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1172A
� _r'lORKERS��o�Pr.NSA.���oN oE�iA,�AT�<>N- - -- '.. 76A663�� . -qppLICATfON fOR ELECTRICAL PE�RMIT . � � � ' � CE-806G l2-80) \;/hereby affirm that 1 have a eertiticute of�o„se„t�to s��s� � �COUNTY OF LOS ANGELES ; � BUILDING AND SAFETY . � lnsure,or n certificnte of Workers'C'ompensation Insurance,or - a certifnied rcopy thereof(Sec-3800,Lab.CJ �J't„IpC.tj�S ' �A�l��ia...� FOR APPLICANT TO FILL IN JOB 7.���c� ' � Yoltcy IVo. Compeny � EACH NO. FEE AODRESS(„S /,-A ��'�"c•�e' . ���`Z:%'�'� New Residential Bldgs.&Pools � Certified copy is hereby furnished. J&2•Family,5q,Ft. � — $ LOCALITY� �t w.4��,� ��^'Cy� �(�/7Ee:�j- � NEAREST / `� ' � �J�„���� �Curtified eopy is fited with the cnmity building inspection , Multi-family Sq.Pt. CROSS ST � � ,l.,-_.�.v1�.n...a,� Residential Swimming Pools oWNER OR � ✓ } ��'} p�rtment. � ��� )�e FIRM NAME �py✓N„I�.�S lfi✓s�� ���� Da[e1Z' «� Applicanl ��/��"��� � � . MAIL .. Outlets:Rec.�Li�ht^Sw., '�t j G� qpORE55 �ii�.�% �.,�/ First 20 CERTIFICA'fB UP IXEMf'1'ION FROM WORKNItS' Total No. � Addrtional _ CITV �7 � Tel Na.�'��-�''��yv� COMPi'sNSA't'ION WSURANCE PLAN CHECK 4�, � . APPLICANT ___ ' (a (This section need not be completed if thu wotk involved ' Lighting Fixtures First 20 AooRe55 � by the permit is for one hundred doltazs (5100)or lessJ Additional � - 'fL Total No. CITY Tel No. � :O � 1 ccr[ify[liat in the petformxnce of the wnrk for which this pjxed ApplianCes Not Over 1 HP --- . permit is issued,i shyll not employ any person in any mavner PERMIT C.S so as to become subject to fhe Workers'Compensation l.aws. � Range_Heater D.W._ APPLICANT 'Q i+AY'�,�;J� .� � : Oven _Dryer_W.M._ ADDRESS}7. /�'?' n �� i c..i`.fl,i_ �d C:i�� Y. A'. �G5[ h9-�-' .� Date APFlicant__. : Top _FAU _W.H._ CITY� TcI�C�y �-��F'� Hood—Fan —Other_ '�"Lc'LLi+�r"�1D� NOT[CF,TO AI'VLICAN7':If,aYter muking this Certificate of pisp. _Room Air Cond._. � LICENSE OR � !> I•;xemption, you should Yrecume subject t<i the 1N�rkers' REG.NtJMBER Class � Compensatiun provisions of the l,abor Code,you mu;:t furth- power Apparatus&Large Appliances DISTRICT NO. PFOCESSED BY with comply with such provisions or this permi[ shall Ne $iz.&Type HP,KW,KVA,or KVAR . deearyed revoked. l :.'-�-i..e:sd��t=-' ; . . �g � � � G� UPtollncl. �3 f_ ��', . FINAL [ Over 1 to 10 Incl. DATE � ai' �� VALIDATION r LICP:N51?7)CONTRACTORS DECLARATTON .Over 70 to 50 Incl. } I heTe6y xffirm that I ym licensed under provisions of Chssptcr Over 50 to 700 Inc, B;NAL � - H (commencing with Seotion 7000)nf Divieion 3 of the Uusi- :Over 700 � ��L���7N���.. ncss xnd Profassions.Code,a�id my license is in Sull force and � effect. �� Jj' ��'L���i G•�•f� Services � .2!C�_�� Lic.C(ass C ��._.__�_—��y� 0-200 Amp.UncSer 600 V � License Number 201-100D Amp.Under 600 V� . Contractor fiTh . .^.�+ Date_�� 1 ' Over 100D Amp,or Over 600 V � IjOME OWNER-BUILUER DECI.ARA7'[ON ?emp.Power Pole&Appurtenance5 ?Sign with One Branch Circuit . - ' I hereby affirm thak i am ezempt frum the Contractor's -Additional Sign BYanCh Circuits � License Luw for the folluwing reason (Sec[iun 7031.5. Auei- � �=j � 1,C({ [ ness und Vrofessiuns Code): �Misc.Conduits&Cnnductors �s •w a e`Z , � 1, �s owner nf the property,will do the�vork and the ,Other(See Complzte Fee Schedule)— s structure is not inteoJed or ofFered for sale (Section � � m� 2,� � 7044,Ausiness xnd Professions CoJe). -�— - � : CONS'CRUCTION LF.NDING AC3&NCY "— � �> a �� Z� {�c=.> i . 1 hereby affirm tiiat there is a construction lending agenCy � for tlie performance of the wurk for which [his pennit �s pERMIT FEE � (Sub-Total) � ��). 1 ?3 0�81 � '� issued(Sec.3097,Civ.C.). � . LendePs Name . PLAN CHECKING FEE (One-Fourth Permit Fee� � i � ' I,ender•s qddress PERMIT ISSUING FEE �('� F i � � � ' I certify tha[ 1 h�ve read[his xppticalion und sta[e tha[ the TOTAL FEE �z �� � above information is correct.I agree to comply with al]County � "— �. ' � ' i ordinances nnd State laws regulating F.lectrical wiring, and . h�reby authorire represznta[ives of this Cot�n[y Io ente�upon- . �' the ubove-mentianed property for inspectiun purposes. SlE"REVF.ILS1?PDR EXPLANATORY LANGUA6H , < > .�#fr�.�.� atG�s-' l�� ��u`� Sigm�ture of Permittee Date . . , • � , � . . . ! � � i ' , � �;a ,; ' � � . . � - �, �r � . ' . . � ` � . ` j � k C 1-1 � �� ,�' ;a ��-n � p.Z�� ..� � • 1 2 . ,a m ro'v �� -n O jC'Sl. '9 O' fp" �' S� 1,�ZS�C.�: �'N ��'Q ' � ' � • ' N . � C`` N•: y'W..��i y .. . ' � � 1 � -4 O �z'�'v I ' .: !� .+� ,.'. a, �O � .. 1 '_ �I`��'� � , ' � ' ' ` . � ,' T,.x ,� 1� ',T.' 1 � � � � � � � � o =� � . !. t _ � . ` ' 1i 'J . _ , � f. � �' ., � i O ... .�. ! � � 1 � i I � .. :� � � �� , . �: i �� : :. , � I � . I: � �, ,� _ . � � I. ` � � ' � � � ' � � � I . � ',�i . N� � � . 1 , � � . . �... �m . ! .` , , 1 . . � yf� . ti � � _.y , ' z � l a-� , ' i , .. �I 1 t ' ��� � - 4 ` � 1 i p�� � t � ' - mN . ` . ' ' 4 ' ' � � � �. � 1 , i ... 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