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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 J_ l - enticred 7]]4 1 AM11:28 gk- rta t poses SEE REVERSE FOR EXPLANATORY LANGUAGE 17 9 urs