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Home My Public Portal About5675 LOMA AVE_Electrical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0507200004 'BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 28S-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 16305 LT: 1 5675 LOMA AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802451 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5387-022-009 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, C F1 120V, 15/20A BR CKTS 1.00 BR 17.25 TENANT: G1 OUTLETS-LGT,SW,RECP 30.00 OUT 52.50 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: G2 LIGHTING FIXTURES 10.00 LGT 19.50 07/20/05 JK 01/16/06 TOTAL FEES 117.00 OWNER: TEL. NO: FINAL TE FINAL BY: CODE: TSENG, TSUI CHUNG (626) 286-5059- _- 5675 LOMA AV TEMP 917802451 - DESCkIPTTON OF WORK ELECTRICAL FOR ADDITION APPLICANT: TEL. NO: HENRY YING KUN HUNG (626) 705-1638- 6123 RENO AVE SPECIAL CONDITIONS: TEMPLE CITY CA 91780 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE HENRY YING KUN HUNG (626) 705-1638- 6123 RENO AVE LIC. NO TEMPORARY POWER POLE TEMPLE CITY CA 91780 808139 B UNDERGROUND CONDUIT ARCHITECT OR ENGINEER: TEL. NO: UFER GROUND LSC. NO: ROUGH CONDUIT ROUGH WIRING MAIN WATER LINE PLASTIC Y/N METAL Y/N UTILITY COMPANY NOTIFIED REPORT ID: DPR265 ROUTE TO: BS0508 ,r 76A663-CE80610-62 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING j BUILDING AND SAFETY DIVISION ADDRESS .1-7076 JOHN A. LAMBIE, COUNTY ENGINEER J I i WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. — r2 RECEPT. TOTAL NO. EACH FEE OUTLETS FIRST 20 /, $.20 $ M-.a OWNER - LIGHT MAIL ADD'L 10 ADDRESS � SWITCH. O ,�. VER 20 ` ZZLIGHTING TOTAL FIRST 20 .20 CITY w' TEL. NO. FIXTURES ADD'L r / OVER 20 .10 ELECTRICIA RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS GARB.DISP. STA.COOK CITY TEL.NO. i DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(1A H.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER H.P. DISTRICT NO. GROUP ONE JP�4MED BY ' O 1 1.00r 1 7 3 1.5o INSPECTION RECORD s s s 2.00 & 15 2.50 - V 75 50 3.00 0 J 50 100 5.00 d SIGNS: NO.TRANS. h NO.LAMPS �' z SERVICE 0.600V-NOT OVER 200A 1.00 SERVICE 0.60OV-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 -MISC. PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE $ IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI 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 I l_ -��'-'�y 5, 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LOF ENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES LIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE SCRIBED RESIDENTIAL PROPERTY POWER GNATURE /_..-�._ � _UTILITY CO.NOTIFIED * .� PERMITTEE FINAL VALIDATI ARTHUR C. VEIT CK MO QAs H SUPERVISING ELECTRICAL ENGINEER 768667_.' 68S SA 3-50 �0� APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES�r® p.� �� ' aC I WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT N.O. ELECTRICIAN $ Ba A: 'ir // RECEIVED BY READY FOR DATE ISSUED ADDRESS �D Ac- �/AA 6-f6 ('!'(9,,,9 ,,p 4 •ir e, FIRST INSPECTION ✓„, m� � CITY S 6a .G,vS TEL. N0. //'�/®/e7 ./i' - I COUNTY LICENSE NO. ..� EXPIRES, Co �A BUILDING �/F� �QerntrrJ1 PERMIT FEES 1 NUMBER EACH FEE LOCALITY J�}/v/��iy��/5✓ ,� 0 LIGHT OUTLETS NEAREST CROSS 9T. RECEPTACLES _ WALL SWITCHES OWNER IJ TOTAL OUTLETS SO $ s MAIL s ELEC. RANGES 25 K. ADDRESS NO ELEC. HEATERS 25 RSC ,�. CITY e 42A a r TEL. NO. FIXTURES 'S `� I HEREBY ACKNOW DGE THAT 1 HAVE READ THIS MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS, REGULATING ELECTRICAL WIRING. MOTORS 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS NUMBER HORSEPOWERFEE ANGELES COUNTY LICENSE, /711=I1'AM THE LEGAL OWNER NEW I MVD. HP OVER INC. EACH OF THE RESIDE - L PROP E DESCRIBED ABOVE. PH'G� /�Ir1 SIGNATURE V2 & LESS $ .25 OF 2 .50 PERMITTEE - I 2 s 1.00 INSPECTION RECOAff- 5 15 1.50 15 50 2.50 50 200 5.00 200 500 10.00 S00 1000 15.011 Q Z OVER 1000 1 20.00 M.G. SET/FREQ. CHANGER-HP WELDERS: AC-KVA O GENERATORS - KW TRANSFORMERS - KVA TEMP. MOTORS (75% OF ORIG.) MOVED MOTORS (75% OF CRIB.) MISC. SIGNS NO. NO.TRANS. N0. NO. LAMPS APPROVALS FOR EACH PERMIT: DATE INSPECTOR'S NAME WIRING $1.00 CONDUIT FIXTURES $1.00 WIRING e- -(o T7 SUPPLEMENTARY .SO FIXTURES POWER TOTAL FEE $ do//// UTILITY CO. NOTIFIED DOM r tn/I �U�' FINAL 76A663•CE606.10.5. APPLICATION FOR ELECTRIC PERMIT 1 BUILDING AND SAFETY DIVISION Department of County Engineer BUILDING �-�• County of Los Angeles ADDRESS fv®dH 61 JOHN A. LAMBIE, COUNTY ENGINEER CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY N EAR EST FOR APPLICANT TO FILL IN CROSS sT PERMT FEES nye f OWNER 1,Fb C.OA& e LIGHTS RECEPTACLES SWITCHES ,am+ NUMBER I T E M EACH FEE MAIL ADDRESS TOTAL OUTLETS $ .10 1q EEC:--R4N. 5 WATER HEATERS, CITY o " �/J`�"� TEL. NO.Rf'7432, ® CLOTHES DRYERS .50 HEATERS, STAT;Y. COOK. ELECTRICIAN ING UNITS, GARBAGE DISPOSERS, AUTO WASHERS, DISHWASHER .25 ADDRESS P LIGHTING FIXTURES ,10 CITY mos TEL. N0.�� V MOTORS STATE LICENSE NO. � Yf HORSEPOWER H.P. OVER INC. DISTRICT O. GROUP �NE I READYFOR INSPECTION V_ @ LESS .25 ..� 1/2 2 .50 INSPECTION RECORD 2 5 1.00 5 15 1.50 15 50 2.50 50 200 5.00 MISC. SIGNS NO.TRANS NO.LAMPS SERVICE O-600V 1.00 • p SERVICE OVER 600V 5.00 WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 APPROVALS TOTAL FEE $ AM DATE INSPECTOR'S SIGNATURE 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING leo 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OVYNER OF THE ABOVE POWER DESCRIBED RESiDENTI YROPERTY ' SIGNATURE �"`�- / UTILITY CO. NOTIFIED %e - OF FINAL 4 l► JOHN A. LAMBIE. A ATION ARTHUR C.VEIT. COUNTY ENGINEER CK M CASH SUPERVISING ELECTRICAL ENGINEER u�v 2 4 o JJL 15 2 d - J�tW t; Lc- I6A668-CE8064.60 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER rADDRESS ILDING �J BUILDING AND SAFETY DIVISION JOHN A.LAMBIE• COUNTY ENGINEERWILLIAM A. JENSEN, SUPT OF BUILDING CALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. PERMIT FEES OWNER ` I I T E M INUMBER EACH FEE MAIL •••�/_ OUTLET ///• S S ADDRES LIGHTS RECEPT. SW. (� .10 LIGHTING FIXTURES �- 1O CI EL.NO. ELEC. RANGES CLO. DRYERS ELECTRICIA WATER HEATERS .50 ADDRESS ELEC.SPACE HTRS. DISHWASHERS CITY TEL.NO. GARBAGE DISPOSERS AUTO.. STATE WASHERS STA.COOKING UNITS .25 LICENSE NO. MOTORS: OVER INC. H.P. DISTRICT NO. GIROUP CESSED BY O — 1/2 .25 1/2 — 2 .50 INSPECTION RE ORD 2 — 5 1.00 a 5 — .15 1.50 0 15 — 50 2.50 d' 1 Q 50 200 5.00 U W NO TRANS. d SIGNS: NO. LAMPS NZ SERVICE 0.600V 1.00 SERVICE OVER 600V 5.00 MISC. WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 TOTAL FEE S 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE 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 AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _ DESCRIBED REBID NTIAL PROPERT POWER SIGNATURE UTILITY CO. NOTIFIED " OF PERMITTE - FINAL 1 � ice• LIDATION ART UR C.VEIT.: C MO CASH SUPERVISING ELECTRICAL(�ENGINEI:R 76AG63 APPLICATIONDBS•5A 3-55 FOR 11 ELEC ■ RIC PERMIT DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles BUILDING 47 WM.J. FOX, COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN. SUPT OF BuILDING i LOCALITY FOR APPLICANT TO FILL IN NEAREST PERMIT FEES CROSS ST. NUMBER EACH FEE LIGHT OUTLETS OWNER MAIL RECEPTACLES . .ADDRESS WALL SWITCHES TOTAL OUTLETS 5¢ $ CITY TEL. NO. ELEC. RANGES 25 _ELECTRICIAN _ELEC. HEATERS j 25 a• ADDRESS KW EA CITY TEL. NO. FIXTURES 5 LICENSE NO. NUMBER OF LIGHT CIRCUITS - DISTRICT NO.. GROUP I ZONE I_I_READY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS a - MOTORS VV NUMBER HORSEPOWERFEE INSPECTION RECORD NEW 'MVD. HP OVER I INC. I EACH 1�2&LESS $ .25 th 2 .50 - 2 5 1.00 515 1.50 _15 50 2.50 50 200 5.00 MISC. NO.SIGNS NO.TRANS. - NO.SIGNS NO. LAMPS FOR EACH PERMIT: WIRING $1.00 FIXTURES $1.00 SUPPLEMENTARY .50 APPROVALS TOTAL FEE g_ DATE INSPECTOR'S SIGNATURE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT I Jt AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING ELECTRICAL WIRING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED SIGNATURE ^A OF PERMITTEE FINAL WILLIAM J. FOX.COUNT IIWGINEER VALIDATION A.C.VEIT. CHIEF ELECT. INSPECTOR 3493 FEB 27 21.30 �' 75A683 DBS=SA 3.55 APPLICATIONYY FOR ELECTRIC PERMIT .i DIVISION OF BUILDING AND SAFETY Department of County Engineer County Of loos Angeles BUILDADDRESS �. WM.J. FOX, COUNTY ENGINEER CASSATT D.GRIFFIN. SUPT OF BUILDING I SERMIRM LOCALITY ; FOR APPLICANT TO FILL IN NEAREST PERMIT FEES CROSS ST.,e NUMBER EACH FEE, OWNER LIGHT OUTLETS MAILr RECEPTACLES ) ADDRESS (J �J WALL SW ITCHES d �� dK (� e1 TOTAL OUTLETS 5¢. $ i� 79 CITY TEL. NO % 6C ELEC.RANGES 25 ELECTRICIA r" r _ELEC. HEATERS 25 ADDRESS 044 KW EA i CITY TEL.NO. FIXTURES 5 -'�J LICENSE NO -00000r- NUMBER OF LIGHT CIRCUITS - DISTWT NO. GR UPI ZONE READY FOR INSPECTION NUMBER OF RECEPTACLE CIRCUITS I MOTORS NUMBER HORSEPOWERFEE INSPECTION RECORD _ ('� •�� Ii NEW MVD. HP OVER INC. EACH Z„�.,�ll�'U �'9 F_•.��9'F�` �!�'r. -7` -_— 1/2&LESS $ .25 1/2 2 .50 2 5 1.00 5 15 1.50 F11 15 50 2.50 50 200 5.00 MISC. NO.SIGNS NO.TRANS. NO.SIGNS NO. LAMPS .IIL- FOR EACH PERMIT: I WIRING $1.00 s� ✓" FIXTURES $1.00 SUPPLEMENTARY .50 R APPROVALS TOTAL FEE I S DATE INSPECTOR'S SIGNATURE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT rt AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING 2 Y �� X11•"'� ELECTRICAL WIRING. 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA ORTHAT I A THE LEGAL OWNER OF THE ABOVE POWER DESCRIBED RESIDENT PR ERTY. UTILITY CO.NOTIFIED SIGNATURE pp•�, OF PERM LTTE FINAL `IP WILLIAM J. FO ' OUNTY ENGINEER VALIDATION A. C.VEIT.CHIEF ELECT. INSPECTOR ; 299SZR fEB.16 2 2.55 0 I 76A663-CE80610-62 APPLICATION FOR ELECTRICAL PERMIT as COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEERfELECTRICI G RPM BUILDING AND SAFETY DIVISION s f. JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A.JENSEN,SUP'ToF BUILDING Y -FOR APPLICANT TO FILL IN T.RECEPT. TOTAL NO. ACH FEEOUTLETS FIRST 20 $20 S LIGHT SWITCH. ADD' SOVERO .10TOTAL TEL. NO.LIGHTING FIRST 20 .20 FIXTURES ADD'L ICIAN OVER 20 .10 f .RANGES CLO.DRYERS WTR.HTRS. 1.00 -:ADDRESS GARB.DISP. STA.COOK CITY TEL.NO. DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(l/z H.P.MAX.) :50 LICENSE NO. MOTORS: OVER NOT OVER H.P. DIST �IT NO. GROUP ZONE PRQCESSED BfY O 1 1.00 ,..� Y' AA-` I 3 1.50 INSP CTION RECORD 0 O /J V 3 8 2.00 ..,� sem' W 8 15 2.50 IL 15 5o 3.00 50 100 5.00 SIGNS: NO.TRANS. O d NO.LAMPS SERVICE 0-600V-Nor OVER 200A 1.00 ~ SERVICED-60OV-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 ✓ TOTAL FEE ffi r I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 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 I 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 RESIDENTIAL PROPERTY.. POWER SIGNATURE UTILITY CO.or, OF PERMITTEE r FINAL VALIDAT104, ARTHUR C. VEIT CK MO j'CASH SUPERVISING ELECTRICAL ENGINEER 76A66C-CE#806 5-67 APPLICATION FOR ELECTRICAL PERMIT LLL��111 COUNTY OF LOS ANGELES DEPARMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A.JENSEN,SUPT of BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. PERMIT FEES OWNER ° f I T E M NUMBER EACH FEE MAIL •� OUTLETS: ' $ $ ADDRESS LIGHTS RECEPT. SW. •10 CITY TEL. NO. LIGHTING FIXTURES ,10 ELEC. RANGES CLO. DRYERS ELECTRICIAN W A T E R HEATERS .50 ADDRESS ELEC.SPACE HTRS. DISHWASHERS CITY TEL NO. GARBAGE DISPOSERS AUTO.- STATE WASHERS STA.COOKING UNITS •25 LICENSE NO. MOTORS: OVER IN/C. H.P. DISTRI$.Tr. GROUP ZONE P CESSED BY ' 1, .25 �.a (� 2 50 INSPECTION RECORD >- 2— 5 1.00 s =�' ' ! e f, -=� T 5— 15 1.50 is— 50 2.50 0' A ta° 50— 200 5.00 W SIGNS: NO TRANS. NO.LAMPS N SERVICE 0-600V 1.00 SERVICE OVER 600V 5.00 MISC. WIRING PERMIT 1.00 FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 TOTAL FEE $ , 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE ,� INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT ELECTRICAL WIRING. WIRING �fN.Y ,1��' ��h,•%'� ' 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR - / ✓ Ii>�: u LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES 1 CALIFORNIA OR THAT 1 AM THE LEGA OWNE OF E ABOVE .J DESCRIBED RESIDENT L PROPERTY. POWER SIGNATURE UTILITY CO.NOTIFIED � OF PERMITTEE i FINAL a VALIDATI ARTHUR C. VEIT CK mo CAH SUPERVISING ELECTRICAL ENGINEER U11-1 WORKER'S COMPENSATION DECLARATION 9DPW 9189 APPLICATION FOR ELECTRICAL PERMIT 76A66 I**-ieby affi76A663 rm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab. C.) / j� Policy No. Company—"l !h-re— <ry lA FOR APPLICANT TO FILL IN JOB ADDRESS Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ❑ $ _ $ LOCALITY Certified copy is filed with the county bu' • g i ection 1 &2-Family,Sq.Ft. department. l Multi-family Sq.Ft. CROSS S7. 0 VJ'e �j Residential Swimming Pools ASSESSOR Date N Jam• Applicant MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WO KERS' Outlets:Rec._Light Sw. FOWNER OR IRM NAME COMPENSATION INSURANCE �- (This section need not be completed if the work involved by the First 20 MAILADDRESS permit is for one hundred dollars($100)or less.) Total No. Additional I certify that in the performance of the work for which this permit CITY`°&ylt PLe C Tel.No. is issued, I shall not employ any person in any manner so as to PLAN CHECK become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS Date Applicant 150R 20A,t20V BRANCH CIRCUITS NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PERMIT APPLICANT provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH >_ LICENSED CONTRACTORS DECLARATION ADDRESS. �3 a- I hereby affirm that I am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH (commencing with Section 7000) of Division 3 of the Business and CITY � Tel.No. �[I 0 Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR 7 Power Apparatus&Large Appliances REG.NUMBER classic License Number 1n Lia Class c C s Size&Type HP,KW,KVA,or KVAR DISTRICT NO. PROC SED BY C. � -<v Up to 3 Incl. LR- JJ a- 41— Over 3 to 10 Incl. FINAL ' Contractor— le /�� C L e ate .I" /- • DATE c' ❑ Over 10 to 50 Incl. ( �� Z I am exempt under Sec. Over 50 to 100 Incl. VALIDATION Over 100 FINAL B.&P.C.for this reason BY Services,Swbd.,MCC&Panelboards Date: / 0- 00 mp.Under 600 V VZ I Signature 201 -1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Law u for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): ❑ »...,» I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) rL and Professions Code). M.»..` CONSTRUCTION LENDING AGENCY .,Rrlt(TI I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE Lender's Name :"= :•- PERMIT ISSUING FEE r--•• '(='-'= ' Lender's Address �� I certify that I have read this application and state that the above TOTAL FEE inform is correct. I agree to comply with all County ordinances and gate la s regulating Electrical wiring, and hereby authorize repr sen a es this County to enter upon the above-mentioned pr f r I ctio purposes' SEE REVERSE FOR EXPLANATORY LANGUAGE GNATURE OF AP LICANT OR AGENT yDATE