HomeMy Public PortalAbout6456 TEMPLE CITY BLVD_Electrical__ ..E LA 12 BA APPLICATION FOR ELECTRIC PERMIT 1
DIVISION OF BUILDING AND SAFETY
Deplatment of County EngfneeT
County of Los Angeles BUILDING X60 7'P
WM J FOX, COUNTY ENGINRUR ADDRESS 1 t
GnBATT D GRIFFIN SUP T OF BUILIDING n
FOR APPLICANT TO FILL IN LOCALITY C +
PERMFEES NEAREST
CROSS 6T
NUMBER EACH FEE ,
LIGHT OUTLETS OWNER
RECEPTACLES MAIL
ADDRESS
WALL SWITCHES
TOTAL OUTLETS at f CITY TE6. N
ELEC RANGES 25 ELECTRICIAN
ELEC HEATERS 215 DO
KW EA y __
FIXTURES n O CITE TEL NOVI
LICENSE NO L
NUMBER OF LIGHT CIRCUITS DISTRICT NO GROUP I READY ron IR.vecrlox
MBE IR U TB
MOTORS
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVO HP OVER INC EACH
•L[n6 • 2n Z
_ z n Ioo
no zoo n o0
MISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS _
FOR EACH PERM IT
_ww
WIRING $100 V V
FIXTURES $1OO d
SUPPLEMENTARY 50 _
APPROVALS
TOTAL FEE $ ?. DATE INSPECTOR S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY /
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING gg
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES O 7LS"
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER
CALIFORNIA OR THAT 1 AM TH LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT PE ...L'_�
SIGNATURE UTILITY CO NOTIFIED
OFF • FINAL -17x— (ttTKvmj-t&
WILLIAM FOX,CouNTYENGINKKR VALIDATION .Z 2.80 to
w
&L 7"6 1 s- from 21
BY
® EPUT
�5-A4OZF CITY,
76A663-C EE,0611/10 APPLICATION FOR ELECTRICAL PERMIT
COUNT' OF LOS ANGELES t
77
DEPARTMENT OF COUNTY ENGINEER FT
BUILDING AND SAFETY DIVISION
COLEMAN W JENKINS u N NT OF I
FOR APPLICANT TO FILL IN L
OUTLETS A H FeE
,n s s RECEPT JQ
LIGHTFIRST 20 ADDRESS
_ TyOT�AL a 0
SWITCH _P.__L OVER 20 O CITY TEL NO
10 PLAN CHECK
LIGHTING l TOTAL FIRST 20 25,2_ 00
APPLICANT
FI%TURES 10
J)
OVER 20 ADDRESS
APPLIANCES CITY TEL NO
PERMIT
RANGE�_DRYER_WTR HTR_ APPLICANT
STA COOK 1--DISP -t_F A U _ ADDRESS
SPACE HTR AIR GOND CITY 77 r . TEL NO
CLOTHES WASH DISHWASH LICENSE NO CLASS
FAN_OTHER 100 O I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY
MOTORS TRANSFORMER! RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND HEATERS ETC HP KW RVA ELECTRICAL WIRING
SIZE S TYPE OVER TO
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED S AKD/OR
Q - 1 100 CALIF
AS REOAT EO BY LOS LEGAL
OS COUNTY AND STATE OF
CALIFORNIA OR THAT AM D ANGELES
OWNER EN AND INTEND TO r
1 — 10 300 RESIDE IN THE ABOVE O CRISED RESIDENTIAL PROPERTY d
SIGNATURE O
10 - 50 5 D OF PERMITTEE 1
EN
50 - 100 1000 0
DICT xO c s
Q Qzone PRO E ED
100 - 500 ISM ..
a
el
SIGN GAS SIGN AND ONE CIRCUIT 5 D NOTES
TUBE OR I ?
MARQUEE ADOITIONAL CIRCUITS IDO
SERVICE NOT OVER 600 VOLTS OR 200-AMP 300
APPROVALS DATE IXSPlC1M'S SIGNATURE
S ERVI LE OV ER 600 VOLTS OR 200AMP 1000
TEMP POWER POLE
TEMPSER VICE POLE 8 APPURTENANCES 3O0
UNDERSLAB WORK
TEMP LIGHT OR RECEPT SYSTEM 3 O
ROUGH CONDIUT
WIRING Zi
FIXTURES
POWER AUTHORIZED
PERMIT FEE (SUB TOTAL) 0
UTILITY CO NOTIFIED
PLAN CHECK FEE ��f-.
FINAL
PERMIT ISSUING FEE 300 3,00 JOS PH C ROOHAN
TOTAL FEE SUPERVISING ELECTRICAL ENGINEEP
PLAN CHECK VALIDATION CK M D CASH PERMIT VALIDATION CK M 0 CASH
L�lod077JM24 20 15.70-
SEE DAM OF APPLICATION FOR COMPLETE SCHEDULE
7,r4foa[ C TY
7eA63 cfAe I 1/10 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY BUILDING AND SAFETY DIVISION SUIl01NG `� C ARU
COLEMAN
COLEMAN W JENKINS, SUPSURINTIENDISHT 01Y BUILDINGLOCALITY .C .
NEAREST
FOR APPLICANT TO PILL IN CROSS ST
OUTLETS " rce
S S OWNER
RECEPT MAIL
LIGHT TOTAL FIRST 20 0 25 0 ADDRESS
SWITCH, CfIIL OVER 20 CITY TEL NO
10 0 PLAN CHECK
FIRST 20 APPLICANT
LIGHTING TOTAL
FIXTURES 10 25
OVER 20 ADDRESS
APPLIANCES CITY TEL NO
PERMIT G
RANGE HTR_ APPLICANT L.G/ .G L
JFC ,
STA COOKDISP _F A U _ ADDRESS
SPACE HTR _AIR GOND CITY n C, TEL NO
CLOTHES WASH DISHWASH _ LICENSE NO 0 CLASS C- O
FAN_OTHER100 400
O I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND !TATE THATTHE ABOVE IB CORRECT AND AGREE TO COMPLY
MOTOR! TRANSFORMER! RATING WITH ALL COUNTY ORDINANCE! AND !TATE LAW! REGULATING
]NO HEATERS ETC H• KW KVA ELECTRICAL WIRING
SIZE E TYPE OVER TO
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
O - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
rFIXTURtS
ORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO }
1 - 10 300E IN THE A OYE D RIeeO RCf ID[MTML OPCRTT 0
10 - 50 500ERMSIGNATURITTEE / U
Cr
50 - 100 1000ICT N S ZON R 8f 0
100 — 500 15 Do • Q ISIGN GAS SIGN ANO ONE CIRCUIT 5GOES NZ
TUBE ORMARQUEE ADDITIONAL CIRCUITS 100SERVI CENOT OVER 600 VOLTS OR 200 AMP 300
APPROVALS DATE INSPECTOR'S SINATURE
SERVICEOVER 600 VOLTS OR 200 AMP 1000 POWER POLETEMPSERVICE POLE &APPURTENANCES 500
RSEAS WORKTEMP LIGHT OR RECEPT SYSTEM 300
H CONDIUTNGURESPERMIT FEE (SUB TOTAL) ER AUTHORIZEDITY CO NOTIFIEDPLAN CHECK FEEL PERMIT ISSUING FEE !00 JO PH ROOTOTAL FEE 0 SUPERVISING ELEC C ENGINEER
PLAN CHECK VALIDATION CK M O CAB PERMIT VALIDATION CK CASH
�>Lo 7 , , � DEC 2 0 2 0 10.8
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
76AeE3 CE606 11-7I APPLICATION FOR ELECTRICAL PERMIT Ll
•COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS ,� 7
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
OUTLETS F
OWNER
RECEPT s S MAIL
25 ADDRESS .p�
FIRST 20
LIGHT� TOTAL "?
OVER 20 CITY TEL NO y G
SWITCH_ 10 PLAN CHECK
LIGHTING 1 TOTAL FIRST 20 25 APPLICANT
FIXTIO
T
OVER 20 ADDRESS
URES
RESIDENTIAL APPLIANCES CITY TEL NO
PERMIT q
RANGE
_DRYER_WTR HTR_ APPLICANTeg!�- CO
STA COOK_DISP_F A U ADDRESS (p
SPACE HTR AIR GOND CITYZ;a TEL NO j7
CLOTHES WASH DISHWASH_ LICENSE NO CLASS Ca
FAN—OTHER 100 Q1 HERBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STAT! THAT THE ABOVE In CORRECT AND AGREE TO COMPLY
MOTORSTRANSFORMERS "TING WITH ALL COUNTY ORDINANCES AND STAT[ LAW/ REGULATING
IND HEATERS ETC HP KW KVA ELECTRICAL WIRING
SIZE B TYPE OVER To
I H[R[RY C[RTIPY THAT I AM PROPERLY REGISTERED ANOAHI
O — 1 100 LICENSED Af RlOOIR[O GY LOS ANGCI[/ COUNTY AMD STATE OF
CALIFORNIA 011 THAT IAM THE LEGAL OWNER OF AND INTEND TO O
1 — 10 Sop RESIDE IN THE ABOV fCRt09D RE/ OE TIAL PRO STY
V
SIGNATURE
10 — 50 500 OF PERMITTE 0
60 — 100 1000
o1nT^ItT xo ttAen Roc[ [D BY
100 — 600 1500 .Q
N
SIGN GAS SIGN AND ONE CIRCUIT 500 NOTES ?
TUBE OR
MARQUEE ADDITIONAL CIRCUITS IAO
SERVICENOTOVER 600 VOLTS OR 200 AMP 900
SERVICEOVER 600 VOLTS OR 200AMP lowAPPROVAL! DAT[ UI![C1011'G/NIMTUIeI
TEMP POWER POLE
TEMPSERVICE,POLE, &APPURTENANCES 500
UNDERSLAB WORK
TEMP LIGHT OR RECEPT SYSTEM 300
ROUGH CONDIUT
WIRING
FIXTURES
PERMIT FEE (SUB TOTAL) POWER AUTHORIZED
UTILITY CO NOTIFIED
PLAN CHECK FEE
C)
FINAL
PERMIT ISSUING FEE 300 V
TOTAL FEE
PLAN CHECK VALIDATION CK M O CASH PERMIT VALID K w o CAM
JAEo ^ 5 7 1\ JAN16 2 D 4.25- Q
n[! BACK OF APPLICATION FOR COMPLETE SCHEDULE
Ta•aee cEBoe a-ee APPLICATION FOR ELECTRICAL/ PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER UILDING �+
BUILDING AND SAFETY DIVISION ADDRE55
B6 �-! �3G/A
JOHN A LAMBIE COUNTY ENGINEFR
COLEMAN W JENKINS, SUPSRINTSNDtNT W BUILDING ILOCALITY TC:�I9T �Iv C!
NEAREST
FOR APPLICANT TO FILL IN IrRnSS ST
NO AC Fri RECEPT _
S OWNER
MAIL
LIGHT_ TOTALERST
20 ADDRESS
SWITCH_ 10 CITY TEL NO
PLAN CHECK
LIGHTING lTOTAL 20 APPLICANT
FIXTURES /( 10 ADDRESS
RANGE_DRYER_WTR HTR _ CITY TEL NO
STA COOK_,DISP _F A U CONTRAC rOR wolos
SPACE HTR —AIR COND _ ADDRESS 23z Ste'
CLOTHES WASH _DISHWASH __ CIT TEL N Z+Z-
FAN—OTHER 1 00 LICENSE NO O CLASS
MOTORSTRANSFORMERS RATING
IND HEATERS ETC HP KW KVA I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
SIZE IS TYPE OVER TO AMD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING
0 - 1 11 00
I HEREBY CERTIFY THAT I AM PROPERLY REGIBTERCD AMD/OR
1 10 3 00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR TN1T I AN THE LCOAL OWNER OF AND INTEND TO
10 - 50 S 00 RESIDE IN THE ABOVE DESCRIf ED RE DEMTIAL PROPERTY
SO - 100 1000 SIGNATURE
OF
PERMITTEE •dam' V
100 - 500 15 00
SIGN c•s DI$=fj1CnT N G P N PR ESSED BY p
TUBE A SIGN AMC ONE CIRCUIT 3 00 �[ f/7S
MARQUE! ADDITIONAL CIRCUITS 1 00 d
NOTES y
SOVICE NOT OVER 600 VOLTS OR 200 AMP 2 00 Z jplPR
SERVICE OVER 600 VOLTS OR 200 AMP S 00
TEMP SERVICE POLE 6 APPURTENANCES 3 00 APPROVALS DATE INSPECTOR S SIGNATURE
OWER POLE
SLA 3 WORK
CONDUIT
PERMIT FEE (SUB TOTAL) RESPLAN CHECK FEE (SOX PERMIT FEET AUTHORIZEDPERMIT ISSUING FEE 200 Y CO NOTI FIE D7 ¢ f.PERMIT ISSUING FEE 1 00 TOTAL FEE JOSEPH C ROOHAN
SUPERVISING ELEC ICAL ENGINEER
PLAN CHECK VALIDATION CK M D CASH PERMIT VALIDATION CK M O CASH
IEf Oo74% JLIL 9 2 D 4.00-
CE OACK OF APPLICATION FOR COMPLETE FEE SCHEDULE �V
76AC63 CEdoa A a! {�
APPLICATION FOR ELEtTRICAL PERMIT LJ
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING S
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE COUNTY ENGINEER �T
COLEMAN W JENKINS SUPT OF BUILDING LOCALITY LF C
mmmmmmNEA
A REST LC7rI an!
f'T CROSS BT (/C'
RECEPfACLEI TOTAL NO ucN '[R //
Jly ourLETS FIRST 20 S zo a OWNER {/J v Al. /
LIGHT
MAIL
SWITCH ADD
OVER L f0 ADDRESS /T
TOTAL FIRST 20 20 CITY �" TEL NO G ��T
LIGHTING 1 PIX REB
FIXTURES J ADD L fo CONTRACTOR
OVER 20
RANGES CLO DRYERS NTA HTRB 100 ADDRESS
OARS 01" STA COOK
/ CITY TEL NO
OISNWASH AYtO WASH STATE
SPACE NTRS STA MP ({y HP MAK ) SO LICENSE
MOTORS OVER NOT OVER MR DIST ICT NO GRQUP Z E P ESSED BY
O 1 100
1 e too INSPECTION RECORD
S 8 200
S 15 ISO
to SO 300 0
V
ISO 100 Soo
Dt
SIGNS, No TRANS O
No LANPa YYrjj
SERVICED SOOV NOT OvER 200A 100 d
N
SERVICE 0 800V OVER 200 A 200 Z
SERVICE OVER SOOV 500
OTHER ($EE COMPLETE FEE SCH[OULE)
PERMIT ISSUING FEE 200 -90
SUPPLEMENTABY PERMIT ISSUING FEE 100
TOTAL FEE 4.43 Q wT,< INEPECTOw rugs
1 HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION UNDERSLAB WORK
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY ROUGH CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING 1
WIRING
1 HEREBY CERTIFY THAT M PROPERLY REGISTERED AND/OltFIXTURES
LICENSED Aa REOUIREO a ANGELES COUNTY AND STATE OF
CALIFORNIAORTHATI [ LEOALOWNEROF ANOINT[N TO POWER
RESIDE
IN TN[ASOV[ AIBED RESIDENTIAL P11yPERTY
SIGNATURE UTILITY CO NOTIFI D
OF PERMITTE
FINAL
LCON JOSEPH C ROOHAN
CK NO NO GELECSM SUPERVISING ELHCTRICAL ENGINEER
- LACp 8 1 0 9 DEC 16 2 D 1 3.0 0- q
«.".a I. APPLICATION FOR ELECTRICAL PERMIT
BUILDING D SAFETYDIVISION
FOR APPLICANT To FILL IN JOB
New Residential Bldgs &Pools
EACH NO FEE ADDRESS
1 &2 Finaily Sq Ft $ _ S LOCALITY
Multi family Sq Ft — NEAREST
Residential Swimming Pools CROSS STOWNER OR
FIRM NAME Y
Outlets Light Switch&Receptacle MAI L
First 20 ADDRESS
Additional CITY Tel No
PLAN CRECK
Lighting Fixtures APPLI DANT �Asyy''��
First 20 ADDRESS /.{yy
Additional
CITY Tel o
PERMIT
Fixed Appliances Not Over 1 HP APPLICANT
Range_ Heater_ DW _ ADDRESS
Oven _ Dryer _ W M _ ^�
Top _ FAU _ W H CITY Tel No
Hood Fen LICENSE OR lh�Syyss
Dap AC REO NUMBER X0 Clan p
HEwe.r w HAVE wEwo T cwnoH C
AND STAY. YNAr rH. weovE u ......T AND wo E.e roLCO rrLr O
Power Apparatus& LDge Appliances WIITH ALL COUNTY ORDINANCE. AND STATE LAW w.DULATINO
Size&Type He KW KVA,or KVAR •L..T"'CAL WI"'ND W
UP to 1 Incl , NEEEA. o.OD"`T ..LEE r...IY r". w"Droll z
Over 1 to 101nC1 uc.WEO w w.ro LIE• c vHrr RED ETwre or
CALIFORNIA' `THAT O L OWNER O THE A.OVE
Over 10 to 50 Intl Dc.cwle.O...IO FEOFTN
Over 50 to 1001ncl PERMITEE
Over 1 D SIGNATURE
Service) DISTRICT N I ROCE ED BY
15 0 2DO Amp Under 600 V
201 1000 Amp Under 600 V APPROVALS DATE ISIGNATURE
Over 1000 Amp or Over 600V ,
TEMP POWER POLE J ^�
Temp Power Pole&Appurtenances UNDERSLAB WORK
Sign with One Branch Circuit
Additional Sign Branch Circuits LFIXTURES
DUIT
(Other)
HORIZED
PERMIT FEE (Sub Tota l) NOTIFIED
PLAN CHECKING FEE (One Fourth Permit Fee)PERMIT ISSUING FEE
TOTAL FEE
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION C M O CASH
8 3 2 JUL 2 7 2 B 1 5.1 0G?'a
L -
- -
76A 663-CEO DRAT 0/72 APPLICATION FOR ELECTRICAL PERma
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER JOB
ADDRESS
BUILDING AND SAFETY DIVISION _
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
OUTLETS 0EACH FEE OWNER OR
S S FIRM NAME
RECEPT_ MAIL
LIGHT_ TOTAL
FIRST 20 23 ADDRESS Y!
OVER 20 CITY G TEL O
SWITCH_ 10 PLAN CHECK
LIGHTING
TOTAL FIRST 20 ZS APPLICANT
OVER 20 10 ADDRESS
FIXTURES
RESIDENTIAL APPLIANCES CITY TEL NO
PERMIT
RANGE_DRYER_WTR HTR_ APPLICANT
� -T
STA COOK_OISP _F A U ADDRESS J/ J �
SPACE HTR AIR GOND CIT ^/ � TEL NO
CLOTHES WASH DISHWASH REGN UMBSE ER �J Qpl 2 - CLASS /
FAN_OTHER IDD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AOREE TO COMPLY
MOTORS TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND HEATERS ETC HP KW KVA ELECTRICAL WIRING
SIZE 6 TYPE OVER TO
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 100 • LIC ENSCD AS REQUIRED BY LOS ANGELES COUNTY AND STATETEOF
OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER O TXE ABOVE
I - 10 300 DESCRIPED RESIDENT IS RTY os
C,
PERMITEE U
10 - 50 300 SIGNATURE w
O
50 - 100 1000 DISTRICT NO y��7 PROCE SED B
100 _ SOO I S DD S5 U !/ `
SIGN GAS SIGN AND ONE CIRCUIT 300 APPROVALS DATE INSPESPA!SIGNATURE
TUBE OR
MARQUEE ADDITIONAL CIRCUITS 100 TEMP POWER POLE
SERVICENOTOVER 600 VOLTS OR 200 AMP 300 3 UNDERSLAB WORK
SERVICE OVER 600 VOLTS OR 200 AMP 1000 ROUGH CONDUIT
TEMPSERVICE POLE &APPURTENANCES 300 WIRING
TEMP LIGHT OR RECEPT SYSTEM 300 FIXTURES
' POWER AUTHORIZED
UTILITY CO NOTIFIED
FINAL
PERMIT FEE (SUB TOTAL) NOTES
PLAN CHECK FEE
PERMIT ISSUING FEE 3 D
TOTAL FEE Y
PLAN CHECK VALIDATION CK M D CASH PERMIT VALIDATION cK M D CASH
3 9.0 0 A96
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE (
fi
WORKERS'COMPENSATION DECLARATION 20-0019 DPW=,w APPLICATION FOR ELECTRICAL PERMIT O
J hereby'offirm that I have a
a certificate of consent to sell
,Insure or o certrficate of Workers Compensation Insurance COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS
or a certifiedcopy thereof (Sec 3800, Lab C J
Pplicy No dc
�pyerCompany-�' � E: Fit Lo FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished New Residential Bldgs &Pools EACH NO FEE ADDRESS
Certified copy is filed with the county building mspec 1 &2 Family, Sq Ft 5 — S LOCALITY
/-�hson department �ss� /���� Multi-family Sq Ft — NEAREST
e'L�-W--A-�APP >�El•--1 � —' Residential Swimming Pools VW0 R 7
Dat locant OWNER
FIRM NAME[vW-4 RAI
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Reca—Light�Sw L MAIL '
COMPENSATION INSURANCE First 20 y D /� ADDRESS
(This sodlon need roof be completed If the work imolved by CIN Tel No _
the permit Is for oee hundred dollars($100)or louTotal No Additional) RAN-- .
1 certify that in he performance of the work for which this APPLICANT
permit is issued I shall not employ any person in any manner
so as to become subject to the Workers'Compensation Laws Lighting Fixtures�js Font 20 ADDRESS
Total No Additional
Date Applicant CITY Tel No
NOTICE TO APPLICANT If, cher making this Certificate of Foxed Appliances Not Over 1 HP PERMIT
Exemption, you should become subject to the Workers Range— Heater—DW — APPLICATION otq CC7.{j
Compensation provisions of the Labor Code you must forth Oven _ Dryer —W M — ADDRESS
with comply with such provisions or this permit shall be T — FAU —W H —
deemed revoked Hood — Fan —Other— CITY << Tel No 207-��
DECLARATION CONTRACTORS DLARATION Disp _ Room Air Cond _ LRECENR
GNEUMBER 3 Class
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO PlReWSSED BY >
and Professions Cade,and my license is in full face and/gffea p IL
y"fin{/� ySize &Type HP, KW, KVA, or KVAR O O
License Number.YS136q Loc CI... Up to 1 Incl FINAL �/
� y ' — Over 1 to 10 Incl D'0`� /'I Z VALIDATION K
Contractor Date-�v. FL O
O -- � Over 10 to 50 Incl FINAL
I am exempt under Sec Over 50 to 100 Inc BY 0
B 8P C for this reason Over 100 1 1 W
Q.
Fn
Date Services Swbd , MCC 8 Panelboords Z
0 200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V
O Exemption fOver 1000 Amp or Over 600 V
ee Reg Mainz Elect
SINGLE FAMILY Temp Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor s License Sign with One Branch Circuit Al i.T.y r
Law for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits a.
Professions Code)
J]] 56. i
❑ I as owner of the property will do the work and the Mise Conduits&Conductors 1 1 I EDIT.:
structure is not intended or offered for sole(Section 7044 Other (See Complete Fee Schedule)— , c
Business and Professions Code)
T13TAL 56 _ 50
CONSTRUCTION LENDING AGENCY LHELY 50.fid]
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec 3097, Civ C )
Lender s Nome
PLAN CHECKING FEE
I�Q11Q-I]l}Il1 2�1 JJT71
Lender s Address
PERMIT ISSUING FEE PIO
853S 1 AM 7:'
L '�f
I certify that I have read this application and state that the TOTAL FEE
above information is correct I agree to comply with all County
ordinances and State lows regulating Electrical wiring and
hereby authorize representatives of this County to enter upon
the ab ntio r party for inspection purposes t
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sr nature of mine. ms
COUNTY OF LOS ARLES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508°9808310002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE. (818) 285-0488 EXT j
LEGAL ID' FEES PAID BUILDING ADDRESS
ON FILE j 6456 TEMPLE CITY BL
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917801436
ASSESSOR INFORMATION NUMBER i NEAREST CROSS STREET LEMON
5383-013-014 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE. 596 GRID J1 LOCALITY TEMPLE CITY
01 OTHER INSPECTIONS 1 00 HOU 109 35
TOTAL FEES 137 10 ISSUED ON PROCESSED BY: PLAN BY EXPIRES ON:
08/31/98 UT 08/31/99
OWNER TEL NOFINAL DATEI
SMITH LAWRENCE W,FAY S TRS (818) 446-1347- I CODE:
6456 TEMPLE CITY SL IDA--i
TEMP 917801436 I p)'Twrm.IDA
-1
OF SWIMMING POOL PER HEALTH DEPT SENATE BILL 873
AFFLI TEL NO
SAME AS OWNER -
SPEC rAL-CDffDTTTONS--
I
S PNGELES CoCONTRACTOR TEL NO
SAME AS OWNER .0 NTAPPROVALS DATE I NsFn76VlTU9T9ffE-J
LIC NO TEMPORARY POWER PULE
i
TEL NO UFER GROUND
LIC NO 1111111ROUGd CONDUIT
ROUGH WIRING
` PUBLIC WORKS PLASTIC Y/N METAL Y/N
UTILITY COMPANY NOTITM
c Service Thati
REPORT ID. DPR265 ROUTE TO BS0508