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HomeMy Public PortalAbout5940, 5942, 5944 TEMPLE CITY BLVD_Electrical__ DOB SA 21M BETS 2-47 i4 P Cl1�IRON 'BAR PERM! DOARTMENT OF BUILDING AM SAFETY �lIC 1Cf1�i�E��i 1� iV COUIM OF LOS ANGELES ELECTRIC WM. I FOX, CHIEF ENGINEER a NAME .�a! Amt' J DISTRICT NO, GROUP ZONE PERMIT NO. - • v �1� 0 ADDRE6 o f CITY TEL.N RECEI ED BY READY FOR DATE ISSUED FIRST INSPECTION o, qq COUNTY CERT.NO. EXPIRES APPLICANT FILL IN HEAVILY OUTLINED PORTION 2VEY (DESCRIPTION OF WORK A DRESS NUMBER OF OUTLETS ON CIRCUITS LOCALITY LOCATION BY ROOMS NEAREST LIGHT OUTLETS SW. PLUGS Fl CROSS ST CIRCUIT A B C D 1 E F G IH m NAME ��x-�t t��, ���_J• ��.�.Q_, ADDRESS, O CITY C_ TEL.N� 1. •i� / 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS 9WW ANGCOUNTY CERTIF:lvTn OF QUALIFI�N.. ws//rr���iJJ ff ELECTRICIAN. H AM UM LZMAL OVYNER O E PROPERTY DESCRIBED ABOV$ 1� OWNER. coMONS r� J Q Z_ O a R O TOTAL vv/.2, NO. OF OUTLETS $ b APPROVAIS NO. OF FIXTURES 99 U DATE INSPECTOR'S NAME NO. OF MOTORS a H.P. @ S CONDUIT NO. OF SIGNS TRANS. S WIRING NOr-.:- OR HEATERS CC) FIXTURES MISC&LANEOUS POWER PERMIT FEE S ' /S UTILITY CO.NOTIFIED -mlrAL FEE S SIM'70 FINAL `! v D.B.B.SA SSM BETE IO-47 APPLICATION FOR PERM BDFPARTMENT OF BUILWNG AND SAFETY Hca a, COUNTY OF LOS ANGELES �LEC IC J. F HI F GI fifiR Q I NAME CARUMN ELECTRIC DISTRICT NO. GROUP ZONE PERMIT NO. itei E* s ADRESS Y • f ' CITY TEL-NO. RF-CEIV READY FOR DATE ISSUED 'FIRST INSPECTION ION COUNTYW CERT.NO. EXPI ES JJ��1Z. , .�7� `; APPLICANT FmL4N I;EAftY OUTLINE®PORTION ONLYJOB �) DESCRIPTION OF WORD ADDRESS-� 1 NUMBER OF OUTLETS ON CIRCUITS LOCALITY l LOCATION BY ROOMS NEAREST LIGHT OUTLETS BW. PLUGS FWT CROSS BT. - - ��,�' � CIRCUIT A B C D E F G H W NAM I e7e oc'-.{_P./®_'_,i et-! Z MAIL ADDRESB«�- �i tet., G ! C._ CITY 1 TEL.NO. 1 AM THE LEGAL POSSEBSOR OF THE ABOVE LOS § ANGD.ES COUNTY CERTIFICATE OF QUALIFICATION.. r N+ ELECTRICIAN. 1 1 AM TH$LEGAL OWNER OF THE PROP$RTY DESCRIBED + ABOVE r ' OWNER. CORIdIi;MIONS s I�1 J Q Z_ O 19 O TOTAL NO. OF OUTLETS E APPROVALS NO. OF FIXTURES $ DAT6 INSPECTOR'S NAME NO. OF MOTORRI H.P.9" /w G .`]r7 CONDUIT NO-.CW-Mr'hls '"AH3 y EJ. $ � WIRING NO. OF RANGES OR HEATERS $ FIXTURES MISCELL SOUS G / POWER PERMIT FEE $ P ��:j UTILGTYCO.NOTIFIED TOTALF ��� FI D.B.B.SA 25MLTS 113-47 AP TCATI®N FOR ,R P DEPARMIENT OF BUELM(; AND SAFM +� COUNTY OF LOS ANGELES ELECTRIC WM. J. FOX CHIEF ENGINEER Q NAME a ectrical Products Corp. DIST NO. GROUP ZONE PERMIT NO ADDRESS 1100 N.Main St. 1-i U CITY L.A. —12 TEL NO.CA 161Lµ GII�JCEIV®� READY FOR DATE 155UED N 1 o r FIRST INSPECTION y r CERT.NO. 556®B EXPIRES 6-30®'d9 APPUCAW FUf IT. IIN HFAVMY®UT'MEgD PORnON 0 ly JOB IDESCJL E } O OF WORK ADDRESS 210 North Sunset Blvd® HUMBSR OF OUTLETS ON CIRCUITS LOCALITY Temple City LOCATION BY ROOMS NEAREST Woodruff Ave. LIGHT OUTLETS 811Y. PLUGS PIli7 CR'3SS ST. CIRCUGT A S C O K F O H V NAME Southern Calif. Edison Coo Z MAIL ADDRESS 601 V1. 5th Street _ O CITY L.A. -13,Cal. TEL.No. I ARI THE LEGAL PO'392 30R OF THE RBOVC LOS Amin s cour TY cm-a I6'/�e$ OF QUALIFICs1TIW4. - - . GL�Ci:lCIA11. I A;4 TH:Z LMa.C3L$INER OF ly,3 PROP Ri 1( DECCRISED AEiOvE 1 = do iblf ced ver 'ca e in OWNER. re 3.diog 113D le G®1�r� �HDNS 2m3 imp trns . a a 0 � r Pd O. OF FIXTUh_ �C, DATE INSPECTOR'S NAME NO. OF MOTORS H.I+. $ C014DUIT I NO. OF SIGN3 �' TRA"rQ. L 10 Co WIRING NO`OF RANGES OR HEATERS ('i FIXTURES MISCELLANEOUS It ` POiWFR PERMIT FEE !I {� 1. 00 UTILITY CO.NOTIVIED TOTAL M n a o FINALi i =J, 76A66S-CE606 9-64 APPLICATION FOR. FlE TRICAL. PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER FNEAREST DING ` BUILDING AND SAFETY DIVISION RESS G JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT. OF BUILDING LITY FOR APPLICANT TO FILL IN SS ST. LOA RECEPT. TOTAL NO. EACH FEE Ald LIGHT OUTLETS, FIRST 20 15.20 $ NER MAIL . ADD'L SWITCHOVER 20 .10 ADDRE88�9 ,C • E CITY TEL.NO. LIGHTING TOTAL i I [FIRST 20 .20 FIXTURES 1 _ ADO'L OVER 20 "0 ELECTRICIA e4 4 r RANGES CLO.DRYERS WTR.HTRS. 1.00 ADORF-88 GARB.D18P. STA.COOK CITY TEL.NO. DISHWASH. AUTO.-WASH. STATE /�I SPACE HTRS. BTA.APP.C Vs X.P.MAX.) .50 LICENSE NO. / T MOTORS: OVER NOT OVER H.P. DISTR[JG7 NQ. GROU ZONEIP P OCE BY 0 I 1.00 O S C Z 1 s 1.50 INSPECTION RECORD s 8 2.00 d 81 s 2.50 O 15 So 3.00 m y s0 100 5.00 O SIGNS: L NO.TRANS. ! d NO.LAMPS N z SERVICE 0.800V-NOT OVER 200A 1.00 SERVICE 0-60OV-OvER 200 A. 2.00 SERVICE OVER 600V 5.00 MISC. PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT ISSUING FEE 1.00 TOTAL FEE R 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INBPECTOR'B BIGNATU AND STATE THAT THE ABOVE 18 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 FIXTURES ~ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF. AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. POWER SIGNATURE + I OF PERMITTEE ©•� UTILITY CO.NOTIFIED FINAL Y �-�•�� VA (DATION JOS H C. ROOHAN CK MO CASH SUPERVISING ELECTRICAL ENGINEER Lko4 3 3 7 AUG 2 4 2 D 4.00 11 1 . li 'ill q u 76AG63-CES06 6-62 APPLICATION FOR ELECTRICAL PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING'�r W BUILDING AND SAFETY DIVISION ADDRESS J/ JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A.JENSEN,SUPT OF BUILDING. LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST REC_EPT, TOTAL NO. EACH. FEE OUTLETS FIRST 20 S.20 $ OWNE D + O s LIGHT MAIL ADor L ADDRESS SWITCH. OVER 20 .10 LIGHTING TOTAL FIRST 20 20 CITY C.'Tj� TEL.NO. ` FIXTURES ADD'L .to ELECTRI IAN V/V'2 111 OVER 20 RANGES CLO.DRYERS WTR.HTRS: 1.00 ADDRESS /S-3/I Wkl GARB.DISP. STA.COOKy CITY � EL.NO.�� b DISHWASH. AUTO.-WASH. STATE SPACE HTRS. STA.APP.(Vs H.P.MAX.) ,50 LICENSE NO.. MOTORS, OVER NOT OVER N.P. DIS MCT-N ROUPJ NSE P ED Y O 1 1.00 �5 i J 1 s 1.50 I SPE ION RECORD 5 S 2.00 s is 2.50 1s so 5.00 �. a so 100 5.00 O NO.TRANS• / V SIGNS: NO.LAMPS O "? ov] SERVICE 0.600V•NOT OVER 200A 1.00 G Lu SERVICE O.600V•OVER 200 A. 2.00 N SERVICE OVER GOOV 5.00 ,z MISC. _ 1 PERMIT ISSUING FEE 2.00 SUPPLEMENTARY PERMIT'ISSUING FEB 1.00 TOTAL FEE $ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 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 1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ' LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL ROPB POWER ' SIGNATURE UTILITY CO.NOTIFIED OF PERMITTE FINAL. DATION ARTHUR C. VEIT CK MO CASH SUPERVISING ELECTRICAL ENGINEER LFLo O.9 6 84 AUL 7 2 D 4.00- 4 -.mac-- Cerci �' 76A 663-CE806 11-71 APPLICATION FELECTRI AL PE ii RMI `y7 COUNTY OF LOS ANGELES ftPARTMENT OF COUNTY ENGINEER ADDRESS ��'/• Pj, BUILDING AND SAFETY DIVISION LOCALITY' NEAREST FOR APPLICANT TO FILL IN CROSS ST OUTLETS NO. EACH FEE $ $ OWNER RECEPT._ MAIL LIGHT TOTAL FIRST 20 25, ADORES SWITCH OVER 20 .10 Cl TEL. NO wer f0 PLAN CHECtV LIGHTING TOTAL FIRST 20 .25 APPLICANT FIXTURES OVER 20 f0 ADDRESS RESIDENTIAL APPLIANCES CITY TEL. N0. PERMIT RANGE DRYER_WTR. HTR. APPLICANT STA. COOK DISP. F.A.U. ADDRESS SPACE HTR. AIR COND. CITY TEL. NO.� CLOTHES WASH. DISHWASH. LICENSE NO.?, CLASSezz-ol FAN OTHER 1.00 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING IND. HEATERS, ETC. HP. KW.KVA. ELECTRICAL WIRING. SIZE & TYPE OVER TO I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 0 - 1 1.00 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF a CALIFORNIA OR THAT I THE LEGAL OWNER OF, AND INTEND TO - 1O 3.00 Q� RESIDE IN, THE A V DESCRIBED RESIDENTIAL PROPERTY. V c SIGNATURE Am 10 - 50 5.00 OF PERMITTEE O So- 100 10.00 1- DISTRICTNO. CLASS ZONE ROC SEB B u Lu 100 — Soo 15.00Q 'Z CL U) SIGN, GAS SIGN AND ONE CIRCUIT 5.00 NOTES: Z TUBE, OR MARQUEE ADDITIONAL CIRCUITS 1.00 SERVI CENOT OVER 600 VOLTS OR 200 AMP 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE SERVICEOVER 600 VOLTS OR200AMP 10.00 TEMP.POWER POLE TEMP SERVICE,POLE,&APPURTENANCES 5.00 TEMP LIGHT OR RECEPT. SYSTEM 3.00 UNDERSLAB WORK ROUGH CONDIUT WIRING �°�r (J_7e! 91. FIXTURES POWER AUTHORIZED PERMIT FEE (SUB TOTAL) UTILITY CO. NOTIFIED PLAN CHECK FEE FINAL PERMIT ISSUING FEE 3.00 Q TOTAL FEE eC77 PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK M.O. CASH 7 5 9 LZ APR 30 2 D 6.0 O SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE DES S-A 2-46 - APPLi(:ATION FOR PERMIT DEPARTMENT• OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ELECTRIC WM. J. FOX CHIEF ENGINEER 3 �1 i. DISTR19PNO. G P ZONE PERMIT NO. 4,P_a NAME ,1ry �» �e. 41 j Z4r�-a �' U ADDRESS ! '�. C'37t.c+. s�• �� ��F �" � � RECEIVED 13Y READY FOR DATA ISSUED NU CITY -e tx,, TEL.NO. _ -1� FIRST INSPECTION C� � J COUNTY' / SS d ��_ �-A9� o W CERT.NO. EXPIRES APPI:ICANT FILL IN HEAVdY OUTLINED PORTION ONLY DESCRIPTION OF WORK JOB DRESS. f.' n �' l A'` Nor _ NUMBER OF OUTLETS ON CIRCUITS LOCALITY 0 t� rl LOCATION BY_ROOMS NEAREST tt p A LIGHT OUTLETS SW.l PLUGS F1iT CROSS CIRCUIT A B Ic I D E F IG IH 0: NAME P6 b MAIL ADDRESS CITY TEL NO. 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGEL= COUNTY CERTIFIC IleQU FICATION.. w.. 71ea t I AM THE LNGAL OWNER OF THE PROPERTY DESCRIBED ABOVE OWNER. CORRECTIONS J _Z - L7 R' O [PERMIT OUTLETS APPROVALS FIXTURES 4 $ A ' DATE INSPECTOR'S NAME MOTORS H.P. $ CONDUIT SIGNS TRANS. $ WIRING OF RANGES OR HEATERS $ FIXTURES LANEOUS $ POWER FEE $ UTILITY CO.NOTIFIEDFEE 8 FINAL COUNTY OF LOS-ANGELES" APPLICATION FOR- PERMIT Department of County Engineer - DIVISION OF•BUILDING & SAFETY �����R=� ' WILLIAM J. FOX, County Engineo F1,96MTT MFet t'(RIC•CO DISTRICT NO. E'aROUP ZONE PERMIT N1]'. ELECTRICIAN - / /a 0 "' ADDRESS TYLER RECEIVED BY READY ,FOR DATE ISSUED FIRST INSPECTION CITY ELL P •TEL.NO. COUNTY LICENSE Nl7 BUILDING � �+ 07 .y . Ir PERMIT FEES ?-'Ta* ADDRESS J�` R `I �J l— I NUMBER EACH FE LOCALITY !�/V/PhE OrY LIGHT OUTLETS NEAREST r'y� I RECEPTACLES CROSS ST. F/! WALL SWITCHES OWNER-9G V[J� TOTAL OUTLETS 5c S _ MAIL ELEC. RANGES 85 •. ' - ADDRESS ELEC.,HEATERS, 25 CITY TEL NO. FIXTURES 5 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ, THIS Misc. APPLICATION AND STATE THAT THE ABOVE IS CORRECT NUMBER OF LIGHT CIRCUITS• AND AGREE TO COMPLY WITH ALL COUNTYORD'LNANCES NUMBER OF RECEPTACLE CIRCUITS AND BTATE LAWS REGULATING ELECTRICAL WIRING. ' MOTORS 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOB NUMBER :HORSEPOWER FEE ANGELES COUNTY LICENSE. ORA AM THE LEGAL OWNER New MVO. HP OVER INC.•, �EAOH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. 1/2 & LESS S .25 • SIGNATURE OF 1/2 2 .50 PERMITTEQ � rA 2' s 1.00 INSPECTION RECORD B 15 1.50 is 50 2.50 50 200 5.00 200 BOO 10.00 J 5013 1000 .15.00 Z OVER 1000 20.00 M.G. SET/FREQ. CHANGER-HP WELDERS:AC-KVA O GENERATORS'- KW TRANSFORMERS - KVA ' TEMP. MOTORS (75% or ORIe.) MOVED MOTORS .(75% of BRIG.) MISC: - • .. _ Na a N13.'TRANS. APPROVALS ' NO. NO.LAMPS FOR-EAOH'PERMITI DATE INSPECTORS NAME WIRING, 411.00 00 CONDUIT FIXTURES $1.00 �e WIRING SUPPLEMENTARY •.50. FIXTUREB POWER ' TOTAL FEE S I. UTILITY CO—NOTIFIED FINAL. U Mv 46A668 DBS#5A 4-52' i - e i, COUNTY OF LOS ANSELn APPZ.MTM FOS PST Dwwrtuient of C°°° ELECTRIC i DMSION OF SFII.DII'�G 8c SAFBTY WILLIAM J. FOX.Omft Eglow FOR APPLICANT TO FILL IN 018TRICT NO. OROUP ZONE PERMIT NO. ELECTRICIAN �� , �� AODREs ]100 N. Hain St �Rs}o�slvs�op■Y VicAnFIRsr mspe°DRTiDN 7z11°�� CITY TEL.NuGA 1,631a COUNTY LIC ■E NO. 5533d KRPIR!■ NUILDINN 5944 Tanple City Blvd FED= F= ADDRESS NUMBER KAON FOX LOCALITT Temple City LICHT CUTLETS NEAIIENT Las T�mae REOEPTAOLKS C OSS R Dr WALL MWITCHER _OWNER BOtLtb= Corns TOTAL OUTLETS SD M MAILsb �.Clle�• $t CLEC. RANMEM Y ADDRESS ELJUL HKATKMM ss CITY L.A. Calif* TEL. ND. FIXTURES M 1 HERESY ADKNDNILEMM! THAT 1 HAVE READ THIN MIND. APPLICATION AND STATE THAT THE A■OV! IM CORRECT HUMMER OR LIMNT UIRCUITM AND ARM TO OOMPLY WITH ALL COUNTY UNDINANOKN NUMBER OF RECEPTACLE OIROUIT■ AND ■TAT! LAWN RESULATINM ELECTRICAL WIRINS. MOTORS 1 CKRTIFY THAT I POM■ THE ASW! VALID LOS NUMBS HORN�R FEE ANOEs■ OCUNTV LICEN■% OR 1 AM THE LEMAL OWNER HSM MvD. •HP IMII IND. ICADII OR THE RESIDENTIAL PROPERTY D RIMED A■CV L 8 SiRb .Sb ■ISNATURE OR S .bO PKRM • S s 1.00 niSPECMN RIMRD M is f.sD fs an M.Mo so Sao s.DO Mao am law J soo f DDD f s.Do Z ov= Imo Ss m n p M.S. ■cr OHANMER-HP ••� r WKLDERSI AO-KVA MENERAT13 M - KW TRANMFORMEI■ - EVA MR Dr ORIS MCVKa MOTORS « Dr DRIR.1 818NB N4 OOO No.TRANS. OZO le 00LPPSOYALS MIL LAMM Ei&t4NM ]so FOR EACH PERMITS TK IN■PEOTOR7 NAM! WIRINS 1.00 CONDUIT ri3rm O f.00 WIRIHM J�MEMTA ,S0 FIXTURKM •� MOWER TOTAL FEE s2, 50 UTILITY OO.NOTIFIED FINAL 7MS10 DSIR�RA SrbR DOE SwA DEPARTMENT OF,BUKLDING AND SA1�E'1'!Y. ,=. CA�'ION FOR PERMIT COUNTY OF LOS ANGELES OX Cbl NGIIVEE - ELECTRIC _zNAM DISTRICT NO. GROUP I ZONE PERMIT NO. U 'ADDRESS s ✓� i- URECEIVED,BYt 'READY-FOR DATE ISSUED" W CITY TEL:NO ��jw FIRST INSPECTIONCUNTYf W I .CERT.O. ` EXPIRE �(. °�d•'r% , .• - - 6L--' /. PLICANT" U01EAVEIX OUTLINED PORTION ONLY DESCRIPTION OF WORK • JOB - DESCRIPTION ADDRESS NUMBER OF OUTLETS ON CIRCUITS' LOCALITY LOCATION BY ROOMS , NEAREST , LIGHT-OUTLETS ISW. PLUGS FoiT CROSS ST. t� .. CIRCUIT.- AB_ C D E. F G H W, NAME t r Z. MAIL +� ADDRESS 1 • 4 CITY TEL.NO. r - 1 AM THE L AL POS OF E LOS ANGKi��.w COON CERT F Q F • n _ (( eLECTR1 RAN. I AM T=jj=AL CiNNER G TH6 PROPERTY RiBED ABOV6 IF .. -A�D� OWNER. rr CORRECn0p\S ' Z 1] TOTALI.e. NO. OF OUTLETS ,+ . APPROVALS NO.-OF FIXTURES S DATE INSPECTOR'S NAME NO. OF MOTORS H. _ S / CONDUIT. NO. OF SIGNS/ TRANS. S _ ry' ,r_) WIRING rrn 'NO.OE.RANGES OR H S $ -F=UR ES f• MISCELLANEO $ �: �" POWER-.Jf f r ^J, PERMIT FEE S f e�•`�� UTILITY CO.NOTIFIED 1IF 1 . l .Q t l�A/W�> TOTAL FEE r �i _I �' FINAL / ��� `20 WORKER'S COMPENSATION DECLARATION6A6083 DPW(12.91) 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 i COUNTY OF LOS ANGELES u r DEPT.OF PUBLIC ORKS BUILDING AND SAFETY DIV. copy thereof(Sec.3800 Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN JOBYJ/''� q ADDRESS `7 7 (! Certified copy is hereby furnished. New Residential Bldgs.&Pools NO. EACH FEE LOCALITY "y e ❑ Certified copy is filed with the county building,inspection 1 &2-Family,Sq.Ft: _ $ $ NEAREST , department. Multi-family Sq.Ft. CROSS ST.rA! Date Applicant Residential Swimming Pools ASSESSOR MAP BOOK PAGE PARCEL CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Ree._Light Sw. ORM NAME !vo COMPENSATION INSURANCE First MAIL � �0 (This section need not be completed If the work Involved by the Total No. Additional ADDRESS permit Is for one hundred dollars(8100)or less.) I certify that.in the performance of the work for which this permit 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 RESIDENTIAL APPLIANCES NOT OVER 3 H.P. NOTICE TO'APPLICANT.: If., after making this Certificate of CITY Tel.No. Exemption,you should become subject to the Workers'Compensation i OTHER APPLIANCES NOT OVER 3 HP. PERMIT provisions of the Labor Code,you must forthwith comply with such power A g pp provisions.or this permit shall be deemed revoked. pparatus&Large A liances APPLICANT LICENSED CONTRACTORS DECLARATION ! Size&Type HP,KW,KVA,or KVAR ADDRESS I hereby affirm that I am licensed unifier provisions of Chapter 9 Over 3 to 10 Incl. CITY Tel.No. (commencing with Section 7000)of Division 3 of the Business and , Professions Code,and my license is in.full force and effect. Over 10 to 50 Incl. } LICENSE OR Class d Over 50 to 100 Ind. REG.NUMBER O Over 100 DISTRICT NO. ESSED BY V License Number Lie.Class Services,Swbd.,MCG&Panelboards Contractor Date, i 0-399 Amp.Under,600 V DAA ❑ 400-1000 Amp.Under 600 V V I am exempt under Sec. I VALIDATION UJ I Over 1000•Amp.or Over 600 V FINAL IL B.&P.C.for this reasonBRANCH CIRCUIT FEES BY Z Date: j 15A,or 2.0A,120V,Lighting•or Recept. Signature I 1 To 10 Branch Circuits 11 To 40 Branch Circuits 41 Or More Branch Circuits ❑ Exemption for Reg.Maint.Elect. 15A,20A,208V To 2T7V Lighting Br.Circults SINGLE FAMILY } Temp.Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATIONI Sign with One Branch Circuit ACCT A I hereby affirm that I am exempt from the Contractor's License Law I for the following reason(Section 7031..5,.Business and Professions Additional Sign Branch Circuits 3303 44a40 • Code): j I,as owner of the property,will do the work and the structure Misc.'Conduits&Conductors 1 ITEMS is not intended or offered for sale(Section 7044, Business 910r(See Co plete Fee Sched e) poll. TOTAL 44.40 and Professions Code). d CHECK 44.40 CONSTRUCTION LENDING AGENCY CHANGE a d� I hereby affirm that there is a construction lending agency for the ' performance of the work for which this permit is-Issued(Sec.3097,',( ERMIT FEE (Sub-Total) Civ.C.) PLAN CHECKING FEE 0000-0001 1/31/96 Lender's Name f PERMIT ISSUING FEE d 4611 1 AM 9:17 Lender's Address I certify that I have read this application and under penalty of purjury state , TOTAL FEE that the above information is correct. I agree to-comply with all County. II ordinances arid State laws regulating Electrical wiring,and hereby authorize I F representatives of this County to enter upon the above-mentioned property I 1 for inspection p rpose . , SEE REVERSE FOR EXPLANATORY LANGUAGE I SIGNATURE OF PERMITTEE DATE i