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
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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
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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