HomeMy Public PortalAbout6424 TEMPLE CITY BLVD_Electrical__ 7GA663-CROOS ALN APPLICATION FOR ELECTRICAL"PERMIT U
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING Z �� - Vr
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY Em0IN[[R _
COLEMAN W JENKINS. SOPRRINT r'BNT OF BUILDING LOCALITY C//)
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NO A
RECEPT_ OWNER
MAIL
LIGHT_L
L FIRST 20 20 ADDRESS
SWITCH_ OVER 20 10 CITY TEL NO
PLAN CHECK
LIGHTING L FIRST 20 20 APPLICANT
FI%TURESOVER 20 10 ADDRESS
RANGE_DRYER_WTR HTR _ CITY TEL NO
STA COOK_DISP _F A U _ QQIJTRAC iOR Q O
SPACE HTR _,AIR COND ADDRESS i✓ JVD
CLOTHES WASH _DISHWASH CIT O NrM TEL NOK- ON Z
FAN_OTHER 1 00 LICENSE NO 1V SDI CLASS IO
MOTORS TRANSFORMERS RATING
IND HEATERS ETC HP KW KVA I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
SIZE 6 TYPE OV CR TO
AND !TATE THAT TNC ABOVE 13 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY OROIMA MCE3 AND STATE LAW! REGULATING
ELECTRICAL WIRING
O - 1 1 00
HERESY CERTIFY REQUIR TNAT I AM PROPERLY IN Y AND ED AND/OR
1 - 10 3 00 LICENSED AS REQUIRED BY HE ANGELES OW ER OF AND STATE OF
TO
CALIFORNIA OR THAT 1 VE THE LEGAL OWNER OF AND INTEND TO T
ID 5D 5 DD RERIDf THE ABOVE DE3[PIf CO Rf DC NT IAL PROPERTY O
SIGNA I U
50 - 100 10 00 pF PERMI 5
O
100 - 500 1500 ~
DISS T N G OUP N� P CESSED BY w
SIGN GAS A�
TUBE OR SIGN AND ONE CIRCUIT 300 A y
MARQUEE ADDITIONAL CIRCUITS 1 00 Z
NOTES AA (!
SERVICE NOT OVERNSOD VOLTS OR 200 AMP 12 00 2_ 00
SERVICE OVER 600 VOLTS OR 200 AMP 5 00
TEMP SERVICE POLE IN APPURTENANCES 3 00 APPROVAL! DATE 1N3PECTCR5 SIGNATURE
]ROUGH
EMP POWER POLE
NDERSLAB WORK
CONDUIT
PERMIT FEE (SUB TOTAL) IRING -
IXTURES
PLAN CHECK FEE (SO% PERMIT FEE) OWER AUTHORIZED
PERMIT ISSUING FEE 2 00 2- UTILITYCO NOTIFIED �7
SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL
TOTAL FEE Iry JOSEPH C ROOHAN
SUPERVISING EL EC CAL ENGINEER
PLAN CHECK VALIDATION CK M D CASH PERMIT VALIDATION CK M O CASH
.00"Errr,,0 3 7 9 JUL 9 2 D 4.00-
EE
E BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE V/1. y�Yl'C�"✓E✓
COUNTY of LOB ANGELES APPLICATION FOR PERMIT
Department of County Engineer ������'�
DIVISION OF BUILDING & SAFETY
WILLIAM 1 FOX, Gu[b EiFIaMT
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN L.
rT A-1 <r3/Ci-8'
RECEIVED BYREADY FOR DATE 1
ADCREBB /n rI RBTI NeP[OT ION
GITY TEL N -Z� ✓5//V}•/ �,
COUNTY LICENIIE NO E%PIR[B BUILDING
PERMIT FEES ADDRESS TT
ML• FEE
NUMBER EACH LOCALITY
LIGHT OUTLETS 16 NEAREST -4 kL-v--A
RECEPTACLES CROSS ST �•O _ .— 1
WALL SWITCHES OWNER
TOTAL OUTLETS Sc MAIL
[LCC RANGES 25 ADDRESS
[LEC HATERS SS y5 CITY TEL N
FI%TUR[H S D I
I HERE AGKNf] EDO THAT 1 HAVE READ THIS
MISO APPLICATION AND STATE THAT THE ABOVE IB CORRECT
NUMBER OF LIGHT CIRCUITS AND AOR[[ TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER Or RECEPTACLE CIRCUITS AND STAT[ LAWS REGULATING ELECTRICAL WIRING
MOTORS 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOB
NUMe[R HORSEPOWER FEE ANO[L= COUNTY LICENSE. OR 1 AM THE LEGAL OWNER
N[w MVD MP o m ,ND EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE
3 . Lt" 25 SIGNATURE O►` dTf_
A V27 SO PERMITTE
2 ° ' OG INSPECTION RECORD
S is 1 60
IS 50 250
IID 21m a o0
200 000 /0.013 J
500 1000 1500 IQ
� PA Z
EOVER lOOO 2000 � � O
N O ST FR CHANGER-HP Tv Y EL
WELDERS AO-KVA x — Ftp ) O
GENERATORS - KW
TRANSFORMERS - KVA
TEMP MOTORS (75 or oERR)
MOVED MOTORS 75 or Dele)
misc
SIGNS
NO NO TRANS. APPROVALS
N LA
FOR EACH PERMITR DATE � INBP[CTOR'S NAM[
WIRING 91.00 O CONDUIT
FIXTURES mica I WININGNUPPLKMKW
TARY So rIKTUR[B
POWER
TOTAL rEE UTILITY CO.NCTm ED _ //-,r,
FINAL
7Ma61 Dee#e11 1.61
WORKER 9avea ca8AT1ON of consent
7""3 DPyy9fee APPLICATION FOR ELECTRICAL PERMIT "
I heroSY affirm iMl I have a certdice{e of convent to self Insure 78AeSs
or e.cenlflcate of worker a bompeneation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy thereof(Seo 3800 Lab C 1 _ • ) I _
Poky No 4/4Z" Company /" /'UN� FOR APPLICaNf To taLL IM O EWIrlmA,44211_
G
❑ Certdkd copy m hereby fumlehed New Residential Bldgs 6 Pods EACH NO FEE
❑ C(Niled copy la Bled with the county,building I 1&2 family SQ Ft S — LOCALITY '
department Mulct family So Fl NEA
ST
B '
Date 'Applicant Residential Swimming
ee I A99ES90R
ULAIR BOOK
CERTIFICATE OF SATI N IN FROM WORKERS Ordlels R. Light FlrsSw L 70 7 0� q�RHI Ful
COMPENSATION INSURANCE ',/ J
(This section need not be completed If the work Involved by the tool No Addtional W'AODBEL 99 Et9 BG!/
permit Is for one hundred dollars($100)or lase)
I certify that In the performance of the work for which this permit _ CITY v Tel No
IS Issued I shall not employ any person in any manner so as to
CHEM
become subject to the Workers Compensation Laws r Lghlurg Fixtures Q Fast 20 O r
Total No Additional ADDRESS Lt7
Date Applicant 4-=R 2DA,120V BRANCH CIRCUITS'—
NOTICE TO APPLICANT If alter making this Certificate of CITY ��(a Tel No
Exemgbn you should became subject to the Workers Compenaslion 1 TO 10 INCLUSIVE EACH
provisions of the Labor Code you must forthwith comply with such 11 TOM INCLUSIVE EACH
provisions or this permit Shell be deemed revoked n OR MORE BRANCH CIRCUITS EACH
LICENSED CONTRACTORS DECLARATION 15 OR 20A 209V TO 277V LIGHTING EACH ADDRESS d
I hereby affirm that 1 am licensed under provisions of Chapter 9 O
(commencing with Section 7000) of Division 3 of the Business and CITY _ a TOW V
Professions Cade and my[menu Is In full force and effect RESIDENTIAL APPLIANCES UP TO SHP LICENSE OR Own rr
Power AppereNa A Large Appliances _ REO NUMBER O
License Number 603 4,,LL// Lo Class Size&Type HP KW KVA or KVAR DISTRICT N`,0 F-
'- Upto31rmI /•e8 1 W
ContractorM FP GOd/ST Data to101nci RNA_
Over 130 W 50 Incl _ TE
\\❑
I ern exempt under Sac Over SOW 100 Ind b-3o •./ VALIDATION
B 8P C for this reason Ger 100 FINAL
NAL
Services Sw od MCC 6 Panemmrde
Dale 0 200 Amp Under 800 V
Signature 201 1000 Amp Under 800 V 2
E] _ Over 1000 Amp or G00 Over SV v t
Exampaon for Reg Mamt Elect ACCT,
SINGLE FAMILY Temp Power Pole 8 Appurtenances
99.97
HOME OWNER BUILDER DECLARATION Sign with One Brand)Circuit
hereby affirm that I am exempt from the Contractor a License Law
for the following reason (Section 7031 S Business and Profifulons Addbrwlal Sign Branch Circuits 1 ITEMS
Code)
❑ I as owner d the property will do the work and the Structure Mae Conducts, e a DonducnorTOTAL '99 ;97
Is not intended or offered for Sale (Section 7044 Business Other(See Complete Fee Schedule)_ CHECK 79.97
and Professions Code) - - - ► CHANGE •Oil
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 _ _ _ _ (SubTWA Z Q9DU-rio0 i r •,n
' 7/92
CN C)
PLAN CHECKING FEE 6094 i AMi[f'11
Lender a Name
PERMIT ISSUING FEE Z
Lander a Address TOTAL FFF
I certify that I have read this application and stele that the above 1 •-1
information is c rract I agree to comply with all County ordinances
and Stele Is regulating Iecirlcel wiring and hereby authorize
repreaentet of ihi my to nter upon the above mentioned
props 1 peal SEE REVERSE FOR EXPLANATORY LANGUAGE
-7-imcm `�Z
AOFHT DATE