HomeMy WebLinkAbout1834A (11) __, ti�i - ..t�9 � _..
_ A ION DECLARATION �ba663 �o,e, qpp�{CATION FOR ELECTRICA! PERMIT
I hereby affirm fhot I have a cerlificole of consent to self CE-806G �
i�sure o cer�ifiwlP o4 worke�s'Cor.ipe� t o �ns�.ance, COUNTY OF LOS AN6ELE5 BUlLDWG AND SAFETY
or o c}e��f Qd copy ihereof Sec�Q Lab C) 1
`�7 S�'C' t G����' � �� -�l j4�
olicy No� o P Y j°�.� r�-��%� � FOR AP►l7fANT T0 Rll IN JOB ,� �� /�— ` t ,
/ /��
� C tified copy is hereby f nished. v� New Residentlol�dgs.8 Poals EACH NO. FEE �flDRESS ,�f f(/� ��`/i..'._1 C- �!�. �—'
� Canifisd copy is filed wilh Ihe mun�y 6uilding inspeo I&2-fomily,Sq.Ft. $ = 8 LOCAtI7V ��v j; ���' �/�n,�
Multi-fomil 5 Ft. NEAREST
ti@n depanm[eni. Y 4� CR�55 ST.
Dote���{/—,�i',� Applimnr�'����u�_ ����'�'����`�i Residentia15wimmingPools RµAh� t�_ � r
CEHTIFICA7f OF EXENSPTION FROM WORIfERS' - � N�Aii
COA4PEN5.hTION IlJ511RANE€ Outle�s:Rec Light_Sw._ /�� �_�,� �„�� �� ,,-�,�jf�:�
�,r ADDRESS '{_
/� Pirst 20
[Th4s z�c/ion n��d rwt b�compiNrd if fh�werk Involwd by Total No. (�,: Addiiional CITY Tel.Na ri�� � � c
eM p�rmie�s ior a�e hundr�d dolfon(f100)or IMs.) �
PIAN CH[CI(
I certify that in fhe performonce of ihe work for which this APPUCANT
permit is iss�ed.I shall no�employ any penon in ony manner
so as to bacome subject fo 1he Workers'Compensaha�Laws. Lighling Fix�ures Firsi 20 A�pRESS
To�al No. Addi�ionol CITY Tel.No.
Dote Applicant Fized Appliances Nat Over 1 HP PERMi7 /� f -
NOTICE TO APPLICANT: if, after making this CerYifimte ot �an Heaier_.D.W. _ APPLiCANT �.F}-� r�,7.�.f��� ` �"���-�
Exemprion, you shou�d become subjed fo fha Workers' 9e—
Compensa+ion provisions of the lo6or Cade,you mus+fonh- Oven _.Dryer _W.M.— ADDR£5$ -'7 lA� �`� . ��- '
wi�h comply wirh such provisions or �his permit shall 6e iop _.FAU —_W.H.—
dser„ed re�oked. CITY�l�-�y �n`/,Y Tel.N . ��7��'�7�
Hood _Fan _,Orher_ �
LICENSED CONTRACTORS DEC4ARATION UCENSE OF � G /
Disp. _f2oom Air Cond. _ REG.NUMeER r°"�1��9 �i Closs. /'L�(,�!`
I heraby offirm that I pm licensed under provisions of Chopter 9 a
(commencing with Section 7080)of Division 3 of the Business DISTRICT MO. PROC 6Y
and Professions[ode,and my liaense is in full force ond effed. PO`^'er Appo�atus 8 Large P.ppliances Q
^5 ,�^ Size 8 Type HF,KW,KVA,or KVAR Q
V
License Nu�.J'� �� :� lic.Closs��-�—���'{r'� UP�0 1 Incl. FINAL �
��-."._��-! �Z�If�°; rf� � � ��_l,� ,��"- Over 1 ta 101nc1. DATE YALIDAFIOW �"'
Conira�tor j� ` �i':�%h7�nie �r f�t- � Over 10 ro 5�Incl. U
❑ FINAL � Q.
I am exerr�p�u�der Sec � Over 50 to 100 Inc BY � 2i N
8.8P.C.for ihis redson Over I00 Z
Date: Services,Sw6d.,MCC&Ponelboards
0-200 Amp.Under 600 V ► �
Signarure 201-1000 Amp.Under 600 V -".��'�� �7-���...� ' �
� Over IOOf)Rmp.or Over 5@0 V �— ��-�
Exemprion for Reg.Maint.Elect.
SINGLE PAMIIY Temp.Power Pole 8 Appur�enoncas
HOME OWNER-BUIIDER OFCLARATION Sign wi�h One Branch Circuit q� � �.�A(��
I hereby o4firm 1ha11 om eaempt from the Controcfor's License Additionol Sign 6ronch Circults
Low for 1he following reason (Sec�ion 7091.5,Business ond , c p F
��
PfOfB5510�5 Code): �
❑ I,os owner of�he property,will do the work ond the Misc Conduits 8 Conduc�ors � ,. ,. 1 c�C
structure �s no���,e�ded or affered for sale(Set7ian ��her(See Complete fee Scheduie)_. �
7044,Bvsiness and Professions Code). '� - 1 :%U G�'
CONSiRIJCTION LENDING AGENCY � ', �����(�
I hereby affirm lhar rhere is a wnNruc�ion lending e gency for �
ihe performance of the work for which this permit is issued PERMIT FEE (Sub-To1al) �
(Sec.3097,Civ.C.).
PLAN CHECKING Ff€
Lender's Name
7ERMI7155UING fE€
Lender's Address
I certify that I hove reod this applimtion and sia�e rhot the TOTAL FE€ F
a6ove informmion is correct.I agree 10 comply with all County
ordinonces and State laws regulating Elecviwl w ing,ond
hereby authorize represeMa+ives af fhis Counry to eNer upon
ihe ab��e- �..�nonad p�operry for inspecnon purposes. SEE REVERSF(-0R EXPtANA7aRY LAN6UACrE
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L.A. CO. �.»� �' . . '
Bui�_r�i;���� -;,, o,:.; .
� 201 E. Br�,,:!� F.� .nas, �
;� Te�ls (714) 5��'-.��:: c,: 3�� �..... i
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4
' ; ��SPEC�IQ►!�I REC�RQ
i
PERMITS WILL BE VOIDED IF WORK IS
STOPPED FOR 120 CONSECUTIVE DAYS
� ; �/9 �=z3-� R-3
� � BLOG PERMIT NO. pATE ROUP
i .219 oS �. c�+�..�e.�c.. T (�• F3. - �•T-� '�/D a.
j NDDRESS e
, �' �'`� V� � . �
OWNER
NOTE:Do Not Cover Wails UntiJ Frame,lnsulation,Electrical,
' MechanicaJ and Plumbing Have Been Signed.
�
�
��� UVIL�IIYG DATE INS O SSIGNATVRE
�I FDUNOATION: 1ACATI ^
FORM&SETBACK ` �
I , �
{ � 5v1B� � '
� Pour!Uo Concre n i ve Haa �en Signed
; w
�'? � � FBRACING B L7'S � lt L A �"� .
INSULATION ���
' � LATH.IML ��
;� DRI�WALL �
.,y LATH.EX7'. � ��
� I
ELECdRiCAL OATE INSPECTOR'SSIGNATURE
UNDER SLAB WORK
� �� ROVGM CONOUI7 �
'� L
ROUGH WIRING
:�I TEMP,POWER
}
";
'�,� MECHANICAL DATE INSPECTOR551GNATURE
� FAU AG. RFF
� -� BO�LER OTHER
�:�•I AIOp,DUCTS&VENTS,ETG tl L� A �g'�� `
,� LACATION,CLEARANCE�
ACCE55
�
ALUM811VG E St�CT GNATURE
�::.
�;. uN�ew w►e wowK + ,
woucM R.u�+e�N� �
ROUGH GAS P1ANG �
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NOUSE E6WER -
SHPTIC TANK SEEP PIT�S) '
AND OR ORA�NFlELD
FINAL APPROVALS onre �ns� R'SSIGNAT
���+ ELECTRICAL
A
� 6AS PIPIN6
MEGMANICAL r
�+� PLUM9ING FlXTURES
)
BLJILOING
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