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Home My Public Portal About6438 TRELAWNEY AVE_Electrical__ WORKER I have a certificate DECLARATION 76ASW DPW(12 91) APPLICATION FOR ELECTRICAL PERMIT 7G-DO1 I hereby affirm that I have a certificate of consent to self 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(Sec 5600 Lab C) i - Policy No Company POR APPt1CANT TO RLL IN JOB ADDRESS ❑ Certified copy is hereby furnished New Residential Bldgs 8 Poria NO EACH FEE 1 8 2 Famiy, If Sq Ft — S LOCALITY j +' ❑ endretl copy filed with the county building inspection i department Multi/smile Sq Ft NEAAEs — CROSS gT V isK Data Applicant Residential Swimming Pools ASSE650R �/� /J' MAP BOOK PASE `�- PM L L CERTIFICATE OF EXEMPTION FROM WORKERS Outlets REc Lid-Light�Sw _L L .J Q FRN NAME �'` y CtJpA COMPENSATION INSURANCE ./ First 20 J MAIL (This section need not be completed If the work Involved by the Total No f 7 Additional ADDRESS LAW G permit Is for one hundred dollen(5100)or leu)' I certify that in the performance of the work for which this permit CNVF—K cc- ctilTs, " LtLO is issued I shell not employ any p on in any manner so as to ID PIAN CHECK become su ct to the Workers Co eehon Laws Lighting Futures First 20 11-AN C.E u ` Tole No �_ Additional ADORES$ Data Applicant RESIDENTIAL APPLIANCES NOT OVER 3 HP NOTICE O APPLICANT If after making this Certificate of CRY Tat No Exempbon you should become subject to the Workers Compensation OTHER APPLIANCES NOT OVER 3 HP provisions of the Labor Code you must forthwith comply with such PERMF O W.1 "A provisions or this permit shall be deemed revoked Power Apparatus 6 Large AplAu nces APPLICANT f`' , LICENSED CONTRACTORS DECLARATION Size 8 Type HP KW Ay/er��1(�V('�� ADDRESS I hereby affirm that I em licensed under provisions of Chapter 9 �_ 3 t/o'TD c, (commencing with Section 7000) of Division 3 of the Business and CITY Tal No Professions Gods and my license is in full force and effect Over 10 to 50 Incl } LICENSE OR Class fl Over 50 to 100 Incl REG NUMBER O License Number Lm Cleve Serncea MCCB Ponalbasrde DISTRICT O PROCE BY Q 051 FINAL T Contractor Date •u :>na Amp Under 600 V I ` DATE ❑ I am exempt under Sec 400 1000 Arne Under 600 V 2-lo-JI VALIDATION W Over 1DD0 Amp or Over 60o V FINAL d B&P C for this reasonBY (n BRANCH CIRCUIT FEES Date 154 or 20A 120V Lighting or Recept z 1 To 10 Branch Circuits Signature 11 To 40 Brandi Circuits ❑ Exemption for Reg Mamt Elect 15A 2DA 2DBV To 277V Lghbing More Br Circuit 41 Or Branch s SINGLE FAMILY Temp Power Pole 8 Appurtenances HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor a License Lew for the following reason (Section 7031 6 Business and Professions Additional Sign Branch Circuits Code) I as owner of the property will do the work and the structure Misc Conduna A Conductors li� is not intended or offered for sale (Section 7044 Business 011ier(See Complete Fee Schedule) and Professions Code) CONSTRUCTION LENDING AGENCY lei ITEM" 1 hereby affirm that there is a construction lending agency for the - - I( 1u V performance of the work for which this permit is issued (Sec 3097 PERMIT FEE (Sub Total) Civ C) CHECK PLAN CHECKING FEE LHPNGE Lender s Nertre q� PERMIT ISSUING FEE L{0 Lenders Address _ I certify that I have read this application and under penalty of purjury state TOTAL FEE Q QO UDOD-0Mf 7/ 6/94 that the above information is correct I agree to comply with all Cuunry orN noeeaMStatelawsragulating Electrical wining and hereby authorize J971F 7 5:1,t re nttives of M Count'to emer upon the above mentioned property i r i pectian SEE REVERSE FOR EXPLANATORY LANGUAGE SOMMSE OP PERMITTEE COUNTY OF LOS ANGELES TEMPLE CITY 9 0508 CLECTRI CAL PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EL 0508 9804130024 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA `- PHONE (818) 285.0488 EXT LEGAL ID: ---MTTXID BUILDING ADDRESS TR 12706 LT 4 BL- .001 56438-TRELAWNEY CA-CA AV� FEE DESCRIPTION: QUANTITY LOU. AMOUNT NEAREST CROSS STREET ASSESSOR INFORMATION liURffEF---- NEAREST CROSS STREET 5382-022-021 Al PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 5% GRIDD Jl J1 LOCALITY TEMPLE CITY G1 OUTLETS-LGT,SW,RECP 2 00 OUT 3 90 TENANT. G2 LIGHTING FIXTURES 2 00 LGT 3 90 ISSUED ON PROCESSED BY- PLAN BY EXPIRES ON H1 RES ELEC OVEN LT 3HP 1 00 OVE 10.80 04/15/98 UT 04/15/99 H2 RES GRBG DISP LT 3HP 1 00 DIS 10 80 OWNER TEL NO N3 RES DISHWASHR LT 3HP 1 00 DIS 10 80 FINAL CODE WEAVER MATTHEW J,DEMISE A - H4 RES RANGE HDS LT 3HP 1 00 HOD 10.80 _ 6438 TRELAWMEY AV TOTAL FEES 78 75 TEMP 917801313 ELECTRICAL-FOR-ENLARGING KITCH _7 APPLICANT. TEL NO SAME AS OWNERCONTRACTOR TEL NO - SPECIAL CONDITIONS 5 PNGELES Co APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - �.� �Tf. LIC NO TEMPORARY POWER POLE ARCHITECT OR ENGINEER TEL NO UFER GROUND LIC NO ly 117111ROUGH CONDUIT ROUGH WIRING N nMAIN WATER LINE Ju��I�J�'`� I v��JJ ��« �� PLASTIC Y/N METAL Y/N \L UTILITY COMPANY-96rrrrm SeTvIce7Si� REPORT ID DPR265 ROUTE TO BS0508