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Home My Public Portal About6360 TEMPLE CITY BLVD_Electrical__ WORKER sCOMPENSATION oon csnoN 7A663 � ' _ APPLICATION FOR ELECTRICAL PERMIT I,hereby affirm that Ihave a certificate o1fconsent to Ball Insure or a certificate of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES _ DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof(Sac 3800 Lab C) Ln "icy No OM 77 59 Company I6eA ve r FOR APaUCAIIr TO wu all JOB G 1:1 Certified lled cop/Is hereby lumished New Residential Bkfge 6 Pools EACH- NO NlFEE LOCALITY 66 Ter LG City' pLVp ❑ Certified cop/is Bled with the county building Inspection 1 &2 Family Sq Fl It, s LOCAL? deparBNII Multi family 9q Ft I if CROSS ST Dote 4 - l14 -12- Apprani ow e/J Residential Swimming Pods IuAP BOOK r! $3 PAaE 01 PARCEL 007 CERTIFICATE OF EXEMPTION FROM WORKERS Outlets, Rec _Light—Sw _ RW�i NAM Qw� GAN IjtfL.� re.� Co J+K COMPENSATION INSURANCE (This Section need not be completed If the work Involved by the TotalFirst No 2n� - "'"'.m`Ress 2�3 1 5 r I< AVO Permit is for one hundred dellen($100)or leas) I certify that in the performance of the work for which this permit CITY Giv1/OV-v} Tw M0 9-3ZIf Is issued 1 shell not employ any person In any manner to as to become subject to the Workers Compensation Laws Lighting FMures First 20 Pp � Q W eN �oNSf�rcErµ Co Total No Additional ADDRESS 70 3/ sv yf t L� /f✓Q Date Applicant 1608 20A 120V BRANCH CIRCUITS NOTICE TO APPLICANT If after making this Certificate of CITU GN O V r A Tw NO 357-7-371'Exemption you should become subject to the Workers Compensation 1 TO 10 INCLUSIVE EACH provisions of the Labor Code you must forthwith campy with such 11 TO 40 INCLUSIVE EACH AP "M 41 OR MORE BRANCH CIRCUITS EACH provisions or this permit shall be deemed revoked } LICENSED CONTRACTORS DECLARATION I ADDRESS 15 OR 20A 208V TO TTN LKiHTI11G EACH d I hereby affirm that I em licensed under provisions of Chapter 9 0 (commencing with Section 7000)o1 Division 3 of the Business and _ CITY Td W 0 Professions Code and my license Is in full force and affect RESIDENTIAL APPLIANCES UP TO SHP LICENSE ata cc Q Poop Apparatus 6 Large Appliances REO NUMBER CYu 0 License Number y q 4 7 S 8 Lie clava 13 Size 6 Type HP KW KVA or KVAR DISTRICT NO PROCESSED BY -x Up to 31ncl W �.�� Contractor O e'N AL Date - y 9Z Over 3 to 10 Incl OEAM Z Over 10 to 50 Ind El am exempt under Sec Over 50 to 100 Incl VALIDATION B&P C M this reason Over 100 R Services Swbd MCC 8 Paneboerde _ Date 0 200 Amp Under ODD V Signature 201 1000 Amp Under 500 V ❑ Over 100D Amp or Over 800 V Exemption for Rag Meint Elect n HOME OWNERSINfY BU RLE I DECLARATION LY Temp Pourer Pole A AppuMnencSe _ raCCT.Y I hereby affirm that I am exempt from the Contractor a License Law Sign with One Branch Circuit -,- r� r for the following reason (Section 7031 5 Business and Professions AACIsonal Sign Branch Circuits =.j' S"6' 1 Code) ❑ I as owner of the property will do the work and the Structure Mae: Conduits A Conductors is not Intended or offered for"is (Section 7044 Business Other(See Complete Fee Schedule)_ T10-1 Ai 63 - 60 and Professions Cade) ; .17 CHECK CONSTRUCTION LENDING AGENCY tHAKE I hereby affirm that there Is a construction lending agency for the performance o1 the work for which this permit Is Issued(Sec 3097 PERMIT FEE (Sub Totao Cry C) NIA PLAN CHECKING FEE 01300-0161 L11;191 Nome,Lentlera Nem �. s' �� PERMIT ISSUING FEE o? 2795 1 Ar �.I_ Lende�Atldreee app TOTAL FEE 3i (O� I cetyl that I have reed thea IIcellon entl state that the above Information le correct I agree to comply with all County ordinances and State laws regulating Electrical wiring and hereby authorize representatives of this County to enter upon the above mentioned ' property for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 21r•-� /Q• �G r N —/ 4l Hula AARv"x:urrwr � wTE ION ARATION WORKER I have a certificate of consent to 70AM P`Y°f8° APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I have a ceridicele of consent to self Insure ]BI�e&9 r or a certificate of Worker a Compensation Insure ntt ora canoed OOUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV copy thereof / f�((Sao SSBy0�0Lab C) Policy No/1Z�JVO� Company FSR APPLIGNI i0 FlLL IX CRESS G C ❑ S'j 1:copy to hereby furnished New Residential Bld°e 8�'�'7� EACH NO FEE LOCALITY e �~]--Ir/Cii copy le filed with the cou m° ion ,�,. 1 8 2 Family Sp Ft 1...L� _ _ XF�wE3T t Mufti ferny S9 Ft GROSS 8T Date Residential Swimming Pods ASSESSOR MAP BOOK V PASS PARfEL CERTIFICATE OF EXEM N FFI WORKERS OVMER OR a •/ O H COMPENSATION SURANCE Outieb Rio; _Light - Fs01 NAME VG First 20 • MAR. (This section need not a compNted H the work Involved by the Total Additional * ADDRESS permit Is for ons hundrsd dollars ($100)or leu) S9f 1 cerlity that In the performance of the work for which this permit - CITY G N i.l 1b is Issued I shall not employ any person In any manner on as to PG become subject to the Workers Compensation Laws Lighting Fixtures Final 20 APPUCNli TOUT No AddMonal ADDRESS r_ Date Applicant lb OR 20A 120Y BRANCH CIRCUITS NOTICE TO APPLICANT If after making this Certificate of CITY Tr NO Exemption you should become subject to the Workers Compensation I TO 10 INCLUSIVE EACH provisions of the Labor Code you must forthwith comply with such II TO 40 INCLUSIVE EACH µfp T /� Y)ZO r L provision or this permit shall be doomed revoked 41 OR MORE BRANCH CIRCUITS EACHAGGRESS R 17,j p 0 d LICENSED CONTRACTORS DECLARATION I hereby affirm that I em licensed under provisions of Chapter ° 1b OR 20A 208V TO 277V UGHTIgG EACH Tal No O CITY(commencing with Section 7000) of Division 3 of the Business and 7 V Professions Code and my license is In full farce and effect RESIDENTIAL APPLIANCES UP TO SHP LICENSE ORcc Power ApparatusAAppliances;Appliances; REA tg1LQP 1773 ,' [x� ic-- 0, O Ucerue Number LIC Cie. /D BType HP KW KVA or KVAR OlHrtvCi XO p O 6EO B� U Up to 31nc1 �QQ W Over 3 to 10 Irld -FN— DO DO Gmradar a Over 10 b 50 Incl DAM vL ? ❑ I exempt Sao Over 50 to 1DO Incl q-17VALIDATION B aP C far this reason Over 100 Dow Services Swbd MCC 8 Penelbomds 0 200 Amp Under 800 V Signature 201 1000 Amp Under 800 V Over 1000 Amp or Over 800 V ` ElExemption for Reg Malin Elect - SINGLE FAMILY Tamp Power Pole 8 APpurtenarlces ACCT.r HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I em exempt from the Contractor a License Lew d.l_( SGC•-- far the following reason(Section 7031 5 Business and Professions Additional Sign Branch Crouha Code) j 3TGI".5 ❑ I as owner of the propery will do the work and the structure Mies Condwta 8 Conductors - T_ITFL 239 e 05, Is not Intended w offered for sale(Section 7044 Business Other(See Complete Fee Schedule)_ NECK --- -I- and Professions Code) - , NECK � I�•'--- CONSTRUCTION LENDING AGENCY - l flfii I� h)i I hereby affirm that there Is a construction lending agency for the performance of the work for which this Permit is issued(Sec 3087 PERMIT FEE (Sub-Total) Cm C) PLAN CHECKING FEE Cpl'ICrJCN= Di 19 '9.. Lenders Nemo 07� 4C14 1 0 8:44 PERMIT ISSUING FEE Lander a Atltlroaa TOTAL FEE Q I cenity that have reed this application and elate that the above Information Is correct I agree to campy with all County ardlnances and State lawn regulating Electrical wrong and hereby authorize represent vee of this County to enter upon the above mentioned r Inepe an pu oaes — SEE REVERSE FOR E)(PLANATORV LANGUAGE OF RA a AT - Z