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Home My WebLink About1346A (7) ��... _� ,��.�„��anAT,o� 76A663 APPLfCAT10N FOR ELECTRIEAL PERMIT {� � – �E-8�6��2-80, I hereby affirm that I have a certificate of c�nse�t to se�f COUNTYOF LOS ANGELES BUILDING ANLD SAFETY LJ insure,or a certificate of Workers'Compensation[nsurance,or ��fied copv thereof(S¢c.3800,Lab.C.1, . 3pg�,�e,� '.i�- FOR APPLICANTTO PILL IN JOB { / YolicyNo. Company��f�> EACH NO. FEE ADpRE9S ��.�� I 'J' �. � New Resldential Bldgs.&Poots � Cer[ified copy is heroby fumished. 1&2-Family,Sq.Ft. g — � �OCALITV y � Multi-f3Tily$q.FL. — NEAREST Cer[iflnd copy is filed with the county building inspectinn CFOSS 3T departmenL •R�esideryial imming Po01s F�RM NAME M� ��''y}[� ir�1Q a Date�Applicant�� OuNets.Rec.'Light_Sw..� L' qDDRE98 F�rst 20 CF.RTIF7CATF.OF EXEMPTION PROM WDAKERS' Total N0. Addltional CITV el No. CO�IPENSATION INSURAKCE � - } PLAN HECK a (This section need not be comflkted iP the xvrk irtvolvecl APPLICANT � a by the permit is fo� one hundrad do3lars ($100) or less.) Lighting Fixtures First 20 qooRESS � Additional 1 cer[ify[hat in the performance of the work for which this Fi�ced Appliances Not Over t HP CITY Te1 No. v permit is issued,1 shall nnt employ any person in any manner PERAIIT � so as to become subject to[he Workers'Cumpensution Ln�vs. Range_Heater D.W._ APPLICANT -f q, Oven �DrYer_W.M._ AOORE55 � _ �!(�1 � y 7oP _FAU —W.H..— �Q[w:s�L__. z Date Applican[ _ ��Ty (�� T' I No. Hood_Fan �Other� �y,�.� NOTICE TO APPLICANT:If,after making this Certificate of Disp. _Room Air Cond� LICENSF bR �s Exemp[ion, you should becnme suhject to the Wnrkers' RE .NUMeER 4 .�Class � � Compensation provisions of the Labo*Code,you must forth- Power Apparatus&Large Appliances OISTRIC7 NO. PROf�HSED-eY� with comply with such Oruvisions or this petmif shati be Size&7ype HP,KW,KVA,or KVA f(�,. � ' / deemed revoked. Up[a 1 Incl, �–'� , y �Y` FII+3AL LICF.NSED CONTRACTORS DECLAEtA'IION Over 1 to 101nc1. DATE p Z pver10to501nc1. r L' �L VALIDATION I hereby affirm tha[t am licensad under provisions of Chnpter Over 50to 1001nc. � �FINA� „ 3 � 9 (commencing with Section 7000)o(Division 3 of the 8uni- Over 100 '$Y �7(�� _ j � ness and Professions Code,and my�icense is io full force and effvct. Services License Number7..�5�� Lic.Claes �� 0�200 Amp.Under 600 V q�" 201-1000 Amp,Under 600 V Contractor�,.�� Date, �+�'��(L_ Over 7000 Amp.or Over 800 V . HOn1E Olk'NER-HUILDER PECLARATION „ Temp.Power Pole&Appurtenances �I hereby afFirm that 1 am exempt from the Contractor's Sign with One Branch Circuit License Law for the following reason (3ection 7031.5,HuSi- Additional Sign Branch Circuits ness and Professions Code): Misc.Conduits&Conductors � I, a owner of the properb�,wil]do the work and the pther(See Complete Fee Schedulel— sttucture is not in[ended or offered for sale �se�t�o� :�1 3<.,6 F 7044,Business and Professions Code). CONSI'RUCTION LI?NDING AGENCY � I hereby effiun tlia[ there is a consteuction lending agnncy �° � � � �� for the performanre nf the wurk for which this permit is pEFMIT FEE (Sub-Totaq issued(Sec.3097,Civ.C.). ' '� ' a g'� � Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee) e � � x •4.1U� Lender'a Address PERMIT I�sSUING FEE - b 0 L27�-82 I certify that I have read this aDp��cation and state that the TOTAL FEE �" � above informxtion is correct.I agree to comO�Y«'�th all Coun[y , nrdinances and State laws regulating llectricxl wiring, and hereby auCt ae rapresantative of this CouniY�o eater upon the ab� �e- /ttiofleU proper i inspec[ion purposes. SEERLVERSE FOR EXPLANATORY LANGU,4GE f`��•M�L_. ig ture of rmittee � Duto 4 . i i. i . .�_._ .._..... . . .r., s._ , . . o... _'__"_'_ __"'_ �a- ..'4� yib� � ,� ' .�+ � , .��11iA�� .,'-y �' ..,' . . . . _ .. ._.. .�. . . . , a'�' r�„ . . � .,w .. � . . . . � . . . ��. _�. `i J�«� - - ^ _- —.. . .. . � . . . . . .. . . _ . . _ . . . , t . , . , . _.. . . � � . �,.. _. _. ... _ .. . � . . ' . u� � -- , ' •_ . .. � - . ,. fr: . ..i . y . , .,� . ,„ � . . � � ` ' ' . .. • . . . . r' .�. r.� .. . ',.-a'.'i_ f .a"' _ . _. . __. .___... .. . . . 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