HomeMy Public PortalAbout5949 TEMPLE CITY BLVD_Electrical__ D.B.S.neSM BETS 10-47 APPUC1TION FOR rPfl
DEPARTMENT OF BUILDING AND SAFETY "ELECTRICSOUNTY OF IAS ANGELES
J./M. CHIEF ENGINEER 1.1 !ti
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NAME /P.N `l��//�lG4l �.ta��' � IC/ .,DISTRICT NO. GROUP ZONE PERMIT NO.
ADDRESS d. ?r 1f/. f L.PAe �J�y �//�CITY ! it<,� ? r, 1 TEL.NO.;f'!,(L1'Xl 13Y READY FOR DATE4SSU.ED
� ��// � FCERT.of t F�XPIIt-JLC,(. 1—
APPLICANT FII IN~HEAVILY-OUTLINE®PORTION ONLY
JOB
(DESCRIPTION OF WORK —ADDRESS I��/a�o�
NUMBER OF OUTLET'S ON CIRCUITS LLI
I:OCATY ,1 R�l n ("//��i J% { r w /
LOCATION 13Y ROOMS NEAREST
LIGHT OUTLETS SW. PLUGS rl* CROSS Sr. F.r��.11�� s�(-<��• '/VV
CIRCUIT A 13 C D E F G H R NAME /� C,(":tea it-/9.fl I.1 GIS
aJ z MAIL r~ r
ADDRESS [�BJ I` '•L�l
0
CITY
4 Jai t.f:MiJ TEL-No.
l 1 AM THE LEGAUY FOSS ESSO OF THE ABOVE IAS
/ll•a✓1�1'�� , ANGEL COUNTY CERTIFICATOF QUALIFICATION:/
XY4,11 1 "111w
ELECTRICIA .
kI AN THE LFZA* OWNER OF THF.PROPERTY DESCRIBED
'sf OWNER.
CORRECTIONS
ri All,Ar/Ai /r ll.t a 6 oe.:L t .1 J
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_Z
17
, !C
O
T A Os Ii ry ,
NO. OF OUTLETS / v $ APPROVALS
NO. OF FIXTURES / $ DATE INSPECTOR-8
NO. OF MOTORS H.P.- $ CONDUIT 1 P
NO. OR SIGNS TRANS. $ WIRING ,l
NO. OF RANGES OR HEATERS $ FIXTURES (J-Z G
NIISCEL N $ .POWER
PERMIT FEE $ - TILITYCO.NOTIF19D A • i11 � `/ /� �
TOTAL FEE $,
N :>. "fill. WORKERS'COMPENSATION DECLARATION 78A683 10/81
CE-806G APPLICATION FOR ELECTRICAL PERMIT {�
hgrebylaffirm that I have a certificate of consent to self insure �J
o�a certific$te of Workers' Compensation Insurance,or a certifiet�l COUNTY OF LOS ANGELES BUILDING AND SAFETY
cd�y thereof 7S8c 3800,Lab.C.)
.r^ FOR APPLICANT TO RLL IN JOB '
Policy No. Company ADDRESS
❑ Certified copy is hereby furnished. New Residential BI;gs.&Pools EACH NO. FEE j
+ $ — $ LOCALITY r/��//•G �'
❑ Certified copy is filed with the count building inspection 1 &2-Family,Sq.Ft.
department. y g Multi-family Sq.Ft. — NEAREST
CROSS
Date
Residential Swimming Pools OWNER OR
Applicant `
CERTIFICATE OF EXEMPTION FROM WORKERS' i ' 1 ,+ '� , FIRM NAME
COMPENSATION INSURANCE Outlets:Rec—Light SVJ�y - e a ' �L�
1 First 20 ADDRESS
(This section need not be completed if the work involved by thei Total No._� Additional CITYMUD ,L� G No.
permit Is.for one hundred dollars($100)or less.) 1 PLANICHECK
I certify that in the performance of the work for which this permit ► APPUCANT
is issued, I shall not employ any pets jt, any manner o as to
become subject to the Workers'Co a ,tion Lighting Fixtures First 20, ADDRESS
Total No.
Additional� CITY Tel.No.
Dates Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICA T: f, ter m g this Cer to of
Exemption,you should become subject to a Workers' r mpensation Range_ HeateD.W. _ APPLICANT d
provisions.of the Labor Code,you must forthwith comply with such Oven_ Dryer W.M._ ADDRESS ' ,/
provisions or this permit 6hall be deemed revoked. Top _ FAO W.H. _ CITY Tel.No. Z —
Z
LICENSED CONTRACTORS DECLARATION Hood — Fan Other_ 4090
I hereby affirm'that I am licensed under provisions of Chapter 9
LICENSE OR -7 j
Disp. — Room Air Cond. REG.NUMBER f l� 1Class��v
(commencing with,Section 7000),of.Division 3 of the Business and
Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. PROCESSED BY
/J Siz Type HP,KW,KVA,or KVAR v
License Number Lim Class. Up to-1 Incl., FINAL _yf{'} .8
Over 1 to 10 Incl. n. DATE
VALIDATI
Over 10 to 50 Incl. -FIN +
❑ I am exempt under Sec. Over 50 to 100[nc. BY w
BAP..C.for this reason. y Over 1.00 - L1.
+ Services,Swbd.,MCC&Panelboards 8 4 2 4 A N
Date: 0-200 Amp.Under 800 V o.,,o �
o .o o�Q,']
Signature ' 201 - 1000 Amp.Under 600 V o o (0
Over 1000 Amp.or Over 600 V c o 'o 6 4.7 5_0
❑ Exemption for Reg.Maint.Elect. f 1- 1.24-87
SINGLE FAMILY Temp.Power Pole&Appurtenances '
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractors License Law Sign with Sign Branch Circuits
for the following reason.(Section 7031.5,Business and Professions'
Code): .'
E] 1,as owner of the property,will do the work and the structure) Misc.Conduits&Conductors
is not intended or offered for sale (Section 7044, Business�t 'Other(See Complete Fee Schedule)
and Professions Code).
CONSTRUCTION LENDING AGENCY
,
I hereby affirm that there.is a construction lending agency for the
performance of.the work for which this permit is issued(Sec.3097,.; PERMIT FEE (Sub Total)
Civ.C.).
PLAN CHECKING FEE
Lender's Name ;
PERMIT ISSUING FEE +
Lenders.Address.
l 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'
representatives of this ibunty,110 enter upon the above-mentioned
property f s action eI
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign of !ties Date
, I .