HomeMy Public PortalAbout6103 MUSCATEL AVE_Electrical__ WORKERS'COMPENSATIQN DECLARATION. CE soed' 10i81 APPLICATION FOR En ECeTRICAL PERMIT
hereby affirm that I have:% certificate of consent to self insure; ! Ir (�y [L. 1,r I� ?�1 PERMIT
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELESi BUILDING AND SAFETY
copy. thereof(Sec.3800,Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN ,i'OB B� ;
❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS 3C.Jr!'
New Residential Bldgs.&Pools
❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq..Ft. $ — $ LOCALITY P G l b'
department. Multi-family Sq.Ft.. — NEAREST
Rdsidential Swimming Pools OWNER
O
Date Applicant I OWNER OR
FIRM NAME M IGtL C�
CERTIFICATE OF EXEMPTION FROM WORKERS' Outle :Rec— _ MAIL
COMPENSATION INSURANCE Light t 2 —
ADDRESS
(This section need not be completed If the Work involved by the I First 20
permit is for one hundred dollars($100)or less.) Total No. Additional CITY Tel.No.
I certify that in the performance of the work for which this permit APPLICANT K
is issued, 1 shall not employ any person in any manner so as. to
become subject to t e Workers'Compensation Laws. Light! g Fixtures First 20 ADDRESS
����qq�� /�q� T4
Additional
Date Applicant M1�f+IP'r'�ii �V•`� Total No. CITY Tel.No.
i.
NOTICE. APP I ANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT
APPLICANT
Exemption,you should become subject.to the Workers'Compensation Range_ Heater_ D.W. _ �(D
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS
provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. _
CITYTel.No.
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ own
I hereby affirm that I am licensed under provisions of Chapter 9LICENSE'OR
Disp.. - Room Air Cond. REG.NUMBER Class.
(commencing with Section 7000)of Division 3 of the Business and �
Professions Code,and my license is in full force and effect. DISTRICT.O. PR E ED BY
Power Apparatus&.Large Appliances IL
Sij e&Type HP,KIN,KVA,or KVAR a Q
License Number Lic.Class. Up to 1 Inc]. FINAL D C�
Over 1 to 10 Inc[. DATE VALIDATION 0
Contractor Date4W I
I Over 10 to 50 Incl. FINAL U
•
❑ I am exempt under Sec.. Over 50 to 100 Inc. BY LN
Over 100 LL
B&P.C.for this reason Z
� Services,Swbd.,MCC&Panelboards
Date: 0-200 Amp.Under 600 V
Signature 201 - 1000 Amp.Under 600 V
❑ Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect. l'
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 additional Sign Branch Circuits ACCfor the following reason(Section 7.031.5,Business and Professions AC C�T e v
Code): 3X77 20. U(
I,as owner of the property,will do the work and the structure Misc.-Conduits&Conductors
is not intended or offerdd for sale (Section 7044, Business Oth r(See Compl_etp�Schedule) — ® i ITEMS
and Professions Code). �W TOTAL 20.00
CONSTRUCTION LENDING AGENCY 20.00I 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 f 0000-0001 4127190
1 certify hat[.have read this application and state that the above TOTAL FEE a� ®v � 7�1 1 �°1:
information is correct. I agree to comply with all County ordinances
and State laws re ulating Electrical wiring, and reby authorize
represent es of th County to enter upon the bove- entioned
propertyA inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature o i tee Date
0..y1lORKERS;: MPFNSATION DECLARATION I 76A663 10/Bl APPLICATION FO �LE�;TRICAL PERMIT
�I hereby affi�m thibt I h�ve a certificate of consent to self CE-806G t
insu z,ora cartificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copii thereof(Sec. 3800, Lab. C.)
C a. /�/
Policy No. Company FOR APPLICANT TO FILL IN JOB D✓ ,g(� T tG
Certified co is hereby furnished. EACH NP. j FEE ADDRESS 0
PY• Y New Residential Bldgs. &Pools
Certified copy is filed with the county building inspec, 1 &2-Family, Sq. Ft. $ — $ i LOCALITY �� /
tion department. Multi-family Sq. Ft. NEAREST
CROSS ST. /1 n t (\/
— /"�YG L.J
Residential Swimming Pools
Date Applicant I OWNER OR /I : /O
FIRM NAME �d-'�iC�
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light L � � r MAIL
COMPENSATION INSURANCE _ First 20 , ADDRESS
(This section need not be completed If the work involved by Total No. Additional CITY
s No. ��/' Q Q
the permit is for one hundred dollars($100)or less.) , ...�
I certify at e that in the performance of the work for which this � PLAN CHECK permit is issued, I shall not employ any person in any manner APPLICANT
74
so as to become subject to the Workers'Compensation Laws. Lighting Fixture First 20 ADDRESS
Total No. Additional CITY Tel. No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT dv
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_ CITY Tel. No.
CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER Class.
(commencing with Section 7000)of Division 3 of the Business Power Apparatus&Large Appliances DISTRICT NO. _/ PROCESSED Y
and Professions Code,and m license is in full force and effect. Q(/ 0.
Size&Type HP, KW, KVA, or KVAR O
License Number Lic. Class FINAL
Up to 1 Incl.
Over 1 to 10 Incl. DATE VALIDATI
Contractor Date❑ Over 10 to 50 Incl. /FINAL
I am exempt.under Sec. Over 50 to 100 Inc. BY UM
B.&P.C. for this reason Over 100 #A
Date: Services, Swbd.,MCC&Ponelboards
' 0 -200 Amp. Under 600 V
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 ;91 5 5 6 A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # 0 0 0 0 0 2
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
R
for th following reason (Section 7031.5, Business and I oo [((a00
es ' s Code):
Misc. Conduits&Conductors
I, as owner of the property, will do the work and the - 46005
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_
7044, Business and Professions Code).
0220-85
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
•(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and state that the 11 TOTAL FEE U
above information is correct. I agree to comply with all County
ordinances and to 1pws-*re ulating Electrical wiring, and
hereby auXor eprtao',sentativ s of this County to enter upon ,
the abo - on opert for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
ISid natu a of Permittee Date
76A&53-CE30A 11/70 . APPLICATION FOR ELECTRICAL 'PERMIT ,
COLA;TY.OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER TADDRESS
NG /i]2 f,/� n,��s /�L ,/r
BUILDING AND SAFETY DIVISION (ll�3 / �7 AllCOLEMAN W. JENKINS, SUPERINTENDENT OF BUILDINGTY STFOR APPLICANT TO FILL IN STOUTLETS NO. EACH FEEOWNER
RECEPT. S $ i[1�1-ti MAIL
(/ r
LIGHT TOTAL FIRST 20 .25 CJ V
CITY TEL. N0.
SWITCH „ OVER 20 10Gol
PLAN CHECK
LIGHTINGTOTAL FIRST 20 25 1 APPLICANT
FIXTURES
OVER 20 •10 ADDRESS
APPLIANCES CITY TEL. No.
'/ PERMIT
RANGE DRYER v WTR. HTR. APPLICANT
1
STA. COOK DISP. F.A.U. I ADDRESS
SPACE HTR. AIR COND. I CITY TEL. NO.
CLOTHES WASH.�DISHWASH. +� ^ LICENSE NO. CLASS.
FAN OTHER 1.00 ! I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND. HEATERS, ETC. HP. KW. KVA. ELECTRICAL WIRING.
S1ZE & TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO a
1 - 1O 300 RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. Q
SIGNATURE'S e>zsu
10 - 50 5.00 OF PERMITTEE O✓
50 - 100 10.00 0
D 15 TRI CT NO. 1CLASS ZONE R SSED.BY V
100 - 500 15.00 W
v G.
07/
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES: zD7� ?
TUBE, OR
MARQUEE ADDITIONAL•CIRCUITS 1.00 e,�/Z
SERVI CENOTOVER 600 VOLTS OR 200 AMP 3.00 ��
APPROVALS DATE INSPECTOR'S SIGNATURE
S ERVI CE OVER 600 VOLTS OR 200 AMP 10.00
TEMP.POWER POLE
TEMPSERVICE,POLE,&APPURTENANCES 5.00
UNDERSLAB WORK
TEMP LIGHT OR RECEPT. SYSTEM 3.00
ROUGH CONDIUT
WIRING
FIXTURES
POWER AUTHORIZED
PERMIT FEE (SUB TOTAL)
UTILITY CO. NOTIFIED
PLAN CHECK FEE
.3 FINAL
PERMIT ISSUING FEE 3.00 JOSEP C. ROOHAN
TOTAL FEE SUPERV ING!ELEC RI AL ENGINEER.
,0
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALID .� CK. M.0. CASH
L AGO 2 6 2 FEB 3 2 D 16.75- 00
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE
WORKERS'COMPENSATION DECLARATION CE-80G
3 10/81 APPLICATION"FOR ELECTRICAL PERMIT
I hereby affirm that I have a cR;rtifirdte�'of consent to s self CE-80013
jns4re, or a cet$ificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a cd1'tMed copy thereof(Sec. 3800, Lab. C.)
P❑olicy,No._Z� ompany,/l�/�,yaag , Ca. FOR APPLICANT-TO FILL IN JOB V
&rtified co is hereby furnished. I rACNO. FEE ADDRESS � /i/t'PSG�jeLPY Y New Residential Bldgs. &Pools 1 &2-Famil S Ft. — $ LOCALITY .1
Certified copy is filed with the county building inspec- Y. q• — NEAREST
tion department. Multi-family Sq. Ft.
/ ` S _ Residential Swimming Pools CROSS ST.
Date Applicant OWNER OR /yJ
/ FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Reco_Light,�Sw.v MAR t .3
COMPENSATION INSURANCE ADDRESS AU-C.0 Tal.
This section need not be completed if the work involved b First 20 ZO7
( p y Total No.'-#'o Additional CITY � �� Tel. No.
the permit is for one hundred dollars(;100)or less.)
I certify that in the performance of the work for which this APPLICANTK elklls�
permit is issued, I shall not employ any person in any manner ,, ��4
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS C7✓��9A `/Tl
Total IVo._ Additional CITY Tel. No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT /
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT ! L
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. CITY �L � Tel. No.olg—
Hood _ Fan �Other_
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG.NUMBER ?�a Class. _110
(commencing with Section 7000)of Division 3 of the Business DISTRICT NO. P SSED BY
and Professions Code,and my license is in full force and effect.,: Power Apparatus&Large Appliances �( �q IL
Size&Type HP, KW, KVA, or KVAR , CJ fv� O
License Number J ic. Class Gf.a Up to 1 Incl. FINAL V
eg
� f ` Over 1 to 10 Incl. DATE VALIDATION
� ��—
Contractor CDate Over 10 to 50 Incl.
13 FINAL ri
I am exempt under Sec. Over 50 to 100 Inc. BY IL
tw
Over 100
B.&P.C. for this reason �
Services, Swbd., MCC&Panelboards
Date.: I 0 -200 Amp. Under 600 V pool ;91 3 5,7 A
Signature 201 - 1000 Amp. Under 600 V # o 0 0 0 0 2 I
Over 1000 Amp. or Over 600 V
❑ Exemption for Reg. Maint. Elect. 0 - 35,50
SINGLE FAMILY Temp. Power Pole&Appurtenances =
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit o o o 3 5,5 0 5
1 hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and Q 1. 16-85
Professions Code):
I, as owner of the property, will do the work and the Misc. Conduits&Conductors
ID
structure is not intended or offered for sale (Section, Other(See Complete Fee Schedule)_
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name PERMIT ISSUING FEE.
Lender's Address
I certify that I have read this application and state that the TOTAL FEE
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon)
theve-mentioned proper for' spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date i
WORKERS'COMPENSATION DECLARATION 76-883 10/81
CE-806G APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that'I have a`certificate of consent to self insure,
or a certificate of Workers' Compensation Insurance, or g! certified+ i COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800.Lab.C.) �1
Policy No. Company FOR APPLICANT TO FILL IN JOB O2 . ^ 1 e� L' �/.
❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS L (�'(/�
New Rgsidentlal Bldgs.&Pools LOCALITY
❑ Certified copy is filed with the county budding inspection 1 8!2-Family,Sq.Ft. $ _ $
department. Multi-family Sq.Ft, NEAREST
CROSS ST.
Date Applicant (V
Residential Swimming Pools OWNER OR _ 1
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL
w.
COMPENSATION INSURANCE Outlets:Rec_Light_First 2 t 20— ADDRESS
(This section need not be completed If the work involved by the
permit is for one hundred dollars($100)or less.)
Total No. Additional CITY s Tel.No.
I PLAN CHECK
I certify that in the performance of the work for which this permit APPLICANT
is issued, I shall not employ any person in a as to ,
become su"totheorkers'Compensatio Lighting Fixtures First 20 ADDRESS
Additional
Date AQplicant Total No. CITY Tel.No.
NOTICE TT If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT
Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. _ APPLICANT
Iry
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS
provisions or this permit shall be deemed revoked. Top' _ FAU _ W.H.
LICENSED CONTRACTORS DECLARATION HooY — Fan _ Other_ CITY Tel.No.
I hereby affirm that I am licensed under provisions of Chapter 9Dis , — Room Air Cond. LICENSE OR Class.
(commencing with Section 7000)of Division 3 of the Business and p REG.NUMBER
Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT PR SED B
Size&Type HP,KW,KVA,or KVAR of 0
License Number Lic.Class Up to 1 Incl. FINAL V
Over 1 to 10 Incl. DATE VALI -TION
Contractor Date O
Over 10 to 50 Incl.
FINAL
❑ I am exempt under Sec. Over 50 to 100 Inc. BY W
B.&P.C.for this reason Over 100 n-
fn
Service�Swbd.,MCC&Panelboards
Date. 0'-200 Amp.Under 600 V V /
Signature 201'- 1000 Amp.Under 600 V
❑
Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V
SINGLE FAMILY Temp.Power Pole& Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit a
I hereby affirm that I am exempt from the Contractor's License Law ACCT.v
for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits �_ r_
Code): 33r f7 31.1
Misc.Conduits&Conductors a •� n
I,as owner of the property,will do the work and the structure • Z ITEMS
Eli,}
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)
and Professions Code). ® TOTAL �- ��
CONSTRUCTION LENDING AGENCY CHECK 1.CLI
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) CHANGE °if.±
Civ.C.).
PLAN CHECKING FEE
Lender's Name EOC13-1031010 1 5/2219).1
PERMIT ISSUING FEE
Lender's Address Q�01 033? f AN 9:
I certify that I have read this application and state that the above TOTAL FEED
information is correct.I agree to comply with all County ordinances
and State laws Electrical wiring, and hereby authorize
representativ f this Cc ty to enter upon the above-mentioned
property fo pection pur oses.
SEE REVERSE FOR EXPLANATORY LANGUAGE
S y qti
Signature of Perms ee to
,iWORE
DECLARATION 20-0019
PEN
I ftereby affirm that 1,havpMa cert�if elate of consent to self Insure, 76A663 DPW(12.91) APPLICATION FOR ELECTRICAL PERMIT
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(Ssc.X3800 Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN ADDRESS ro 3 N, v S I^�4-�-�. A v
Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY T—
$ $ G�lPJ/ eco
Certified copy is filed with the county building inspection 1 &2-Family;Sq.Ft. _ NEAREST
department. Multi-family Sq.Ft. CROSS ST. 19A[ t
Date Applicant Residential Swimming Pools gSSESSOR
MAP BOOKPAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec. Light SW. OWFIRM NER OR pn(G
COMPENSATION INSURANCE �� , NAME 9r/
First 20 MAIL J n SCC A
(This section need not be completed 0 the work Involved by the Total No. Additional ADDRESS 644 2 A
permit is for one hundred dollars($100)'or less:) •1 G c
I.certify that in the performance of the work for Which this permit CITY— SAW /vrJ2( ( el ° Z 6 /65"
is Issued, I shall not employ any person.in ma . or so as to PLARCHECK
become subject to.the Workers'Compens on aws. Lighting Fixtures First 20 d APPLICANT
Total No. Additional
Z 1Qf 2 � ADDRESS
Date / Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No.
.Exemption,you should become subject to the Workers'Compensation. OTHER APPLIANCES NOT OVER 3 HP.
rovisions of the Labor Code,you must forthwith comply with such PERMIT
p p y Power Apparatus&Large Appliances APPLICANT _.e
provisions of this permit shall be deemed revoked. ,
LICENSED CONTRACTORS DECLARATION- Size&Type HP;KW,KVA•,.or KVAR ADDRESS
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl.
(commencing'With Section 7000. )of Division 3 of the Business and CITY Tel.No.
Professions Code,and my license is in full force and effect. Over 10 to 50 Incl. LICENSE OR
I Over 50 to 100 Incl: REG.NUMBER Class' O
License NumbLIC.Glass Over 100 DISTRICT NO. PROC SED BY
er ^ V'
Services,Swbd.,MCC&.Panelboards /!J!/ All—
Contractor Date, 0-399 Amp.Under 600 V DATE V
0 I am exe400-100-mpt under Sec. 0 Amp.Under 600 V �� VALIDATION W
Over 1000 Amp.or Over 600 V FINAL. a
B.&P.C.for this reason BY
BRANCH CIRCUIT FEES co
Date: 15A,or 20A,120V,Lighting or Recept. Z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
❑ 41 Or More Branch Circuits
Exemption for Reg.Maint.Elect. 15A,MA,208V To 277V Lighting Br.Circuits 3307 36.95
SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp.Power Pole&Appurtenances i ITEMS
Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law --a
for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits TOTAL 36.65
Code): CHECK 36.65
I,ss 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) CHANCE ,0f
and Professions Code).
CONSTRUCTION LENDING AGENCY -0001
_000 i2/2i/92
I'hereby affirm that there is a construction lending agency for the
OW
performance of the work for which this permit.is issued (Sec. 3097, PERMITTEE (Sub-Total) Q 7160 i AM 8 48
Civ.C.)
PLAN CHECKING FEE _
Lender's Name
PERMIT ISSUING FEE 4
Lender's Address ��
I certify that 1 have read this application and under penalty of purjury state TOTAL FEE l�J
that the above information is correct. I agree to comply with all.County
ordinances an a laws ulating Electrical wiring;and hereby authorize
representat this Coun y to enter upon the above-mentions property
for inspect urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
1 Z,21 9 Z
SIGNATURE OF PERMITTEE DATE
WORKERS'COMPENSATION DECLARATION 2o•aolvDOW 3ie7 APPLICATION FOR ELECTRICAL PERMIT O
•,l her4by?-affirrfi! that I have a certificate of consent. to self �7
!nsuret or a,certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or a certified copy thereof(Sec. 3800, Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB ,)
❑Certified co is hereby furnished. EACH NO. FEE ADDRESS v _ AtA
PY Y •.New Residential Bldgs. &Pools
Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ I—Is LOCALITY
s
tion department. ; Multi-family Sq. Ft. NEAREST
CROSS 5T. ti�
Date Applicant Residential Swimming Pools OWNER OR.
�'•• FIRM NAME �j
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light—/&—? Sw.�3 MAIL
COMPENSATION INSURANCE ADDRESSLA
First 20
(This section need not be completed if the work involved by '! Total No. Additional 3 a CITY ( qjkI o.
the permit is for one hundred dollars-($100)or less.) PLAN CHECK
I certify that in the performance of the work for which this APPLICANT
permit is issued, I shall not employ any y manner
' so m t i issued,
me ublect to the Worker mpensa ion Laws. I Lighting Fixtures First 20 �3 ADDRESS.
Additional
Date `L—Applicant Total No. �� CITY Tel. No.
NOTICE T AP lICANT: .If, after making this Certificate of 'Fixed Appliances Not�ver 1 HP PERMIT
ALO,if
Exemption, you should become subject to the Workers' Range— Heater`�.W. APPLICATION
Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS
with comply with such provisions. or this permit shall be I Top . FAU —W.H. —
deemed revoked. Hood � Fan —Other CITY Tel. No.
• —
LICENSED CONTRACTORS DECLARATION LICENSE OR
Disp. — Room Air Cond. — Class.
I hereby affirm that i am licensed under provisions of Chapter 9 REG. NUMBER
(commencing with Section 7000)of Division 3 of the Business ! Power Apparatus&Large Appliances DISTRICT NO. P O ESSLcED BY a
and Professions Code,and my license is in full force and effect. II ��y�
Size&Type HP, KW, KVA, or KVAR J O
License Number Lic. C1 Up Up to 1 Incl.. FINAL U'
Over 1 to 10 Incl. DATE 7 = VALIDATION
Contractor Date Over 10 to 50 Incl. FINAL C� ~
❑ I am exempt under Sec. I, Over 50 to 100 Inc. By U
W
B.&P.C.for this reason I Over 1.00 (L
Date: ' Services, Wbd� jC . I ards U)
0-200 Afi!p- Dnder b00 .1 � , Z
Signature 201 1000 Amp. Under 600 V
❑ i Exemption for Reg. Mairit. Elect. .Over 1000 Amp. or Over 600 VI
SINGLE FAMILY I Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License I Sign.with One Branch Circuit
Law for the following-reason (Section 7031.5, Business and ,Additional Sign Branch Circuits f" I ''T
Profess' Code-):. }.:.
I, as owner of the property, will do the work and the Misc. Conduits&Conductors
structure is not intended or offered for sale Section 7044, Other (See Complete Fee Schedule)_
Business and Professions Code). + , In.
0.)6
CONSTRUCTION LENDING AGENCY t:! ;Mi'.� ,=L ?L
I hereby affirm that there is a.construction lending agency for !
the.performance of the work for which:this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
'PLAN CHECKING FEE _
Lender's Name t: w "
PERMIT ISSUING FEE I "�_"" "'�?� i '} rfi,f i
Lender's Address
•l certify that I have read this application and state that the TOTAL FEE
above information is correct. I agree to comply with all County
ordinances a e taws regulating Electriddl wiring, and !
hereby ou ize rep sentatives•of this County t enter upon
the above entione property for inspection,p po S.
1 '
SEE REVERSE FOR EXPLANATORY LANGUAGE
0 ' 'Z.
gnature of Permittee D e ( ®s
r,
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1209120035
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 5903 LT': 51 1 6103 MUSCATEL AV
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:] TEMP CA 91780
[ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
15386-009-046 1A1 PERMIT ISSUANCE FEE 27.80 1 THOMAS PAGE: 596 GRID: G2 LOCALITY: TEMPLE CITY, Cl
IGl OUTLETS-LGT,SW,RECP 20.00 OUT 40.00 1 I
(TENANT: IG2 LIGHTING FIXTURES 5.00 LGT 10.00 IISSUED ON: PROCESSED BY: PLAN BY:
IH2 RES GRBG DISP IT 3HP 1.00 DIS 11.00 09/12/12 SR I
1 IH4 RES RANGE HDS IT 3HP 1.00 HOO 11.00 1 ]
(OWNER: TEL. NO: TOTAL FEES 99.80 IFI,AL DATE FINAL BY: CODE: ]
[WONG, DAVID (972) 623-7820- I ] ]
16103 MUSCATEL AVE I I ]
ITEMPLE CITY CA 91780 I IDOCRIPTIO19 OF WORK ]
I I (ADD 20 OUTLETS, 5 LIGHT F S, GARBAGE DISPOSAL FOR I
I I IKITCHEN AND 3 BATHROOMS REMODEL 1
APPLICANT: TEL. NO:
SAME AS OWNER
I I ISPECIAL CONDITIONS: 1
I I I I
[CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE [
ISAME AS OWNER - I I I
I LIC. NO 1 [TEMPORARY POWER POLE I I I
[ [ ]UNDERGROUND CONDUIT I I [
I I I
]ARCHITECT OR ENGINEER: TEL. NO: 1 IUFER GROUND I 1
LIC. NO: I IROUGH CONDUIT i [
(ROUGH WIRING i� 1
] [ IMAIN WATER LINE
] ] IPLASTIC Y/N METAL Y/N I I
I ] [UTILITY COMPANY NOTIFIED( I I
I I I I I
I I I I
I I I I I I
I I I I I
I I I 1 I I
I I I i I I
IREPORT ID: DPR265 ROUTE TO: BS0508 I I I