HomeMy WebLinkAbout1067A (5) ����,,oN 7dA663 �o�a� ApPLICATION FQR ELECTRICAL PERhft�T �
y offi�rm rhat I hove o certificaie of cansent fo self CE-BaaG
e,�,tmate os wo�ke�s'co.riPe�sat�oo��s�ro��e, [OUNTY OF LOS ANfrELES BUILpfNG AND SAFETY
�rtf ad copy thereof(Sac.3800,Lab.C.), ,
�I 31 irFl L.t a—TJ---�s�T'w r:�
Uo p ompany . �' . � POR AYrLICP:kT TO PILL IN JUB
ertifled to s hereb furnished. �y-' ERCH NO. FEE ADOR�:55 ,��r- '�GA� _�"1'P•�1^1�W
py� y �4.0-_ , e�/'DY,.: � esiden�iol BId9s.&Pools
;enified mpy is filed with the county building insp 1 8 2-Family,Sq.F�. $ — b LOCALITY ,�' 'y-��,�,t, ��(�_
M�I�i-famil 5 Ft. Nta.aE57
�ion deparrmenl. Y 4� CROSS ST.
•�_/ ^�_, ' �y y- ResidenHolSwimming Paois OWNER Oq " ,4
./� APPlicani:� �"_�+- FIRMNAA� � . 4 -
CERIIFICATE Of E%fMPTION FROM WORICERS' O�tleis:Rec�li bi_bw.� M��� • 7
COM,C€NSATIOfJINSURRNCE 9 ADDRESS 4 S�_l ,�-av�?-d=1i�y, ,�{�-'C-'7
firsi 20 -.y-�
a�rdion nwd nef tn cemPid�d ii tM work involrad 6y Totai No. Additional CITY�' -i�.,�.�, Tel.No.l.�,� � /'
rrmii if fm o�hundssd dofluri(31QR)or I�sc.) p;.qN CHKK
ify�hof in the performance of the work for which Ihis 1+PflLl[pN�
it is issued,I shall nor employ a�y p�*son in any man�er
ro become subjed to 1he Warkers'Compensation la�Ns. Ltghflng ffxlures Fin�20 M7�RFS5
. Total No. Additionol CIiY iel.No.
npplicant Fixed Applionces Nm Over I HP PER,wi
iCE TO APfl1.ICAfdi: If, afler making this Cerlificafe of qpvl�CnNT ��"�`�
�npiion, yo� should become su6jecl �o the Workers' Ronge—Heoier_D.W. �
�pensction pravisions of the Labor Code,you musr for�h- Oven ,�ryer _W.M.— ADORE55
� comply ith wch provisions or this permif sholl he Top _FAU —W.H.—
med revoked. Hood —Fan _O�her� CITY Tal.No.
LIC�hFSFD COWTRhCTORS DECLARATION LIfENSE OR �,;--�- '
raby offirm�Mat I am licensecl�nder provisions of Chapter 9 Disp. _.Room Air Cond. — pfC;.NUMBGR _, � �'�'r� G055. �.)
'nmencing wlrh Sscrion 70FI0}of Division 3 of the Business power Appam'us$La�ge Appliances DISiMCT NO. � CESSFD BY �,
i Professlons Code,and my license is in full force and eifect f y� �
/ �! Size 8 Type HP,KW,KVA,or KVAR �
=nse Number�_�_�4'""�'f Llc Class�.2_._ LJp ro 1 Incl. ��NA� �
Over 1 to 10 Ind. DATE �l ���naN- q
.,o-a�w���-7' �� i�l.:��?oaie�-1/ o�e,io ro so i„d.
FINAL U
� I am exempt under Sec. Over 50 to 100 Inc eY 0.
8.8P.C.fw this reason Over 100 �°
_ Se�vices,Swbd_,MCC&Panel6oards � �
Date: 0-200 Amp.Under 6�0 V
Signature _ 201-1000 Amp.L)nder 600 V
� Over 10�0 Amp.or Ovar 694)V
Exemplion for Reg.MainL Elect.
SINGLE FAMILY Temp.Power Pole&App�rtenonces
HOME OWNEtt.BUILDER DECLkRATION �ign wi�h One Bronch Circdit ,=� �b,J A
1 hereby afflrm that I om exempt trom the Controcror's License Add��ionol Sign Eranch C-�rcui+s �
Low for fha following reoson (Seclion 7031.5, Business and ii . . ,� W
c�
Professions CodeJ:
❑ I,as owner af the t � ill do the wark ond Ihe Misc Condui�s 8 Cond�dcrs
praper y, ,prher See Ccm feae Fse Schedule � ' U e�����G
strudure is no�Inbnded or of#ered for sole (Section ( p f—
7044;busintss and Rofassions Code). " ' '� ��`�-���
CONSTRUCTION LENDING AGENCY . O�,O� -�,G,
I here6y affirm tho�there is onsfrudion lending agency hor � _
� the performonce af the work�for which this permit is issued PERMIT FEE (Su6-Totol)
(Sec.3097,Civ.C.).
PLAN CHECI€IPiG FEE
Lender's Nome � "'b
- PERMI715SUIWG FEE
Lender's.4ddress � .-�
I certiFy that I hove read this application ond sta�e tha+rhe 70TAL FEE
above informatian is ortxt.I agree to mmply wifh all County .
ordinonces ond Srote laws regulafing Electricol w ing,and
, hereby authorize representar'rves of ihis County ro enter upon
the a6ove-men�ion pro/pe/rry for inspecrion pu�poses. gEE RbVERSE FE.R EXPLAt�IATORY LAHGUA6E
�"'f;ti�1 e;ro-- ! "�"{L;•./=_ �/-�,_,_.7:-�_.___
..,S�n�p�ur f Perm�free Dote
� � �
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` ' �� � � �1r+��1
��� s��.w� *� .
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- - ++ �.�^
A�P�VALS`� DATE �M�-�i11C� • -
Ti�
TEHFP,fOWER POLE I hereby nHirm thot I nm e:xempt fram tne Ccnirocror'a
- , License La�n•for thn folla•xing rea;on (Soction 7031.i.
UNO@R`s:AB WORK Buslness ar,d Prof^ssicns CodeJ:Any cRy or eounty which
ROU6H COFlBU'7 regWres a pe�rmii to.construci,aller,ir,=�ravc,�o-lish,
tX fq00jf aRx STPUEiUfP�EtYrG((O Ik5 i%'JryIICt�, q�5t3!B
WMiN6 4ufres�fx opptissni lor w¢7��rnif fa!r!s a�,'g�ed sttse-
ment that he i:IFesased pvroeant te f4:a prcvisicn:of inc
HXTURES Cw�tcec�tor's ticwnzs tavr{CF.op!«�9(c rnor.ina wirf�
POVJ€�R AUiHpRIZ€O Sxtion 786tl)of Div'rsiorr 3 of Hie Busaness anel IMalss�-
srons CoeleJ or tf�at he is oxerr,pf ihaa��o�`rem cnc'fna bsci:
UTILITY CO.NOTIFlED tor tha alieged exsm�tion. h:;y 41Fn�QI:M ot S�ti�sn
- FINA: r�"sr an henf 703I.5 by any applir.ont for a permif x�}�sts fhe o�w'i-
eonf fe a eivll psnoHy of not mcro tfian five hundred
NOTES do}(ors(R50QJ.:
Q I,ae om�ner af the proparty will c+c the�work,nnd
ihe str�cturs is not inteneied or of{w�vel for r,ale.
(Sac.704F,&:stnecs w�d Profwaiens Co�: The Cortrrc<-
10f 5��EfIRS@(,(3W G1fJ!`i n0}G�'IY 10 Lfi 64YAK D{f)SOFI�fYY
wha builds or impreve, Iheracn, and whe d:.es wefi
werk hlrs�seff pfev'rderf tisat such im�-cvwvents c;e nof
infend►d or o#ferael for sale.I?,howeve-,ihe buildir�g or
Im�rove,ment is sold with7n cne ywF+r cf co�r.rylsticn,fhe
ewnar-6ulldar wfff havc iho burden of prev;ne�fnat ha did
net bulld or Improvc/cr thc purpofa cf sela.)
I am eauss�mp!under Sec. ,
B&P.C,for this reason
�ate ____.�_._..________
Owncr _
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