HomeMy Public PortalAbout5349TEMPLE CITY BLVD_Electrical hereby
Oro that I have
a certificate
of cons
ATKKJ 7eAssa ,p,B, APPLICATION FOR ELECTRICAL PERMIT {�
I hereby efhrm that I have a certificate d torpent to sell insure �6080 LJ
Or a certificate of Workers Compensation Insurance or a certified - .- FOUNTY OF LOS ANGELES BUILDING AND SAFETY
copy�thoreof(Sac 3800
007Labb ) _ / /�
Policy NO 7/7 Commpany �7L� rUIVfJ FOR AVPDCMR TO FILL IN JOB
ADDRESS
❑ Certified copy 0 hereby furnished EACH NO FEE _i vD
Now Residential Bldgs 8 Pods l
Certified copy is filed with the county buil p �6 1 & 2-FarmLOCALITY rty Sq Ft S — $ k fiAr\ Gl
Mulb-family, So Ft
Date_(! , ApWica Residential Swimming Pools OWNER OR NRV,4
CERTIFICATE OF EXEMPTION FROM WORKERS FimA ��
COMPENSATION INSURANCE Outlets RocLight �SW y0 ! 0Pio as
(This eedbn need ndved by the First 20
not be completed If the work Im
permit Is for aria hundred dollars ($100)or lose) Total No �� Additional CITU Tel No
I certify that in the pertormartca of the work for which this permit
APPLICANT CHECK ,..AME AS vY
Is issued I shell not empty ery person in any manner so as to
became subled to the Workers Compensation Laws LgMing Fixtures First 20 `v ADDRESS
Additional
Tote)No �_ CITY Tel No
Nate Apdicant Fixed Appiances Not Over 1 HP PERMIT
y
NOTICE TAPPLICANT alter Making this Cale d AITiJCANT `�. \
Exemption you ahoud becomea subject to the Workers Cornpeompereaton Range— Heater_ D W tel•(/�/ l`
prowswns of the Labor Code you must forthwith comply with such Oven — Oryer— WM _ ADDRESS l3- Sn.7��R
prorlsionm
a or this permit shall be desired revoked T _ FAU WH —
UCENSED CONTRACTORS DECLARATION Hood — Fan 9— Other_ CITY A- -CAD u4 Tel No
I hereby affirm that I am licensed under provisions of Chapter B Dsp — Room Air Cord UCENSE OR 4q6q i p Cl..
(commencig with Section 7000)d DN X.IBER bb I
Professions Code and my,licerise rs in full force and effect Power Apparatus 8 Large Apptiarrcea 0131RUIr NO ED BY
/AI1/A1� ��Q Size& Type HP KW KVA or KVAR - r� o�
License Number" A,�IC/-1 Lic Class Up to 1 Incl FINAL ,/ 8
CantractorAtJT�I-) A—I&OC Data 101191 Over 1 to 10 Ind DATE T '� VALIDATION r
Over 10 to 50 Ind FINAL 0
❑ I am exempt under Sec Over 50 to 1 DO Inc By
BBPC lar this reason Over 100
Services Swbd MCC 8 Panelboards - Z
0-200 Anp Under 600 V
Sgnah A 201 1000 Amp Under 600 V
❑ Over 1000 Amp or Over 600 V
Exemption for Reg Maim Elect
SINGLE FAMILY Tamp Power Pde It Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractors License Lew Adtlitiorol Sign Branch Cucurts
for the following res (Sechon 7031 6 Business and Professors g
Code) 1 7
❑ I as owner of theMisc Conduits d Condretors ,
property will do the work and the structure ACCT.i
is not intended or offered for sale (Section 7044 Business Other(See CamPlete Fee Schedule) — pop. 3307 39.5(1
and Professions Code) -
CONSTRUCTION LENDING AGENCY - 1 ITEMS
I hereby affirm that there is a c truclm lending agency, for the
Performance of the work for which this permit is o ued(Sec,3087 PERMIT FEE (Sub-Total) TOTAL 39 . 60
CN C)
-PLAN CHECKING FEE (HECK 39.50
Lender s Name
PERMIT ISSUING FEE CHAKE ,Q(I
Lenders Address
I certiy that I have read this application and state that the above TOTAL FEE
information is correct I agree to coni with all County ordinances k- C 0000-0001 9] 7/90
and Stale laws regulet ElecirgaI wining and hereby authorize -
representat of th my to enter upon t
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l - enticred 7]]4 1 AM11:28
gk-
rta t poses
SEE REVERSE FOR EXPLANATORY LANGUAGE 17
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