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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