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HomeMy Public PortalAbout6361-6363-6365 TEMPLE CITY BLVD_Electrical__ APPUCANT FUL INBEAVELY OUTMED PORUON ONIY DESCREMON OF WORK FEE 3 W21W I., NUK13UR OF OUTLETS ON CIRCUFTS LOCATION BY ROOMS ♦��/ Fm � u■■■■n■©.o "Wm- am■■■n©el■o r��an.C.■n.d■■ .i�'�u■ ■■©■IJ■0 r�Mo■■■■■■■■o rm—mu■■■■u■©■n. Rcj-�M■■■■■■©■■.■ IMM MEMI■■■■■■.■■IN IM�■■■■■■.■■ ■ �■■■■■■■.■ ■ �■■■■■■■■■ MMMl■I■■■■■■■■■ �■ ■■■■..■■■ �■■■■■■■.■■■ MEMI■.■■■■■.■■ N IMM er. v�■...■n■■m■■� s�� 1 u. ._ rs- "AR" CK f0 " RR'n APPLICATION FOR ELECTRICAL PERMIT I ' COUNTY OF LOS ANGELES pp I • DEPARTMENT OF COUNTY ENGINEER ADDRESS U BUILDING AND SAF DIVISION FOR^PPL CANTTO FILLIN LOCALITY TQA CLIP- New Residential Bldgs &pools EACH NO FEE NEAREST I &2 Family Sq Ft ,:�iy7 $ 025 — S T Multi fomilysq Ft 02 — OW NAME ResidentialResidential Swimming Pools 25 DD ADDRESS C IrV Outlets Rec Light—Sw CITYTel No First 20 50 PLAN CHEC Total No Addmonal 30 APPLICANT J r H I ADDRESS /z- Lighting Fixtures First 20 50 CITY Tel No 6_7000 Total No Addmonal 30 PERM IT APPLICANT J 0 14 s YIU H f6 Fixed Appliances Not Over 1 HP ADDRESS Range—Heater_D W _ CITY Tel No VA,-706a Oven—Dryer—W M_ LICENSE OR Top —FAU _WH _ REG NUMBER 332._ -3Y,3 Claris Hood_Fon _Other— i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE Disp — Room Air Cond 250 THAT THE ABOVE 15 CORRECT AND AGREE TO COMRY WITH ALL COUNTY ORDIN AWES AND STATE LAWS REGLAATING ELECTRICAL WIRING Power Apparatus&Large Appliances Size&Type HP KW KVA or KVAR I HEREBY CERTIP'THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 250 REWIRED BY LOS ANGELES COUNTY AND STATE Of CALIFORNIA OR THAT I AM Upt01 Incl THE LEGAL OVV ROFT ATE E DjjRIBED RMDENTIAL PROPERTY Over I to 101ncl 5 GO Over 10 to SO Incl 1250 PERMITTEE Over 50 to 100 Inc 2500 SIGNATURE Over 1D0 4000 DISTRICT NO �j ED BV Services (� Cl = rj 0 20OAmp Under 60O V 1250 APPROVALS DATE INSPECTOR qUE 201 1000 Amp Under 600 V 2500 Over 1000 Amp or Over 600 V 50 00 TEMP POWER POLE - 7 Temp Power Pole&Appurtenorces 1000 UNDERSLAB WORK Sign with One Branch Circuit 1000 ROUGH CONDUIT 200 WIRING -�7 Additional Sign Branch Circuits Mlsc Conduits&Conductors 10 DO FIXTURES Other)See Complete Fee Schedule, POWERAUTHORIZED ,' UTILITY CO NOTIFIED FINAL PERMIT FEE (Sub Total) NOTES PLAN CHECKING FEE (One Fourth Permit Feel PERMIT ISSUING FEE $7,00 TOTAL FEE PIAN CHECK VALIDATION CK MO CASH PERMIT VALIDATION CK _MID CASH 2 1 7nFMAR 23 2 D 70.68A:3 SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE C J T ' °°° DE°°'° APPLICATION FOR ELECTRICAIT� COUNTY OF LOS ANGELES .3 Y 7-,C DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE. COUNTY ENGINlER ADDRESS IRT' COLEMAN W. JENKINS, SUPRINTNDID. OI BUILDING LOCALIT FOR APPLICANT TO FILL IN IrROSS ST NO EAC. RECE PT_ f $ OWNER MAIL LIGHT_ TOTAL FIRST 20 20 ADDRESS SWITCH__ OVER 20 10 CITY TEL NO PLAN CHECK LIGHTING iTOTAL FIRST 20 20 APPLICANT FI%TURES 7( OVER 20 10 ADDRESS RANGE_DRYER—WTR HTRTr�•Y. – � CITE--'-. j l FEL' NO STA COOK_DISP _F A U I 1 Ir COIJTRAC iOR SPACE HTR _AIR COND �_ I \ �• _ ACDRESS CLOTHES WASH _OISHWASH ti ` CITY 'TEL NO FAN—OTHER ( 1 00 LICENSE NO 2/ 2 7Z16 CLASS MOTORS TRANSFORMERS RATING IND HEATERS ETC HP KW KVA I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SIZE 6 TYPE OVER TO �� AMD STATE THAT TME AD VE IS CORRECT AND AGREE TO COMPLY WITX ALL CWMTY ORDINANCES AND STATP LAWS REGULATING • O\ 1 1 00 ELECTRICAL WINING . 1 I LICENSED HEREBY CERTIFY THAT I AN PI10Pf R l Y1REGISTERED AND/OR 1.11 - 10 3 00 C L ORN At REQUIRED M HE LEGAL Et COUNTY AND STATE or CALIPORX IA OR THAT 1 AM THE,LEG AL OWNER OF AND INTEND TO 10 - 50 S 00 REtIDE IN THE ABOVE DESCR RESIPE.TIAL PROPERTY 1j Y SO - 100 10 00 \ SIGNATURE CD OF PERMITTE U 100 - S00 15 00 ` ¢ DISTRICT O G_R�•LIP N PROC E BYSIGN o TUBE GAS OR SIGN ANO ONE CIRCUIT 3 00 �Z_ V jO "MAROUEC ADDITIONAL CIRCUITS OTES SERVICENOT OVER SW VOLTS OR 200 AAP ,!SERVICE ODER SOO VOLTS OR 200 AMP TEMP SERVICE POLE 6 APPURTENANCES 1APPROVALt DAT[ INSPECTORS SLGMATWIL MP POWER POLE NDERSLAB WORK OUGH CONDUIT PERMIT FEE (SUB TOTAL) RING PLAN CHECK FEE (SO% PERMIT FEE) WER AUTHORIZED PERMIT ISSUING FEE TILITY CO NOTIFIED SUPPLEMENTARY PERMIT ISSUING FEENAL TOTAL FEE JOSEPH C ROOHAN SUPERVISING ELEC ICAL ENGINEER PLAN CHECK VALIDATION CK -M 0 CASH PERMIT VALIDATION CK M 0 CASH LAP,,9 9 7 9-� MAY14 2 D 6.00_ EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE WORKERS COMPENSATION DECLARATION 8 CE E06G (2 801 APPLICATION FOR ELECTRICAL PERMIT OB I hereby affirm that I have a certificate of cement to self COUNTY OF LOS ANGELES BUILDING AND1gAFETY Insure or a certificate of Workers'Compensation Insurance,or /(/� a certified copy thereof(Sec 3800, Lab C) FOR APPLICANT TO FILL IN JOB Policy No Company ADDRESS ALV New Residential Bldgs &Pools EACH NO FEE Certified copy Is hereby furnished 1 &2 Family,Sq Ft $ — $ LOCALITY Certified co g inspection Multifamily Sq Ft Certi copy n filed with the county buddm im action Residential Swimming Pools CROSS ST ,J . department OWNER OR � FIRM NAME Date ApplicantOutlets Rec—Light_Sw_ AM B� Fret 20 CERTIFICATE OF EXEMPTION FROM WORKERS Total No Additional CITY c Tel o S" COMPENSATION INSURANCE } PLAN CHECK iL APPLICANT O (This section need not be completed if the work Involved Lighting Fixtures First 20 L) by the permit n for ono hundred dollars (f 100) or less) e e ADDRESS Total No Additional I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel N O permit is issued, 1 shell not employ any person in any mannerPERMIT F_ so as to become subject to the Wo a Co pe tion Laws Range_Heater_D W _ APP (CANT W Oven _ Dryer_W M _ ADDRESS z1vT� �i0� Z Dales_qpplicant Top _ FAU _W H _ Hood _ Fan _Other_ CITU �� f Tel No v�/.S✓0��' NOTICE TO APPLICANT If after making this Certificate of Disp _Room Air Cond— L CENSE OR Exemption you should become subject to the Workers REG NUMBER Cln `d" Compensation provisions of the Labor Code you must forth Power Apparatus& Large Appliances DISTRICT NNO^ ROC SSED BY with comply with such provisions or this permit shall be Size&Type HP KW,KVA or KVA �l C D FINAL T deemed revoked Up to 1 Incl \"J// y Over 1 to 10 Incl DATE a O� 8'U VALIDATION LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl 1 hereby affirm that I em licensed under provisions of Chapter Over 50 to 100 Inc FINAL 9 (commencing with Section 7000) of Division 3 of the Buai Over 100 By " ness and Professions Code and my license is ,n full force and effect Services License Number22 Lie Clan- 40'7ec? 0-200 Amp Under 500 V 201 1000 Amp Under 600 V Contractor. Date 2.5'�© Over 1000 Amp or Over 800 V HOME OWNER BUILDER DECLARATION Temp Power Pole& Appurtenances I hereby affirm that I am exempt from the Contractor's Sign with One Branch C,rieunt License Law for the following reason (Section 7031 5, Bus, Additional Sign Branch Circuits nese and Professions Code) , Mist: Conduim&Conductors I as owner of the property will do the work and the Other(See Complete Fee Schedule)— structure is not intended or offered for sale (Section 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 1 8 6 8 A for the performance of the work for which this permit is issued (Sec 3097 Civ C) PERMIT FEE (Sub-Total) # e e e e e 2 Lender s Name PLAN CHECKING FEE (One Fourth Permit Fee) Lender's Address 2 e e 1 700 PERMIT ISSUING FEE • • • 17 1 certify that I have read this application and w 004 state that the TOTAL FEE ' above information,s correct I agree to comply with all County 0 8 25—8 0 ordinances and State laws regulating Electrical wiring and hereby authorize rep enlat v ('this County to enter upon the abv rati oon p perry, or inspect purposes ` SEE REVERSE FOR EXPLANATORY LANGUAGE -Signature of Permittee to ' t WORKERS'COMPENSATIONDECLARATION CEaO6G (2 BO) APPLICATION FOR ELECTRICAL PERMIT {� EE061J 1 hereby affirm that I have • certificate"of'coiiSent to self ' COONTY OF LOS ANGELESBUILDING AND SAFETY / insure or a certificate of Workers'Compensation Insurance or � / 3 b /L a a certified copy thereof(Sec 3800, Lab C) 6 may/ Policy No Company FOR APPLICANT TO FILL EACH N NO FEE ADDRESS - �''�'• E] Certified Residential Bldgs &Pools Certified copy rs hereby furnished 1 &2-Family,Sq Ft ' It — S LOCALITY 710. NEAREST Certified copy a filed with the county building inspection Multi family Sq Ft CROSS S7 r department Residential Swimming Pools OWNFIRM N R `� Ef Date Applicant Outlets Rec_Lighl__rl Sw _ MAIL • CLS G First 20 CERTIFICATE OF EXEMPTION FROM WORKERS Total No Additional CITY Tel No y COMPENSATION INSURANCE PLAN CHECK 0 APPLICANT (Thu secmn need not be completed tf the work involved i Lighting Fixtures First 20 ADDRESS U sect: Km the permit is; for one hundred dollars ($I00) or less) cc Total No Additional 0 I certify that in the performance of the work for which this Fixed Appliancesot NOder 1 HP CITY 7a 15 permit a issued, I shall not employ any person in any manner PERMIT W so as to became subject to the W kers' Compensation Laws Range_ Heater_D W PPLICANT Oven _Dryer _W M _ ADDRESS Date�� 2SADphcant .d Top — FAU _W H �y Hood _ Fan —Other— CITY �� Tal No ��Sl✓j d NOTICE TO APPLICANT If after making this Certificate of Disp _ Room Air Cond_ CEN R Exemption, you should become subject to the Workers' REG NUMBER=R J tau Compensation provisions of the Labor Code, you must forth Power Apparatus& Large Appliances DISTRICT NO O ESSED BY with comply with such provisions or this permit shall be Size&Type H �1 D Q P,KW KVA,or KVA L' deemed revoked Up to l Incl FINAL / �-7,_ Over 1 to 10 Incl DATE r � % VALIDA N LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl I hereby affirm that I am licensed under promions of Chapter Over 50 to 100 Inc By AL 9�(commencmg with Section 7000)of Division 3 of the Buri Over 100 nese and Professions Code and my license is in full force and effectServices �� i��ey ' License Numbers Lm Class `-' r O' 0 200 Amp Under 600 V r+� 201 1000 Amp Under 600 V Contractor Date ,�ftQ.�,r`�0� Over 1000 Amp or Over 6D0 V HOME OWNER BUILDER DECLARATION Temp Power Pole&Appurtenances 1 hereby affirm that I am exempt from the Contractors Sign with One Branch Circuit License Law for the following reason (Section 7031 5, Busi Additional Sign Branch Circuits nese and Professions Code) Muc Conduits&Conductors 1 as owner of the property will do the work and the Other (See Complete Fee Schedulel— structure is not intended or offered for sale (Section 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY :91 867 A I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is PERMIT FEE (Sub Total) i # • • • • • Z issued(Sec 3097 Civ C) Lender's Name PLAN CHECKING FEE IOne Fourth permit Fee) 2 a -10900 Lender's Address PERMIT ISSUING FEE • • • • 900 1 certify that I have read this application and state that the TOTAL FEE Q a25-80 above information is correct I agree to comply with all County ordinan a and State laws regulating Electrical winng and here a thonze r p entatives this County to enter upon t abo a men efia r rnpect purposes SEE REVERSE FOR EXPLANATORY LANGUAGE ignetura of Permittee e