HomeMy WebLinkAbout0972A "�"T�°"°��`����°" '�' '°,81 APPLICATION FC�R �LECTRiCAL PERM#T
I h.;a5y aSfirm that I have a certiticate of consent to self insure, cE-sosG �'I
, •or a certi/icate of Workers'Compensation Insurance,or a certitied COUNTY OP LOS ANGELES BUILDING AND SAFETY � �
copy ihereof(Sec.3800,Lab.C.) U
aoiicyNo.7g6z9g ��ompany ^�'T ,COMQ FUND FORAPPUCANTTOFIlLIK JOB 2637 SO. BLAZE TRAIL
❑ Certifietl copy is here5y fuinished. EACH NO FE� AODR[SS
New Residential 81dgs,&Po I
� Certitietl co�y is filed with the county 6uil�ina insp=ction 1&2-Family,Sq.F!. ��Q1 g, ._ g �. LOCALITY DIAMOAID B.AR
de{�artment. Multi-family Sq FL — NEAaE57
2/29/89 BROFtN ELECTRTC ResidennaiswlmmmgFoois caosssT.
oate qpPiicant oR�NAOMEaMR. & MR5 . DIPAK DOSHS
- CER71FICATE OF E%EMPTIOM FROM 4tlOR}CERS' putlMs�Rec_Light_Sw._ ooa[ss 1�$Q . `j' � D R I V E
COMP�NSA'+�IOPo IM�UFANCE First 20 �
(Thi�e�ciMM'+�ad not b6 campleEed if the work IFlvotved by the Tota Wo. Additional CITY A I�O�D B AR Tei.N�61 9 5 9 7
permit is for ons hunAred dollars($700�or Iw.)
I certify that in Ihe performance of the work for which this permit NLn�u CHiCN
is issued,I shall net�y any person in ariy marmer so;as to npaucANrTA7 DEVELOPMENT CORPORA ION
become subjec:to the Vdorkers'Gompansation Laws. Li9hting Fixtures First 20 RDDFiES6
Totai No. AAditional -
oare aPpr�a�f F�xed aPpra�oes No�o���i HP ciTv I ND RU 3 TRY Tel.N�6 S 4 0 2 3
NOTICE�TO APPLICANT: If, after making this Certificats o( PFA>ali
Ezemption,you shoWd become subja^t to the Warkers'Comperisation A�nge_ Heater_ D.W. _ A�PLICANT I F T F C'T R T C'
prcwrewns of rne Laber code.you must fortnwitn comp�y wim sucn oven_ oryer^ w.M,_ � nooRess 13860 SM6KE TREE ROAD
provisions or this permi:shall 6e decmed revoked. 7op _ FAU _ W H..�.
LICENSED CONTRAGTORS DECLARRTION Hood— Fan � Other_. C�TY T�� 90 5
I Freieby affirn+Thet 1 am I�eansed unc.'�er pro�isrons of Ghapte:r 5 Disp. — Room Air Co�. _ u�ENSE oa
(commanein9 witn Section 7000)ot Division 3 of the Businoss and eeG.nun+se� 2 3 0 2 0 3 ���s�C 10
Profes5i0ns Code,and my licensc is in full force antl C`fect. DISiRICi NO. PROCE55Eo eV �
Power ApP�ratus&Large Appliznces
Size 8 Type HP,KW,KVA,or KVAR �Q �� �� Q
License Number Z 3 0 2 0 3 Lia Ciasel� Up to 1 Incl. 'FINAL �.7
Over 7 to t0lncl. DATE _ ��_,L1� VAWDA710N �
Contractorannwv Frvrmatl�Date ]{99�ft9 Overi0to501nc1. � Q
FlNAL ����� �
❑ I am exempt undar Sec. Over 50 to 1001nc gy
B.&P.C.far th5 reaeon Over 100 �
Services,Swt�d..MCC&Penelqoards � � �
�a�: 0-200 Amp.Undzr 600 V -
Signature 201-1000 Rmp.Undc:r 600 V
❑ Over IOOD Amp.or Over 600 V
Exemption tor Reg.Maint Elect.
SIfdGLE FkFAfLY Temp.Power Pale&Appurtenances
HOME OINH€R-BU7LDER D€CLkRkTION Sign with Onc Bra�ch Circuit
I hereby affirm thaf I am exernpE fmm the Contractor's license L�w AddrHonal S' &anCh Circuits
fw tHe fdlewin�reaeon(3ee�ion 7031.5,Business and Professions '�'
Code):
Misa Condufts&Contluctors `��� �'�-��'
❑ I,as owner of the properry,v✓ill do the work antl[he structure
is not intended or offered for sale(Section 7044,Businecs Other(See Camplete Fee Schedule)_ � ��' � � � n�1
and Pmfeeeions Godej. I o c%�'� �:
CONSTRUCTION LEN�ING AGENGY
I hereby atfirrn ihaF there is a construction lending a�ency for tY�e s ,_ , i . , t
performance of thc work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Tota1) g� 0 / �
Civ.C.1. G C�.1 f"�—. . '
PLAN CH[GKING FEE � � �
L�der's Name
PERMIT ISSUING FEE ]_Q S
Lender's Addres�s
I certify thai I have reacl[his application antl state that[he abom: TOTAI FEE � z']g�5 �
information is correcL 1 agree to comply with alI Gounty ordinance�
and Staie laws regulating Electrical wiring, antl hereby authorize
represerrt � s ot this Cotinfy to entzr upon the above-menfioneA �
propert.�n in�pecf�Pw � �
9EE REVER88 POF EXPLpNAFORY LfYNGUA6E .
, �'���1���$
Dete
e . , i . .�
� aP��;ova � oare� �r�=i-�cra.�s � . . . CY�N�f3t�4�9E14 D�CEFiIAqRt�Ri
� �GI UfSE
T6�1�P��iER PG E^ � � I hareoi'�ffr that I x �x��.mpt trom the Co t ���tor. C�a. -.
�1 L�w i� U. toLox �r a,on(S�etion 7031 Bt�slrie;s a d
� � UNJcRaI AE YVUHK I,� Rrolessr.:uis Cotl� .Ari/a ty or ca nry whlch re.��tw+e�s +pu,nif
�� - � � RvU('11 GOhJ�U T � ,�to con tr et *._ im�r� de no h o t-,ssrr�ny s#rucdur=.,pr or
- � ��� to its :v c� a.:�rc�t r-�,fha a��c a n t�r such pe.m�'to f9e
VJIRING' � a S7y�a9 vta#,merii 4hn h is hCPtsetl pUr uri i tfie rytvrs'G»S
_ � ���-"^'"����--`""� af the Conbac�`s U„=ose Le�v tGnap,r 9(cwnmenc�ng viiih
� . ' RX?U:7ES Section 700D)of Civ,aen 3 d the Busire�c,s arv1 P,n6waacros
POWEFt AUTHvRiZELI � Cede) ot ff�:t he is exemFX hlaeAom a.id fH� baeis lor Bm
. . . , �. _� _ ��-�-��---.-.-- � o7tec�tl e�n ;��i F�n�va��Nnn o! 4lm.*.bn 7031.5 Ay�eny
U"I"I 1T"CO-NOi FI G
2�p!(�'i�f fpt 3 R2It1 it l j C25 N2 ./Jf`iCu^nt t0 L C�V'I(;Bfia/:Y
:. . FlN:16 � FYltE7 GYl�'Yf)122 ___`� of no mar ttana ti h nGi�d C,�/rars($5001
[]I �s uvrn_r :r•��properiy will do the wnrk,2nd thr
`?0C=5
� - - strticCure is not intand�d or ofiered Yor s�le-
� (Seo.7044.Ba�ihess�:�v Proles;ions Cu1e. 7fre ConPrae[or's
.. --- —._---•— ----- Ln:en��^Larr Oas r:of�,�„ly.a an rnvrirr oi prty�fty who baild��
- . � or iinptives thc�enq�.nd who tlo�such wnrk.himseN�:rcvltled
-��-----�--�-- -- -- -- - that such imp:urrmrnis arza r,ct inien;,�tl or o(far�c;far sa7er.I!,
� � howevei,thn bu!(r:ing cr Imarovanxni is sokl witl;in o;�c year of
,� ^--. ..—�_._._... �..�.�_.�.� er�mpk.Si�n.ihe ov ne,r-burF"er wBt h�we thc bursien o�pio�mg thst
� he did nof bi�i?d cr inuarnvn for thc=purpa,e o1 sate�)
.. �� ._..._ I�am exempt un�i�r S�c. - ^.
--�-- �— �— ----��------�--- B R.P.C.for fhis reuscn_
._.._.—����._._ -��.-.�-._-_.------_—._ - _._�.._�� Date ..� .�
----.—�__.__.�. _..._...�_..— �'_ Ovdner