HomeMy Public PortalAbout5202 TEMPLE CITY BLVD_Electrical__ 1ON
76A
yrm that S ave a certificate
of consent
to CE-80G ,D,e; APPLICATION FOR ELECTRICAL PERMIT
I Fte.olry affirm that I have a certdicate a consent to self insure �-t>ns0 -
or a certificate of Workem Compensator Insurance or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec 3800 Lab C)
Policy No Company FOR APPLICANT TO RLL IN JOB .�
I-] Certdied copy Is hereby furnlshod New Readental Bkfp y Pods EACH NO FEE ADDRESS vMAIA ofp'
❑ Cerbhed copy is filed with the county building inspection 1 d 2-Fanny Sp Ft $ =!::1LoCAlfT1' r e ry.rV.
department - Mulb-famiy, Sp Ft — NEAREST
CROSS W '
Date ' ' Appcanl Residential Swimming Pools ' OWNER OR
FIRM NAME N -
L
CERTIFICATE OF EXEMPTION FROM WORKERSlets,Ret4_ t Sw - MAA.
COMPENSATION INSURANCE — ADDRESS eq
(The section need not be completed ff the work ewaved by the First 20
Wmh Is for one hundred dollare ($700) or less) i • Tom No Additional CITY Tel
PLAN CHECK
I certify that in the performance of the work for which the permit APPtICAM
is issued I shall not employ arty person in arty manner was to ' _
become subject to the Workers Carrpereeton Laws Lighting Fixtures Fust 20 ADDRESS
�/ Additorel '
Date �V �`�Applroanil/�i1/�1'. L r.�rY>9Dw1 Total No CITY ' Tel No
NOTICE TO APPLICANT If after making the Certificate of Fixed Appliances Not Over1 HP pER�
Exemption you should become subject to the Workere Compensation Range_ Heater_ DW _ R PL rJtr/ G
provisions of the Labor Code you must forthrmth comply with such Oren _ Dryer _ W M _ ADDRESS S r AD
ormnsions or this permit shall be deemed revoked Top — FAU _ WH _ _ y '
LICENSED CONTRACTORS DECLARATION Food — Fen _ Other_ CIN /Q Tel No
I hereby affirm that I am licensed under prows of Chapter 9 Dep _ Room Air Cond LICENSE REG MlAOPt a/ CSG-�
(commenctrg with Sector 7000) of Division 3 of the Business and
Professions Code and my license Is in full force and effect PD Apparatus d Large Appliances DISTRICT NO -�! PROCESSED y
Sae 8 Type HP KW KVA or KVAR v U(/Y G-
Lcense Number Y2 0 4;az Lc Cis Up to 1 Ind FINAL OIrrJ /�- / J if 8
Con(ractor�/AA2 S Date) �O- IV over to to— Over Ito 50Ind ✓G-. G Cf�f
❑ 1 am exempt under Sec _ Over 50 to 100 Irx; IFN
6
BBPC fa the reason Over 100 ,
Services,Swbd MCC 8 Panelboards • N
Date 0-200 Amp Under 600 V eZ+
Signature 201 - 1000 Amp Under 600 V
❑ Exemption for Reg Mant Elect Over,1000 Amp or Over 600 V -
SINGLE FAMILY Temp Power Pae 8 Appurtenances J 9 5 6 6 A
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit a • see • Z
I hereby affirm that I am exempt from the Contractors License Lew
fC�; following meson(Section 7031 5 Business and Professors Additional Sign Brarch Circuli - - -2625
e
Mlsc Corduis s Conductors
❑ I ns owner of the property,will do the wank and the structure Other(See Compete Fee Schedule) * - * 2&255
is not Interdetl or offered for Sale (Sedan 7044 Business', ► - 0509-88
and Professions Code) -
CONSTRUCTION LENDING AGENCY -
I hereby affirm that there is a construction lerdug agency for the_, _ _
=�perlomnarge a the wok four which ttds pertnM Is Issued(Sec-3097' -PERMrr FEE T - (Sub•Totel) ,
PLAN CHECKING FEE
Lenders Name
' PERMIT ISSUING FEE �J .
n Lenders Address '
I oarbly that I have mad the application and state that the above TOTAL FEE
information Is corred I agree ro can* with an County ordinances ' -and Stas Tawe regulehng Eledncal wing and hereby authorize
represemalwes of the County to enter upon the above-mentioned • , -• -
property for inspector purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE _
ALir e ,_ 3=ia-ala'
Signature of Permittee Date