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