Loading...
HomeMy Public PortalAbout4446 TEMPLE CITY BLVD_Electrical__ ION WORKERS have a certificate of consent to CE 8e3 10,91 APPLICATION FOR ELECTRICAL PERMIT {1 I hereby affirm that I have a certilcate of consent to sell insure CE epeo L J or a certificate of Workers Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof (Sec 3800 Lab C) Policy No Company FOR APPLICANT TO FILL IN- JOB ADDRESS ) r ` ❑ Certified copy is hereby furrushed New Residential Bales 8 Pools EACH NO FEE �"f ❑ Cerhfretl copy is filed'with the county building Inspection I d 2-Family Sci Ft $ — $ LOCALITY department Multi-family Set FtNEAREST — GROSS ST DateResdentiml Swimming Pools , OWNER OR K' Applx;ant vija - FIRM WAE KQQCD &) 0641?f CERTIFICATE OF'EXEMPTION FROM WORKERS IAAk Outlets Rec Light _Sw — COMPENSATION INSURANCE - ADDRESS q-2 777MP1-1r C hf- Q. _ Fust 20- __� c CITVT � / Tel No Petr is need anotnd be completed H the work HlvoNed by the pnmtt fa for one hundred dollars($100)or Ilue 1 Total No Pddltiorel v N _ - � I caddy that in the performance of the,work for which this permit 1 111= rl is Issued 1 shall net employ any person in any manner so as to' APPLICANT become sub)ed to the Workers Compensabon Laws Lghhng Fixtures First 20 ADDRESS ' A Total No Additional ' Da Applicant CITY Tel No NOTICE TO APPLICANT If after making this Certificate of Fixed Appliances Not Over i HP Exempixxi you should become subject to the Workers Compensation Range_ Heater— DW _ AAEPPUCANT D LSC�- C 5-4{ p isucri9 of the Labor Code you must forthwith comply with such Oven _ Dryer _ W M _ ADDRESS J LJ J-J Z € L provisions or this permit shall be deemed revoked Top — FAU _ WH _ LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other— CITY [.6G�J-. "'471-� 1 hereby of rim that I am Licensed under provisions of Chapter 9- LICENNUSEOR (comriierxSectioDivisionD�sp — Roam Ar Coed PE ng with Section 7000)of Division 3 of the Business end O MBER Prcfessxxls Code and my ixense is In full force and effectIDISTRICT NO PROC D BV Power Apparatus 8 Large Appliances 040 J Lc C License Number`T � y" 10 Size 8 Type p 1 KVA or KVAR t lJto 1 Incl FINAL' //_ -� _ pg Over 1 to tO Incl ' DATE VALIDATION Contractor Jl�^'r`-� Data 5 S -O 1 Over 10 to 50 Ind ❑ I em'exampt under Sec Over 60 to 100 Inc FI BBPC for this reason Over 100 Services Swbd MCC 8 Panelboerds " - Z Date O-200 Arta Under 600 V� Signature 201 - 1000 Amp Under 600 V ❑ Exemption Over 1000 Amp or Over 600 V Exemption for Reg Maint Elect r SINGLE FAMILY' Temp Power Pole 8 Appurtenances v 7 _ HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor a License Law for the following reason(Section 7031 5 Business and Professions Additarel Sign Branch Circuits Code) 7Ti''-' 2c r10 ❑ I as owner of the prpperty vnll do the work and the structure Mm Corxk"ts 8 Conductors w not intended or offered for sale (Section 7044 Business Other(See Cartlplete Fee Schedule) ` and Professions Cade) - Tl%JI- 29ry .5,101 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the _ �I performance of the work for whch this permit is soled(Sec 3097 '- PERMIT FEE (Sub-Total) Civ C) Lerdera Name PLAN CHECKING FEE ?.r__ 1 5i 5/89 Lentlera,Adtlrsea PERMIT ISSUING FEE TOTAL FEE �Il-r - ��Op 1 codify that I have read thus application and state that the above _ U _ mformation is correct I agree to comply with all County ordinances ` and State laws regulating Electrical wining and hereby authorize representatives of this County to enter upon the above-mentioned v ' property for Inspection purposes • SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Pwmmee Date ' I