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HomeMy Public PortalAbout5126 TEMPLE CITY BLVD_Electrical__ COUNTY OF cos ANGELES APPLICATION FOR PEBMT DEPARThIDIVISION O OF BUILDING COUNTY ENGINEER SAFETY ELECTRIC 1 DWULULM I. F XCOUA E GINEER WQ.LIAM COIINY! ffiYGIIiffi FOR APPLICANT TO FILL IN DIS'TM4=r NOQROUP ZONE PERMIT NO ELECTRICIAN `7r If/� ADDRE88ff' R IV BY READY FOR DATE ISSUED FIRSTINSPECTION /f_�� ty CITY EL NO 7 Q(} LI 2 E EXPIRES BUILDING -PERMIT FEES c _ _. _ _, __ _ ADORB9H FEE NUMBER BACK LOCALITY LIGHT OUTLETS NEAREST RECEPTACLES CR ST WAR'L SWITCHES OWNER TOTAL OUTLETS sc n&r RANGES Ya ADMADIL 8BH RLEC HEATERS IIS ofFIXTURES 0 CITYrc� TBL NO 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS NUMBER OF LIGHT CIRCUITS APPLICATION AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VAUD LOB No HORSEPOWER FEE ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER N: MYO HP ovaa I IIIc GSI OF THE RESIDENTIAL PBRTY DBSCRIS ABOVE a L[tt S Ya SIGNATURE OF 2 s0 PERMIll Y E 1 DO 1N�EClION RECORD a la 1 00 1s so 2 00 50 200 a 00 200 000 f0 00 a0o1 IS 00 a z vER 1000 20 DO (� M G. Girr/FRKQ CHANGER-NP LL' WELDERS, AC•KVA O GENERATORS KW TRANSFORMERS•KVA TEMP MOTORS 75OF oRIR MOVED MOTORS 78OF CMo IGC SIGNS NO NO TRANS APPROVALS O PERDATE INSPECTOR'S NAME FOR MACHWIRING $1 00 CONDUIT FIXTURES 91 00 WIRING 5 NAdA— B PPLEM ENTARY S0 FIXTURES J POWER TOTAL FEE s / O UTILITY CO NOTIFIED 10 f5 S v �l"6" UN4 M Mt WORKER S COMPENSATION DECLARATION DPW(12 9„ APPLICATION FOR ELECTRICAL PERMIT IJ 1 hereby 76ABM a111rm Wet I have a certificate of consent to sell Insure �� or a certificate of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sec 3800 Lab C) + Polity No�C�pmpany � Ff(L_ A� FOB APPLICANt TO FILL IN ADDRESS ❑ Cenlfled copy Ia er t1v furmshsd New Residential Bldgs &Poole NO EACH FEE r , , § $ LOCALITY ❑ , `Cerldled copy Is filed with theV1Y ;Id, Ion 1 &2 Family Sq FI NEAREST / Eepanment r Multifamily Sq Ft CROSS ST I yDve '- Ilcant Residential Swimming Pads ASSESSOR t MAP BOOK ' PARE PARCEL CERTIFIC4 OF EXEMPTION FROM WORKERS Outlets Rac Ught iq�Sw / OQ FENAUE G f} p COMPENSATION INSURANCE p (This wcUori need not he completed If theworr k Involved by the - - gESy permit le for one hundred dollars(0100)or lose) Total No Addict v I certify that In the performance of the work for which this permitCITY �' l Tel No� 6 (i is Issued I shall not employ any person In any manner so as to PLAN CHECK ' became subject to the Workers Compensation Laws Lighting Fixtures (� Fiat 20 APPUCANT ,. Total No Additional ADDRESS Date' Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE TO APPLICANT If after making this Certificate of CITY' Tel No Exemptron,you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code you must forthwith comply vnth such PERMR L _ provisions or this permit shall be deemed revoked Power Apparatus&Large Apphences LICAIvr ` LICENSED CONTRACTORS DECLARATION Sao&Type HP KW KVA or KVAR ADDRESS 7V N ` I hereby affirm that I am licensed under provisions of Chapter B Over 3 to 101nc1 (commencing with Section 7000) of Division 3,of the Business and CITY �D Tel No Professions Code and my license is in full force and effect Over 10 to 50 Incl LICENSE OR ! } Over 50 to 1001ncil REG NUMBER Class Q 0 License Number Uc Class-. Over 100 INSmi1CT NO assn IaY V 1- - - Jam— Swbd MCC&Panelboards Contractor Sca� v'.Xaµ. �'� 399 P UAL nder 600 DaTE ❑ I ern exempt under Sec / 400 1 Amp Under 600 V �� VALIDATION w,j Over 1000 Amp or Over 600 V FINAL d B&P C for this reason BRANCH CIRCUIT FEES By Z Dote I ISA or 20A 120V Llghung or Recept It Signature 1 To 10 Branch Circuits 11 To 40 Brunch Circuits 41 Or❑ Exemption for Reg Mamg t Elect 154 20A 20BV To 2M Lhbng Br�e farms omits SINGLE FAMILY Temp Power Pole&Appurtenances HOME OWNER BUILDER DECLARATIONLT•a T I hereby elllrm that I am exempt from the Contractors License Law Sign with One Branch Circuit r15 for the following reason (Section 7031 5 Business and Professions Atldtlonal Sign Branch Circuits 3307 99'25 Code) I 1 ITEMS ❑ I as owner of the property will do the work and the structure Misc Conduits&Conduclon, TOTAL - �- 9 . 25. 25 Is not intended or offered for Bale (Section 7044 Business Other(See Complete Fee Schedule)_ - and Professions Code) - ► CHECK -99.25 CONSTRUCTION LENDING AGENCY l"GE '0(1 I hereby affirm that there Is a construction lending agency for the ' performance of the work for which this permit Is Issued (Sac 3097 PERMIT FEE (Sub Total) PLAN CHECKING FEE M-00101 4I 6193 Lender a Name 9M 1 AM11:21 PERMIT ISSUING FEE �� Lender a Address Q I certify mat I have read this application and under penalty of purjury stele TOTAL FEE /' Y, that the above Information Is coned I agree to comply with all County ordinances and SlMelaws regulating Electrical winng andherebyauthorize representatives of this County to enter upon the above mentioned property - - for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 61r3NATUBE OF TTEE DATE