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HomeMy WebLinkAbout1264A __........�.vect,aRATION �6A663 ,o,e, APPLICATI4N FOR ELECTRICAL PERMIT {� i nereby affirm that i have a certificate oF Cansent to self insure. CE•806G ,.tra"certilicate o�NJorkers'Gompensa!ion Insurance,or a certifed COUNTY OF LOS ANGELES � BUIlD1NG AN�SAFETY u copy thereaf(Sec 3800.Wb.C.1 Il Ocy No.i OOSA?B:��„y I�DS C�D.t�T Fon awi.waar ro flu.x� �oB �„(3 Rv+QERJ I$�P—v .EACH NO. FEE ADDRESS I Certified eopy is hereby lwnisheQ New Residential Bldgs.8 Pools LOCAU7Y /� ��Certifietl coOY�s filetl vnth !he county buildifg inspec[ion �g 2-Family,Sq.FL § — $ � " � �tleparlmeM. � � �� Multi-tamily Sq.Ft. — neaitEST Q 'C���j!'�S Residential Swimmin9 Poois �p�yNEp� � bate ����D AppliCan� r� . � KIRM9lAME , � -CERfIFICATE OF EXEMPTION FROM WOfiKER5 . � � MA�� COMPENSATION INSURANCE . �lets:Rec Ught Sw. pDOREss ��- .J� /¢�iQA' -(Thia sactlon need not be campleted if ihe work Inrolvad by tAe � First 20 t�� permR Is for one buntlred dollero iS 700)or bss.) Total No.� Additional CITY�� ��1 Tel,hb. .i certify that in Ihe pe�lormance o�the work for which this permit . Ptar�CMECK i9 issued,1 Shall no[employ atry person in am/m3Mer So as t0 APPLICAM . � become subject Ia Ihe YJorkers'Compensation Laws. : Lighting Fixtures First 20 AD�RESS � - � . � Total No. /n Atltlitionat . _L CITY Tel.No. Oate Avplicant Flxed Apoliances Not Over 1 HP reqmrt NOTICE TO RPPLICANT: If, aftei making this Certificate ot aPwCaNT �'�W1 K Id'�J Exem0lion,you should become subject to the Nbrkers'Compensation Fan9c_Heater��.W. _ provisions ol ihe LaCor Code,ycu must forlhwith cOmply with such Oven_.Dryer_W.�1.^ ADDRESS Z � � E,� �provis�ons o�fhis Dermit shall 6e deemed revaked . � Top _FAU _W.H._' . � � LICENSED COPliRACTORS DECLARATION Haod_Fan _Other_ CITY Ll� £� L►qlel,Np.7� GZ/ jC� O 1 hereby attirm inat 1 am lirensed under provisions of Chaptur 9 . - Oisp. _qoom Air CoiM.�_ uCENSE oR Gass. (commencing with Section 7000)of Division 3 of the Business and REG.NUMBEi� ap (o B• PfOfC55ionS COtle,8nd Iny IiCfnsE i5 in 1u�I Ialce ffrld ef/BCf. .ppwe!App.Y2[us&LHf9E App�idRGES .. OISTFlICT NO. PROGESSED BY �a� y�� Size&Type HP.NW,KVA,or KVAR l V Q�r p . Ucense Num6er Lic.Class� �� Up[0 7 InCI. � FMA� nnn 0 ���,5 ` ���'�� Over 1[0 10 Incl. DATE ,/ . / . . VALIDATION ,i O ' contractor 1��3 Date � ��., . ❑ Owr 10 to 501nc1, fINAL 7� 1 am exempt under Sec. Over 50 to 100 Ix. By � �� 2(a j , W Over 100 63P.C.tar Ihis reason . O g O 'S 7 � � $ervices,Sw6d..MCC d Pareiboards - � � � � Z . . Date: 0-200 Amp.Un� f '� � � Signature 201•10 Amp.Untler 600 V � � - ��O, �&7 ❑ o��i000 nma.o�o�e�soo v �� p�u q Ezemptian for Fieg.Maint Elect. � � �SINGLE FAMILY- � Temp.Power Pole 8 Appurfenarices _. . . .. ��� . �2 - HOh1E OWNER-BN��ER OECLARATION Sign with One Branch Cireuit f • •L!4 2 rJ I he�eby atfirm Ihat 1 am exempt from the Contractor's Licenso Law Additional 519n Branch Circuits �or the lollowing�eason(Sec[ian 1031.5,8usiness and Professions �- � ' - Code): a 0 s([G'�5� Misa Contluits&Conductors ❑ I,as Owner of the property,will do the work and the structure O 9.O��8 7 is not�Merwed or oflered for sale[Sec[ion 7044,Business Other ISee Complete Fee Schedule)_ , aiW Protessions Code). CONSTRUCTION LEN�ING AGENCY � � � �-�� ' � I hereCy af(irm that there Is a construction lentlirg agency(or tho pedormance of the work for which(his permit is issuetl(Sx.309T, pERMfT FEE � � - (Sub-Totap � � - Civ.C.). PLAN CHECKING FEE � • Lender'S N�me - PERM�T ISSUING FEE - - . - 1(} . _ . . - . Lender's Addmss .�5 1 certity Ihai I have read mis application arW state that the obove TOTAI,FEE ... . - - . information is correct.1 agree to comply wiC�all County ortlinances antl State laws�epulatin9 Elecirical wiring,arM hereby authorize . . . . .. . .. _ _ . . . . representative this County to enter upon[he above�mentionetl property ns ction pu�pose SEE REVERSE FOH EXPIANASORV LANOUAGE ___���i '� ,�'-a �.?d, . naNre o�Permittee Date � �. .. .. . � . . � . . . . .. , . �, i. . . . .. . . � ' . .. , . . � '.I , � ... . ......�_' . ii � .._ .� . . . ... �..�. .. � ..l � .. �.i i._. .� . �.'.�... .. .. .. . .. ..... . . . . .. . . .. -.�...� - ..._.� .. . . _..._�......_..._...,..__.. _ ..-..__.._ .. _ .. . . . ......__._. ._ .._... __.... . . ... .. . ;� . � � r - . wSPecTOR S.� :_. .�' ... � il�..��.�-=..� .OWN�EA-BUILDER DEClA5A7tON-'� '� „ ,}, �. ) �..�..�:-� �(.APPRO�f?,LS -DATE- -, SIGNATURE . .-.. �._.- � __._ ._.. ... _ . . i l � ----- --�- �-�-�-� ���� � ' � � �hereby a!Iirm tha!I am exempt from the ConVzctofs License f -'''•S1�S.__�>'..TEb1P�.QO`NER�POLE � � , � . . , . � � ,. ^ j .� ,UNDERSLAB WORK. �. . .�. _ .__ ._. __. �:. ' . 1 Rnfessan^,eCfode)`Airyec ry a counry H,0�7.�fLrsm�s��md 4.__. .r=-J ' . ROUGH CON�UIT , � �.��" � .. .�� I m���cG'�!wtiMp L��e,demol�sh or?e��i; stn�t re,Prior , ���,� � : ' , „\ �� � to'rts iss ance,afs eGu'ms fhe applcan�/or}s�h pe m t to file 0 � WIRING � � � .is �•� � � �� �� a signeU sLv'cmenf lhaf he is licensed pwsuant to the prwisions '�:'�' -' ���-.� '>:��: .�... ._ ,: . : �, .- � ,, � ' of fhe Contracia's'Lkense Law(Cnap(er 9(commene�ng witn �- -- � , -+ FIx1'URES-� , ,.. - � ._. .. � �, y..' ,. �, ... .,�Sec{ion 7000)ot Div'slon 3 otYhe£L,sirress and fYofessiorts �� � �alle ed c ��""--- ��--� - � -POLRER AUTHORiZE��- ' . Cale)oi�thaf he'is exempt'fhcrelrom rrid!hC Msis'lor 1he i , , , , , � g semptipn. Any viWotian o/Section 7031.5.by orry ;----�----� - ---. .- UT1L17Y-CO.N071FIED � ', , . �' ...a,epGcnnt la a Permit 5ublects Ihe�,opl�cant lo-o dv�l peoalty � ' �-�i-�-"-� --� � o(not more tnan!"ve h�ndred da!(ms l5500).• � � � � � -- FINAI -._._____ jJ11[Ct"072�Y011t . " ,- , � �.� ' , � ; 0 I,es own�r of the property wili do the wurk,and lhc ,_.._ ._�.._._ .____.NorEs____, .__., _ . .� �, ' . . , � ._. -structure is not intended or oft.red�far sale. . _ .' �=I ; f��-,1;�' � � � � � '(Sec.704a,8usiness and Prolessions Code: 7he Conhaaor's - - - • - - � '' - Lkense Law daes nvt a�ty to er+amer ot property who 6uiuis ���� .'_ .�:1 , f•�'� t� , '`. ; " � ' .. '- . . ... ' . . cv rrrrFrrnrs therce.v,and who does such vrcrk h,rue 1 pw;ded , ,.� .``� ..�,.��., ...{..,,�.•,.. Y'-.{\.y,�✓ � ' �: that st.eh improvemen:s nrc Irof intendcC w apc/cd fOr SelC.'p, .- . , , . . , . . . . -�- � - -� - � - -- � ��� - � � ' ' hw+evc�,'thC Du➢tlutg o�imp�ovemcnf�is Soid Within pnC ycer 01 , ..'. . .. � . ' �� . - . . . . ..'�.'~........ .' .._.:.�; •• � •.. F� .�.... ; � . .. . .. .. . � hetlptl not b Id or Ir 6uiltlerwill have tYie burtlen o/provin�Inat � . _ -" �� "�` ' - . . � . . � mprdve Por fhe puipose o!salc.J � i � _A.. �� � � � �. , . . ..____... __._ "__'.._ � ' " �. ' , . .-. �. . . - � ._,: ._�. .__ ._�..._ � .. � . . .... . . � .. _. .._... . .. . .., _ . �. . .. G, ,. � � � � � ' ' � t am exem�[under Sec .., . . � � � .�- ,,, , .. --- .-.. ___ _ .. ._ , , , , --B E P.C.for lhis teason � ':� -.� _�� .- �.-�.i I � ' , . �. .� , ,�� . �.' . L . ., . . . .. ...___. __... . , _ � _ ._. __. .. . . .. ; . . . .. --. . . .Date _. _... ._. � � � . . f . . � Owner - ' . . , � .. ._. ._ ' � i � � � . . .. , ..-. . - .� .. , i. ... - , _.._ ; . .,. .,� . �;�. , .. � . . �. . ._ .. ._ � . _.. . , _ ���: � . . __.�._. . . ..__ _. .__. . ._.__.__' . � � 1 _ . ..._ . ._. __..,.-.. . . _ . . . . . � .C- ,.�:.' , ,\ . , . . �`�-:. ,. _ .,_ .. .- _ . .'j�