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Home My Public Portal About5403 TEMPLE CITY BLVD_Electrical__ • COUNTY OF LOB ANGELES APPLICATION FOR PERMIT Department OF of CouLOIN �� ELECTRIC � DIVISION OF BUILDING & SAFETY WILLIAM J FOX. o.md EeFIRMr FO AYPLIMANTTOFILLIN DISTRICT NO. GROUPZONE PERMIT No. ELECTRICIAN s - y w PRF RECEIVED BY READY FOR DAT[ IRBU[D ADDR fIRSTINGP[OTION A q clTv TEL.NO VA A.),.f p COUNTY LICENSE N6 KPIRE8 BUILDS J PERMIT FEES — ret NUMBER EACH LOCALITY LIGHT OUTLETS NEAREST RECEPTACLES ORORR R WALL SWITCHES OWNER TOTAL OUTLETS ae • MAIL [LEC. RANGES IV ADDRESS [LEO HEATERS as CITY TEL NO 9N A rl R[R 6 1 M[R[SY ACKNOWLEDGE THAT 1 HAVE READ THIS M APPLICATION AND STAT[ THAT TM HEREBY ABOVE IB CORRECT NUMBER ft L MT CIRCO TR AND AGR[[ TO COMPLY WITH ALL COUNTY ORDINANCES NUMBER Or RECEPTACLE CIRCUITS AND STAT[ LAWS REGULATING ELECTRICAL WIRING MOTORS I CERTIFY THAT I PO•B<OS THE ABOVE VALID LOM NYMR[R HORSEPOWER RE ANGELES COUNTY LIC[NR[. OR 1 AM THE LEGAL OWNER HP BVLR INC EACH Or THE RESIDENTIAL PR13P[�D ORIS[D ABOVE N[w M ; A uea IIS 210MATURa a T 60 PR M 1'ITEE B B 1GO INSPECTION RECORD a 1a 1 so in So 200 a0 TDO S GO _ TOO app 10 DO J am 1000 I a 00 Q Z OVER 1000 •O.00 � No RET FRED CHANGER-HP WELDERS AO-KVA O GENERATORS - KW TRANSFORMERS - KVA TEMP MOTORS (76 Or CRIB) MOVED MOTORS (75or ORIY) SC BIONS NO NO TRANS. APPROVALS ND NO LAMPR FOR EACH PERMITt DATE INBP[OTOR'R NAM[ WIRING 91.00 C,b CONDUIT FIXTURES 01 OO WIRING SUPPLEMENTARY a0 r0(TUREa 1 POWER TOTAL FEE • L d IfTILIT,Do NOTIFIED FINAL MAEDI DB8#5A 46E WORKERS COMPENSATION DECLARATION TeAaea tDra, APPLICATION FOR ELECTRICAL PERMIT J'I `Ir{�by eflem rthet I have a certificated convent to sell more CEe� y I oc're'certnicate of workers Compensation Ireu arca or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY fLJI copy thereof(Sec 3800 Lab C) Policy No Cpmpeny r FOR APPLICANT TO FILL IN JOB ❑ Cerbfied copy is hereby fumehed ' New Residenlsl 91des d Pods NEAREST EACH NO FEE ADDRESS ❑ Certified copy s hied With the county blliidlnp invpactgn 1 & 2-Famay SR Ft E — S LOCALITY department ' Mulh-famdy SO Ft — Data Applicant Residential Swimming Pooh ��O OL/t/f S� z2 L FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Recce Light Sw MAIL / ,COMPENSATION INSURANCE _F4at 2000(1 ADDRESS0k; T Y (This section need not be completed If the work involved by the CR Permit s for one hundred ddlsre(8100)or less) Total NO . Additional CITU L / Tel W I certify that in the performance d the work,for witch this permit PLAN CHECK 1 w,mm*d I shall not employ arty person in arty manner so as to 1 become subject to the Workers Compensation Laws Lighting Fodures First 20 ADDRESS v ^ Total No Atltldcnel Date_A�� Applicant CRY Tel No NOTICE TO q FLIOANT If, a meWng Ns Cendicate d Finad Applsnces Not Over 1 HP pEp Exemption you, become sublect to the Workers Compensation Range— Heater_ DIN _ APPLICANT prrnnsare of the Labor Code, you must fodhmth comply with such Oven _ Dryer _ W M _ ADDRESS pro slors or the perrut shell be deemed revolted Top — FAU WH LICENSED CONTRACTORS DECLARATIONCm Tel 1401 hereby affirm that I em licensed under Hood — Fan Other prowl t e B Chapter 9 DeP ��Nr�� LICENSE OR (commenccag with h Section 7000) Dryd scn 3 the Business and — REO HUMBER �s i Professions Code andmy license s in full force and effect Power Apparatus d Large Appliances DISTRICT NO / PROCESSE by Size d Type FIP KW KVA or KVAR 7 Ca/ Lcerse Number Lc Class Up to 1 Inc RNAL - —L Over 1 to tO lrc ❑ l DATE / Ca] I Contractor - Date Over 10 to 80 kid FINAL am exempt uMer Sec Over 60 to 100 Inc BY BBPC for Itis reason Over 100 fA Date Services MCC 8 Parhelbcards 200 , Z 0-200 Amp Under 800 V Signature 201 - 1 DDD Amp U"r ego V :2 9 6 9.6 A ❑ Exemphon for Rep Maim Elect Over 1000 Amp or Over 600 V SINGLE HOME OWNER-BUILDERLY DECLARATION Tamp Power Pole 8 Appurterhences I • e 5 3 7 5 1 herebyaffirm that I am ex Sign with One Branch Circuit const hoer the Cusmass a License Lew AdtlrtanN n Branch Circurle for the fdlowug reason(Section 7031 6 Buainsm and Professions – • • - 53755 Code) ❑ Mac Conduits d Corductm v ' 0 5 2 5 8 8 I as owner d the Property will do the work a70 the stricture Other(See Complete Fee Schedule) _ s not intended C deered for sale (Section 7044 Business pop- and and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the Pertorrtsnce of the work for which the permit is issued(Sec 3097 PERMIT FEE (Sub-Total) CN C) PLAN CHECKING FEE Lenders Name PERMIT ISSUING FEE . O Lenders Address I certify that I have read the application and Nate that the above TOTAL FEE _ information is correct I agree to comply with all County ordinances and State'Iaws regulating Electrical wrong, and hereby authorize repree matives of the County to enter upon the above-mermwned ` for inspection purposes ' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permmee Date i .WORKERS COMPENSATION catsDECLARATION once APPLICATION FOR ELECTRICAL PERMIT O I hereby affirm that I have a certificate of consent to self a� insure, or a certificate of Workers Compensation Insurance, COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS br a certified copy thereof (Sec 3800 Lab C ) , / ' Percy No Company FOR A"LJOB ICANT TO FILL IN r 0� / E .gGYj� U Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE ADDRESS t' Certified copy is filed with the county building inspec 1 8 2-Family, Sq Ft $ — f LOCALITY - ,y tion department n Multifamily Sq Ft NEAREEAREST (� S l.i 1') (6e I�, Residential Swimming Pools. NOWNER Date- Applicant 1 FIRM NAME CERTIFICATE F EXEMPTION FROM WORKERS Outlets Rec_Light_Sw_ MAIL L✓ COMPENSATION INSURANCE First 20 ADDRESS (This sedlon nood not be complated If,the work Involved by Total No Additional CITY E (,� Tel IN 7 the pormit Is for one hundred dollars ($100)or Ins) PIAN CHECKl / v 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 as to become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS Additional CITY Tel No Date Applicant Twat No NOTICE TO APPLICANT If after making this Certificate of Fixed Appbances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range— Heater—DW — APPLICATION 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 — FAU —W H deemed revoked Hood — Fan —Other—i CITY Tel No LICENSED CONTRACTORS DECLARATION Dnp _ Room Air Cond — LICENSE OR- -- Class I hereby affirm that I am licensed under provisions of Chapter 9 REG N M R (commencing with Section 7000)of Division 3 of the Business Power Apparatus &Large Appliances DISTRICT NO, y and Professions Code and my license is in full face and effect 0- Size Size 8 Type HP, KW, KVA, or KVAR Q License Number Lic Closs Up to 1 Incl FINAL U rFINAL Over 1 to 10 Incl DATE VALIDATION Contractor Data - � Over 10 to 50 Incl � � 0 ❑ am exempt under Sec ,y Over 50 to 100 IncBY LU B 8P C for this reason Over 100 tl Date Services, Swbd , MCC 8 Ponelboards , - Z 0-200 Amp Under 600 V Signature 201 1000 Amp Under 600V ❑ Over 1000 Amp or Over 600 V - - -- Exemption for Reg Maint Elect SINGLE FAMILY Temp Power Pale&Appurtenances 'z HOME OWNER BUILDER DECLARATION - - - - -- I hereby affirm that I am exempt from the Contractor's License Sign with'One Branch Circuit ACCT. Additional Sign Branch Circuits r Law Tw the following reason (Section 7031 5 Business and 9 - - ProfessionsCode) 3307 29.5 INI as owner of the property will do the work and the Mix Conduits 8 Conductors - - - ' 1 ITM structure is not intended or offered for sale(Section 7044, Other (See Complete Fee Schedule}_ ► Business and Professions Code) TOTAL - 29 . 50 CONSTRUCTION LENDING AGENCY CASH u 29_50 1 hereby affirm that there is o construction lending agency for the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec 3097, Gv C ) - PLAN CHECKING FEE _ _ _ Lenders hame R 12/27/39 PERMIT ISSUING FEE Lender's Address - 5 7M - 1 - fel 8:20 I certify that I have read this application and state that the TOTAL FEE above information is correct I agree to comply with all County - - ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon _ th ve mentioned property for inspection purposes � SEE REVERSE FOR EXPLANATORY LANGUAGE Z 2- L Signature of Permittee Dat ®' s