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HomeMy Public PortalAbout5300 ROSEMEAD BLVD_Electrical__ ,76A6 63C-_ CE9066 12/75 APPLICATION FOR ELECTRICAL PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN New Residential Bldgs. &Pools EACH NO.' FEE ADDRESS S Ijb J 1 &2 Finaily!Sq. Ft. $ — $ LOCALITY- E Multi-family Sq. Ft — NEAREST C Residential Swimming.Pools CROSS ST. J Er OWNER RM NAME ' /L oc"C.n"11 Outlets: Light, Switch &Receptacle MAIL ADDRESS (` First 20 _ ^^�� ,t/ Additibnal CIT /✓� C t Tel No.rs' .�6 46 PL Lighting Fixtures: AP //gg First 20' - ADD ��++ Additional C YstN , '(4j%4L( Tel.,No.j5kJ^/ P RMIT Fixed Appliances Not Over 1 HP' A ICAN Range Heater— D;W. ADDRE Oven Dryer W.M. Top OAU W.H. CITY Tel..No. Hood Fan LICENSE OR //� REG. NUMBER: J :2 Class. a Disp. A.C. cC:)� 1 HEREBY ACKNOWLEDGE THAT I HAVE READ' HIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY O Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING I.-- Size&Type HP, KW, KVA,or KVAR ELECTRICAL WIRING. V W Up to 1 Incl. I HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR N Z Over 1 to 10 Incl. LICENSED AS REQUIRED BY S A+-LES COUNTY AND STATE OF CALIFORNIA OR THAT A' H EEG L OWNER THE ABOVE Over 10 to 50 Incl. DESCRIBED RESIDE P O ER Over 50 to 100 Incl. PER A1TEE Over 100 SIGNATURE DISTRICQ. P.RO"CE SES 'DBY9�_� Services ! © CJ-%'"`-1 � • .0-200 Amp: Under 600 V kj 201 -1000 Amp. Under 600 V APPROVALS DATE INSPECTOR'S SIGNATURE Over 1000 Amp.or Over 600 V. TEMP. POWER POLE Temp. Power Pole&Appurtenances UNDERSLAB WORK' Sign with One Branch Circuit ROUGH CONDUIT L Additional Sign Branch'Circuits , (Other)—r;,O W& V�_'C? WIRING T 171Z F- FIXTURES POWER AUTHORIZED PERMIT FEE (Sub-Total)` UTILITY CO.NOTIFIED PLAN CHECKING FEE ' (One-Fourth Permit Fee) . FINAL �' 0-77 PERMIT ISSUING FEE NOTES TOTAL FEE r,) e PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDATION C M.0. CASH, :7 4'--dbW.1,7 6A663-CES06 10/74 I - APPLIC .7ATION F E�:ECT ICAL: PERMIT COUNTY.OF LOS ANGELES ,, DEPARTMENT OF COUNTY ENGINEER ? ADDRESS ��O U -�IiYA U' BUILDING AND SAFETY DIVISION` LOCALITY E • FOR APPLICANT TO FILL''IN NEAREST • '�G f�, pf '•9 _ 1 OUTLETS NO. EACH FEE OWNER OR nn „ FIRM NAME i/1 G c,,//t 1 t.t,G u C ROSS • RECEPT. $ $ MAIL •� FIRST 20 ADDRESS LIGHT TOTAL •Y5 OVER 20 CITY r i,e i TEL. NO L � 06 SWITCH .10 PLAN CHECK FIRST 20' APPLICANT LIGHTING TOTAL 25 OVER 20ADDRESS FIXTURES ` .10 RESIDENTIAL APPLIANCES- CITY TEL, NO. I "PERMIT, RANGE DRYER_WTR, HTR. APPLICANT C �L STA, COOK ' OISP. F.A.U.' ADDRESS �Ip,�j� ,SJy�✓�� J A , SPACE.'HTR, ' AIR COND. CITY Lu A[rv'pp�•`"\ TEL. N0. 1 CLOTHES WASH. DISHWASH. "LICENSE OR / REG. NUMBER CLASS.C FAN OTHER 1.00 _ I'HEREBY ACKNOWLEDGE THAT (,.HAVE READTHISAPPLICATION 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. SIZE%& TYPE OVER. TO •,. ' 'I HEREBY CERTIFY THAT I•,AM PROPERLY- REGISTERED AND/OR 0 —.1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAII' AM THE LEGAL OWNER..OF THE, ABOVE 1 - 10 3.00 DESCRIBED` RESIDENTIAL PR PE T p 5.00 PERMITEE 10 -'50 SIGNATURE O. 50 -,100 10.00 v DISTRICT NO. - OCE S ED BY r i.e. 100 - 500 15.00 2' SIGN, GASSIGN AND ONE-Cl RCUIT 5.00 APPROVALS DATE INSPECT 'S SIGNATURE TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE, SERVI CENOTOVER 600 VOLTS OR 200 AMP 3.00 UNDERSLAB WORK . SERVI CE OVER 600 VOLTS OR 200 AM P 10.00 ROUGH CONDUIT TEMP SERVICE;POLE, &APPURTENANCES 5.00 WIRING. TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED 'UTILITY CO. NOTIFIED '- FINAL PERMIT FEE (SU B,TOTAL) NOTES:.' PLAN CHECK FEE. 'PERMIT ISSUING FEE - � � ., 3:00 TOTAL FEE, G W ,PLAN CHECK VALIDATION CK. M.o. cAsn PERMIT VALIDATION cK..'. M.o. CASH:. 1 5:5 4�{ j', 2•?� 9.0.0 A SEE•BAC K OF APPLICATION FOR COMPLETE SCHEDULE r 76A663-0,806 3-69 ' APPLICATION LIC ATION FOR .ELECTRICAL PERMIT couN NG DEPARTMENT OF COUNTY ENGINEER r^✓ BUILDING AND SAFETY DIVISION AD RELD ISS JOHN A. LAMBIE,.COUNTY ENGINEER 7MM COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY a NEAREST FOR APPLICANT TO FILL IN CR OSS ST. NO. EACH FEE $ $ OWNER �. � ,J ./ RECEIPT._ MAIL r •� ! / �`•� LIGHT TOTAL FIRST 20 .20 ADDRESS CITY TEL.NO. 7 '� ° SWITCH OVER 20 •10 ..PLAN CHECK.. — _ LIGHTING TOTAL. FIRST 20 ,20 APPLICANT - G - FIXTURES } OVER 20 :,10 ADDRESS`�a_ f1 !! - •� RANGE_DRYER_WTR. HTR. CITY TEL.NO.41_-' � , STA. COOK`DISP. F.A.U. CONTRACTOR/ �',;^> SPACE HTR. AIR COND. 'ADDRESS/o/ jJ;' ♦' /� C f� CLOTHES WASH. DISHWASH. CITY ?;'/,.'��y/N,�G�- TEL.NO,j FAN OTHER 1.00 LICENSE NO. - ' :/ - CLASS. 131 MOTORS,TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION IND. HEATERS, ETC. HP. KW. KVA, AND STATE THAT THE ABOVE IS CORRECT-AND AGREE TO COMPLY SIZE & TYPE OVER TO WITH,ALL COUNTY' ORDINANCES AND .STATE LAWS 'REGULATING ELECTRICAL WIRING. - O -' 1 1.00 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS .ANGELES COUNTY AND STATEOF ' 1 - 10 3.00 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,.AND INTEND TO LL RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. O 10 - 50 5.00 V SIGNATURE p� 50 - 1.00 10jDO OF PERMITTEE Q H 100 - 500 15.00 DISTRICT NO. GROUP ZONE ROC SSED BY W GAS SIGN AND ONE CIRCUIT 3.00 u —�'� N Z ��st�• MM IBE ADDITIONAL CIRCUITS 1.00 NOTES:- - OT OVER 600 VOLTS OR 200 AMP 50600 VOLTS OR 200 AMP 5.00 1 *IC-EPOLE, &APPURTENANCES .00 APPROVALS DATE INSPECTOR'S SIGNATURE (, TEMP. POWER POLE a . UNDERSLAB WORK ROUGH CONDUIT kT >� PERMIT E (SUB TOTAL) FIXTURES t PLAN CHE FE RMIT FEE) POWER AUTHORIZED �q',0- PERMIT IS NGFE L UTILITY CO.NOTIFIED ;,.t''ger! SUPPLEMENRY PE r- S FINAL Ml+f � UING FEE � TOTALFEE p �� JOSEPH C. ROOHAN . G SUPERVISING ELECTR CA 'E.NGINEER PLAN CHE A 1 A ION CK M.O. CASH PERMIT VALIDATION M.6. CASH- Lo0 6 ? 7 J 322 l 8.00 SEE BACK OF APPLICATION F"'OR COMPLETE FEE SCHEDULE v, - " Iw>1�(lle ' Cc y ' •—.. ,.-76A663_CE80611-7'Iy APPLICATION FOR ELECTRICAL PERMIT ' i COUNTY OF LOS ANGELES •DEPARTMENT OF COUNTY- ENGINEER. BUILDING + BUILDING AND SAFETY DIVISION ADDRESS LOCALITY . i /e- . C ( T NEAREST FOR APPLICANT TO FILL IN CROSS ST. OUTLETS NO. EACH FEE - - OWNER $ $ RECEPT. 9 _ MAIL - LIGHT lr-.o TOTAL FIRST 20 20 .25, D6 .ADDRESS SWITCH .ice 8.1 �.� .10 G �• CITY ' TEL. N0. - OVER 20 PLAN CHECK - 0 APPLICANT LIGHTING - .25 ��.Q TOTAL FIRST 2 FIXTURES / OVER-20 10 �O' ADDRESS - - RESIDENTIAL APPLIANCES clTv TEL. N0.PERMIT / /� RANGE DRYER_WTR. HTR. APPLICANT U�6f� -Wnl7 J ° �Ge-C.r STA. COOK DISP. - F.A.U. ADDRESS, ppB)(_ SPACE.HTR. AIR COND. CITY S© L�141^D!nJ Tiz TEL. NO. (O7ij CLOTHES WASH. DISHWASH. LICENSE N0. 9ZZ Z/ CLASS. G`!O 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. SIZE & TYPE OVER TO _ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR O — 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF .CALIFORNIA OR THAT LAM,THE LEGAL OWNER OF, AND INT TO r/iS� /�sS 1 �'.1 O 3.00 O O RESIDE IN, THE AB OV DES fBED RESIDENTIAL PRO RTY. O SIGNATURE _ ox.�3raAri �GJZI/]P2, 10 - 50 5.00 ��© OF PERMITTEE 50'- 100 10.00 �j DICT NO. JCLASS ZONE. PROCE_S ED BY 100 - 500 - 15.00 _Z r SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES�� .TUBE, OR ,MARQUEE. ADDITIONAL"CIRCUITS '.1.00 - - SERVICENOTOVER600 VOLTS OR 200AMP 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE SERVICEOVER600VOLTS OR200AMP 10.00 0Q) TEMP.POWER POLE TEMP SERVI CE,,POLE, &APPURTENANCES 5.001.. 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. ' FI NA PERMIT ISSUING FEE 3.001- rt3 - d 0 TOTAL FEE ' ��//'' PLAN CHECK VALIDATION CK. M.O. CASH aPERIAIT VALIDATION OK M.O. CASH .. 1. -D, 2 D 5.1..50~ N SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE ' 76A663CE80610/72 APPLICATION FOR ELECTRICAL PERMIT '"COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER JOB r - BUILDING AND SAFETY DIVISION- ADDRESS 5 3 ,S-&� �. LOCALITY NEAREST FOR APPLICANT TO FILL IN NEARES CROSS ST. OUTLETS N0. EACH FEE OWNER OR . $ Is FIRM NAME RECEPT._ MAIL FIRST 2025 ADDRESS LIGHT TOTAL CITY TEL, NO. SWITCH OVER 20 .10 PLAN CHECK LIGHTINGTOTAL FIRST 20 25 APPLICANT FIXTURES 10 OVER 20 ADDRESS RESIDENTIAL APPLIANCES CITY TEL. NO..PER IT RANGE DRYER_WTR. HTR,_ APPLICANT C.TP`I�V STA. COOK DISP. F.A.U_, ADDRESS 1700 1,—) f�6/ k A W ILS� 7� SPACE HTR. AIR GOND. CITY L-,,,O " P' 16,7CAC'4TEL. N0.777T-3&Z7 CLOTHES WASH, DISHWASH. LICEREG.NUMBER ,z v CLASS. Chi ,; FAN OTHER 1.00 1 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 IN TYPE OVER TO I HEREBY CERTIFY THAT .1 AM PROPERLY REGISTERED AND/OR ' 0 -. 1 100 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAII AM THE LEGAL OWNER OF THE ABOVE a 1 - 10 3.00 OESCRIPED2RELNTIAL ` PROPERT � � U PERMITEE 10 — 50 5.00 SIGNATU CD 50 — 100 10.00 c DISTRICT NO. PROCESSED BY LL.I aL 1 00 — 500 15.00 J Z t SIGN, GAS SIGN AND ONE CIRCUIT 5.00 TUBE, OR APPROVALS DATE INSPECTOR'S SIGNATURE MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE I SERVICENOTOVER 600VOLTSOR2OOAMP 3.00 UNDERSLAB WORK SERVICEOVER600 VOLTS OR 200AMP 10.00 ROUGH CONDUIT TEMP,SERVICE,POLE, &APPURTENANCES 5.00 WIRING TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES POWER AUTHORIZED` ' UTILITY CO. NOTIFIED ' FINAL �l PERMIT FEE (SUB TOTAL) - NOTES: PLAN CHECK FEE ' PERMIT ISSUING FEE 3.00 (70 - r� TOTAL FEE 00 PLAN CHECK VALIDATION CK. M.O. CASH PERMIT V LID TION cK. M.G. CASH �`r, 0 1 6 27 3 WAR 2 2 2 9.00- SEE .GGcmSEE BACK OF APPLICATION FOR COMPLETE SCHEDULE .. l _ WORKERS'COMPENSATIONDECLARATION' 764663APPLIC 4TI®N. FOR. ELECTRICAL PERMIT a . CE-806G (2 B0) I`:hereby. affirrri that I' have a certificate-of consent to self- .`COUNTY OF NGELES BUILDING•AND SAFETY insure', or a,certificate of Workers'Compensation Insurance,or 'a certified copy,thereof(Sec. 3800;•Lab. C.)' FOR APPLICANT TO' L IN JO ( Policy No. Company ADDRESS �J� �T cif . �1J• NeW.ResldentW Bldgs.&Pools • ACH NO. F .F� Certified copy-is'.hereby.furmshed 1,&2-Family,Sq. Ft. $' $ LOCALITY Multi-family Sq. Ft.- NEAREST' �/ 1 Certified,copy'is filed with the county building inspection y' ' CROSSST Residential Swimming Pools department. i OWNER ORIC FIRM NAME CI Date Applicant s; Rec_Cight` Svv -MAIL _ Outlet • ,. .. First 20 ADD CERTIFICATE`OF EXEMPTION FROM WORKERS' ' A Total No. Additional CIT R Tel COM.PENSATION.INSURANCE ESS. } :'PLAN CHEC d (This section need not.tie completed if.the work involved y the permit ;is.for. one'hundred.,dollar`s',($ Lightin Fixtures First 20 b 100) or less.): . APPLICANT 9 ADDRESS T I certify that in.fhe performance of the'work for:which this Total No..' AddiLo nal Fixed Appliances Not Over 1 HP CITY permit is issued-, I shall'not'employ any perso in an`y.manner PERMITS Tel-No.' 0 �^C o so as'to become subject'to the Wor s' o e saLion+La s. Range_ Heateir_D.W. APPLICANT,/—IF7 4 ��V �� W Oven 'Dryer-W.M. Date(I, 'l QQI tlpplicant Top FAL) _W H ADDRESS 5 a'� S► Z Hood Fan _Other'_ CITY ��T 66,VIpjTel No. /�/a ` l 6 NOTICE.TO APPLICANT. If;,after making this Certificate of 'Disp.._ Room.Air Cond. LICENSE OR h Exemption, you should become subject to the Workers'- REG.NUM ER la B /�o I�� ssC. Compensation piovisions.of the Labor,.Code,.you must forth: Power Apparatus&;Large Appliances DISTRICT O. P S D BY with comply with such provisions or this permit shall he, K r deemed revoked:.' - Size&Type HP,KW, 4 VA,o KVAR -����' , Up to 1 Incl. �J - FINAL Over 1 t 10 Incl DATE 7 VALIDATION LICENSED CONTRACTORS•DECL 9RATION Over 1'O to 50 Incl: I hereby..affirm that I am licensed under provisions of'Chapter Over 50 to'100 Inc 9 (commencing with Section 7.000) of Division 3 of-the Busi- :Over100,,_ FINAL' 'r B Y ness and.Professions.Code;and my license is in full force;and L cense;Number Services r • �?���'��� � 0-200-Amp. Under 660'V - aCL Lac.Clas' Contractor. e� ��2L 'L-bat Over201 1100 O00 Amp;Under 600 V ^`�� 1 e Amp.or Over.600 V DECLARATION : Temp,;Power Pole-&'Appurtenances z p,1 :9�[t A- I hereb HOI��O hNYER-BUILDERSign with One Branch Circuit ' exempt .from. the Contractors o;o o 0.0 2 License Law for the following reason (Section:7031.5,, Busi- .Additional';$ign Branch Circuits ness and Professions Code): % 2 0`'0l1 Misc:Conduits'&Conductors. 0 I as owner,of the,property; will do the work and'the GO 0. Other (See Complete Fee Schedule) o o`0 1 O a structure is not intended or.offered for sale .(Section 0 Q.0 7044, Business and Professions Code), CONSTRUCTION-LENDING AGENCY 0 `1 1:hereby affirm that there 'is a+construction lending agency for the erformance of the work"-fon-which this permit is issued e performance Civ.of . p PERMIT FEE (Sub-Total,) y r l 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 above information is correct:I'agree to comply with all County., ordinances and state 'iaws regulating Electrical wiling, and z_ hereby authorize epresentatives of this Counfy'to enter upon } - .the e f e rproperty f inspection purposes. - >. SEE REVERSE-FOR EXPLANATORY LANGUAGE . .15 Signature o ermittee; Date `° WORKERS'COMPENSATION DECLARATION CE 806 (2-80) APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self COUNTY OF L S N EL S BUILDING AND SAFETY insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab. C.) 7 FOR APPLICANT TO.FILL IN JOB Policy No. Company EACH NO. FEE ADDRESS P New Residential Bldgs.&Pools O Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — $ LOCALITY F-1 Multi-family Sq. Ft. — NEAREST } Certified copy is filed.with the county building inspection CROSS ST department: Residential Swimming Pools OWNER O 1' FIRM NAME \(j- '� Date Applicant Outlets: Rec.—Light— Sw. ADDRESS First.20 i CERTIFICATE OF EXEMPTION FROM WORKERS' Total No. Additional CIT W Cn IE, 1� Tel No o COMPENSATION INSURANCE PLAN CHECK APPLICANT U �- (This section need not be completed if the work involved LightingFixtures by the permit is for one hundred dollars ($100) or less.) FiFirst ADDRESS Total No. Additional � 0 I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY Tel No. permit is issued, I shall not employ any person in any manner PERMIT W so as to become subject.to the Workers' Compensa 'on Laws. Range_ Heater_D.W. APPLICANT - 1 it i Oven _ Dryer_W.M._ ADDRESS 10 I Top _ FAU _W.H.. Date plicant t,-^tire ,\ JX y� �: rIul Hood Fan' _Other— CITY 1`I Tel No.i �'`J NOTICE TO APPLICANT: If, after making this Certificate of Disp. _ m RooAir Cond. LICENSE OR i� ` Exemption, you should become subject to the Workers' REG.NUMBER_ �+ \� Class Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PR D BY with comply with such provisions or this permit shall be Size&Type HP,KW, KVA,or KVAR deemed revoked. Up to 1 Incl. FINAL Over 1 to 10 Incl DATE VAI IDATIO :� LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. I hereby affirm.that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL BY 9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 ness and Professions.Code, and my license is in full force and effect. Services License Number Lic.Class 0-200 Amp. Under 600 V /, �e � 201-1000 Amp. Under 600 V Contractor Date Over 1000 Amp.or Over 600 V -P439.5A HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances Sign with One Branch Circuit # 0.0.0 0 0 2 I hereby affirm that I am exempt from the Contractor's Additional Sign Branch Circuits License Law for the following reason (Section 7031.5, Busi 2 0.0 12 5 0 ness and Professions Code): Misc.Conduits&Conductors o 0;0 2:5 0`:6) El I, as owner of the property, will do the work and the Other (See Complete Fee Schedule) structure is not intended or offered for sale (Section 7044, Business and Professions Code). 061 '7-82 CONSTRUCTION LENDING AGENCY _ � S I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is PERMIT FEE (Sub-Total) issued(Sec. 3097,Civ.C.). 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 o above information'is correct.I agree to comply with all County ordinances and State laws regulating Electrical wiring, and - hereby thorize epresentatives of this County to enter upon thea menf ed op ty for i pection urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signat re of.Permittee Date '. „�: WORKERS' COMPENSATION DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT I'fiereby affirm that I have a certificate of consent to self CE-806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES ,'A �IIIIGAjV� AFETY or a certified copy thereof (Sec. 3800, Lab. C.) 1i C1 L Y L Policy No. Company FOR APPLICANT TO FILL IN JOB T v �p Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 00 Iy A ROS1a iEAD BLVD. ❑ LOCALITY TEMPLE Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ — $ .L.fai'�P11L� CI IY tion department. Multi-family Sq. Ft. — NEAREST SERENO Residential Swimming Pools CROSS ST. 'D AA Date Applicant C OWNER OR .H.5• .A L TA FIRM NAME '-., -gT CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL Outlets: Rec Light Sw.— ADDRESS .501 E LEl'400,” COMPENSATION INSURANCE First 20 E. (This section need not be completed if the work'involved by Total No. Additional CITY TEI�'I�'ZE CITY Tel. No I, 6 1 the permit is for one hundred dollars ($100)or less.) 1 certifythat in the performance of the work for which this PLAN CHECK P APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Work s'Compensa ' n Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional 6-�10-8 � � � CITY, Tel. No. Date J Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Range_ Heater_D.W. — APPLICANT DALES ET, ,CiTRIC Compensation provisions of the Labor Code, you must forth- Oven — Dryer — W.M.— ADDRESS P.O. Box 429 with comply with such provisions or this permit shall be Top _ FAU —W.H. — {� deemed revoked. Hood _ Fan _Other_ CITY SAN GABRIEL 8 - LICENSED CONTRACTORS DECLARATION ` LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. t REG. NUMBER 276218 Class. Cis .0, (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESSED BY and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances o Size &Type HP, KW, KVA, or KVAR' 5.C}6 O License Number 2r7/621 8 Lic. Class C-10 Up to I Incl. FINAL v Over 1 to 10 Incl. DAT — VALIDATION ad Contractor Date 4?0/ 11Over 10 to 50 Incl. FINAL � ❑ I am exempt under Sec. Over 50 to 100 Inc. BY LM B.&P.C. for this reason Over 100 Z Services, Swbd., MCC& Panelboards Date: 0 -200 Amp. Under 600 V. Signature 201 - 1000 Amp. Under 600 V ;9 2 2 9,4 A ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V "# © © 0 0 0 2 SINGLE FAMILY Temp. Power Pole &Appurtenances a 5 0 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits '0001 ,55006 Law for the following reason (Section 7031.5, Business and Professions Code): 0 6,. 20-85 ❑ I, as owner of the property, will do the work and the Misc. Conduits &Conductors structureis 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 _g2 _ 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 (03 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 the a ve- en' n d prop ty for inspection purposes: SEE REVERSE FOR EXPLANATORY LANGUAGE 6-10-85 gnat re of Permittee. Date WORKERS' COMPENSATION DECLARATION CE-806 to/st APPLICATION FOR ELECTRICAL PERMIT A I hereby affirm that I have a certificate of consent to self CE-806G , insure, or a certificate of Workers' Compensation Insurance, I COUNTY OF LOS ANGELES BUILDING AND SAFFTY or a certified copy thereof (Sec. 3800, Lab. C.) r Kawasaki Pk. Lot Policy No. Company FOR APPLICANT TO FILL IN JOB n Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 00 Ns Rosemead Blvd ❑ Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY Temple City tion department. Multi-family Sq. Ft. — 'NEAREST Sereno CROSS ST. Date Applicant Residential"Swimming Pools OWNER ORFF'® . e ase 'nam. FIRM NAMEs. Mmm CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets: Rec Light Sw. ADDRESS 9501 E. Lemon, First 20 (This section need not be completed if the work involved by Total No. Additional CITY Temple, City Tel. No.355-3691 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 person in any manner so as to become subject to the Work s'C pensation Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional CITY Tel. No. Date J Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANTDale f S. El.eCtrl.C: Exemption, you should become subject to the Workers' Range_ Heater_D.W. _ p Compensation provisions of the Labor Code, you must forth- Oven — Dryer — W.M.— ADDRESS 1668 Sandia Ste with comply with, such provisions or this permit shall be Top ^ FAU —W.H. eS Covina Tel. No. deemed revoked. CITY• 33 —936 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 276218 Class. C_10 (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESS BY and Professions Code, and my license is in full force and effect. Power Apparatus & Large Appliances 0. Size &Type HP, KW, KVA, or KVARS-O 0 License Number lic. Class . l_ Up to 1 Incl FINAL / ) 09 Over 1 to 10 Incl. DATE VALIDATION 0 Contractor Date Over 10 to 50 Inc). FINAL U ❑ I am exempt under Sec. Over 50 to 100 Inc. BY d B.&P.C. for this reason Over 100 Services, Swbd., MCC& Panelboards Date: 0 - 200 Amp. Under 600 V I! Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp: or Over 600 V SINGLE FAMILYs 2 0 31 A HOME OWNER-BUILDER DECLARATION Temp. Power Pole &Appurtenances Sign with One Branch Circuit P' o 0 0 o o 2 I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits • Low for the following reason (Section 7031.5, Business and Professions Code): , 20 . 1550 ❑ I, as owner of the property,.will do the work and the Misc. Conduits&Conductors o 0 0 1 .5 ,rj 0= �; structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— ► 7044, Business and Professions Code). 0 6 1 5-84 w •, ; CONSTRUCTION LENDING AGENCY empor ary -e p m 'e Fireworks Stand � 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 v PERMIT ISSUING FEE O Lender's Address I certify that I have read this application and state that the TOTAL FEE S U 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 the ab do e roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE G . Signatu of Permittee Date WORKERS' COMPENSATION DECLARATION CE-806G10/81 APPLICATION FOR ELECTRICAL PERMIT I�her,by.affirm that I have a certificate of consent to self insure: or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY 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 53001 N. ROSEMEAD BLVD• copy y New Residential Bldgs. & Pools ❑ 1 & 2-Family, S Ft. $ _Is LOCALITY TEMPLE CITY CA. Certified copy is filed with the county building inspec- Y, 9 p� tion department. Multi-family Sq. Ft. '&ft&NO-KAWASAKI PARKING LOT.' Residential.Swimming Pools OWNER OR Date Applicant FIRM NAME • • • • CERTIFICATE OF EXEMPTION FROM WORKERS'( Outlets: Rec Light Sw._ MAIL COMPENSATION INSURANCE ADDRESS 01 E. LEMON: AVE. This section need not be'completed if the work involved b First 20 the permit is for one hundred dollars ($100)or less.) Y Total No. Additional CITY TEMPLE CITY Tel. No. X55-3'691 PLAN CHECK I certify that in the performance of the work for which this APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Woc rs' mpens do Laws. Lighting Fixtures First 20 ADDRESS Total No. Additional 5_3_88 CITY Tel. No. Date Applicant Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT DALES ELECTRIC 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 P.O. BOX 1+2 with comply with such provisions or this permit shall be Top , FAU —W.H. — deemed revoked. Hood _ Fan `Other_ CITY SAN GABRIEL CA.el. N0287-862_7 LICENSED CONTRACTORS DECLARATION Room Air Cond. LICENSE OR 2_7621V Q Class. I hereby affirm that I am licensed under provisions bf Chapter 9 Disp. — — REG. NUMBER ( (commencing with Section 7000) of Division 3 of the Business DISTRICT 5�,, PROCES and Professions Code,and my licens is in fuII for and ebct. Power Apparatus & Large Appliances / 0.�} OC?L/ � !{ Size & Type HP, KW, KVA, or KVAR' (J (, O IV U License Num e �`' Lic. Class`— Up to 1 Incl. FINAL 09 5.3-88 Over 1 to 101ncl. DATE ��. � � VALIDATION Contractor ate Over 10 to 50 Incl. FIN U ❑ I am exempt under Sec. Over 50 to 100 Inc. B.&P.C. for this reason Over 100 4400 Services, Swbd., MCC & Panelboards f 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. ;2978.6A SINGLE FAMILY Temp. Power Pole& Appurtenances HOME OWNER-BUILDER DECLARATIONo o . o 0 2 Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits ( o - 15.50 Law for the following reason (Section 7031.5, Business and Professions Code): o 0 0 1 5.5 0 6 ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale (Section Ot r S C Fee Schedule)— , 0606-88 7044, Business and Professions Code). ��0��'. CONSTRUCTION LENDING AGENCY F J 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 v 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 a'nd State laws regulating Electrical wiring, and A ze representatives of this County to enter upon e- do property inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 5-3:-88 ignature of Permittee Date • ,v0 _`WORKERS'COMPENSATION DECLARATION 76A663 10/81 There v affirm YMt I have a certificate of consent to self insure, CE-806G APPLICATION FOR ELECTRICAL PERMIT {� or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY �J copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs.& Pools EACH NO. FEE ADDRESS 5300 N. Rosemead Blvd. Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY Templ a City, CA department. ' Multi-family Sq.Ft. NEAREST 13erno Kawasaki Park.ing Lo- CROSS ST. Residential Swimming Pools OWNER OR- - • ase;5a lean Date Applicant FIRM NAME Parents C c- CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rec Light Sw. — MAIL COMPENSATION INSURANCE First 20 ADDRESS 9501 E. Lemon Ave. (This:section need not be completed if the work involved by the CITY Temple City CA Tel.No. 3515-3691 permit is for one hundred dollars($100)or less.) Total No. Additional CHECK PLAN I certify that in the performance of the work for which this,permit APPLICANT I is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. Lighting Fixtures ! First 20 ADDRESS Additional Dkalif -i 1-89 Total No. CITY ' Tel.No. aleS El PER-: I Fixed Appliances Not Over 1 HP PERMIT NOTICE TO •APPLICANT:- If,. after making this Certificate 'of APPLICANT Dale's Electric Exemption,you should become subject to the Workers'Compensation Range_ Heater_ D.W. provisions of the Labor.Code, you must forthwith comply with such Oven _ Dryer _ W.M.— ADDRESS 672 Ardilla Street provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _ - CITY La Puente CA Tel.No.287-862.7 LICENSED CONTRACTORS DECLARATION• Hood — Fan Other_ ' I hereby affirm that I am licensed under provisions of Chapter 9 LICENSE OR (commencing with Section 7000) of Division 3 of the Business and Disp. Room Air Cond. REG.NUMBER 276218 Class.C-i0 Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO.� PROCESSED Size& Type HP,KW,KVA,or KVAR License Number 27621 R Lic.Class C-10 Up to 1 Incl. FINAL U Over 1 to 10 Incl. DATE Contractor "�?1 �'�' F1 Pr i.ri r Date Z I—�� VALIDATION IX v / ❑ Over 10 to 50 Incl. I am exempt under Sec. Over 50 to 100 Inc. W BAP.C.for this reason Over 100 Q„ Services,Swbd.,MCC&Panelboards N t 0-200 Amp.Under 600 V Signature201 - 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 21 1 hereby affirm that I am exempt from the Contractor's License Law 8 for the following reason(Section 7031.5, Business and Professions -Additional Sign Branch Circuits oa (� {C c; Code): :r,.r3.+� 1:�o:Etl ❑ Misc.Conduits &Conductors 1,as owner of the property,will do the work and the structure 1 ITEMS is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) TOTAL and Professions Code). , ® Temporary �+/•� �•^{ CONSTRUCTION LENDING AGENCY 1 c d CHECK 15.50 1 hereby affirm that there is a construction lending agency for the Fireworks Stna performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) `� CHANGE .011 Civ. C.). PLAN CHECKING FEE Lender's Name1 _�I OOM-17001 5/16/89 PERMIT ISSUING FEE Lender's Address , 3297 1 AM 8:4t 1 certify that I have read this application and state that the above TOTAL.FEE —5 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 the above-mentioned grope t for" giourpose SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of ermittee Date WORKERS'COMPENSATION DECLARATION 10/81 APPLICATION FOR ELECTRICAL PERMIT ' I hereby affirm that I,have a certificate of consent to self CE-806G insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY ora certified copy thereof (Sec. 3800, Lab. C. KAWASAKI PARKING LO Policy No. Company FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS - , ❑ Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ _ $ LOCALITY ' PLE CITY" tion department. Multi-familyS Ft.9• —'NEARESTCROSS ST. ERE,NO Date Applicant Residential Swimming Pools OWNER OR -L U.11 0. ffAbEffAlli. FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' MAIL COMPENSATION INSURANCE Outlets: Rec Light Sw. 95 EMON ADDRESS O This section need not be completed if the involved b First 20 1 E. L ( ip Y Total No. Additional CITY TEMPLE CITY Tel. No. the permit is for one hundred dollars ($100)or less.) 1 certifythat in the performance of the work for which this PLAN CHECK P APPLICANT permit is issued, I shall not employ any person in any manner so as to become subject to the Wor rs'Com e ation Laws. Lighting Fixtures First 20 ADDRESS 6-6-86 Total No. Additional CITY Tel. No. Date Applicant FiO xed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT DALES ELECTRIC 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 P.o. EO 429 with comply with such provisions or this permit shall be Top. FAU —W.H. — deemed revoked. CITY SAN, GABRIEL Tel. Na.28 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 2,762 1 8 Class. C_ 10 (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCES D BY >. and Professions Code,and m license is in full force and effect. Power Apparatus& Large Appliances Y r J @s Size &Type HP, KW, KVA, or KVAR' t L/ 0 License Number 276218 Lic. Class C-1 O Up to 1 Incl. FINAL . at Over 1 to 10 Incl. DATE /� L� VA ATION Contractor Over 10 to 50 Incl. FINAL vV u ❑ I am exempt under Sec. Over 50 to 100 Inc. BY UA Over 1'00 B.&P.C.for this reason g Services, Swbd., MCC& Ponelboards ate: 0 - 200 Amp. Under 600 V r F Signature 201 - 1000 Amp. Under 600 V <w Ca - ❑ Over 1000 Amp. or Over 600 V , Exemption for Reg. Maint. Elect. ` SINGLE FAMILYTemp. 8 3'1 A Temp.Power Pole & Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit # o.o-o o o 2 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 ( o o:1 5 5.0 Professions Code): ❑ I, as owner of the property, will do the work and the Misc. Conduits&Conductors o o,-1 5,505 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)— , 7044, Business and Professions Code). nNP0 617-86 CONSTRUCTION LENDING AGENCY OR�R 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 Q 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 the abo -me n roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 6-6-86 Signature f Permittee Date a WORKERS'COMPENSATION DECLARATION Tn CE 806G 10/81 APPLICATION FOR ELECTRICAL PERMIT ' I het `ri,- that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN JOB SAT T�7T Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE ADDRESS 530.0 N. ROSEMEAD BLVD. ❑ Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ _ $ LOCALITY TEMPLE CITY CA. tion department. Multi-family Sq. Ft. AMN —KAWASAKI PARKING LOT Residential Swimming Pools OWNER OR . Date Applicant FIRM NAME M. CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw. MAIL COMPENSATION INSURANCE ADDRESS 01 E. LEMON( AVE Tis section neenote completed if the work involved b First 20 ( hneed b p Y Total No. Additional CITY TEMPLE CITY Tel. No355-3691 the permit is for one hundred dollars ($100)or less.) that in the performance of the work for which this PLAN CHECK I certify p APPLICANT permit is issued, I shall not employ any person in any manner so as to-become subject to the War rs' pen do Laws Lighting Fixtures First 20 ADDRESS p Total No. Additional 6-1-87 Applicant CITY Tel. No. Date Fixed Appliances Not Over 1 HP PERMIT NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Range_ Heater—D.W. — APPLICANT DALES ELECTRIC Compensation provisions of the Labor Code, you must forth Oven _ Dryer — W.M.— ADDRESS P.O. BOX 42 with comply with such provisions or this permit shall be Top _ FAU —W.H. — deemed revoked. Hood _ Fan _Other_ CITY SAN G BR Tel. N,287-8627 LICENSED CONTRACTORS DECLARATION LICENSE OR I hereby airm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. REG. NUMBER 276218 Class. off (commencing with Section 7000) of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO. P SED BY >_ and Professions Code,and my license is in full force and effect. G' r Size &Type HP, KW, KVA, or KVAR, 5 J License Number 276'218 Lic. Class C-10 Up to 1 Incl. FINAL6J DALES ELEC 6-1-87 Over 1 to 10 Incl. DATE�'_� - _ Q� Contractor Date FINAL I am exempt-under Sec. Over 50 to 100 Inc. BY G VALIDATION 0— ❑ Over 10 to 50 Incl. LU Over 100 B.&P.C. for this reason Date: Services, Swbd., MCC& Panelboards ► — 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 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I 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 Professions Code): ❑ 1, as owner of the property, will do the work and the Misc. Conduits&Conductors structure is not intended or offered for sale (Section Other (sere Complete Fee Schedule)_ 7044, Business and Professions Code). u uu"1P0tfH Y ► -2 7 2 9.2 A CONSTRUCTION LENDING AGENCY F STAAm # 0 0 0 0,© 2 1 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) 4 o o 1 5 J5 0 (Sec. 3097, Civ. C.). PLAN CHECKING FEE o ° ° 1 5 5 0 c=.) Lender's Name PERMIT ISSUING FEE p 0 6 2 2-8 7 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 lawsregulating Electrical wiring, and hereby authorize representatives of this County to enter upon the"Z nti propert 'r inspection�?.gurpose —1-87 SEE REVERSE FOR EXPLANATORY LANGUAGE Si ature of Permittee Date