HomeMy Public PortalAbout6356 TEMPLE CITY BLVD_Electrical__ DEC
2D.0019
affirm
that
I haveCOMPENSATION
ate of consent
7SAM '� APPLICATION FOR ELECTRICAL PERMIT
y alhrm [hal I here a certificate of concent to Gell locate 7eAee�
orlilicete of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
thereof(sac 38000 yLab C) t
Cprp,y54 ed{7 FOR APPLCAArT TO F61 M ADDRESS ,^,' '
copy is hereby furnished Residential BMgs 8 P d �— —'/�' EACH NO FEE LOCAL x el
p
Certified copy is Bled with lha coup Ing Irm 1 8 2 Family Sq FI o i — S _— C
ant Multi family SclFl — CROSS ST
NEAREST
10 APW Residential Swimming Poole ASSESSOR
MAP BOOK PAGE PARCEL
CERTiFlCATE OF E7lEA1 N FROM RKER9 OFFWWIERo C (AfI( d
COMPENSATIONINSURANCE titillate Res —Light
1 MAL
tion need not a canpletad If the work Involved by the Total No FlAdditonel r-
te for one hundred dollars($100)or Nae) AOorEs.S
ly that in the performance of the work for which this permit CITY OyT No 95-1 ,mss{
jed, I shell not employ any person in any manner so as to
1e auDJect to the Workers'Compensation Laws Lightingxtu
Flrea First I
20 pp�
Total No Additional ADDRESS
Apples 16 OR 27A 120V BRANCH CIRCUITS
'E TO APPLICANT If after making this Certificate of CITY TW No
flan you should become sub)ect to the Workers'Compensation I TO 10 INCLUSIVE EACH PEfilA1T /
Ione of the Labor Code YOU must forthwith comply with such 11 TO w INCLUSIVE EACH APPLICi1NT /
no or this permit shall be deemed revoked 41 OR MORE BRANCH CIRCUITS EACH
LICENSED CONTRACTORS DECLARATION -' ADORES' R a✓00 1
I
affirm that I am licensed under provisions of Chapter 9 15 OR 20A 208V TO 277V LIGHTING EACH
ncing with Section 7000) of Division 3 of the Business and _ CTY4 le
TN W �6 R
ions Cade and my license Is In lull force and effect Rcc
g 8�� UUP TO 3HP REGI
S(�R / rs � �I D VO
Power
pparatus
Number / 79 L,c Class � Size 6 Type HP KW KVA or KVAR DISTRICT NO J p� ED� V
_ UP to 31ncl ��O UJ
�/ over 3 t0 10 Ind DATE d
Z�JAt Over 10 to 50 Ind DATE �
FINAL r
I kexempt u ar Sec Over 50 to 10D Incl [ 2— VALIDATION ?
B$P C for this reason Over 100 BY
Services Swbd MCC 8 PaneWomds
Date 0 200 Amp Under 800 V
Signature 201 1000 Amp Under BOO V
Over 1000 Amp or Over 800 V
(Exemption for Reg Maim Elect -j
II+ SINGLE FAMILY Temp Parer Pole&Appurtenances y
HOME OWNER-BUILDER DECLARATION Ell CT.7
affirm that I am exempt from the Contractor a License Lew Sign with One Branch Circuit
ollowing reason (Section 7031 5 Business and Professions Additional Sign Branch Gmuds _ CJI]!
_ 1 iTP7i1c
as owner of the properly will do the work and the structure Alms Conduits A Conductors
a not intended or offered for sale (Section 7044 Business Other(See Complete Fee Schedule)_ TOTAL fTAL 30 1 95
edProfessions Code) ► "HE_K -.31.9
CONSTRUCTION LENDING AGENCY - CHANGE .«1
affirm that there 13 a construction lending agency for the
nce of the work for which this Permit Is issued (Sec 3097 PERMIT FEE (Sub-Total)
PLAN CHECKING FEE 001301-1113'21 i 119/92
Name
PERMIT ISSUING FEE _ 4.1 Sr) a Art 8%44
�hat I have read this application and state that the above TOTAL FEE
n is correct I agree to comply with all County ordinances
laws regulating Electrical wiring and hereby authorize
tiles of this County to enter upon the above mentioned
Ins pe D PurPoee 'of SEE REVERSE FOR EXPLANATORY LANGUAGE
a
1 uGurr Orr A(iEHnATs