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HomeMy Public PortalAbout5025 TEMPLE CITY BLVD_Electrical__ 37a ones.. 11 APPLICATION FOR kEAT DEPARTMENT OFNG AND SAFETY ELECTRIC COIINTY OFF LOS LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. 13ROUP ZONE PERMIT NIL ELECTRICIAN FRANK'S ELECTRIC CU R[O[IV[D BY FOR DAT[ ISSUED ADDREBH T FIRSTSTINSPECTION CITY L.05 ANGELES 22 T,,`MOAN 7494 COUNTY LICENSE NO1051 XRE EPIS BUILDING f.U PC.n FEES ADDRESS NUMBER EACH RE LOCALITY LIGHT OUTLETS NEAREST Ave rjn� �f CROBB BT. RECEPTACLES /-- WALL&WITCHER OWNER TOTAL OUTLETS So S MAIL ELEC RANGES 98 ADDRESS ELEC HEATERS 95 CITY TEL NO. FIXTURES S 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS MIBO APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND BTATE LAWS REGULATING ELECTRICAL WIRING MOTORS 1 CERTIFY THAT 1 POBBESB THE ABOVE VALID LOB NUH9e11 HDR9EPOWER FEE ANGELES COUNTY 1-11391418K. OR 1 AM THE LEGAL OWNER New My Duce INC eAOM DF THE RESIDENTIAL PROPARTY DESCRIBED ABOVL �� 40 a u®e YS SIGNATURE Of va B 60 PE _� ' S 100 INSPECTION RECORD S 1S 1 SO is SO 250 SO 200 S GO 900 SOD lam -1 am IDOO 16 DO = OVER I Om 9O OO 9 M G BET FRED CHANGER-HP Q' WCLDERBI AD-KVA O GENERATORS - KW TRANBFORMERB - ICVA TEMP MOTORS (75% or 01110) MOVED MOT13RB (76 or Gem) 1 Q SIGNS NO NO TRANS. APPROVALS NO NO LAMPS FOR EACH PERMIT: DAT[ INSPECTOR'S NAM[ WIRING St 00 CONDUIT FIXTURES Bl OO WIRING SUPPLE IENTARY SO FIXTURES !� a POWER TOTAL FEE B S, UTILITYCD NOTIFIED FINAL WORKERS Ihove COMPENSATION Date of consent `7 a uvwsim APPLICATION FOR ELECTRICAL PERMIT O esess � I hereby affum that I have a certificate of consent to self asow insure, alto certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS or a certified copy thereof (Sec 3800, Lob C ) I Policy No Company FOR APPLICANT TO FILL IN JOB ADDRESS 1 7 I ❑Certified copy a hereby furnished New Residential Bldgs 8 Pools EACH NO FEE LOCALITY lion � Certified copy is Tiled with the county balding mspec 1 8 2-Family, Sq Ft E — S tion department Multi-family Sq Ft — 7fAREST Residential Swimming Pools CROSS ST Date Applicant Q OWNER hOR FIRM AME In R5 2r, tiF CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec3LLight 7 Sw 7 /70 ly MAIL- COMPENSATION AIL COMPENSATION INSURANCE `J ADDRESS t his soctlon nood not be com hied R the work trwolrod b ]2 - First 20 R P Y Total No _L Additional 7./T- CIN e Tel No the jsermlf 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 os to become subject to the Workers Compensation Laws Lighting Fixture First 20 ADDRESS ��-- Total No Additional DateLApplicant ,/��'=�! -u+�^��_ CITY Tel No Fixed Appliances Not Over I HPPERMIT NOTICE TO APPLICANT If after making this Certificate of Range— Hooter D W — APPLICATION f �i Exemption, you should become subject to the Workers Compensation provisions of the Labor Code you must forth- Oven _ Dryer —W M — ADDRESS with comply with such provisions or this permit shall be Top — FAUW H deemed revoked _ Hood — Fan Other_ 9 P CITY r L Tel No LICENSED CONTRACTORS DECLARATION ` Disp _ Room Air Cond LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 REG NUMBER Class -1 U (commencing with Section 7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRICT NO P D BY Y and Professions Code,and my license is in full force and effect Size 8 Type HP KW KVA, or KVAR ��� O License Num 815 Lic Class 4,_-10 Up to I Incl FINAL C..1 -S'9,� Over 1 to 10 Incl DATES Z /Cj VALIDATION 0 Contracto to Over 10 to 50 Incl IDI am exempt under Sec Over 50 to IOD Inc g� ILL - B 8P C for this reason Over 100 d Date Services, Swbd , MCC 8 PonelbZ oards Z 0-200 Amp Under 500 V — Signature 201 - 1000 Amp Under 600 V ❑ Exemption for Reg MoOver IODD Amp or Over 600 V mt Elect I SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Temp Power Pole 8 Appurtenances a•.rT.i I hereby affirm that I am exempt from the Contractor s License Sign with-One Branch Circuit Law for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits Professions Code) I fE'n_• ID1, as Mise Conduits 8 conductors I owner of the property will do the work and the ' structure is not intended or offered for sole(Section 7044, Other (See Complete Fee Schedule)_ }I IT, 70 - 69 Business and Professions Code) - CONSTRUCTIONLENDINGAGENCY 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 3D97 Civ C ) Lender a Name - PLAN CHECKING FEE fii IDL-1 _II I[I I 3/ PERMIT ISSUING FEE I AM 5:24 Address - J 1 certify that I have reod this application and state that the I TOTAL FEE above information is correct 1 agree to comply with all County ordinances and State jaws regulating Electrical wiring and hereby a th nze repirppenta lives of this County to enter upon theab a ention property for inspection purposes - SEE REVERSE FOR EXPLANATORY LANGUAGE 3- 5 yz rigrZture of Permittee Date - _ ms