HomeMy Public PortalAbout9412 GIDLEY ST_Electrical__ WORKERS'COMPENSATION DECLARATION 20-M19 DPW 3 APPLICATION FOR ELECTRICAL PERMIT
I hereby Gform that I have a certificate of consent to self •CES
insure, or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or a certlfled copy thereof (Sec. 3800, Lab. C.)
Policy No. Company POR APMK-ANT TO RLL IN JOB
❑Certified copy Is hereby furnished. New Residential Bldgs 8 Pools EAOi NO. FEE ADDRESS
❑Certified copy Is filed with the county building Inspec- 1 8 2-Famlly, Sq. Ft. $ = $ LOCALITY
tion department. Multi-family Sq. Ft. NEAREST
CROSS ST.
Residential Swimming Pools 0W_N t _
Date Applicant FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL
COMPENSATION INSURANCE Outlets: Re•c Light Sw._ ADDRESS
9t 1
First 20
(This section need not be completed If the work Involved by Total No. Additional CITY T.I. No. T
the permit b for one hundred dollar.($100)or lees.) PLAN CHECX
1 certify that In the performance of the work for which this APPLICANT
permit It Issued, I shall not employ any person In any manner Lighting Fixtures First 20 ADDRESS
so as to become subject to the Workers Compensation Laws.
! otal No. Additional 01-Y - No.
Date /`-l � gppllcant ed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate APPLICATFOtJ
Exemption, you should become subject to the Workers' Range— Heater—D.W. —
Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS
with comply with such provisions or this permit shall be Top FAU —W.H. —
deemed revoked. Hood — Fan —Other— CITYTel. No.
LICENSED CONTRACTORS DECLARATION LICB,JSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Dlsp. — Room AJr Cond. — REG NUMBER Class.
(commencing with Section 7000)of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO. BY d
and Professions Code,and my license Is In full force and effect.
Size 8 Type HP, KW, KVA, or KVARDO
Ucerse Number LIc. Class Up to 1 Incl. FINAL U
Over 1 to 10 Incl. T
VALIDATION IMContractorrtiactor to Over 10 to 50 Incl. O
IL
I am exempt under Sec Over 50 to 100 Inc. W
B.BP.C. for this reason Over 100
e. Services, Swbd., MCC 8 Panelboards Z
O
0-200 Amp. Under 600 V.
Slgnature 201 - 1000 Amp. Under 600 V
❑ Exemption for Reg. Malnt, Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY Temp. Power Pole 8 Appurtenances 2
HOME OWNER-BUILDER DECLARATION `
I hbreby affirm that I am exempt from the Contractor's License Sign with One Branch Circuit ACCT
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits r
Professions Code): .?M7 31■I]�J
Mtsc. Condults 8 Conductors 1 UPS
s as owner of the property, will f o the work and the her a Complete Fee Schedule Poo.
J
structure a not Intended or offered for sale(Section 7044, ( p TOTAL 3 1 � 00
Business and Professions Code).
CONSTRUCTION LENDING AGENCY \CVAUQDEal 31.10
I hereby affirm that there Is a construction lending agency for 717 1 4 .10
the performarce of the work for which this permit Is Issued PERMFr FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name 11/27/9[I
PERMIT ISSUING FES ;J
Lender's Address 411 1 10:1-6
I certify that I have read this application and state that the TOTAL FEE D�
above Information Is correct. I agree to comply with all County
ordinances and State laws regulating Electrlcol wiring, and
hereby authorize representatives of this County to enter upon
the above-mentioned property for Inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
S g 1 re erm ee Da e
T -�5 't
76A 663'-S'.EBl6 10-67 ELECTRICAL APPLICATION FOR PERMIT
1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS I Z �/OLE V
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY�� PfE
NEAREST el
FOR APPLICANT TO FILL IN CROSS ST.
I T E M NO. I EACH FEE
OUTLETS: (FIRST 20) $.20 $ OWNER
LIGHTS RECEPT. SW. MAIL
OUTLETS: (ADD'L UNITS) 1O ADDRESS
LIGHTS RECEPT. SW.
LIGHTING FIXTURES: (FIRST 20) 20 CITY T P /Cir)" TEL. NO.
LIGHTING FIXTURES: (ADDITIONAL) ,10 ELECTRICIAN 6/�L{�ES
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS-1 714 11 O 7-Y,----A—
/�
GARB.DISP. STA.COOK CL el� 'rE /ti./ ✓r.'/-�(7
CITY G N/ TEL.NO.L� y
DISHWASH. AUTO.-WASH. STATE
SPACE HTRS. STA.APP.(y=H.P.MAX.) ,50 LICENSE NO.
MOTORS: OVER NOT OVER H.P. DISTRICTCNNO. GROU =ZONE PR ESSED BY
O 1 1.00 (� ` Z4'f
1 3 1.50 SPECTION RECORD }
3 S 2.00 7 /'�/ 0
8 15 2.50 U
15 50 3.00 0
50 100 5.00 /i r Il-J
t'
/ Z- ., F ,
W
7
w � �n
SIGNS: NO.TRANS. ` h
NO.LAMPS --?i" '..1. ,.I�•,:� Z
SERVICE 0.600V-NoT OVER 200A 1.00 ^"
SERVICE 0-600V-OVER 200 A. 2.00
SERVICE OVER 800V 5.00
MISC.
PERMIT ISSUING FEE 2.00 •
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE
LLECTRICAL
BY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
LL COUNTY ORDINANCES AND STATE LAWS REGULATING
CAL WIRING. WIRING
EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/ORD AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURESNIA OR THAT 1 AM THE LEGAL OE F 7HE ABOVE
ED RESIDENT RO RTY. POWER
URE UTILITY CO.NOTIFIEDMITTEE
FINAL
C
ALIDATION A THUR C. VEIT
SUPERVISING ELECTRICAL ENGINEER
� MO CASH
pry
78A683-CEB06 f0-e1 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.<f4O✓0.2A
1 T E M NO. EACH FEE
OUTLETS: (FIRST 20) $20 $ OWNER 'E e S COA-)
LIGHTS /O RECEPT./�. SW. IG MAIL t�
OUTLETS: (ADD'L UNITS) 10 ADDRESS / 7/ / �G
LIGHTS RECEPT. SW.
LIGHTING FIXTURES: (FIRST 20) Io .20 U CITY /��[. Ci TEL.NO.
LIGHTING FIXTURES: (ADDITIONAL) .10 ELECTRICIAN
� �/ /� F-1- E /e / C-O
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS -37 J 111' L
GARB.DISP. STA.COOK CITY "A16- SEA'-- L.NO 6%-5_'
DISHWASH. AUTO.-WASH. STATE /
SPACE HTRS. STA.APP.(yz H.P.MAX.) ,50 LICENSE NO. C—/V /(O(O �—
MOTORS: OVER NOT OVER H.P. DIST ICT NO. (313pup ZONE P ESSED BY
O 1 1.00 q
1 3 1.50 JINSPECTION RECORD
O_
3 6 2.00 S ` � � r/ O
8 Is 2.50 U
ce
15 50 3.00
G
50 100 5.00 ? ll ✓ I
d
SIGNS: NO.TRANS. to
NO.LAMPS Z
SERVICE 0.600V-Nor OVER 200A 1.00
SERVICE 0-60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2.00 00
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLIC TION APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIU�ALPERT POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTE _
FINAL
VALIDATION ARTHUR C. VEIT
MO CASH SUPERVISING ELECTRICAL ENGINEER
7 ?
7.2C_
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_ 1
76A663-CE80610-61 APPLICATION FOR ELECTRI AL PERMIT - �1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS /Q L Ev
JOHN A. LAMBIE, COUNTY ENGINEER y-' pL� cry
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
1 T E M NO. I EACH FEE
OUTLETS: (FIRST 20) $.20 $ OWNER r L STlG
LIGHTS ,RECEPT. SW. MAIL /'
OUTLETS: (ADD'LUNITS) 10 ADDRESS
LIGHTS RECEPT. SW. ��.
LIGHTING FIXTURES: (FIRST 20) .20 CITY PSE elrY TEL. NO. p
LIGHTING FIXTURES: (ADDITIONAL) .10 ELECTRICIAN /AL/FS ���+`L'�GTG/G
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS /�r d /y7 4E�
GARB.DISP. STA.COOK
CITY I_ Q 'E EL.NO.///���
DISHWASH. AUTO.-WASH. STATE
SPACE HTRS. STA.APP.(/a H.P.MAX.) .50 LICENSE NO.
y / 1 J/GJ
MOTORS: OVER NOT OVER H.P. DISTRICT N.QL OUP ZONE P E
O 1 1.00 rT
1 s 1.50 INSPECTION RECORD
8 a 2.00 ' '' �'�' d
8 15 2.50 - ; - U
ce
- 15 50 3.00 _. '< 7. %f O
- -
50 100 5.00
SIGNS:
NO.TRANS. / N
NO.LAMPS `
SERVICE 0.60OV-NOT OVER 200A 1.00
SERVICE 0-600V-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
Ilf MISC. ---
-- —
PERMIT ISSUING FEE 12.00 G
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE
AND 8TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING. WIRING
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AB REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE - -
DESCRIBED RESIDEN PROPERTY. POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTEE _--- - - ----- - -
FI NAL
LIDATION ARTHUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
"�
-4 ,j
7"aa2-Cffood-7-ee APPLICAITION FOR ELECTRIC PERMIT ],
BUHMING AND SAFETYDDrMON
_
L'O�lf A��M ADDR IN r
JOHN A.LAMBIS. COUNTY ENCKINEXR
CASSATr D. GRIFFIN,Suri r■UIILIN• LOCALTTY
FO_ R AP�LNT TO ILL IN CR
ZF
NUMBER OWNER
LIGHT OUTLHT8' HAIL
ADDRILSa
RECEPTACLES op
WALL SWITCH EE FEE C
TOTAL OuTLsra D ELECTRICIAN
ILEC.'RA NGES RD ADDItMS
SLAC. HEATERS 2D CITY i
0.
KW EA STATS
FIXTURU 15 LICENSE NO
MOTORS DISTRICT O. GROUP ZONE, tsADT tolt Inspa CTloll
Nums. HORSEPOWER FEE '
N[W MVD. HP OVII1 .INC. [ACS
n I I�. 215 INSBF=0X EUMBD
2 .DO .
Z D 1.00
D iD 1.150
1D DO 2.150
DO 200 15.00
MISC.
NO.SIGNS NO.TRANS.
NO SI N NO. LAMPS
FOR SACH PERMIT: -
WIRING PERMIT •1.00
FIXTURE PERMIT 41.0.0
SUPPLER SNTARY .D O APPHOVAIS
TOT DATE INSP CTOR S SIGNATURE
I HEREBY ACKNOWLaD E THAT 1 HAVE READ TUIS APP CATION CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS RSGULATIRG WIRING Z
lAt-
ELECTRICAL WIRING. FLXTURSB
I HEREBY CERTIFY THAT I AN PROPERLY RSGISTIERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER
CALIFORNIA OR THAT I AM THE LEGAL01 EA OF THE ABOYi
DESCRIBED RESIDENTI Ei1TY UTILITY CO.NOTIFIED l
SIGNATURE V
'OF PERMITTEE FINAL
UFITY NO NB[IR }YALM7T�AtION $AU KRVVLGINa .vrRIcAL EMG.INmi
60,
O_ CAAK .
LT06993E, RR 9 2 4.30 in
78wSe3ctsoe Io-eo APPLICATION FOR ELECT ICAL PERMIT
COUNTY OF LOS ANGELES
DEPARMENT OF COUNTY ENGINEER eUILDINo
BUILDING AND SAFETY DIVISION ADDRESS s�l'2 OL E
JOHN A. LAMBIE, COUNTY ENGIN
WILLIAM A-JENSEN.SUF'T OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
PERMIT FEES OWNER �•
1 T [ Y NUYS[R EACH I F[[ MAIL
OUTLSTSiS ; ADDRESS
LIGHTS REcaI�T rw.3 .10 O CITY((e1E EA D TEL NO.
LIGHTING FUCTURES .10
oEc RwNon cLo. DRYIRB ELECTRIC-LAN /ALES LE67' Gm�l.s1' CD
W A T s R H[A T[R S - .150 ADDRESS / /4 /lQ 1
alC.Sr�HTRS. DISHWASHERI s ._ �j
CITY D/Vr� TEL.NO. I V S�O�'7
oARAAO[DLSFOSERS AUTO.- STATE
WA HX" STA.COOKING UNITS .215
l LICENSE NO.
MOTdRS, OY[R INC. H.P. DIST�I NO. d OUP O E PR ESSED Y
o— TA l .215 �'
Y.— 2 .170 INSPECTION RECORD
2— 15 1.00 d
I D— 117 LSO o
115— 170 2.170
1ce
50— 20.0
SIGNSI No IL IL
ND.LAM" hh
SERVICE 0-6010V 1.00
SERVICE OVER EOOV 15.00
L ISG
WIRING PERMIT 1.00 loo
FIXTURE PERHTT 1.00
SUPPLEMENTARY PERMIT .150
TOTAL FEE s Z Q
I HIRENY ACXNOWL=ON
E THAT 1 HAVE READ THIS APrUCATION APPROVALS DAT= INSlsCTOR'S SIoATURN
AND STATK THAT TH[ ADO" IS CORRSCT AND AGRSE TOC
O iPL.Y
WITH ALL COUNTY ORDINANCES AND (TATs LAWS REOULATINO CONDUIT
Q.[CTRJCAL WI RI No. WIRING / C
I H1DUMY CERTIFY THAT 1 AM FROTQL.Y RZOLSTSRID AND/OR
L.ICJ3tg= AS REOUIR>m 7Y LOG ANGLE " COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM TI-M LE7AL OWMM O T1iE AD05IE
DKSCMUKD RISIDSNTIAL FROlIOtTY. POWER �1
SIGNATUREJAL�7• ILTTY CO.NOTIFIED F n
OF PERHITTE FINAL
I DAT1 ON ARTHUR C. VETT
No CASH SUPERVIDING ELECTRICAL ENGINEER
5 7 0 JUS! 14 2 D 3.2 0 2,
At-,4,0,V
Y $C°'`' `SA"°"D ''°" MAM°°Ma/W APPLICATION FOR ELECTRICAL PERMIT
I herby affirm that I have a certificate of consent to self Insure,
or a certhtcate of Worker's Compensatlon Insurnnoe, or a certifled COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DN.
oopy thereof(8eo 3800 Lab.C.)
No. Company FOR APPLICANT TO F&L IN J0131T
Cerd5ad copy Is hereby fumiehed. New Residential Bidgs.8 Pools EACH NO. FES L T
—
❑ CarttW copy Is}Fled wfth rite county buldtrp Iropecdon a 2-F m y,Sq.Ft $Multl-femly Sq.Fl. MM68TT.
Deis Residentlal Swtnming Poole ASSE89DR
MAP BOOK PARE PAF1Ca
CERTIFICATE OF EXEMPTION FROM WORKETIV Off_P.W.�L U911d 8w. Fina1j NAS u 5 Tb N A
COAMPe48ATION INSURANCE
Ent 20 YAWL
(This section need not be oompleted If the work Involved by the Total No.� Additionel AJ]D T
perrnit Is for one hundred dollars(3100)or Mss.)
I oertify that In the performance of the work for which this permit CITYIO r Tel Na
le Issued, I shall not employ any person any manner so as to PLN CHECK
beoome subject to the Workers' Gompe n Llghtlng FLxft a First 20 APPLICANT
Total No. AAdhkxwU
ADDRESS
DW, AMU,, 16 OR MA,120V BRANCH CIRCUITS
of
NOTICE TO APPLICANT: If, er makln lisle Certllloat6 of CITY T*L Na
Exemption,you should bsoome subject to the Workers'Compwumtk rl 1 TO 10 INCLUSrVE EACH A
provialons of the Labor Code, you must forthwith oompy wtth such 11 TO 40 INCLUSfVE EACH � T
provtelona or this permit shall be deemed revoked. 41 OR MORE BRANCH CUICU178 EACH RE
LICEADD
}O
LICENSED CONTRACTORS DECLAAATN 16 OR 20A 2GBV TO 277V LK3HTW0 EACH `� r a
I hereby affirm that I em licensed under provisions of Chapter f3 / / S
(oommencing with Sectlon 7000) of Division 3 of the Business and CITY T T.W.Nay /-9//
Profeeslons Code,and my Iloense Is In full force and effect RESIDENTIAL APPUANCEB UP TO 3Wci..../�
CPower Apparatus d I"Appliances l
Lrse loerNumber Llo.Claes Stxe S Type HP,KW,KV,,or KVAR DtsTwCT NO. p PFlDCl�BY 8
Up to 3 Ind. 0 W
Over 3 to 10 Ind. d
Dabai".. A. D DATEOyer 10 to 60 Ind. Z
❑ I am exempt under Sea Over 50 to 100 Ind. —2 Z VALEDATION
BP.C.for this reason Over 100 BB
.B
Servkxw 9wbd-,MCC a Panoboerds 1.M
Dee« 0-200 Amp.Under 900 V
Slow— 201-1000 Amp.Under EDO V
Oyer 1 O00 Amp.or Over 61DO V fr 1 AV� Y
❑ E.O.for Reg.Matrlt Elect (f►//Iw+
81 NO LE FAMILY Temp.Power Pois S Appurtenanose I a
HOME OWNER-BUILDER DECLARATION gym One Brsnoh gn�tt
I hereby aftrm that I am exempt from the Contractor's Lloense Law a r�n
for the folloviN rean (Seofion 7031.6, Busineea end Professions Addtlonal Sign Branch grmtL -,--307 l�t.❑r'
so
Code): i ITEMIS
❑ I,as owner of the property,will do the work and the structure Mae.Conduce&Conductors
is not Intended or offered for sale (Saotion 7044, Business Other(See Compiste Fee Schedule)
and Profseelons Code). 10 161.6 9
CONSTRUCTION LENDING AGENCY 1 T�4`rCT .rl
I hereby affirm that there Is a conatruction lending agency for the
performanoe of the work for which this permit Is Issued (Sec. 3007, PERMIT FEE (Sub-Totaf)
Cfv.C.)
PIAN CHECKING FEF l�L�d�—i��1 51./2a 9`2
Lender s Name PERMrr ISSUING FEES
Lsrdere Address
I oertify that I have read this application and state that the above TOTAL ESE
Information Is oorreot. I agree to oomply wish all County ordlnanoes
and State Tawe regulating Electrical wiring, end hereby authorize 1
repre"ribptivea of this County to enter upon the above-mentioned
Prop purpoem• SEE REVER8E FOR EXPLANATORY LA IUAGE
1� 5-20 -92
DATE
COUNTY OF LOS ANGELES TEMPLE CITY f 0508 c ELECTRICAL PERMIT.
DEPARTlXEWT OF PUBLIC WORKS 9071 LAS TUNAS L-EL-050$_9TD5150O07
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
FEES PAID BUILD-
ON FILE i--9442-G YD tEY-ST-`:
FEE DESCRIPTION: GUTANT I TY: UOM: AMOUNT: `-T EMl--X=9 4 7804-2 1 1-
ASSESSOR INFOWTION NUMBER: NEAREST CROSS STREET:
8592-003-047 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID; J5 LOCALITY: TEMPLE CITY
F1 120V 15/20A BR CKTS 1.00 BR 17.40
JX MOT66S, LT 3 HP 7.00 MOT 108.15 .
BRYCE PARKER COMPANY TOTAL FEES 153.30 05/15/97 TC 05/15
OWNER: T NO: FINAL DATE FINAL BY CODE:
ELLINGSWORTH ROBERT A;DEB0RAH K .
-
9410 GIDLEY ST .
TEMP 917804211 - DESCRIPTION UF WWK
�� INSTALL NEW CIR IT8 FOR MACHINERY
APPLIMT: TEL. NO:C W. ELECTRIC 00. (818) 579-6122-
i i ,t
SPECIAL CONDITTW.-
1
DATE INSPECTOR SIGNATURE
TEL. NO: APPROVALS
C & W ELECTRIC CO. (818) 579-6122-
5320 PAL MAL,AVENUE LIC. NO
TEMPLE CITY, CA 91780 411555 C10
L-r
ARCHITECT OR ENGINEER: UFER GROUND
ROM C0N[XJIT
tIC. NO:
Ll li
MAIN-WATER LINE
�LMT.IC Y/N METAL YIN
LIT I Ty MVUTwn=
23-1
REPORT ID: DPR265 ROUTE TO: RS0508