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WORKERS'COMPENSATION DECLARATION: 7 ,DPW 3/87 APPLICATION FOR ELECTRICAL PERMIT Q
I h�reb'y of
that I have a certificate of consent to self CE-806G�,
insdre, ora certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
or a certified copy thereof(Sec. 3800; Lob.C.) I '
polica No. I19-74��ampany FOR APPLICANT TO FILL IN SOB
i
ertified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE ADDRESS TF/m� VM S D
Certified copy is filed with the county building inspec- 1 &2-Family, Sq. Ft. $ = $ LOCALITY J dJ�
❑
tion department. Multi-family Sq. Ft. NEARESCROSS'T.
T.
Date Y- P.Z Applicant /• Residential Swimming Pools OWNER OR CH4m,dlbV JOEULJ4Pm&Mi
FIRM NAME
CERTIFICATE OF EXEMPTION ReM WORKERS' Outlets: Rec - Light First 20 Sw._ MAIL rN
COMPENSATION INSURANCE ADDRESS �/✓ TE f400e
(This section need not be completed If the.work Involved byTotal No. Additional CITY %ou6 �p.4jW a Tel. No.y37-pt1b
,the permit is for one hundred dollars($100)or less.) r 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 Lighting fixtures First 20 ADDRESS
so as to become.subject to the Workers'Compensation Laws.
Additional
Total No. CITY Tel. No.
Date Applicant Fixed A .
NOTICE TO APPLICANT: If, after making thisppliances Not Over 1HP PERMIT'
Certificate of /
Exemption, you should become. subject to the Workers' Range— Heater—D.W. —. APPLICATION a- Sr
Compensation provisions of the Labor Code,you must forth- Oven — Dryer —W.M.— ADDRESS Sty -9
with
with comply with such provisions or this permit shall be Top — FAU —W.H. —
CITY . C/� Tel. No.f-j( 8g
, deemed revoked. Hood = Fan —Other— ®'���
LICENSED CONTRACTORS DECLARATION LICENSE OR.
Disp. Room Air Cond. — Class:
I hereby affirm.that I am licensed under provisions of Chapter 9 REG.NUMBER �O(� 9 C�{S
(commencing with Section 7000)of Division.3 of the Business Power Apparatus&Large Appliances DISTRICT NO. :PR >-
and Professions Code,and my license is in full'force and effect.
Site&Type HP0, KW, KVA, or KVAR "� GI • U
License Number S Lic. Class Up to 1 Incl. FINAL
Over 1to 10 Incl.DATE
-Zl VALIDATION O
Contractor ate❑ Over 10 to 50 Incl.. F-
I I FINAL;
am exempt under Sec. Over 50 to 100 Inc. BY /A W
B.&P.C. for this reason Over 100 a-
CD
Services, Swbd., MCC&Panelboards , Z
Date: - Z
10-200 Amp..Under,600 V
Signature 201 - 1000 Amp. Under 600 V
❑
Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY I
Temp. Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION. I :sy,i n
low
affirm that I am exempt from the Contractor's License Sign with One Branch Circuit
Law for the following reason (Section 7.031..5, Business and Additional Sign Branch Circuits
Professions Code): i TEM
❑ I, as owner of the property, will do the work and the Mis�. Conduits&Conductors „-_,
P �' Other See Complete Fee Schedule a 1.1 i tzV �' '7r = --A
structure is not intended or offered for sale(Section 7044, ( p )—
+`r r
Business and Professions.Code). i C}ECK a 5
CONSTRUCTION LENDING AGENCCHANGE"IS--
I hereby affirm that.there is a construction lending agency for '`f`'��
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.). i I.
PLAN CHECKING FEE _`,i4nZ
Lender's NamePERMIT ISSUING FEE , ` cr 'Ar :y.
Lender's Address I 00
Icertify 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 f;
hereby authorize representatives of this County to enter upon
the abov -mentione pro r for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
.2.- ���
Signa a of er ee Date ®s
I '
• 1
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9612130003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
-LEGAL ID: FEES PAID BUILDING-ADDRESS:
ON FILE 5785 ROSEMEAD BL
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
5397-012-043 Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY
K1 SIGNS, OUTLINE LGT 1.00 SIG 38.85
A : TOTAL FEES 66.60 ISS ED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
GENERAL NUTRITION 12/23/96 TC 12/13/97
OWNER: TEL. NO: FINAL DATE FINAL BY:
CALAC INVESTMENT - Z_�
3709
SAN DIEGO, CA9211137 DESCRIPTION OF WORK
�1jue NEW SIGN WITH CHANNEL LETTERS WIT INTERIOR ILLUMINATION
APPLICANT: TEL. NO:
EAGLE SIGNS (909) 593-7070-
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: �Y / ?� � Fj \ ®�APPROVALS DATE INSPECTOR SIGNATURE
EAGLE SIGNS (909) 593-7070-
9380 7TH ST., SUITE C LIC. NO co �� 0 r1� __ �,=E PO AR ER POLE
RANCHO CUCAMONGA, CA 619628C-45
/�,� ,�� UNDERGROUND CONDUIT
ARCHITECT0 ENGINEER: E 0: ST>q�o i7 U o i n lel UF5R GROUND
LIC. NO: r ROUGH CONDUIT
ROUGH I
RING
MAIN WATER LINE
�g LASTIC Y/N METAL Y/N
UTILITY COMP N OT FIED
TI
REPORT ID: DPR265 ROUTE TO: BS0508
r
• COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
• DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9612190003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
EGA ID: FEES PAID BUILDING DRESS:
ON FILE 5785 ROSEMEAD BL
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS
5397-012-043 G1 OUTLETS-LGT,SW,RECP 34.00 OUT 57.90 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY
G2 LIGHTING FIXTURES 20.00 LGT 39.00
TENANT: TOTAL FEES 96.90 ISSUED ON: PROCESSED : PLA BY: EXPIRES ON:
GENERAL NUTRITION CENTER 12/19/96 TC 12/19/97
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
CALAC INVESTMENT - 12
�3�- ✓0
3709
SAN DIEGO, CA9211137 DESCRIPTION OF WORK
ELECTRICAL FOR TENANT IMPROVEMENT
APPLICANT: TE 0: o
GENERAL NUTRITION CENTER (310) 869-6923-
11603 S. PARAMOUNT '° SPECIAL CONDITIONS:
DOWNEY, CA 90241
CONTRACTOR: TEL. N0: iii,�l \ a APPROVALS DATE INSPECTOR SIGNATURE
TESCO CO. INC. (630) 595-2219- ;'
380 BEINORIS DR. LIC. NO co ! 'l ', p / (T PORAR OWER POLE
WOODDALE, IL 60191 EXPIRES * —=_'�1—� _
UNDERGROUND CONDUIT
0: GROUNDARCHITECT-OR G M � }
TAYLOR, BRAD
11603 S. PARAMOUNT BLVD. LIC. NO: ROUGH CONDUIT
DOWNEY, CA 90241 C053688ROUGH
WIRING X23Am
�` }� /� / MAI WATER LINE
BLASTIC Y/N METAL Y/N
UTILITY COMPANY 0 I ED
31
* ADDITIONAL DATA ON FILE
REPORT ID: DPR265 ROUTE TO: BS0508