HomeMy WebLinkAbout1602A (9) womeeas�cox��„ariory o€uaRanoN �bA�3 �o�A� APPLICAT[QN FOR ELECTRICAL PERMIT �
.re6y affirm. tf�.at I hove o<ertificate of consen�to self CE-806G
,+s'ure,or a ce�rficare of Wo�ke�s'Compensa�io���suro�ce, COUNTY OF LOS ANGEtES BUILDIN(i AND SAfETY
�or a<ertif�e�,c/o9/y j�th�reof(Sec 380 .Lab.C)
- Policy Nq�yf(e".2��Compan �''� FOII A►PLIEAN770 PIIL IN JOB .��
� Certified co s hareb fumished. � CfCH NO. FEE A004[55
py� Y New Residentia�BI s.8 Pools
❑ 1&2-Fomil 5 FL $ = 5 LOCALITY � .
Cer�ified mpy is filed with the county boilding insper 1'� 4�
rion departmenl. n Multi-family Sq.H. �RpSS ST.
� ��' �r�J �l L Residentiol Swimming Pools OWN[R
Dat "@�L_/_-«!�-Applican � FiRM NAME
CERTIFICATE OF EX€MP710N FROM WORICERS' putlets:Rec_lighf_Sw._ '�`�A�� �
COA+�PENSATION IMSURhNCE kD�RE55 ,
Firsl 20
(This s�tftee nNd nol he tomplW�d if}Ir�work invofv�d by Total No. qdditional CITY . / ,� � Tel.No. jd�f/Q, d'
ih�pKmit is 10�on�Iwndr�d dellm�(3100)or 1���.) ptqN CHEC
1 cartify that in the performon<e of the work for which this APPIiCAM1R
permir is issued,1 sho�l not employ any person in c ny monner
so as to become suhject fo the Workars'Campensa7ion Laws. Lighling Fixlures First 20 A�DRE55
Additiona!
Toral No. CI7Y Tel.No.
Dafe Applicpnf fized Appliances Nol Over 1 HP pERMii �- -
NOTICf TO RPPLICANT: It, ofter moking �his Carlifim�e of qppLICANT / t r �iC
Exemption, you should bemme su6ject to the Workers' Range_Healer_D.4�._ g
Compensatron provisions of the Labor Codr,you must for�h- Oven —�rye� --W.lv1.— A�ORESS .a. g0 d �J�
ifh comply wi�h such provisions or rhis permif shall be Top _FAU _-W.H.—
deemed re�oked. Hood _Fan _Other_ CI7Y � �� Tel.N ; �a
LICENSED CONTRACTORS DECLARATION IICEN O
I hereby affirm thof I am licensed unde�provisions of Chapter 9 Disp. —Room Air Cond. — REG.NUM�R� Class.li�/�
(commencing with Section 7000)of Div��sion 3 oi the Business power Apparatus 8 Large Applionces DISTRICT NO. PROCESSE 8Y r
ond Professions Code.and my litense is in f�ll fwce and effeci. /-� / o,
']` l � /( Size 8 Type HP,KVJ,KVA,or KVAR -Ct.0 . �
License Nu U � ic Goss � Up to 1 Ind. FINAL /� �/,/
- Over I to 10 IncL �ATE v�� 7 O `Y- VALIDAT1f�N o
CoNrocfo ��Dafe� Over lO to 50 Ind.
QfINAL � V
I om exempt u�der Sec. O�er S010 iW Inc BY �j, �
B.&P.C.for ihis reason - Over 100 � �� ��-
Date: Services,Swbd.,MCC&Panelboards � - .
0-20C1 Amp.Under 6Q0 V
Signature 201-1000 Amp.Under 600 V
QOver 1000 Amp.or Over 600 V
Exemption for Rag.Maint.Elac1.
SINGLE FAMILY Temp.Powe�Fole g Appurienc nces
HOME OWNER-BUILDER DECLARATION Sign with One&anch Circuil �
I herehy affirm Ihal I om exempt from the Controctor's License Additional Slgn Bronch Circuits � :�.� 6�L A
Low for the following reason(Section 7031.5, Business ond ' '
Profassions Code): �� ° � � ��
� � Misc.Conduits&Conductors
i,as owner of ihe propery,will da the work and the � a "�l�..�.Q
siructure is nor i �ended or offered for sale (Section Other(See Camplete Fee Schedule)_
7044,Business and Professlans Code). l G`� u� ► "� °�6 r.::G�'
CONSTRUCTION IEN�ING AGENCY �> �� 7_�Q_
I hereby affirm that ihere is a consfruction lending agency for � -
ihe performance of the work for which this permit is issued pERMiT FEE (Sub-Total) C C
(Sec 3097,Civ.C.).
PLAN CH€CKING FEE a SC � .
Lender's Nome ✓
PERMIT ISSUING FfE /
lender's Address
I certify that I have read this application and sfate Ihpt ihe TOTAL FEE
obove information is mrrect.I aqree to compfy with oll CooMy
ordinances and State laws regulating Electrical wiring, and
hereby au� rize r nl tives of rhis County ro enter upon
r e ob - ti . t � non purposes. $EE REV�RSf FOR EXPLANATORY LANGUkGE
� - G ' C
gno we of��.millee Oa1e -
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� �#� A�'� �4� ` �� s"�,�"�.-,......., „�.� ,
. *w��� `:�e''.._` "'�'" ... . _""�
y . y��y.
._ _ _' _ _ � �M . ��w .
�APFR'JVALS DATE . ���-�11LDER C£CLi4Ri1Ti6M
R�
� TEP.M.POWER POLE I he�eby affirm thor I am exempi from ih�:Controcter's
License Lew for ihe following revson (Scclion 7Cs"1.5,
UNDER51A6 WORY, Busines,ond Frofessions Cod^):Any ci;y cr wunty which
ROIIGH CONDUIT rsquJres o psrmlt}o es��struct,cft^r,�im�rove,dcmolisF.,
- or repafr ony s#ruefurv,pric�to its lssuarce, also re
� WtRIhCG � qulreslheoppllEeaiforw2hpermifroflfcasigncdsfafe-
menf�Fa/he fs licer�sedpunuanT to The prcvisions of the
, Fl%7URf5 Controttors LJcense law(Chapter 9(mrmencing wifh
POW'€R AUTHORiZED Sect{on 700C)of Diviston 3 af the Eusiness and Froles-
srons Cods)or fhw hs is ez�mpt�6crefrom and fi�c bnsis
UTIEITYCO.NOiIPiLpD {or 16e a)(egr� axamp'ion. Any vlolotiort af S;:tion
� FINAL Gxtsr ort ronl 703).5 by ony applicent fcr a permi�subj�cts ihe cppli-
een�to a clvi!per,offy oF nof morc thon live hundred
� NOTES dall�rs($b00J.:
- ❑1,cw w.varr of iha proqwty will do nc�K�ork,and
.iha shuCure is nd in!en�iud or offared for sale,
(Srt.704i,Eusinesaa:dPrcfessionsCod^: TheControc-
lor's Lieanse Law tkas not a�ly to on owner of property
� who bullds c imprcve�fhercon, and Mrha dr�s such
wosk hlmssif prowded Ihat such tmprov ents a not
�nfendrad or oliwed for;alc.i/,howcver.EtF,�burlc!in
improvernont Is sc:,�d v�1thM onc year of compleiion,�•the
owrror•buitu�rr wilf hnve}fie b�rden olFroving ihaf he did
na#bWld or lmprove for+hz purpose o(sal;•.J
I om ezampt vnder Sec. ,
B&P.C.for ih�s roason
Da'e
Ow�ner