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Home My Public Portal About5843 TEMPLE CITY BLVD_Electrical__ wilm-`110°°'-1111 APPLICATION FOR ELECTRIC PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT ANDS SOF AFETY ENGINEER ADDRESS JOHN A. LAMBIE. COUNTY ENGINEER T, CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY76 6 FOR APPLICANT TO FILL, 19 NEAREST PFRIVRT FEES CROSS ST. r I T E M NUMBER EACH FEE OWNER 7- Wi h" IF 0 OUTLETS: $ $ MAIL. LIGHTS RECEPT. SW. .10 ADDRESS LIGHTING FIXTURES .10 CITY - TEL.NO. ELEC.RANGES CLO.DRYERS ELECTRICIAN Al..-PI- WATER HEATERS .50 ADDRESS .' 0 COD ' ELEC.SPACE HTRS. DISHWASHERS CI TEL.NO (6 Z GARBAGE DISPOSERS AUTO.- STATE WASHERS STA.COOKING UNITS .25 LICENSE NO. MOTORS: OVER INC. H.P. uDISTRICT NO. I GROUP ZON�zE P ESSED BY 0— 1/a :25 I,— 2 •SO MSPECTION RECORD a— s 1.00 s— is 1.5.0 Is- 50 2.50 00-200 5.00 SIGNS: NO.-TRANS. NO.LAMPS SERVICE 0-600V 1.00 SERVICE OVER 600V 5.00 MISC.S X A4 5, 7,5 .� WIRING PERMIT 1.00 FIXTURE PERMIT F 1.00 SUPPLEMENTARY PERMIT .50 TOTAL FEE $ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE 16 CORRECT AND AGREE TO COMPLY . WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ! CONDUIT A ELECTRICAL WIRING. rI WIRING ' 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY AN EL COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT 1 T E OWNER OF THE ABOVE DESCRIBED RESIDENTI PR .P _POWER SIGNATURE �] UTILITY CO.NOTIFIED OF PERMITTE FINAL A,IDATION ARTHUR C.VEIT, K MO CASH SUPERVISING ELECTRICAL ENGINEER 5; NOV 2 7 2 A 2.0 0 ami TEMPLE CHTv 9Ae0.CZ80610-99 APPLICATION FOR ELECTRIC PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER 77—, a y 3 T BUILDING AND SAFETY DIVISION — JOHN A. L.AMBIE. COUNTY ENGINEER WILLIAM A.JENSEN.SUPT OF BUILDING Co , FOR APPLICANT TO FILL IN NEAREST PER= "M CROSS ST. I a 71,T$M. NUMBER OWNER c EACH FEE MAIL FLIGHTS LETS: $ $ ADDRESS RECEPT. SW. .10 LIGHTING FIXTURES .10 CITY TEL.NO ELEC.RANGES cLo.DRYERS ELECTRICIAN WATER HEATERS .50 ADDRESS h Jq 11/071 ELEC.SPACE HTRS. DISHWASHERS CITY 7-, i TEL. NO. GARBAGE DISPOSERS AUTO.- STATE WASHERS STA.COOKING UNITS .25 LICENSE NO. MOTORS: OVER INC. H.P. DISTRJ.CT N ROUP ZONE I P OCE BD BY o— V2 2s V2— 2 so TION RECORD 2— s 1.00 a— 15 1.50 Is— so 2.50 50-200 5.00 . SIGNS: NO.TRANS. NO.LAMPS E SERVICE 0-600V 1.00 SERVICE OVER 600V 5.00 MISC. Eil l U O WIRING PERMIT 1.00 / U FIXTURE PERMIT 1.00 P SUPPLEMENTARY PERMIT s0 TOTAL FEE 1, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR•S•SIGNATURE AND STATE THAT. THE ABOVE IS CORRECT AND AGREE TO COMPLY ! ' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT ELECTRICAL WIRING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR WIRING LICENSED AB REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES f CALIFORNIA OR THAT 1 AM THE LIZOAL OWNER OF THE ABOVE DESCRIBED RESIDENT/ of POWER f C i r SIGNATURE UTILITY CO.NOTIFIED f Y _ ♦ .�' '. OFPERMITT ®. ATION ARTHUWC.VEIT.a , M�c CASHSUPERVISING ELECTRICAL ENGINEER CAJSH 5 2 8 7;Z NOV 2 0 2 ® 2.0 0 TEMPLE CHTY BA009-CE80610-e0 APPLICATION FOR ELECTRIC PERMIT 1 COUNTY OF LOS ANGELES MINES DEPARTMENT OF COUNTY ENGINEER BUILDING s--A y 3 � 1 BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE. COUNTY ENGINEER —�'` /�] WILLIAM A.JENSEN,'SUP'T of BUILDING LOCALITY / / (,a FOR APPLICANT TO FILL IN NEAREST PE CT FEES CROSS ST. ITEM NUMBER I EACH FEB OWNER OUTLETS: $ MAIL LIGHTS RECEPT. SW. .10 ADDRESS 'LIGHTING FIXTURES 10 CITY TEL.NO ELEC.RANGES CLO.DRYERS ELECTRICIAN ��CC WATER HEATERS .50 ADDRESS 6 ELEC.SPACE HTR8. DISHWASHERS CITY TIL.NO. GARBAGE DISPOSERS AUTO:- STATE WASHERS STA.COOKING UNITS .25 LICENSE NO. MOTORS: OVER INC. H.P. rm DISTRITJ�I�. 7�QI�IE a- 1/2— P DB O— 1/s .25 '� 1/fq (`J 1h— 2 .50 INS E ON RECORD 2— S o— 15 1.50 15— SO 2.50 SO—200 5.00 SIGNS: NO.TRANS. NO.LAMPS SERVICE 0-000V 1.00 SERVICE OVER 800V 5.00 Dd WIRING'PERMIT 1.00 1 Q FIXTURE PERMIT 1.00 SUPPLEMENTARY PERMIT .50 TOTAL.FEE Is °� 10 y 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT ELECTRICAL WIRING. I HEREBY CERTIFY THAT 1 .AM PROPERLY REGISTERED AND/OR WIRING LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT 1 AM TH$ I.EGAL OWNER OF THE ABOVE r 'DESCRIBED RESIDENT/ P POWER SIGNATURE �� UTILITY CO.NOTIFIED OF PERMITTE FINAL L✓a'If G'1L'"et=SCM iV Jp ATION ARTHUR C.VEIT. CK MO CASH SUPERVISING ELECTRICAL.ENGINEER D'C 8 9 NOV 21 2 D 2.0 0 7uAe6e_CEBGB_,,.wAPPLICATION FOR ELECTRIC PERMIT 1 00UNTY OF LOS Momm DEPARTN W OF COUNTY ENGINM BUILDING BU=I NG AND SAFETY DIMON ADDRESS tane ]]OFII�A.LA11�IE.Co��ontIpp$�gjp�Bs CA TT D. GffiFF�.Wt o181� LOCALITY p eO ;NEAREST FOR APPLICANT TO FILL 1N CROSS ST. PERM FEES I T E M ' mumBintl EACH FEE OUTLETS: $ $ MAIL LIGHTS RECEPT. SW. .10 - ADDRESS LIGHTING FIXTURES .10 ;CITY TEL.NO. ELEC.RpNdE8 CLO.DRYERS "ELECTRICIAN r Q `rte Eat B,94-YO b`.5 WATER HSATERS •S0 ADDRESS EIEC.SPACE HTRS. DISHWASHERS GARBAGE DISPOSERS AUTO.- CITY ($ TEL.NO. ,09V WASHERS STA.COOKING UNITS .25 STATE el- V q¢%(� LICENSE NO. dr [� ?"j MOTORS: OVER INC. H.P. 0— +/2 .2B DISTR C GR PZoN%READY FOR IN6PECTION ../ _ r I/2 - 2 .SO 2 — s 1.00 INSPE=ON RECORD is — SO 2.80 50— 200 5.00 SIGNS: NO.TRANS. NO.LAMPS SERVICE 0-60OV 1.00 SERVICE OVER 600V 8.00 MISC: 0 cja WIRING PERMIT 1.00 FIXTURE PERMIT 1.o0 SUPPLEMENTARY PERMIT .SO TOTAL FEE $ K APPROVALS I HEREBY ACKNOWLEDGE THAT 1. HAVE READ THIS APP KATION DATE iNSPECT.d3IGNATURE. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ELECTRICAL WIRING. i' WIRING1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/ORFIXTURESLICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFCALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVEPOWERDESCRIBED RESIDENT P ERTY.SIGNATURE UTILITY CO.NOTIFIED //�hOF PERMIPA VALMATIARTHUR C.V-�EEIT. M ( CK o sH SUPERVISING CLECTRICAL F.AiGINIEM LA0 7 0 0 5°° NOV 26 2 A 3.0 0 )A663-CES06 5-62 APPLICATION FOlf E.LIECTRIC L PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS f r JOHN A. LAMBIE. COUNTY EkGINEER WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY NEAREST - FOR APPLICANT TO FILL IN CROSS ST. RECEPT. TOTAL NO. EACH FEE OUTLETS FIRST 20 $.20 $ OWNER zle LIGHT MAIL Lop ADD'L 10 ADDRESS SWITCH. OVER 20 _ CITY TE NO. LIGHTING TOTAL� FlasT20 .20 FIXTURES ADO'L .10 ELECTRICIAN OVER 20 RANGES CLO.DRYERS NRR.HTRS. 1.00 ADDRESS d. GARB.DISP. STA.COOK CITY 1 TEL NO. DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.C Vs X.P.MAX.) .50 LICENSE NO. MOTORS: OVER NOT OVER H.P. DISTRICT NCLG P ZONE P ESSED BY O 1 1.00 I s 1.50 INSPECTION RECORD s S 2.00 9 is 2.50 a Is s0 1 13.00 u so 100 5.00 O . SIGNS: NO.TRANS- V NO.LAMPS IIJ IL SERVICE 0.60OV-NoOVER 200A 1.00 H T. Z SERVICE 0-600V-OVER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC V PERMIT 189UING FEE 2.00 U(, SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPL CATION APPROVALS DATE INSPECTOR'S SIGNATURE AND STATE THAT THE ABOVE IS CORRECT:AND AGREE TO COMPLY CONDUIT ' WITH ALL•COUNTY ORDINANCES•AND STATE LAWS REGULATING ELECTRICAL WIRING. WIRING 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT 1 M THE GAL NER OF THE ABOVE DESCRIBED RESIDEN PE POWER SIGNATURE UTILITY CO.NOTIFIED OF PERMITTE FINAL /VALIDATION ARTHUR C. VEIT (\ „'J MO CASH SUPERVISING ELECTRICAL ENGINEER Ao 7 1 6 1 PdQV 2 0 2 D 4.0 cu ME S-A 2-46 ` APMCAT'ION FOR PERMIT DEPARTMENT OF BUILDING AND SAFM COUNTY OF LOS ANGELES EI;ECTRIC UM. J. FOX CHIEF ENGINEER a .NAME f DISTRICT NO. GROUP ZONE PERMIT NO. 0, ADDRESS/d)'7�/,-e• RECEIVED 13Y READY FOR. DATE ISSUED � CITY TEL.NO. j r FIRST W,Nj FIRSTINSPECTION COUNTY *a3J 7 IN CERT.NO. EXPIRES 4 r _/ APPLICANT FILL IN HEAVIL1 OUTLINED PORTION ONLY DESCRIPTION OF WORE JOB JII NUMBER OF OUTLETS ON CIRCUITS LOCALITY .+moi? `►:.eCeiALeS LOCATION BY,ROOMS NEAREST LIGHT OUTLETS ISW. PLUGS FO[7 CROSS SL '� // ' e CIRCUIT A B C D E F G H m NAME. ag tr�lA� <`� Z MAIL 3 ADDRESS" O cITY TEL.NO. 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANOg ie COU C FICATE OF UAL,I�FICATION.. ELU=MCIAN. ABAM CT=LEQAL�OWNER OF THIR PROPWff DESCRIBED • owmER. CORRECTIONS z m o TOTAL NO. OF OUTLETS ffi APPROVALS NO. OF FIXTURES I $ ` DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ CONDUIT NO. OF SIGNS TRANS. WIRING NO. OF RANGES OR HEATERS B FIXTURES MISCELLANEOUS B POWER ' PERMIT FEE J 1 // s / 6r'a UTILITY CO.NOTIFIED TOTAL FEE OW 5-A IS-49 ZSM- DEPARTMENT OF .BUILDING 'AND' SAFETY, APMCATION .FOR PERIVIIT 'COUNTY OF:LOS"ANGELES ELECTRIC. �. WM.J. FOX CHIEF ENGINEER _ NAME: w i• // /7��.i DISTRICT NO. GROUP ZONE PERMIT NO.- U ADDRESS J�- _p w / CITY I'= sisa�t n:�' TEL.NO. -: '_EIVED 13Y READY FOR -.:DATE ISSUED r ® FIRST INSPECTION dCERT.NO.-1 COUNTY �.� EXPIRES N��.6ri°/►' /d/' L!� AI' '-_ -APPLICANTFILL'IN&AJU.Y OUTLINED PORTION-ONLY JOB . TON--OFWORK-- RBDESCRPL .7 .» NUMBER OF OUTLETS ON CIRCUITSf LOCALITY' t. LOCATION BY ROOMS ? 'NEAREST I LIGHT'OUTLETS. 1SW. PLUGS Pair 'CROSS ST.• '.S.d'Y Hyl• '/� .A CIRCUIT A. -13 1-c I D E R G H rc NAMEMAIL - AD DRESS CITY '/,.rY TEL,NO.' 1 AM, THErLEGAL:'POSSESSOR- OF. THE ABOVE 'LOS ANf3€LES :COUNTY C124TIFICAT OF p / 1F�� OOO TOTAL T •-ELECTRICIAN. ... I AM-THE LKQAL OWNER OF TH6 PROPERTY DESCRIBED. = ABOVE .. OWNER. . -72 19 -NO. OF OUTLETS $ -APPROVALS NO. OF FIXTURES E' n _ DATE INSPECTOR'S NAME' i 'NO. F.MOTORS H.P. P SN CONDUIT. -NO. OF-SIGNS. TRANS. " $ = WIRING fF3 - , NO. OF RANGES OR HEATERS E FIXTURES - 3 MISCELLANEOUS - $ - POWER P ' 13 PERMIT FEE 4 i -UTILITYCO.NOTIFIED' ' Y £�. "Q TOTAL FEE FINAL DB 8-A 4-al sale 1 '` APPLICATION FOR PERMIT DEPARTMENT OF•BUILDING AND SAFETY COUNTY OF LOS ANGELES ELECTRIC WM. J. FOX, CHIEF ENGINEER µ NATURE 'OF INSTALLATION DISTRICTNO. GROUP I �7 7PM zoNE ,PQE �/Ir IVjo. WIRING FIXTURES SERVICE " s•/ �,,; RECEIVED BYREADY FOR DATIV 18$UED RANGE HEATER POWER / rdy FIRST INSPECTION SIGNS MISCELLANEOUS t APPLICANT FILL IN HEAVILY OUTLINED-PORTION ONLY JOBNAME .Be.Q ? �1 �i*.�, �i�CL'Rc- r�(1�) t� ADDRESS ADDRESS l/` y ®,y�ls� cam"v j' LOCALITY I; ill CITY 41.46', TEL.N, (j r z—yX:N � R088 ST.AEST � W COUNTY 9g ) CERT.NO. � r sG} EXPIRES ,yp ��¢ W NAM E •^' •`i DESCRIPTION OF WOR 3 MAIL ADDRESS NUMBER OF OUTLETS ON CIRCUITS O LOCATION BY ROOMS I CITY TEL.NO. LIGHT OUTLETS SW. PLUGS FtxT I AM THE LEGAL POSSESSOR OF THE ABOVE L08 ANGELES COUNTY CERTIFI ATEF QUALIFICATION. CIRCUIT A B C D E F G H � �a .�►°.I? Gia C LIVING ROOM ELECTRICIAN. ————————— I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED DINING ROOM ABOVE. BRFST.RM. OWNER. BATH CORRECTIONS - ENT.HALL —__ r �. HALL NO. 'FRONT PORCH OUTSIDE KITCHEN i SERV.PCH. ..I BDRM.NO. ! Z CLOSET BDRM.NO, n Q CLOSET TOTAL --------- �� NO. OF OUTLETS APPROVALS ' NO. OF FIXTURESe� / $' / 'I DATE INSPECTOR'S NAME NO. OF MOTORS l� H.P. X, O $ f � CONDUIT i NO. OF SIGNS " TRANS. ffi e.e.F ---WIRING ' NO. OF RANGES OR HEATERS S FIXTURES MISCELLANEOUB ffi POWER I ' PERMIT FEE $ /, 05 Ll' UTILITY CC).NOTIFIED TOTAL FEE $ `►. e��,i FINAL 08 G-A 10-41 25M DEPARTMENT OF B ING AND SAFETY' APPLICATION FOR PERMIT Co�NTY OF , ( ' GELES E i! CTRIC 1 W J. FOX CHIEF GINEER ' Q NAME DISTRICT NO. GROUP ZONE PERMIT NO. ADDRESS U CITY TEL.NO. DECEIVED BY READY FOR DATE ISSUED I'lLf FIRST INSPECTION J COUNTY w CERT.NO. EXPIRES APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB DESCRIPTION OF WORK ADDRESS ' NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST LIGHT OUTLETS SW. PLUGS FIXT CROSS ST. CIRCUIT A B C D E F G H R: NAME w Z MAIL ADDRESS CITY 7 EL.No.• 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY, CERTIFICATE OF. QUALIFICATION.; / ^ - ELECTRICIAN., I AM THE LEGAL.OWNER OF THE PROPEIM JDZSCRIBED ABOVE 1 e - OWNER. CORRECTIONS — a z a' O TOTAL NO. OF OUTLETS $ APPROVALS NO. OF FIXTURES $ DATE INSPECTOR'S NAME NO. OF MOTORS+ H.P. $ CONDUIT NO. OF SIGNS TRANS. $ WIRING NO, OF RANGES OR HEATERS $ FIXTURES MISCELLANEOUS $ POWER PERMIT FEE $ !" `� UTILITY CO.NOTIFIED TOTAL FEE , - FINAL "i £"� t DO 6.A 4.41 23M. APPLICATION FOR PERMIT DEPARTMENT OF ]BUILDING AND sAFETT, ELECTRIC TRIC 1 COUNTY OF LOS ANGELES I C WM. J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP I ZONE PERMIT NO. WIRING FIXTURES SERVICE RECEIVED BY READY FOR DATE ISSUED RANGE HEATER POWER I' r� , FIRST INSPECTION SIGNS MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY . � f .los ' NAME •' ..?�f=- �. �`f," ADDRE88 ADDRESS I„o (/ .a ?LOCALITY ✓- CITY L-te !NEAREST ,1 �� TEL.N ,./ ` iCR088 ST. WCERT.NO. ® ,OV EXPIRES al "? NAME MAIL DESCRIPTION OF WORKF 3 ADDRESS NUMBER OF OUTLETS ON CIRCUITS ( 0 LOCATION BY ROOMS CITY TEL.NO. LIGHT OUTLETS SW. PLUGS plxT I AM THE LEGAL POSSESSOR OF THE ABOVE LOS CIRCUIT AB C D E F G H ANGELES COUNTY CERTIFcT6�QFA===;-4 O�A FICATI' LIVING ROOM ELECTRICIAN. E --------- I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED DINING ROOM J ABOVE.. BRFST.RM. OWNER. BATH ---------_ CORRECTIONS ENT.HALL HALL NO. -------- / /1.L r FRONT PORCH OUTSIDE --------- "�lC.!£ t.r,-/, KITCHEN ----- � / _,- SERV.PCH. ------_--_ BDRM.NO, ---------- Z CLOSET (� BDRM.NO. ---- Q CLOSET TOTAL NO. OF OUTLETS $ APPROVALS NO. OF FIXTURES $ DATE INSPECTOR'S NAME NO. OF MOTORS H.P. $ `�k CONDUIT NO. OF SIGNS TRANS.. $ WIRING NO. OF RANGES OR HEATERS $ FIXTURES MISCELLANEOUS ffi POWER PERMIT FEE $ B} UTILITY CrNO-IFIED n Ftdl TOTAL FEE S n V,:,_#*KER'S COMPENSATION DECLARATION 76AGS39 DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a certificate of consent to self insure, + or'a certificate of Worker's Compensation Insurance, or a certified ,`COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C.) Policy No..WC 0671MImpany PY1T.1lFTT EAME FOR APPLICANT TO RLL IN JOB ADDREs9 5841 TEMPLE CITY BLVD. ❑ Certified copy is.hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE LOCALITY ❑ Certified copy Is filed with the county uilding in7ection 1&2-Family,Sq.Ft. $ — $ TEME CITY ,department. Multi-family Sq.Ft. — ST �pp8g LAS TUbW -Date - r/0- Applicant l.. Residential Swimming Pools ASSESSOR PAGE MAP BOOK PARCEL CERTIFICATE OF EXEMPTION FROM WORKEQQ Outlets:Ree._Light Sw. OWNER OR COMPENSATION INSURANCE .FIRM NAME CITY OF TEMPLE CITY (This section need not be completed If the work Involved by the First.20 MNL permit is for one hundred dollars($100)or less.) Total No. - Additional ADDRESS '9701 1 AS TUNAS D R. I certify that in the performance of the work for which this permit CITY T MPM CITY Tel.No. is issued, I shall not employ any person in any manner so.as to PLAN CHECK become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 APPLICANT Total No. Additional ADDRESS - Date Applicant 15 OR 20A,120V BRANCH CIRCUITS NOTICE TO APPLICANT: If, after making this Certificate of CITY Tel.No. Exemption,you should become subject 10 the Workers'Compensation 1 TO 10 INCLUSIVE'EACH provisions of the Labor Code, you must forthwith comply with such 11 TO 40 INCLUSIVE EACH PAPPLI ERMDTW ELECT. CO': provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH LICENSED CONTRACTORS DECLARATION ADDRESS 319 SAN DTMAG CYN. RD. � I hereby affirm that I-am licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH O (commencing with Section 7000)of Division 3 of the Business and CITY SAN DJ11M 7IT--599-5954 U Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO SHP UCENSE ORccPower Apparatus&Large Appliances REG.NUMBER 575339 Class.0-10 O License Number 575.339 Lic.Class C-i_n Size&Type HP,KW,KVA,or KVAR DISTRICT NO. PR S/ED BY i- Up to 3 Incl. t7' 10 l,�"l U.I Over 3 to 10 Incl. FINAL n Contractor RV ETECT- Com. Date F49192 DATE CD Over 10 to 50 Incl. JJ Z ❑ I am-exempt under Sec. Over 50 to 100 Incl. �P VALIDATION B.&P.C.for this reason Over 100 BY AL Services,Swbd.,MCC Panelboards Date: 0-200 Arreerrer 600:V' � Signature 201-1000 Amp.Under 600 V ❑ Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. _ SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's.License Law Sign with One Branch Circuit :�z• r t «� for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits Code): I _L. , r•..:a TIJ ❑ Misc.Conduits&Conductors I,as owner of the property,will do the work and the structure is not intended or offered for sale(Section 7044, Business Other(See Complete.Fee Schedule). ► i; ?I 65- 4 01 and Professions Code). C. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the sj_I e performance of the work for which this permit is Issued(Sec.3097, PERMIT FEE (Sub-Total) Civ.C.) � PLAN CHECKING FEE Lender's Name �� _-J F!-riff_'•, i!:.;��?' PERMIT ISSUING FEE . Lender's Address } V I certify that I have read this application and state that the above TOTAL FEE Information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize I repre tatives of t y to enter upon the above-mentioned ; pro/�r ' m fo ins ctlon, rposes. _ SEE REVERSE FOR EXPLANATORY LANGUAGE i v . SIGNATURE OF APPLICANT O AG DATE