HomeMy Public PortalAbout5945 TEMPLE CITY BLVD_Electrical__ • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0911230024
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAID I BUILDING ADDRESS:
ON FILE I I 5945 #1 TEMPLE CITY BL
]FEE DESCRIPTION: QUANTITY: UOM: AMOUNT-1 TEMP CA 91780 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I
18587-014-007 IAl PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl
I IG1 OUTLETS-LGT,SW,RECP 14.00 OUT 27.30 [
ITENANT: IG2 LIGHTING FIXTURES 7.00 LGT 13.65 [ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: ]
I I TOTAL FEES 68.70 111/23/09 SR 11/23/10 I
1OWNER: TEL. NO: I (FIN DATE F AL BY: CODE:
(TONG, LUCITA C (626) 512-1274- i i � � Q
5945 TEMPLE CITY BL.
TEMPLE CITY CA 91780 I IDESCRIPTION OF WORK
I I IELECTRICAL FOR TENANT IMPROVEMENT RELOCATE 4 CELING LIGHTS, 1
I I 113 OUTLETS, 3 NEW LIGHTS AND 1 SWITCH 1
1APPLICANT: TEL. NO: I 1 I
(LAI (626) 288-2651-
8748 VALLEY BLVD. #K I ISPECIAL CONDITIONS: 1
ROSEMEAD, CA 91770
1CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1
IBEYOND CHOICE CONSTRUCTION (909) 463-9995- 1 1 I
17615 ETIWANDA AVENUE #201 LIC. NO [ ITEMPORARY POWER POLE I I I
IRANCHO CUCAMONGA, CA 91739 916375 B ] I I ] ]
I ] ]UNDERGROUND CONDUIT
� I I
ARCHITECT OR ENGINEER: TEL. NO: - i IUFER GROUND i I
I LIC. NO: I IROUGH CONDUIT I ]
]
(ROUGH WIRING -71k IV I
I I I I I I
] I IMAIN WATER LINE I I I
I I IPLASTIC YIN METAL YIN I I I
I I ]UTILITY COMPANY NOTIFIED I I
I I I I I ]
I I I I I
] I I
I ] I ]
I I I I I
I I I I I I
I I I ] I ]
I I
I I I I ]
] I I I I ]
I IREPORT ID: DPR265 ROUTE TO: BS0508 I I 1
I I I I I ]
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS
EL 0508 1405270078
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
]LEGAL ID:] I FEES PAID ON FILE ] I BUILDING ADDRESS: I
1 5945 TEMPLE CITY BL I
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:] TEMP CA 91780 1
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: WOODRUFF
18587-014-007 1A1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl
D3 BOOTH LGT, SYSTEM 1.00 B00 16.20
ITENANT: TOTAL FEES 44.00 ISSUED ON: PROCESSED BY: PLAN BY:
TEMPLB CITY HIGH SCHOOL BASEBALL 05/27/14 SR 1
(OWNER: TEL. NO: FIfAL DATE BY:
ITEMPLE CITY PLAZA, BOB C (626) 289-4088-
238 S. ATLA
89-4088-238S. TLA TIC BLVD ] Ia /:
ALHAMBRA
1 I
Rt
IFIREWORRKS STAND LIGHTING 2014
I
]APPLICANT: TEL. NO: I I I
ITNT FIREWORKS, BRAD HUDSON (714) 738-1002-1159 1 ] I
1555 N GILBERT ST ISPECIAL CONDITIONS: 1
IFULLERTON CA 92833
] I I
(CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1
IK C ELECTRIC (714) 699-0106- 1 I
14440 CHARLEMAGNE AVE LIC. NO I ITEMPORARY POWER POLE I I
ILONG BEACH CA 90808 699521 1 1 I
I JUNDERGROUND CONDUIT I I
(ARCHITECT OR ENGINEER: TEL. NO: I 1UFE$ GROUND I I I
_ I I �
LIC. NO: I IROUCH CONDUIT I I I
IROUGI4 WIRING I I I
I ] ]MAII4` WATER LINE I ] I
(PLASTIC Y/N METAL Y/N I ] I
I 1UTIY.:TY COMPANY NOTIFIEDI I
I ] I I I I
I I I I I I
I
I I I
I I I ] I I
I I ] I I I
I I I I I
I ] I I I I
1 I ] I I
REPORT ID: DPR265 ROUTE TO: BS0508 I I I I I
,COUNTY dF LOS ANGELES. TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OFPUBLId WORKS "' -9701.LAS TUNAS EL 0508 1210240047
BUILDING AND SAFETY / LAND DEVELOPMENT, f$MPLE CITY CA 911780
.PHONE:. (61-6i.'.285-0488 EX'T:
ILEGAL'ID: I '•'' 7 '• FEES PAID I BUILDING ADDRESS:
ON FILE 5945 TEMPLE CITY BL 1
IFEE'DESCRtPTION': QUANTITY: UOMi, AMOUNT:( TEMP CA 91780
(ASSESSOR INFORMATION NUMBER: I r I NEAREST CROSS ,STREET: WOODRUFF
18587-014-007 JAI PER14IT ISS&,NCE'FEE 27.80 I THOMAS PAGE: 596 GRID: J3 LOCALITY:- TEMPLE CIT,Y,CAI
.1 -IGI OUTUiS-LGT,SW,RECP 8.00 OUT' 16.00 .1
(TENANT: 1 ` • TOTAL FEES43.80 (ISSUED ON: PROCESSED BY: PLAN BY: 1
VISTA IT CONSULTING/TRAINING I 110/24/12 SR 1
(OWNER: TEL: N0: I IFINAL DATE FI Y: CODE: I
.ITEMPLE CITY,PLAZA' (626) 289-4088- 1 I 1
('238 S. ATLANTIC BLVD I
[ALHAMBRA, CA 91801 I IDESCRIPTION OF WORK [
[ 1 IT/I 6 OUTLETS AND 2 SWITCHE I
(APPLICANT: TEL. NO: 1
ILAI, BILLY (626) 512-5748- 1
19173 SOUTHVIEW RD i ISPECIAL CONDITIONS:
SAN GABRIEL CA 91775
ICONTRACTORi TEL. 'N0: IAPPROVALS DATE INSPECTOR SIGNATURE
IS B L CONSTRUCTION INC (626) 512-5748- I I
19173 SOUTHVIEW ROAD LIC. NO I ITEMPORARY POWER POLE I I [
ISAN GABRIEL CA 91775 754301
I I I I I
[ 1 JUNDERGROUND CONDUIT I I I
1ARCHITECT OR ENGINEER: TEL. NO: 1 IUFER GROUND I I I
LIC. NO: i TROUGH CONDUIT
1 i
I ROUGH WIRINGMAIN WATER LINE
[PLASTIC Y/N METAL Y/N
[ (UTILITY COMPANY NOTIFIED[ I
I I [ I [ I
I I I I I [
I I I I [ [
[ I I I I
I I [ I I
I I I I
[ I 1 I I
[ I I I 1 [
1 IREPORT ID: DPR265 ROUTE TO: BS0508 I I I [
[ I I I I [
I
ti COUNTY OF IAS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS
EL 0508 0906080038
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
[LEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE 5945 TEMPLE CITY BL
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ TEMP CA 91780
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: WOODRUFF
18587-014-007 1A1 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl
I 1D3 BOOTH LGT, SYSTEM 1.00 BOO 16.20 I
(TENANT: TOTAL FEES 43.95 11SSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1
(TEMPLE CITY HIGH SCHOOL BASEBALL I 106/08/09 SR 12/05/09
(OWNER: TEL. NO: I IF ALTTE FI Y: CODE: 1
ITEMPLE CITY PLAZA LLC (626) 289-4038- 1 /� 1
1238 S. ATLANTIC BLVD I Iy
IALHAMBRA, CA 91801 ID SCRI TION bF WORK 1
I i [BOOTH LIGHTING FOR FIREWORKS STAND 2009 1
[APPLICANT: TEL. NO: 1 I I
ITNT FIREWORKS (714) 738-1002- I 1
1555 N. GILBERT ST. i 1SPECTAL CONDITIONS:
FULLERTON, CA 92833
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I
IK C ELECTRIC (310) 505-0444- 1 1-' I
16509 GLORY WHITE ST. LIC. NO I ITEMPORARY POWER POLE i 1 I
ILAKEWOOD, CA 90713 699521 C10 1 1 1
(UNDERGROUND CONDUIT I I
[ARCHITECT OR ENGINEER: TEL. NO: I IUFE. GROUND I 1 I
_ � 1 1
1 LIC. NO: 1 IROUGH CONDUIT I I I
_I 1
1 I TROUGH WIRING -1-1
1
1 1 IMAIN WATER LINE
I I IPLA$TIC YIN METAL YIN I I I
I (UTILITY COMPANY NOTIFIED( I I
I I I I I
� 111 I I I I
I I I I I I
1 IREPORT ID: DPR265 ROUTE TO: BS0508 I 1 1
I I I I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 0406140013
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL D: FEES PAID BUILDING ADDRESS:
ON FILE 5945 5953 TEMPLE CITY BL
! FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 91780
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
Al PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY
D3 BOOTH LGT, SYSTEM 1.00 B00 21.25
TENANT: TOTAL FEES 49.00 ISSUED ON: PROC SS D BY: PLAN BY: EXPIRES ON:
AMERICAN LEGION POST #279 06/14/04 VG 12/11/04
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
CHANG, BOB C (818) 289-4088-
238 S. ATLANTIC BLVD �j6 --rr --
ALHAMBRA: CA 91801 DESCRIPTION OF WORK
ELECTRICAL FOR FIREWORKS STAND -2004
APPLICANT: TEL. NO:
MCDOUGAL (323) 567-9391-
3205 INDEPENDENCE SPECIAL CONDITIONS:
SOUTH GATE CA 90280
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
DUNAMIS ELECTRIC (626) 443-6721-
5119 BALDWIN AVE. LIC. NO TEMPORARY POWER POLE
TEMPLE CITY, CA 91780 695667 CIO
UNDERGROUND CONDUIT
I
ARCHITECT OR ENGINEER: EL. 0: UFER GROUND
LIC. NO: ROUGH CONDUIT
RROI R WIRING
MAN WATER LINE
i PLASTIC Y/N METAL Y/N
UNITY COMPANY NOTIFIED
i
i
REPORT ID: DPR265 ROUTE TO: BS0508
• COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1306030078
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I
ON FILE II I 5945 TEMPLE CITY BL I
(FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:I TEMP CA 91780 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: WOODRUFF
18587-014-007 (rIA1 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl
I IID3 BOOTH LGT, SYSTEM 1.00 BOO 16.15 I I
TENANT: 1 TOTAL FEES 43.95 11SS •D ON: PROCESSED BY: PLAN BY:
TEMPLE CITY HIGH SCHOOL BASEBALL 1 106/03/13 SR
(OWNER: TEL. NO: 1 1FI ° D E FI BY: CODE:
ITEMPLE CITY PLAZA, BOB C (626) 289-4088- 1 I
1238 S. ATLANTIC BLVD 1 I77
I
IALHAMBRA CA 91801 1 [DESCRIP ON OF WORK [
I [FIREWORKS STAND LIGHTING 2013 [
(APPLICANT: TEL. NO: [
ITNT FIREWORKS, BRAD HUDSON (714) 738-1002-159 I- J
1555 N GILBERT ST ISPECIAL CONDITIONS: 1
FULLERTON CA 92833
1 � I
� � I
CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1
IK C ELECTRIC (714) 699-0106- I 1 I
14440 CHARLEMAGNE AVE LIC. NO 1 ITEM ORARY POWER POLE I I
HANG BEACH CA 90808 699521 I J
I I 1UND RGROUND CONDUIT 1
ARCHITECT OR ENGINEER: TEL. NO: - i iUFER GROUND
1 LIC. NO: 1 IROU H CONDUIT
TROUGH WIRING I
J I IMAIN WATER LINE I
I (PLASTIC Y/N METAL Y/N I I I
I JUT LITY COMPANY NOTIFIED( [
J I I I I I
I I I I I I
I I I I I
IREPORT ID: DPR265 ROUTETO: BS0508 J I I I
I I I I I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS
EL 0508 1205290051
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: I FEES PAID I BUILDING ADDRESS:
ON FILE 1 I 5945 TEMPLE CITY BL I
(FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 91780 1
ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: WOODRUFF
18587-014-007 1A1 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl
I -ID3 BOOTH LGT, SYSTEM 1.00 BOO 16.15 I I
(TENANT: I TOTAL FEES 43.95 (ISSUED ON: PROCESSED BY: PLAN BY:
TEMPLE CITY HIGH SCHOOL BASEBALL 1 105/29/12 SR
10WNER: TEL. NO: FIPL DATE FI BY: CODE: 1
ITEMPLE CITY PLAZA, BOB C (626) 289-4088-
1238 S. ATLANTIC BLVD 1
IALHAMBRA, CA 91801 1 jDlWCflPTtON OF WORK 1
I i (FIREWORKS STAND LIGHTING 2012 1
(APPLICANT: TEL. NO: I I
TNT FIREWORKS, BRAD HUDSON (714) 738-1002-159 I I I
1555 N. GILBERT ST. 1 (SPECIAL CONDITIONS:
IFULLERTON, CA 92833 1
I I
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1
IK C ELECTRIC (714) 699-0106- I 1 I
14440 CHARLEMAGNE AVE LIC. NO 1 ITEMPORARY POWER POLE
HANG BEACH CA 90808 699521 C10 I I I I
I I 1UNDTRGROUND CONDUIT I I
(ARCHITECT OR ENGINEER: TEL. NO: I IUFE GROUND I I
_ I I
1 LIC. NO: i IROUGH CONDUIT I I I
I TROUGH WIRING
I I
I I (MAIN WATER LINE I I
I I PLASTIC YIN METAL YIN
(UTILITY COMPANY NOTIFIED( I I
I i I I I I
I I I I I I
I ! I I I I
II 1 I I
'REPORT ID: DPR265 ROUTE T0: BS0508
.; COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1105030035
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
l
(LEGAL ID: FEES PAID I BUILDING ADDRESS:
ON FILE I I 5945 TEMPLE CITY BL
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT; TEMP CA 91780 I
(ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET- WOODRUFF 1
18587-014-007 IAl PERMIT ISSUANCE FEE 27.80 1 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl
ID3 BOOTH LGT, SYSTEM 1.00 BOO 16.15 I 1
ITENANT: I TOTAL.FEES 43.95 11S8UED ON: PROCESSED BY: PLAN BY:
ITEMPLE CITY HIGH SCHOOL BASEBALL
1 105/03/11 SR
JOR:ITEMPLE CITY PLAZA, BOB C (62T L. NO: 88- 1 IF i DAT FIN BY: CODE: I
1238 S. ATLANTIC BLVD 1 I 1
1ALHAMBRA, CA 91801 I I S IPTION F WORK
IFIREWORKS STAND LIGHTING 2011
I
APPLICANT: TEL. NO:
(TNT FIREWORKS, BRAD HUDSON (714) 738-1002-159 1 1
1555 N. GILBERT ST. I (SPECIAL CONDITIONS:
IFULLERTON, CA 92833 1 1
I 1 1
1699-0106-
14440
1 1 I
I�NT��TDR TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE
IK C ELECTRIC (714) 699-0106- 1 1
14440 CHARLEMAGNE AVE
1LONG BEACH CA 90808 LIC. NO I (TEMPORARY POWER POLE I I I
699521 C10
1UNDERGROUND CONDUIT 1 1 1
IARCHITBCT OR ENGINEER: TEL. NO: - I IUFER GROUND I I I
LIC. N0: I IROUGH CONDUIT 1 I 1
1 1 (ROUGH WIRING 1 1
I I I I
I
1 I (MAIN WATER LINE
1 1 IPLASTIC YIN METAL YIN 1 I 1
(UTILITY COMPANY NOTIFIED( 1
I I 1 1 1
1 I I I
1 1 I I I I
I I I I
I
1 I I 1 I I
I I I I 1
I I I I I I
(REPORT ID: DPR265 ROUTE TO: BS0508
I
I I I
( COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS EL 0508 1006090034
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I
ON FILE I 1 5945 TEMPLE CITY BL I
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 91780 [
(ASSESSOR INFORMATION NUMBER: IINEAREST CROSS STREET: WOODRUFF
18587-014-007 JAI PERMIT ISSIIANCE FEE 27.75 THOMAS PAIGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl
ID3 BOOTH LGT, SYSTEM 1.00 BOO 16.20 I 1
TENANT: I TOTAL FEES 43.95 JISSUEDON: PROCESSED BY: PLAN BY: I
(TEMPLE CITY HIGH SCHOOL BASEBALL I 06/10/10 SR
(OWNER: TEL. NO: [ IFMEEA E FI BY: CODE:
TEMPLE CITY PLAZA, F (626) 289-4088- I Ir�'Q
1238 S. ATLANTIC BLVD [ 1 1
IALHAMBRA, CA 91801 [ IDESC IPTION OF WORK [
I I IFIREWORKS STAND LIGHTING 2010
(APPLICANT: TEL. NO: I I I
(TNT FIREWORKS, BRAD HUDSON (714) 738-1002-159
555 N. GILBERT ST. 1 ISPECIAL CONDITIONS: [
FULLERTON, CA 92833
I I I
[CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE
IK C ELECTRIC (562) 867-4447- [ 1_ I
16509 GLORYWHITE ST. LIC. NO [ ITEMPORARY POWER POLE i I 1
]LAKEWOOD, CA 90713 699521 C10 I I I I
I [ 1UNDERGROUND CONDUIT
I I
(ARCHITECT OR ENGINEER: TEL. NO: 1 IUFER GROUND I I I
I I I
LIC. NO: i TROUGH CONDUIT I I I
I I TROUGH WIRING [ 1
IMAIN WATER LINE I I 1
I 1 IPLASTIC Y/N METAL Y/N I I I
I [UTILITY COMPANY NOTIFIED( I I
I I I I I I
I I I I I I
I I I I I
I I I I I I
I I I I I
I I I I I I
I I I I I 1
11REPORT ID: DPR265 ROUTE TO: BS0508 I [ [ [
WORKF,RS'fOMPENSATION DECLARATION CE-.8 10/81 �� APPLICATION FOR. ELECTRICAL PERMIT
I,her ,,4affirin,4h:at I have.a certificate of consent to self CE-.8 ;�r >
i sure„ or a certificate of Workers'Compensation Insurance, d;,n v) � �Y ®F LOS ANGELES BUILDING AND SAFETY
!�a certified copy thereof(Sec. 3800, Lob. CC..)) ed
�1]"
Policy No.6r�Company 9 �' &YD 'f O FOR TFILL IN JOB �+
❑ u v I EACH NO. FEE ADDRESS S �J � l®LEs��
Certified copy is hereby furnished. New Resic�entia.l Bldgs. &Pools.
Certified copy is filed with the county. Ing eC- 1 &2-Family, Sq. Ft. $ — $ LOCALITY a
Pion epart pent. Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools CROSS 5T. wov'VRt/ i
Date ApplicantOWNER OR Of,
FIRM NAME
CERTIFICATE OF EXEMPTION FROM ORKERS' MAIL r+
Outlets: Rec Light Sw._ �y ,,(
.COMPENSATION INSURANCE 20 ADDRESS � /y� I.��`e Q A.
(This section need.not Be completed if the work•involved by First t
the permit is for one hundred dollars($100)or less.) Total No. Additional CITY_# Ate. clry Tel..No.. .-.
that in the performance of the work for which this PLAN CHECK
I ceeti
fY P APPLICANT
permit is issued, I shall not employ any person inany manner
so as to become subject fo tkie�ers'Compensation Laws. Lighting Fixtures First 20 ADDRESS,
Total No. Additional
CITY Tel. No:
Date ppl' an.t Fixed Appliances Not Over 1 HP PERMIT +
NOTICE TO APPLICANT': If, after making this Certificate of APPLICANT iC 1�2✓JGr�`
Exemption, you should .become subject to the Workers' Range— Heater._.D.W. _ ?
Compensation provisions of the Labor Cade; you must forth- Oven. _Dryer —W.M.— ADDRESS �.
with .cornply with .such provisions or this permit shall be Top — FAU —'GiI.H. —
deemed revoked.
CIT Tel: No.��VLL
Hood — Fan _Other v� ��gy
LICENSED CONTRACTORS DECLARATION LICENSE OR ��
I herebyaffirm that I am licensed under Disp. — Room.Air'Cond. REG. NUMBER 6-SI'7 Class..C (�
provisions of Chapter 9
(commencing with Section 7000)of Division.3-of the-Business DISTRICT NO. PR ESS .BY
and Professions Code,.and my license is in full force and effect. Power Apparatus&Large Appliances
L Size&Type HP;KW, KVA,'or,KVARi VO
IL
License Number 7�J6S ir.Class �"/� _ .Up to .1 Incl.. 0. FINAL W
Over 1.to 10 Incl. DATE VALIDATION e'
Contractor Date. �' Over 10 to.50 fncl.
FINAL
❑: I am exempt under Sec. Over 50•to 100 Inc. BY M1
B.&P.C. for this reason
Over 100
Services, Swbd., MCC&Panel boards
� 0 -..200 Amp. Under 600'V -2.7 9 2 7 A
Sigriature 201 - 1000 Amp. Under 600'V
Over 1000 Amp. or Over 600 V # a o o 0.0 2
Exemption for Reg. Maint. Elect.
SINGLE FAMILY Temp. Power Pole&Appurtenances I o 0 7 1.50
-HOME OWNER-BUILDER DECLARATION .
Sign with One Branch:GirPuit o 0 0 ']1,5 Q x�
'I hereby affirm:that I am exempt from the Contractor's,LicenseAdditional Sign Branch Circuits
Law for.the following reason. (Section 7.0.31.5; Business and 0 9. 1 58 7
Professions Code):
❑ I, as owner of the property, will do the work and the Mase. Conduits&Conductors
structure. is not intended or offered for sale (Section Other(See Complete Fee Schedule)_
7044, Bus!ness and:Professions Code):
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a Construction nding•agency for
the performance of the work for which this:permit is issued PERMIT FEE (Sub=Total) `
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name
— ZA
PERMIT.ISSUING FEE'
Lender's Address
I certify'that. I have read this applicat'i'on and state that.the TOTAL FEE <
above information is correct. l agree to comply with all County.
ordinances Stat laws .egulating Electrical wiring, and
WAY.a ori r rese a' es of this County to enter upon
tild'a 'e-me ti d y for inspect 0pure es.
SEE REVERSE.FOR EXPLANATORY LANGUAGE
ignature Permittee Date