HomeMy Public PortalAbout6350 TEMPLE CITY BLVD_Electrical__ ]aAaea-CEeoe 3- APPLICATION FOR ELECTRI L PERMIT
• COUNTY OF LOB ANGELES
DEPARTMENT OF COUNTY ENGINEER =L-OCALtTY
Q /� 1
BUILDING AND SAFETY DIVISION Ll
JOHN A LAMBIE, COUNTY ENa1NZER
WILLIAM A JENSEN,SUP T OF BRILDING
NEAREST
R PPLI ANT TO FIL IN I CROSSST
RECEPT TOTAL No GCM FES
OUTLETS FIRaT 20 B EDB OWNER
LIE„T / / / aQ O MAIL
aWiTG„ 1/fi�.J✓1 oven 20 10 ADDRESS
LIGHTING TOT FIRST 20 E0 CITY TEL NO
FIXTURES �� OVER
2 10 ELECTRICIAN RICHARDSON ELECTRIC CO. , Inc
oV R 20
RANGES CLO DRYER[ WTR NERC 100 ADDRESS 8923 E. Broadway
DI STA ODOR a
cln TSL Mo
DISHW AOiO WASH STATE ... /D
SPACE HTRS RA APP J W H P MM I SO LICENSE NO /
MOTORS' ovEw NOT OVER „F DISTRICT N G Z E P S
o — 1 too
1 — 3 130 INSPECTION R RD
3 — B zoo VO
B — 1S 230 a
O
1S — Bo 1300
So 100 300 yd
SIGNS. NO TRANS 2
No LAWS
SERVICE O 300V NOT OVER 200A too �Q
SERVICE O SOOV OVES 200 A i00
SERVICE OVER SOOV Soo
MIBC
PERMIT ISSUING FE[ 200 0
SUPPL[MSMTAEIY PERMIT ISSUING FEE 100
TOTAL FEE B
I IRI®Y ACKNOWUEDGE THAT I HAV[ READ THIS APPLICATION GT[ IN
AND RATE THAT THE A30VE IS CORIQCT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCtl AND RATE LAWS REGULATING
El[LTIIICAL WIRING WIRING S
1 xESESTV�lj" MAVI1 AM PROPERLY GIANDIORLN:ESRDLOS MGEL[E D T[ oP FIXTURES
CALIFORNIAM TN[ LE F MOV[ POWERB10AU1TURUTILITY CO NOTIA D
OP VITO.
FINAL
�I CAS A ESRC VEIr
CK MOO CASH �9UPERVIBING ELECTRICAL ENGINEER
[ACO 8 1 7 9Q FEB 2 "21 D 1 5.8 0- a
a
'°"°°' `E°° APPLICATION FOR ELECTRICAL P"IT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER $UILOINa
BUILDING AND SAFETY DIVISION ADDRESS D
JOHN A LAMBIE COUNTY ENa1NEER
WILLIAM A JENSEN 8l r T or BUILDING LOCALITY
NEAREST
FFIXTURES
O I CROSS STTOTAL NO GCM rQOUTLETS FI°ST 20 •Y0 * OWNER
MAIL
ADD'L 10 ADDRIEMOVER 2OTOTAL F1RST 20 20 uTY TO_ NOADD 10ELECTRICIAN RICSARPSON EUCTRIC CO. . IIIov R t0 DRYEIIS WTR HTRS 100 ADDRESS 8923 S. BroadwayA DOOR CITY TEL NO
DISVNASH AUTO WARM STATE �j
SPACE HTRS STA.APP (%Hp MAN) BO LICENSE NO
MOTOR$' ovER Mm OVE11 MP DISTR ��yOf' O NE P ESSED BY
0 1 100 O O
1 — s too INSPECTION RECORD }
0
s e soo O
u
e — 1$ ago m
to $o $00 O
so — foo Boo ttttLLL'
a
MG TRANS
$IGN$1 No LAMPS Z
$CIVIC[0 600V-Nm ova SODA 100
BERVICE 0 GOOV Ova 200 A S OO
$nEY10E OVER eoov $oo
MISE
PERMIT ISSUING PCC 200 oo
SUPPLEMENTARY PERMIT I$$UING FSM 100
TOTAL FEE $ 3
I MERZRY ACRMowLZOGR TRAY I HAVE RSA$ WIN APFLICATMN OATt 11
AND STATE THAT THE AROW IS CORRECT ANO AGRQ TO COMPLY CONDUIT
WRM ALL COUNTY ORDIMAIK•ER AND RTATR LAWS REWLATINO
ELECTRICAL WIRING WIRING
1 ME CERTIFY THAT 1 AM FROPERLY REGIZTSR AND/OR 1
LICW AS RtGUIRZG BY LOS ANGZLES COUNTY AMO RATE OF FIXTURUE$
CALIFORNIA OR THAT AY THE LEGAL OWNER OF THL AROYE
OERCRIBED RUIDEMTI FRGF[Rry POWER
$IONATURE UTILITY NOTIFIED
OF PERMITT6
FINAL �!
IV DATION A H R C EVEIT
LECTRICAL
CK O CA$N BUPERYI$ING ELECTRICAL ENGINEER
LAC07324`0 Al 6 2 D 3.40
7SA663 ceeoe 4G8 /
APPLICATION FOR ELECTRICAV PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS CJ Z IM PjQZ
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN JENKINS, Summi%rrENDENTOP BUILDING LOCALITY
FXTURES
PPLICANT TO FILL IN NEAREST
A CROSS ST
I NO CH FEE
OWNERMAIL
L FIRST 20 20 ADDRESS
OVER 20 10 CITY TEL NO
PLAN CHECK
L FIRST 20 20 APPLICANT
OVER 20 10 ADDRESS
RANGE_DRYER_WTR HTR _ CITY TEL NO
STA COOK_DISP F A U CONTRAC TOR e,;_
SPACE HTR _AIR COND �
ADDRESS ' }
CLOTHES WASH _DISHWASH CIT' W/T.t TEL NO al2!!--
FAN—OTHER 1 00 LICENSE NO O CLASS �
MOTORS TRANSFORMERS RATING
IND HEATERS ETC HP KW KVA I HERESY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLICATION
SIZE G TYPE OVER TO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING
I HERESY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR
I 10 3 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIIORMIA O HAT I AM THE LEGAL OWNER OF AND INTEND TO
IO SO 5 OD RESIDE IM T ABOVE DEf CRI1E0 RESIDENTIAL PROPERTY
SIGNATURE Y
SO - 100 10 DO OF PERMIT EE O
100 - 500 15 00 U
DIKRl NO UP N P D BY c
SIGN GAS SIGN AND ONE CIRCUIT 3 00 CJJ
CAI
TUEE OR
MARQUEE ADDI TIONAL CIRCUITS 1 00 l 1 �'�
NOTES
SERVICE NOT OVER GOO VOLTS OR 200 AMP 2 00 Z on- Z
SERVICE OVER$00 VOLTS OR 200 AMP S 00
TEMP SERVICE POLE G APPURTENANCES 3 00 APPROVALS DATE INSPECTOR B SIGNATURE
TEMP POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
PERMIT FEE (SUB TOTAL) WIRING
PLAN CHECK FEE (50% PERMIT FEE) FIXTURES
POWER AUTHORIZED
PERMIT ISSUING FEE 200 2 UTI T
YCO NOTIFIED
SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL
TOTAL FEE JOSEPH C ROOHAN
SUPERVISING ELEC CAL ENGINEER
PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK M O CASH
Fl_ 0 s 7 8 .L 9 z D 4.00-
EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE IC? �" '�•✓"C�Y'V
WORKER S COMPENSATION DECLARATION 720 X19 DPW(1291) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I 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 thereof(SeF 3800 Lab C)
Policy No Company FOR APIRJCANT TO FILL IN JOB / TE 1 �t� !] —v yt
❑ Certlrled AGO 0350 r-I r7 V
i c»py Is hereby furnished New Residential Bldgs a PQo aL t t NO EACH FEE LOCALITY
❑ Cemfietl copy is filed with the county building Inspection 1&2 Family Sq Ft '�' — $ $ NEAREST
department Muhl family Sq Ft CR039 3r
Det Appl cent 11,-� �i Residential Swimming Pools ASSEIMIOR 5 3-O "a PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS Gutlets Rai Light J Sw� OWNER On T�
COMPENSATION INSURANCE FlRI4 NAME S4L, LZ---
(This section need not be completed If the work Involved by the Firer 20 b woL _
permit Is for one hundred dollars(3100)or leas) Total No Addmonal ADDRE96
I certify that In the performance of the work for which this permit CITY Tel No
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 PLAN CHECK +`
1 P g APPDCANT
Total NoAdtlrtionel ADDRESS
Dale Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICE TO APPLICANT If altar making this Certificate o/ Cf1Y S' {1L P'�.�" Tel No
Exemption you should become Subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP PERMIT
p
provisions of the Labor Code you must forthwith comply with such pow Apparatus 8 Large Appliances PEPERMIT Bbs1+—
provisions or this permit shall be deemed revoked
LICENSED CONTRACTORS DECLARATION Size 8 Type HP KW KVA or KVAR ADDRESS Q •—t
I hereby affirm that I em licensed under provisions of Chapter 9 pear 330101nd
(commencing with Section 7000) of Division 3 of the Business and CITY Tel No
Professions Code and my license is in full force and effect Over 10 to 50 Incl LICE }
Over 50 to 100 Incl
REG NU B
REO NUMBER Chi fl
License Number LIC Class Over 100 DAR OT NO p P E ED eY 0
Services Swbd MCC 6 Panelboards . Q/ Q
a FlNA
Contract-or-.`� `✓^^^Tmiw- 0 399 Amp Under 600 V DATE H
F1 jam exempt under Sec 400 1000 Amp Under8tV - VALIDATION W
Over 1DOO Amp or Over 600 V FINAL Il
B 8P C for this reasoneY BRANCH CIRCUIT FEES Z
Date 15A or 20A 120V Lighting or RecePt
I To 10 Branch Circuits
Signature 11 To 40 Branch Orcuns
❑ Exemption for 41 Or More Branch Circuit
p Reg Mamt Elect 15A,20A 208V To 277V Lighting Br Circuit
SINGLE FAMILY Temp Power Pole 8 Appurtenances _
HOME OWNER BUILDER DECLARATION Sign with One Branch Cvcuit T
C a
I hereby affirm that I em exempt from the Contractor s License Lew s .i
for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits
Code) 47.1:
I� I as owner of the property will do the work and the structure Mix Conduits d Conductors _ i ITEMS
is not intended or offered for sale(Section 7044 Business Other(See Complete Fee Schedule) , TOTAL. $ �
and Professions Cade)
CONSTRUCTION LENDING AGENCY CHECK 47.25
1 hereby affirm that there is a construction lending agency for the �LI�uALIrrNE Lu
performance of the work for which this permit Is Issued (Sec 3097 PERMIT FEE (Sub Total) a� Q (KA
NE
C)
(V /
Lenders Name PLAN CHECKING FEE I�000 {
v� VVl/V-=L 5/UUL/ L/q.
PERMIT ISSUING FEE �ed G019 1 7%e2
Lender a Address
I Comfy that I have read this application and under penalty of purjury state TOTAL FEE
that the above mformabon is correct I agree to compry,with all County
ordVin
atelawsregulaung Electncalwinng and herebyawhonze
row this County to enter upon the above mentioned property
for , , SEE REVERSE FOR EXPLANATORY LANGUAGE
6�I ''14_7
TUBE MRTEE DATE