- 4500 CAMPUS DRIVE SPECIAL CONDITIONS NEWPORT BEACH, LA S PNGELES COCONTRACTOR- TEL NOOS APPROVALS DATE iwsPEtTM—TrMUTMT-- G 6 J DEVELOPMENT (520) 670-9336- � Tj' 7329 S PISTOL HILL ROAD LIC NO VAIL, AZ 746522 B UNDERGROUND CONDUIT ARCHITECT OR ENGINEER TEL NO UFER GROUND DEBOO ENGINEERING (307) 637-4022-I P 0. BOX 884 LIC. NO 1111111ROUGH WNDUIT CHEYENNE, WY NONE , ROUGH WIRING (PUBLIC WORKSWuw-wm INE PLASTIC T/N METAL Y/N •� 7X� ob/Mc Se•vlce REPORT ID DPR265 ROUTE TO BS0508 COUNTY OF LOS ANGELES TEMPLE CITY R 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0106110028 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 DUPLICATE PHONE. (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING TR- 5904 LT 89 BL .001 6262 ROSE14EAD BLS FEE DESCRIPTION QUANTITY LION: AMOUNT TEMP CA 917801542 ASSESSOR INFORMATION NUMBER. NEAREST CROSS STREET. 5384-005-002 Al PERMIT ISSUANCE FEE 27 75 THOUS PAGE 596 GRID' H2 LOCALITY TEMPLE CITY D3 BOOTH LGT, SYSTEM 1 00 BOO 16 20 TENANT TOTAL FEES 43 95 . AMERICAN LEGION #279 06/11/01 JK 12/08/01 OWNER TEL NO FJMAL OAT% OWE SMALDINO LOUIS P;DOROTHY A - 2� O 13583 WHITTIER BL WHIT 906051935 FIREWORKS STAND - PLUGGING IMT EX STING OUTLET-2001 APPLICANT TEL NO SAME AS OWNERCONTRACTOR TEL NO - SPECIAL CONDITIONS OS PNGELES CCIJAPPROVALS DATE INUMUMURraffr— NT SAME AS OWNER }- LIC NO TEMPORARY POWER POLE UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL NO UFER GROUND LIC N -- iROUGH CONDUIT MAIN WATER LINE lllnl ROUGH WIRING PLASTIC Y/N METAL Y/N O 0 w r �o c Service That REPORT ID DPR265 ROUTE TO SS0508 COUNTY OF LOS ANGELES TEMPLE CITY S 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0206120016 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID FEES PAID BUILDING ADDRESS TR 5904 LT 89 BL- 001 6262 ROSEMEAD BL FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917801542 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET 5384.005-002 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY D3 BOOTH LGT, SYSTEM 1 00 BOO 16 20 TOTAL FEES 43 95 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON AMERICAN LEGION #279 06/12/02 JK 12/09/02 OWNER TEL. NO- FINAL MENDEMA 6262 ROSEMEAD BLVD 6 � TEMPLE CITY DESCRIPTION-6F WORK FIREWI`RKS STAND - PLUGGING INTO EXISTING OUTLET-2002 APPLICANT TEL. NO AMERICAN LEGION - 9522 LAS TUNAS BLVD SPECIAL CONDITIONS TEMPLE CITY CONTRACTOR TEL NO P�1GEL CO AMERICAN LEGION (818) 286-0329- O T "MIALS DATE INSPECTOR TEMPLEOCITTY, CA 91780 LICNO � \ \ St - ARCHITECT OR ENGINEER- TEL NO LIC NO lO � � � MAIN UATER LINE l PLASTIC Y/N METAL Y/N U`TILIiY COMPANY NOTIFIED ���Servlcc 7h2`/ i REPORT ID DPR265 ROUTE TO' BS0508 COUNTY OF LOS ANGELES TEMPLE CITY N 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 9906090003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 ENT LEGAL ID FEES PAID BUIkDING ADDRESS: TR: 5904 LT 89 BL. .001 1 6262 ROSEMEAD BL FEE DESCRIPTION QUANTITY UDM: AMOUNT TEMP CA 917801542 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET 5384-005.002 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY D3 BOOTH LGT, SYSTEM 1 00 BOO 21 30 TENANT ISSUED am PROCESSED BY PLAN BY EXMIW� AMERICAN LEGION #279 TOTAL FEES 49.05 06/09/99 UT 12/06/99 SMALDINO LOUIS P,DOROTHY A TEL NO FINAL- _ 7/Q (�Q WHIT906051935 WHITTIERBL D'ESCRIPTiuN u // FIREWORKS STAND - PLUGGING INTO ENISTING OUTLET APPLICANT TEL NO SAME AS OWNERSPECIAL CONDITIONS. - 9 PNGELES CO CONTRACTOR TEL NO U SAME AS OYNER - �.� APPROVALS�T)- I LIC. NO TEMPORARY POWER POLE UNDERGROUND CUNDUIT ARCHITECT OR ENGINEER TEL NO UFER GROUND LID.-NO. ROUGH CONDUIT MAIN WATER L 1111„ O L C W( K S PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIE15 Op cV tai t. Servcl 0 Tha�� REPORT ID DPR265 ROUTE TO BS0508 00(RITY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS i 9701 LAS TUNAS EL 0508 0006160075 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285.0488 ERT LEGAL ID FEES PAID BUILDING ADDRESS TR 5904 LT 89 BL 001 6262 ROSEMEAD BL FEE DESCRIPTION QUANTITY LION AMOUNT TEMP CA 917801542 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET 5384-005-002 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY D3 BOOTH LGT, SYSTEM 1 00 BOO 16 20 TENANT TOTAL FEES 43 95 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON AMERICAN LEGION #279 06/16/00 UT 12/13/00 OWNER TEL NO- FINAL DATE FINAL BY CODE S14ALDIND LOUIS P,DOROTHY A - d 13583 WHITTIER BL Z-4"Q0 WHIT 906051935 6ESCRIPTI 'F WORK FIREWORKS STAND - PLUGGING INTO E)X ING OUTLET-2000 APPLICANT TEL NOI SAME AS OWNERSPECtAl. CONDITIONS CONTRACTOR TEL NO - PNGELES CO APPROVALS SAME AS OWNER - t,0 ��Ty LIC NO NTEMPORARY POWER POLE UNDERGROUND CONDUIT TEL NO /X LIFER GROUND LIC. N�// 1111111 I�LnC p n p (� /J 1 u I B II �C \�nV Ol0' I(�l ROUGH WIRING PLASTIC Y/N METAL Y/N fill U LLL 55o\V�� o "l, /W1 fill ll �]NNNJJJ ServlaceTha��o� I REPORT ID DPR265 ROUTE TO BS0508 - 1 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL D508 0306100022 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT. LEGAL ID FEES PAID BUILDING Avuxttizi TR: 5904 LT 89 BL .001 6262 ROSEMEAD SL FEE DESCRIPTION. QUANTITY- UOM AMOUNT. TEMP CA 917801542 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LONGDEN 5384-005-002 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY D3 BOOTH LGT, SYSTEM 1 00 800 16.20 TENANT JI GENERATORS +3-10HP 1.00 GEN 19 65 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON: AMERICAN LEGION POST #279 TOTAL FEES 63 60 06/10/03 JK 12/07/03 OWNER' TEL NO FINAL DATE -CODE FIN BY ELECTRICAL FOR FIREWORKS STAND - 2003 APPLICANT TEL NO K C ELECTRIC (562) 972.2706- 6509 GLORYWHITE SPECIAL C)NDITIONS LAKEWOOD 90713 CONTRACTOR. TEL NO APPROVALS DATE INSPECTOR SIGNATURE K C ELECTRIC (310) 867-4447- 6509 GLORYWHITE ST LIC NO TEKPORARY POWER POLE LAKEWOOD CA 90713 699521 C10 UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL NO UFER GROUND LIC. NO ROUGH CONDUIT ROUGH WIRING MAIN WATER LIKE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFM REPORT ID OPR265 ROUTE TO BS0508 Ii I I COUNTY OF LOS ANGELES TEMPLE CITY R 0508 ELECTRICAL PERMIT_d DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9.705190016 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE (818) 285-0488 EXT LEGAL ID FEES PAID BUILDING A DRESS TR 5904 LT- 89 BL 001 16262 ROSEMEAD_BL/ f FEE DESCRIPTION DWINTITY LOM: AMOUNT TEMP-CA 917801542 ASSESSOR INFORMATION NUKBER: NEAREST CROSS STREET 5384-005-002 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY ' 03 BOOTH LGT, SYSTEM 1 00 800 21 30 TENANT TOTAL FEES 49 OS ISSUED 09 PROCESSED BY- PLAN BY- EXRWM� AMERI CAN-LEGION-0279---�9 05/19/97 TC 05/19/98 OWNER- FINAL DATE CODE SMALDINO LOUIS P,DOROTHY A -13583 WHITTIER ��11 J �p dd WHIT 906051935 BL 'V/L_/ OF WORK APPLICANT- TEL. NO. ���� aar�as FIREWORKS STAND - PLUGGING INT EXISTING OUTLET SAME AS OWNER - Ji SPECIAL CONDITIONS: CONTRACTOR SAME AS OWNER - !^ N LIC NO v! �� L L;� 6 ARCHITECT OR ENGINEER. TEL NO 53�uom o11� UFER GROUND (ld LIC.-NO ROUGH CONDUIT ROUGH WIRING � MAINWATER LINE - ( PLASTIC Y/N METAL Y/N REPORT ID. DPR265 ROUTE TO SS0508 COUNTY OF LOS ANGELES r TEMPLE CITY # 0508 [ELECTRICAL PERMIT-- DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EC-0508 9806090009-- BUILDING 806090009-BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE (818) 285-0488 EXT LEGAL ID FEES PAID BUILDING ADD TR: 5904 LT 89 BL 001 16262-ROSEMEAD-BLI FEE DESCRIPTION QUANTITY LM AMOAAIT TEMP CA 917801542 ASSESSOR INFUR TION NUMBER: NEAREST CROSS STREET 5384-005-002 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY D3 BOOTH LGT, SYSTEM 1 00 BOO 21 30 TENANT TOTAL FEES 49 05 ISSUED ON PROCESSED AMERICAN LEGION #279 06/09/98 Uf /09/99 OWNER F I MAL Dl,,, qg FINAL BY COVE SMALDINO LOUIS P,DOROTHY A - 13583 WHITTIER BL WHIT 906051935 ULSCRIFT FIREWORKS STAND --PLUGGING-INTO TING OUTLET APPLICANT TEL NO SAME AS OWNER - SPECIAL CONDITIONS /C5 �GELES co \ APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - TL\ LIC NO � �ARCHITECT OR ENGINEER TEL NO UFER GROUND� TEMPORARY POWER POLE �. � LIC NO � -- - !� � Irr 111� �,I ROUGH WIRING !- u L J'�- �7 L� l.� C�J �L��1 PLASTIC Y/N METAL Y/N 999 \ /J �A 5 G t�� Vb/ _ w orv,Ce T�� REPORT ID DPR265 ROUTE TO BS0508