HomeMy Public PortalAbout6380 OAK AVE_Electrical__ " oRK s'COMPENSATIONDECLARATION 1
0E-806G (2-80) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self • COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure, or a certificate of Workers' mpensation Insurance,0&42 �
er if' o cogy,t}er90 61 -ir-
�C�� 300; ab.C.)
//�r , ;7, FOR APPLICANT TO FILL IN JOB 7
Policy p ADDRESS 7
Kew Residential Bldgs.&Pool EACH NO. FEE c/
Certified copy is hereby furnished.-7— &2-Family,Sq. Ft. $ — $ i?� LOCALIT
�q Multi-family Sq. Ft. — NEAREST y�
I'�XCI Certi ed copy is filed with the county building inspection CROSS ST
de t nt. Residential Swimming Pools OWNER OR Q //
/ FIRM NAME/ (� "4/ /Y
Date Applican ` Outlets: Red Light Sw., J ADDRESS
First 20
R. IFICATEOF•EXEMPTIONFROM WORKERS' TotalNo. *::� Additional CITY Tel No. >_COMPENSATION INSURANCE PLAN CHECK a
(This section need not be completed if the work involved APPLICANT U
by the permit is for one hundred dollars ($100) or less.) Lighting Fixt rt First 20 ADDRESS
Additional W
Total No. O
I certify that in the performance of the work for which this CITY Tel No.. I..
Fixed Appliices Not ver 1 HP
• permit is issued, I shall not employ any person in any manner _/ / PERMIT W
so as to become subject to the Workers'Compensation Laws. Range V HeaterYD.W. N APPLICANT P, � a& e/ p„
Oven Dryer M. ADDRESS y
,cc. a Z
Date Applicant Top —,*AU .H.,� CITY Tel No.
Hood ,_ Fan _Other_ e171?�D- 4 �!
NOTICE TO APPLICANT: If, after making this Certificate of Disp. .i[Room Air Cond._ LICENSE OR
Exemption, you.. should become subject to the .Workers' REG.NUMBER C 0 7 Class
Compensation provisions of the Labor Code, you must forth= Power Apparatus&Large Appliances DISTRICT NO. P D BY
with comply with such provisions or this permit shall be
deemed revoked. Size&Type HP,KW,KVA,or KVAR
Up to 1 Incl.
FINAL
LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE ��—/�_ S�� VALIDATION
Over 10 to 50 Incl. ►O Q
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
9 (commbncing with Section 7000)of Division 3 of the Busi- Over 100 BY
ness and Professions.Code, and my license is in full force'and
'effect. Services Q�
rr 0-200 Amp.Under 600 V
License Numbe Lfc.Class 201-1000 Amp.Under 600 V
Contracto to 7 Over 1000 Amp.or Over 600 V '
HOME OWNER-BUILDER DECLARATION Temp,Power Pole•&Appurtenances
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit
License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits ,
ness and Professions Code):
Misc.Conduits&Conductors
I,,is owner of the property, will 'do the work and the Other(See Complete Fee Schedule)— i 2 3 a 4 A
structure is not intended or offered for sale (Section
7044,Business and Professions Code). ;' 0 0 0•0 0 2
, CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency 2,0 I0 39.7 C
for the performance of the work for which this permit is PERMIT FEE (Sub-Total)
issued(Sec. 3097,Civ.'C.). 0 0 0 f
CJ
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE
I certify that I have read this application and state that the TOTAL FEE W
above information is correct.I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
here authorize representatives of this County to nt upon
th ov�tl Entionejdo pety for inspection pure es. SEE'REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Ddte
- I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 -EL-EC-TR+GAL—PERMIT
• DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS LEL-0-508-9-902-1.000-1 0
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
AL D: FEES PKID B I MG_AD ESS:
ON FILE -¢380 E5 OAK AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801352
ASSESSOR INFORMATION NUMB R: NEAREST CROSS STREET: LONGDEN
5382-014-041 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY
G1 OUTLETS-LGT,SW,RECP 9.00 OUT 17.55
TENANT: G2 LIGHTING FIXTURES 2.00 LGT 3.90 ISSUED ON: PROCESSED BY: PLA Y: EXPIRES ON:
TOTAL FEES 49.20 02/10/99 UT 02/10/00
OWNER: TEL. 0: FINAL DATEFINAL CODE:
CASA ROBLES NAZARENE MISSIONARY - 7,/ G
1546 WASHINGTON BL 2`L L
PASD 911042657 s. SC J-IO F WORZ=-)
1.EJ.EgTj CAL_FOR PAT-IO'ENCL URE
APPLICANT: 0:
SAME AS OWNER -
SPECIAL CONDITIONS:
0ELES CO
CONTRACTOR: TEL. N0: - ®�J ��/,.y APPROVALS DATE INSPECTOR SIGNATURE
SAME ASLIC. NO TEMPORARY POWER POLE
UNDERGROUND CONDUIT
A C I EC 0 ENGINEER: EL. NO: / E GROUND
LIC. N�� 1111111 ROUGH CONDUIT
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MEW
U
D C WGIRWS MAIN WATER LINE
PLASTIC Y/N METAL Y/N
COP OI IE
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REPORT ID: DPR265 ROUTE TO: BS0508