Loading...
HomeMy Public PortalAbout6418 TEMPLE CITY BLVD_Electrical__ I 71' 7�y r .20, ,,•Rdom®® 1 ]WAVILY Y}1 1I I W I PORTION ONLY mo+ , 11 1 1 �17T7". 1♦LIr�' BENE■■■■■■■ ,i �..�■■■■■.. ■■■■ ■EMM■N■ ■■■■■■■■■■ MMIMM■■N■EMM■■ ■■■■■■■■■■ -■■NEEM■■■■ •1 1 �MENE■E■ME■ ■■■ENE■■■■■ - MENNEN ■ ENIM■NEEM■■M■M E■■M■NM■M■NM■M �M■■■NN■■M■■ MMIMM■■■EM■EM■E �M■■■■N■■N■■ ` MSM■■EEM■■E■M IMM�M■■ENE■■E■■ IMME �MMEMEMEN■■■ INIMMIMINNIMMINEM IME !ON■ !'UNN ROME� �m x 41:1 IM ii t: HIP. APMCAW i IN HEAVEHEAVELY OUTLINM POEMON ONLY ■■■■■■n■■■ C�:i■■■■■■Ea■■■ W�!_m■■■■■■"■■■ ��■■■■■■N■■■ ©■■■■■■■■©■i ■■■■■■■■■■■I■ �■■■■■■■■■ ■ �■■■■■■i■■■ ■ SEM�■■■■■■■■■■■ MENI■ ■■■■■■■■■ SOM�■■■■■■■■■■■ IMM�■■■■■■■■■■■ MEMO■■■■■■■■■■ IME■ WMENN ; _.. .. NO ■ l �■■■■ ' = �.� ra��r�■ins■ WORKERS'COMPENSATIONDECLARATION CE-806G 12 801 APPLICATION FOR ELECTRICAL PERMIT EEOBi 1 hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY insure, or a certificate of Workers Compensation Insurance or e certified copy thereof(Sec 3800, Lab C) FOR APPLICANT TO FILL IN JOB Policy No Company xnt New Residential Bldgs &Pool$ EACH NO FEE ADDRESS Certified copy is hereby furnished 1 &2 Family,Sq Ft ; — $ LOCALI Certified copy is fly filed with the count building inspection ms Multi family Sq Ft - CROSS T department Residential Swimming Pools OWNER OR FIRM NAME Date Applicant Outlets Rec_Light Sw MAIL .f __Pi'St 20 AD OR SS .l CERTIFICATE OF EXEMPTION FROM WORKERS' Total No Additional CIT Tel No L22. COMPENSATION INSURANCE PLAN CHE } (Thu section need not be completed if the Work involved APPL tCAN Qd by the permit Is for one hundred dollars ($100) or less) Lighting Fixtures First 20 ADDRESS Total No Additional 1 certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CI Tel No O Permit is issued 1 shall not employ any person in any manner PERMIT so as to become subject to the Workers' Compensation Laws Range_ Heater_DW _ APPLICANT W Oven _ Dryer_W MADDRESS N Date—Applicant Top — FAU _W H — CITY Tel No Ji! Z Hood _ Fan _Other_ NOTICE TO APPLICANT If, after making this Certificate of Disp _Room Au Cond_ LIC E ry Exemption, you should become subject to the Workers' REG NUMBER re& Compensation provisions of the Labor Code you must forth Power Apparatus& Large Appliances DISTRICT NO PRO SS By with comply with such provisions or this perms shell be Size&Type HP KW KVA,or KVA �D O deemed revoked Q Up to 1 Incl LDA Over 1 to 10 Ind 11 —3 —SY VALIDATI N LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl 1 hereby affirm that I am licensed under provisions of Chapter Over 60 to 100 Inc 9 (commencing with Sachon 7000)of Drvawn 3 of the Bwi Over 100ness and Professions Code and my license is in full force and rpeffect ices /` l �U 74200,AmP Under rider 60 VLmenu Number is Class 201-1000 Amp Under 600 V a or ate _ t% / Over 1000 Amp or Over 600 V , N - R TION Temp Power Pole& Appurtenances hereby affirm that I am exempt f e Contractor's Sign with One Branch Circe it �9 1 7 a Q A License Law for the following reason (Section 7031 5, Bwi Additional Sign Branch Circuits nese and Professions Code) * * - 2 Mise Conduits&Conductora I, as owner of the property will do the work and the Other(See Complete Fee Schedule)— 2 - 1950 structure is not intended or offered for sale (Section 7044, Business and Professions Code) �• • • 1 9. 5 0"u CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency I 102-81 for the performance of the work for which this permit is PERMIT FEE (Sub Total) issued(Sec 3097 Civ C) Lender's Name PLAN CHECKING FEE (One Fourth Permit Fee) Lender s Address i PERMIT ISSUING FEE I certify that I have read this application and state that the TOTAL FEE ' above information is correct I agree to comply with all County I F,/ZZ ordinances and State Incas regulating Electrical wiring and hereby authorize representatives of this County to enter upon the above men coned Oro arty for inspection purpo s SEE REVERSE FOR EXPLANATORY LANGUAGE i nature Of Permittee