HomeMy Public PortalAbout6355 GOLDEN WEST AVE_Electrical__ WORKEnI have a oasA7 to DE`��11°" 7EAe� '°'B' APPLICATION FOR ELECTRICAL PERMIT ;
+ I her'abY affhTn tttinf I have a oerrKioate of corteerrt to self � CE-aoso
or a certfffcate of Workers' Compensation Irourance, or a owfflBd .COUNTY OF LOS ANGELES BUILDING AND SAFETY
oopy thereof(Se(-3800,Lab.C.)
Poky Na CompanyFOR APPLICANT To FLL IN
Elc.-d ed spy b hely tunnw,.d. New ReefADDRESS Bldg&&Pools EACH NO. FEE _
❑ 1 & 2-Fan-&y,Sq.Ft. E — S LOCALffY
Certffled copy b (fled with the camtY bufkLng YroPection dapartnent Mufti ferNfy Sq FI NEAREST
CROSS ST.
Data gprt laeeiderttiel 8wirnmtrvg Poole pyK�q
Fi1M
CERTFiCATE OF EXEMPTION FROM WORKERS' Outlets Reo—�t_Sw. AIML
CQMPENSAiON INSURAW;E _
20
(This section need not be cornpk d K the work Vreotved by the Total No. Additional Tel. J
pennn Is for one hundred done re(;100)or less.)
I cartty that In the performance of the work for whbh ttlb permttAPPUGANT
le bald, I "I not employ erry person In arty.manner so ae to
beoorne arb}eot th the Nbrkare'Compeneadon Lean Lighting FIxt— First 20 ADDRESS
Total No. Addttionel CITY Tel Na
Date APPaoerrt FLxad Ap�rOe6 Not Over 1 HP
NOTICE TO APP1_K'„ANf: K, atbr meidng thio Certtfioeie of F�MT
Exemption,you should become sub}ect to the Workers'Compensation Range— Heater— D.W. — 'r'PPUC'wT
provieloos of the Labor Code, you must forthwfth oompfy with auoh Oven — Dryer — W.M,— ADDRESS
provldoneor this permit ehan be deemed m%d-Qad Top — FAU — W.FL —
LCENSED CONTRACTORS DECLARATIONCITY TaL Na
Hood Fan — Otfw—
I hereby affirm that I am licensed under provbbrb of Chapter 9 gyp, Room A1r Cond. UCENSEOR Cue&
{commenchig with Section 7000) of Dtvlafon 3 of the Buefnese and
FEC-NL&43ER
Proteasione Code,and rrry License is In hA force and effect. Paver Apparahm& Large ApOlenoee D*TRJGF NP- PASSED BY
Stre&-Type HP;KW,K)Ak,or KWAR
i Lbense Number Lla Claes i Lip to 1 fnoL FINAL
i Over 1 to 10 Incl. D'A'TE /Q
or Data Over 10 to 60 irioL
FUTAL
❑ I am ezernpt under S. Over 60 to 100 lna BY
BAP.C.for thio reason Over 100 rA
Servbes,Swbd.,MCC&Pdr"boerde ; Z
Date: 0-200 Amp.Under 900 V
SkFWure 201 1000 Amp.Under 600 V-
Over 1000 Amp.or Over 600 V
❑ Exemption for Reg.Mahn Elect.
SINGLE FAMILY Temp.Power Pole&Appurtanenoee 2
HOME OWNER-BUILDER DECLARAiON Slgn with One Branch Cirwg
I! I hereby affirm that I am exempt trom the Contra"a Lber»e.I•aw s� �
for the fo[bwing reason(Section 7031.6,Bue+nsae and Pm +or
faeab � 31.00
Code):
Wee Conduits &Conduotors
❑ I,as owner of the property,wtTl do the work and the einnhae 1 ITEM
Is not Intended or offered for sate (Section 7044, Badness Other(See Complete Fee Schedi�e) —
and Profassbna Code). TOTAL 31 .OID
CONSTRUCTION LENDING AGENCY CHECK 31.00
I hereby effb,, that there la a construction {ending agency for the r{� r
perfomrance of the work for wh1ch this permit b issued(Sea 3097, PERMIT FEE (Sutr �-s'Totsl) v. IE ■LAV�L
Ctv.C.).
PLAN CHECKING FEE
Lenders Name PERMF WS ING FEE —3�' 10f 9/90
Ljxiaes Address 32707 1 AM 10:�'9
that I certify t I have reed thio appllcation and state tliet the above TOTAL FEE
m
Inforation Is oorred. I agree to comply wIth all County ordinances.
and State -Tawe regulating Electrical whing, and hereby authatre
repreaentadvee of this County to ember upon the above-mentioned
�pu �..
SEE REVERSE FOR EXPLANATORY LANGAIAGE
_ D
I
COUITY OF-LOS AM6ELES TEMPLE CITY f 0508 �. y_ Fft�TRIJCLITI
DEPARTMENT OF.PUBLIC WORKS 9071 LAS_TURAS E�05�721OD23
BUILDIMO AND SAFETY /-LAND DEVELOPMENT TEMPLE CITY CA.
= PHONE: (818) .285-0488 EXT �.
BK: .118 PG: 72 PC: 1 �•, °AV
- FEE DESCRIPTION-` QUANTITY:.IlOFI:. AMOUIT: -cAAM01418 '
EEAAkkEST CROSS.STREET:
5383-018-029 - Al.PERMIT-ISSLNMCE FEE 27.75 - TIOMIAS.PAGE: 597 GRID: AT _ L,OCALITY:'TEMPLE CITY
01 OUTLETS-LGT,SY,RECP 2.00 OUT 3.90
TOTAL .FEES 31.65 1 SSLIP ON: PLAN LIT EXPIRES ON:.
= _ _ 07121�W . TC 0781/98
-
BOM LFEL L I JAM�CEf ENIA (818) 287-3227- Q'
6355.&XDEN WM AV' O
TEMP 917801418 - WORK
K _ �.
_ TWO GFI OUTLETS. FOR, ING REHABILITATION
APPILICANT: TEL. NO:
G i E COkSTRLICTION\ _ 1909) 590-7603-_ SPECIAL 1 -
- •
V-L5 ,
CWRAMOR TEL. DATE INSI
8 i'8 CONSTRUCTION- (909) 590-7603- C0
6770.ANGEIJI INA LIC. NO v
CHINO, CA 91710 615634 B 1 /
ARCHITECT OR MINEER: TEL. NO:
bS'LIC. NO: r �. �} ^�'�
ROURH WIRING
pMIN �TR LIVE
_ r P U BL d C .WORKS PLAST C YIN METAL Y/M
UTILITY
n / C7
EPORT•ID: DPR265 ROUTE TO: 880508 m
.. • r. � � _ 3.3 G'.QITA2�.,'' _
ml
r
G' -_
, : zJ
. ��QU►s}.� �F.4Q`�,jE��,J(`� � .�
- F8 - U-L'IN ,ham -:Wil• k� 8.,. -c _ - -•
FJ`1e vl�•4 riftafBTd 8� r� r`, s Et LOCA[,tl
$ 0
2,.
1&2,Fgm�Sq -
�Iv�iiYti-f sr.-
MA
T'MA4 - �f _
111An I first 20• bD ESS- 4 �_
30 . 9
otGLtko - - --Additional- K
NI
i4ghtingi'lxtures First 2Q SP ADDRESS
--Additfbngr-r-7 CITY Tel.No.
TotdITJo. k1PAPPLICA
--- - -P,DDRESS-.
CITY
• tnp .,,_. FA +-rte W.H.�,.�� �. ...lr - - - --- ---__ --'' —
�nn--7- 4: rr `- 2.5 LICENSENUMBE CIS.
I HEREBY AI-cNowLEDGE T I HAVMEAD THIS APPLICA-,
L f{6Weri�pPor¢tus&'Lgrg 4pPllanae3. _ T}ON AND STATE TWAT THE ABOVE is CORRECT AND AGREE TO.
_• &*r^F COMPLY-WTTH`At1-,COUNTY-ORE)Ir -xAND'STATe-LAWS
alze&TY#..HRW,^"^•or.K1JA�,u REGUJATING,EIECTRICAL WIRING.
--i-HERBY--CWFY�F#Ai t AM PROPERLY�EGIST D/OR
.04 LJCENSED AS REQUIRED BY LOS ANGELES COUNTY AND StATF{> C
�T 'pvEr 1 to 101roti LI IA I�I 11°4 4 -9�4�-L
rLAla#o.50-mall-,--- .50 17:1, .. 5 -
O�dr 50 t4
SJGNAT
$grvk4s--'--µ
.02�+ rnp,-l�ridhr
�+ 01:-lQt7Q Amp,-QrKiV 4*
V9 r J N)O,Art,p?ot O4r edQ 'Y
Ttrnp P+dwer P61e:¢d4ppbrterl�SpFtt" '� 110�b.- . .ti_ .�_
�tln Clue Brmifh Ok'-)h
SiQi,w ,
Addit}pnq� 19+��rpnc]i f;Ircu(t4s' __• ��K
INF TION
sc�"grldults�Lrvrtdu¢Ori - `ON REVERS
Qthert$ee CQmPletp Fee5ch ovle)��1� � — - —L SInE — �b 9'�:4 A
_ - --- - T- -- # o o 9,2
0.
WMA F FIE c,
t�l„Ar4.�E&NG1a o 21.0 0
r�
r a is1:n�C.rwi 09.28-79
zpTA 'F55.
' E�iIONfINp,I,�D
1