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Home My Public Portal About5629-1/2-5631-5631 1/2 TEMPLE CITY BLVD_Electrical__ WOthat COMPENSATION DECLARATION 63 10,91 APPLICATION FOR ELECTRICAL PERMIT I here y 'affirm that I have a certificate of consent to self CE�8� ' insure or a certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (Sec 3800 Lab C ) i icy No Company FOR APPUCAM TO FILL IN J08 Ci Certified copy is hereby furnished EACH NO FEE AOORESS _ New Residential Bldgs 8 Pools ❑ Certified copy is filed with the county building inspec- I &2 Family, Sq Ft - $ — S LOCALITY 10 tion department Multi-family Sq Ft — NEAREST CROSS ST Date Residential Swimming Pools Date—Applicant moot OWNER OR Q FIRM NAME CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets Rec_Light_Sw COMPENSATION INSURANCE ADDIRESS (This stolon need not be completed If the work Involved by First 20 the permit Is for one hundred dollars ($100)or less ) Total No Additional CITY - Tel No - I certify that in the performance of the work for mPIAN CHECK h this APPLICANT permit is issued I shall not employ any person in anyy manner A- so as to become subject to the Workers'Compensation Laws Lighting Fixtures First 20 ADDRESS �� /� Total No Additional Date Applicant T CITY '!'r Tel No g6_ 6 NOTICE TO APPLICANT If after making this Certificate of Fixed Appliances Not Over 1 HP _ PERMIT e_ Heater_0 W _ APPLICANT Exemption you should become subject to' the Workers Range 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 Hoo _ Fon _Oer_ CITY ` Tel No Hood th LICENSED CONTRACTORS DECLARATION _ Room Au Co th LICENSE OR - Claes hereby affirm that I am licensed under provisions of Chapter 9D,sREG NUMBER (commencing with Section 7000)of Division 3 of the Busmess power ADISTRICT NO PR Apparatus 8 large Appliances ED BY .r and Professions Code,and my license is in full force and effect Size 8 Type HP KW KVA or KVAR License Number Lm Class 0 lJ Up to 1 Incl FINAL Over 1 to 10 Ind DATE VALI TION Contractor Date O 1:3 Over 10 to 50 Ind I am exempt under Sec Over,50 to 100 Inc FINAL 100 H IL B 8P C for this reason Over Z Dote Services, Swbd, MCC 8 Ponelboords -- 0 -200 Amp Under 600 V S�gn6ture 201 - IODO Amp Under 600 V 31 51.3 A F-1Exemption _ Over 1 Am w Over V Y ' Exemption for Reg Mat Elect # e e is is 92 SINGLE FAMILY Tamp Power Pole&Apurtenances ( • -'2550 HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License • - - 25500 Law for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits Prof ons Code) I as owner of theMisc Conduits 8 Conductors property will do the work and the 0 Z 12-85 structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ 7044 Business and.Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction larding agency for the performance of the work for which this permit is issued PERMIT FEE (Sub Total) (Sec 3097 Gv C ) PLAN CHECKING FEE Lender s Nome PERMIT ISSUING FEE - Lender s Address ' I certify that I have read this application and state that the TOTAL FEE 3 5 above information is correct I agree to comply with all County ordinances and State laws regulating Electrical wiring and ' hereby authorize repre ntatives of this County to enter upon the above gone perry for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE ' /.2-ds" ' - gnatur o ermi ee Date - I COUNTY OF LOS ANGELES TEMPLE CITY S 0508 ELECTRICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0001250004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID FEES PAID allILDING ADDRESS ON FILE 5629 TEMPLE CITY BL FEE DESCRIPTION QUANTITY LION AMOUNT TEMP CA 917802532 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LIVE OAK AVE 8588-007-011 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE- 597 GRID A3 LOCALITY TEMPLE CITY LA 100 AMP PANELS, MCC 4 00 PAN 155 40 1 TENANT TOTAL FEES 183 15 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON 01/25/00 UT 07/23/00 OWNER FINAL DATE ��E CROZCO WI LLIAM;MARIE L TRS 5505 DEL LOMA AV 1 SGAB 917761649 r INSTALL 4 NEW SERVICE PANELS (100 AMP CH) APPLICANT TEL NO C 8 W ELECTRIC CO (626) 579-6122- 5320 PAL NAL AVE SPECIAL CONDITIONS TEMPLE CITY, CA CONTRACTOR TEL PNGELES COAPPROV I ALS DATE INSPECTOR SIGNATURE IJ AND W ELECTRIC CO (818) 579-6122- V�Ty 5320 PAL MAL AVE. LIC NO TEMPORARY POWER POLE TEMPLE CITY, CA 91780 411555 C10 ARCHITECT OR ENGINEER TEL NO UFER GROUND LIC N ROUGH' ROUGH WIRING 1111117 rr �j (j /� /� /J (� i U U I`r',C II I I \l�f�/ IICI \1 PLASTIC Y/N METAL Y/NurrITTT-MRPANY NOTIFIED lul( fid/LS1J ll`..'SS»> \R4.0 `11�" U" p ll UUu U �1 NJ G o O ywl. 7 F,, r r �0 ServOe That�et� I REPORT 10 DPR265 ROUTE TO BS0508