HomeMy Public PortalAbout6439 TEMPLE CITY BLVD_Electrical__ 7GA663-CESOO "S APPLICATION FO ELECTRICAr PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING E.
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN III JENKINS, SUPCISINTBNOBNT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
RECEIPT_ NO Sf OWNER
MAIL
LIGHT_ TOTAL FIRST 20 20 ADDRESS
SWITCH_ OVER 20 10 CIT TEL NO
PLAN CHECK
LIGHTING iTOTAL FIRST 20 20 APPLICANT
FIXTURES /( OVER 20 10 ADDRESS
RANGE_DRYER_WTR HTR _ CITY TEL NO
STA COOK_DISP _F A U _ CONTRAC roR
SPACE HTR _AIR COND _ ADDRESS
CLOTHES WASH _DISHWASH CITY L NO
FAN—OTHER 1 00 LICENSE NO CLASS
MOTORS TRANSFORMERS RATING
IND HEATERS ETC HP KW KVA I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE B TYPE OVER TO All STATE THAT THE OI NV! IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDI MANCES AND STATE LAW{ REGULATING
ELECTRICAL WIRING
0 - 1 1 00
IWIRING HERESY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/ON
I 10 3 00NSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
FORNIA OR THAT M TH[ LEOAL OWNER OF AND INTEND TO
10 50 5 DDDE IN TN [D OESCR Ir ED R OENTIAL PROPERTY
SO - 700 1000ATURE d
ERMITTEE U
100 - Soo 15 00
PRbIGN OASSIGN AND ONE CIRCUIT 900TUBE OR MAROU EE ADDITIONAL CIRCUITS 100TE$ 1Cn
SERVICE NOT OVER 600 VOLTS OR 200 AAO 2 00SERVICE OVER 600 VOLTS OR 200 AMP S00
TEMP SERVICE POLE 6 APPURTENANCES 3 00APPROVALS DATE INSPECTOR S IlIGNIATURE
P POWER POLE
DERSLAB WORK
UGH CONDUIT
PERMIT FEE (SUB TOTAL)
FIXTURES
PLAN CHECK FEE (50% PERMIT FEE)
POWER AUTHORIZED
PERMIT ISSUING FEE 2 00 O UTILITY CONOTIFIEO 7 4 6
SUPPLEMENTARY PERMIT ISSUING FEE 1 00 FINAL I ♦ b
TOTAL FEE JOSEPH C ROOHAN
SUPERVISING EL EC RICAL ENGINEER
PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION cK M o CASH
14D. 1 0 3 4� JUL 18 2 D 4 0�
EE BACK OF APPLICATION FOR COMPLETE FEE SCNEDULE II;OiGyV
APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DePARTMENT OF COUNTY ISRE
BUILDING AND SAFETY DIVISION ER A$ SS 1. ..3
LOCALITY
NEAREST Em o N
FOR APPLICANT TO FILL IN CROSS ST
OUTLETS F OWNER OR
FIRM NAME
RCCEPT $ S MAIL
/
LI GHT_', TOTAL FIRST 20 O ADDRESS 6 ' ''
SWITCH OVER 20 0 Cl TY� TEL NO jt -5-7717/
PLAN CH!
LIGHTING FIRST 20 APPLICANT
TOTAL
A I
FI%TURES OVER 20 10 ADDRESS
RESIDENT14 APPLIANCES CITY TEL NO
PERMIT
RANGE_DRYER_WTR HTR_ APPLICANT Y✓
STA COOK_DISP _F A U - ADDRESS I
SPACE HTR AIR COND CITY q TEL NO
CLOTHES WASH _DISHWASH_ kp%EMB£R CLASS
FAN-OTHER 100 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AMD AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND HEATERS ETC NP KW RVA ELECTRICAL WIRING
SIZE S TYPE OVERTO
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALI FORM IA OR THAI I AM THE LEGAL OWNER OF THE ABOVE
I - lO 3 G DEBCRIBCO RESIDENTIAL PROPERTY p
PERMITEE CT
10 - SO 500 SIGNATURE • O
H
SO - 100 IODO DISTRICT NO PROCE SEDIBY w
100 - SDO 1500 _
SIGN GAS SIGN AND ONE CIRCUIT 500 APPROVALSA DATE U,mr%C ISIMTURE
TUBE OR
MAROUEE ADDITIONAL CIRCUITS 100 [FINAL
WER POLE
SERVI CENOTOVER 600 VOLTS OR 200 AMP 700 B WORK
SERVICEOVER BOO VOLTS OR 200 AMP IOAO NDUIT
TEMP SERVICE,POLE, &APPURTENANCES 500
TEMP LIGHT OR RCLEPT SYSTEM 000 FIXTURES
THORIZED
O NOTIFIED
PERMIT FE! (SUB TOTAL)
PLAN CHECK FEE
PERMIT ISSUING FEE 900 S�
TOTAL FEE
PLAN CHECK VALIDATION CK M 0 ' CASH PERMIT VALIDATION M 0 CASH
0 4 I n"AnY 44 2 0 1 62 0 °�'r
$EE SACK OF APPLICATION FOR COMPLETE SCHEDULE '^
WORKERS have
a certificate
of consent
7eAe8a ,a,e, APPLICATION FOR ELECTRICAL PERMIT {1
1 hereby affirm that I have a certdcete d consent to self insure
are cernf�_e d Mirk Compan Insurance a e certit COUNTY OF LOS ANGELES BUILDING AND SAFETY
copyY3000 C 1
F011 APPLICANT TO FILL IM ADB
❑ Cer4fled copy IS eby herfurnished , New Residential Bldgs d Pads EACH NO FEE ADDRESS
Certified s`pled vwM c vg 1119p8dbfl 1 d 2-Fernery 3q Ft S _ $ NEAREST-
Muki-femlry Sq Ft LOCA JT-
S (� 501
Residential Swimming Pools OWNERORDate App! _
CERTIFICATE OF EXEM FROM RS MAIL rvn1.1E
Outlets Rec Light -L SW —
COMPENSATIONINSURANCE ADORE
(This sector need not be completed If the work Imchrod by the Fust 20
permit is for one hundred dollars(41170)or leas) Total No Adddlanal CITU el No 3
1 ow'* 9*1 in the performance of the work for which this peanut PLAN GHECK ,
APPLICANT
is woad,1 Shall not employ ary, person In ery manner so as to
become subpct to the Workers Compenseton Laws Lighting Fixtures First 20 • ADDRESS 1 ,
' Total No Additional , CITY Tel No
Date Applicant Fined Appliances Not Over 1 HP
NOTICE TO APPLICANT H after making, the Certificated
PEFUT
Exemption you should became Subject to the Workers Compensation Range— Heater— DW — MrLICN a
pmvisons of the Labor Code you must fortlneth comply With Such Overt _ pryer — W M — ADDRESS
.provisions or this permit shall be deemed revoked Top _ FALL _ WH —
LICENSED CONTRACTORS DECLARATION Hood — Fen — Other— t CI el i�e6
I hereby affirm that 1 am licensed under provsrans of Chapter 9 Oso _ Roern Aw Cord LICE
NSE DR �l 7 a e
(commencing with Section 7000) of DivsBusiness 3 of the siness and REG NUMBS O�
Professions Code,and my Icense s in full force end effect Power Apparatus d Large Applance9 aBT+ICT No PROCESSED By
n',/ Size d Type HP KW KVA or KVAR I O
License Lc Ch�elt1� � L UP l0 1 Incl DAT L • _ - C�
Date `/ r//%��!!/���jj//JJ�^_ �—�r 1 to 10 kxi ' ATE / VALIDATION 0
O
Over 10 to 60 Incl FINAL 6t IU
❑ exempt u r Over 50 to 100 Inc, BY
BBPC for the reason Over 100
Date - Services Swbd,MCC d Ponafboards
0-200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V -- -
❑ Over 1000 Amp or Over 600 V '
Exemptan for Reg Maim Elect
SINGLE FAMILY Temp Power Pole d Appurterances _ _ 2 _
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit a
I hereby affirm that I am exempt from the Contractors License Lew ACCT..
for the following reason(Section 7031 5 Business and cu
ss aProfessions Additional Sign Branch Circuits
Code) 3307 23.80
❑ M= Conduits d Conarctons 1 ITEMS
I as Owner vale r the property do the work and the structure Other (Sae Complete Fee Schedule)
end Prolesnlons — poll.
r
a not marked or offered for sale (Section 7044 Business Other - 23. 30
' Cada) � CHECK _ 23.80
CONSTRUCTION LENDING AGENCY '
1 hereby affirm that there is a constriction lending agency, for The CTpL11$ .00
performama of The work for which the perm t s ssuad(Sec 3097 PERMIT FEE (Sub-Total) 0 -•
CN C)
PLAN CHECKING FEE - - - 60 -0001 11/ 9/90
Lerltlere Name '
PERMIT ISSUING FEE - 4`3 S - 3739 1 AM 11:07
Lenders Address
I carbfy that I have reed this application and sate that the abW TOTAL FEE
VLLa"
orrect I agree to comply with all Co my ordinances
regrdebrlg Elecincal wining and hereby authorizes Canty to ento upon the afw.e-rtemioredpurposes SEE REVERSE FOR EXPLANATORY LANGUAGE
ermittee Date