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HomeMy WebLinkAbout1017A �, � SAS QNDECLARATION •. 76A663 � APP�ICATION•FOR ELECTRICAL PERMIT : �����:, � � � . �.. � - � CES06G 12�801 [ hereby effirm that I have q certiflcate os consent to self COUNTY OF LOS ANGELES BUILDING ANp SAFETY � insure,or a certiticate of Workere'Compensation Insurance,or � . � �� �a certified copy thereof(Sec.3800.Lab.CJ � ' � FOF APPLICAN7 TO FILI IN J�g �� Pollcy No. Company ADORESS S t=�/C � � � � New Resid¢ntiel Bldgs.&POO�S EACH NO. FEE � Certified copy is hereby fumished. . 1&2•Family,5q.Ft. $ � E LOCALITY � � � , � Certified.co y �P Multi-{amily Sq.Ft. — A sT py is filed with the count building ins ection CROSS 5T C�.d �!/ department. Residential Swimming PoolS OwNER OR � � � - � � '/ � FIRM NAME ' � Date ' Applicant Outlets:Reo,�.{�Light�Sw.� MAI� . � , - � Firat 20 �d ADDRESS � CERTIFICATE OF EXEMP7ION FROM WORKERS' Total No.� Additional � CITY � Tsl No. � C - COMPENSATIONINSURANCE � \ . . . . PLAN CHECK . �' . �.. APPLICANT � . ' a . .(This section need not be completed if the woxk involved Lightin9 Fiutures Firat 20 � V `,by the permit is far one hundred dollars($100)or lessJ ,/" ApORESS - � � ' � � Total No.� Additional . Q �•certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP eI7Y � Tei No. O�, ermit is issued,1 ahall not employ any person in any manner . � .PERMIT �ae to become aubject to the Workers'Campensa' ws. Range�Heater_D.W._ qPPLICANT �r C..UQ /.�S c•.uP � W . - . � Oven��Dryer_W.M._ . ApDRESS - - � fall vate Applicant � .Top _FAU _W.H.._ s'}A 2 � � Hood�Fen'_Oiher� CITY � Tel No. � pQ� ', — NOTICE TO APPLICANT�!f,after making this Certificate of Diep. ___,Room Air Cond._ � LICENSE H � ExemD�ton, you ehould become.subfect to the Workers' REG.NUM9ER Cless Compensation provisiona of the Labor Code,you m�st[orth- ppwer Apparatus&Large Appliances OISTfiICT NO. . PROCESSED BY with comply with auch provicions or this permit shall be Size&Type HP,KW,KVA,or KVAR � `Q � � deemed revoked. , � i - ' . Uptot lncl. FINAL � � � Over 1 to 70 InCI. DATE - LICENSED CONTRACTORS DECLARATION Over 10 to 50 Incl. �^a —�'Z VALIpATION ! `I hereby aff'um that I am llcensed under provisions oi Chapter Over 50 to 100 inc. FiNA� '� . BY ; 9(commencing with Section 9000)ot DiWslon 3 oP the Busi- . Over 700 , � � � ness and!'rofessions.Code,and my license is in tui!force and . � � . efFect. _ - Services �.License Number������' Lia Ciass - 6200 Amp.Under 600 V � - � 207•1000 Amp.Under 600 V - . � �ContractorCd�,.E�GeC7�C,(,,,G pate���/f�� Over 1000 Amp.or Over 600 V � . � � HOME OWNER-BUiLDER�ECLARATION �Temp.Power Pole&Appurtenances . . �I here6y affum that I am ezempt from the Contractor's Sign with One Branch Circuit- � � License Law.for the following reason(Section 7031.5,Busi- Additional Sign Breneh Cirtuita . ness and Pcofessions Code): . . �. � �'O.'.,A � Misc.Conduits&Conductors � � � � 1, as owner of the property,will do the work and the p�her(SeeCompleta FeeSchedulel— � • �i�`����j'z� � strocture is.not intended or offerod Tor sale..(Section 7044,Business and Protessians Code). - . . . . �, ���'�'9 O CONSTRUCTION LENDING AOENCY , � f hereby affirm that there is a constr�ction lending xgency - " . ;�,��.,�9 O� ��. for ihe perFormance oP the work for which thia permlt is . pERMIT FEE� ISub•TotalS � � � ssued(Sec.3097,Civ.CJ. � . � Lender's Name PIAN CHECK'ING FEE (One•fourth Permit Fee) . - �2�5,�8'�.� '� Lender's Address - pERMIT ISSUING FEE - � , � I cerHty that I have road this application and state that the TOTAL FEE - 7s 9 � ' above information is correct.I agree to comply with alt County . � . ordinances and State laws regulatlng E1ectHcat wiring, and - � � . � � hereby authorize representatives of this Couaty to enter upon . � . . ��, :he��e-mmtioned prope i pection purposes. � SEE'REVERSE FOR EAPLANATORY LANGUAGE � � � , - ign ure of.Perm te � Da� � � - . � � - - �, i ,� , ' ,_.,..�.. ,.�+,�,�rT��i�,A �. _:. ; r ���.p� � . , ^`,. . , �f _ . , . .. .4� , � I . �- . . . ..:�i .�.. . . . ., _. . ... - � . . � . . � ' ._, . $��`.�"��., . . . . . . . � . ��. � 1 hereb affixm t am exem�� ....�. ��.� � . �� � � �' � � Y that� . . .�.i . ' ........_. ,.._....,_, - .._.. '�. . .. . �.. . ' . Pt�from,[heCant�actoc's � � � � .APPPOVALS � DATE iNSPEC"Coa^S . . - . License I.�w foz the fullowing rcason�/Sec[ion 703I.5, � . �_ -� � � s�cNaruRe.. . _� .- -. . -. ..Business�a.ed Wofe.sseo'ns��CudeJ: Anp�crry ar county ; '; . ..:�... � �•,:. ..� . .— . . .-- .. .�. �.. -. . � 'TEMP.POWER.PO�E.',. '�"' `-""" ,_'i' -�""-;.- '��' ' '" ' ` � '�� � x'hich requires a perrnil Yo constMct, after, lmplave, � . � ` .•�;. - :. .. � . , - - ��. .-. . - ' � .-..- . .-..: . " .. . demolish.nr repair.any�tinrertlre:�Prior io r`t& issvance, � " '��.�...._.. . � � tfNDERSLAe WORK � . � � . . . : �, ..� . -.... ` � --. ._ . .._ ..�.�.� . . . also,�cquires rhe,appiic4nt for,such permit,to ffle a � ' -"�--" � ���,��- - AOUGH'CONDUt7�-- �,� �--� - � -! .�` -� .-.�.�� � � .� , � �,sigrted stnrertieist tl�at he ts Yicensed pvrsuant-to-the �- � -�i; � " provisio�es of the Comtmctor's Ltcense Luw(Chaprer 9 '. , : . . ... ..... .... WIRING . _ . . � . : ;. ,. . . . . - -�-� � � .. ���. . �.. - .,,.(co»�men"eing w�tk.Secnon ,i000J.of Dirision�3 oj the . M . ,, . . �. . .:.�� � . � . ` . FixiuReS .__...� '� ''^.� _- ,' ��� . , . � � - @u„ine.rs arz�Professions Codef or rhot he i.c exempt � �. .. .. � ��� . �. .�_.- ' _..,�. �.��.��... ` �� � � ���themfrum and��(he basis jar:the n!leKed�exemyJion.Any . . ___ .. '.��. P.owERa�7HflRiZED� - � , � ���violutioiaofSection7031.Sbyanyapp(icantjorapermir � '� - � uT_Wrr co.r�,oT�K�ED � 1°� - � � � � � � . .subjects rhe app/icant ta a ciuil pertalry of not more than'� � .. �. .. ._ �: _� . ...- . . _ , � /��� ;:;':� . � ���.;, -.. . ' fir�e Nundred dolfars($500J.:. :�..� � . � . : ,._ .__ ._. FInIA� .. _. �'r�� Otf,�ttiWa� � -,r. . � . . :.. . �❑1,as owner of the propertY-�11,do the wi�rk,ar : - .;. :., . . ' f ' °'-� � No7Es � � �-i ' - _ � : -� � '� . � ,�the stiuctuce is not intended o[pffeied for sate.. � �, � _...__._ _.... .__. .. _. . . .. , , �.' . . . .� . � .(Sec. J044. Business arid Prqfeasions Code:,.�The C� � � _ - � � ., �� � . � , rracror's:Lirertse.low dces nar�apply�,to an.owner� �.. ,.. .. . . .. . .� . - � . , . , �. � . . , , . , , . � ��,propeTty who butldS or improves�therenn,�pnd who de . .� .:�� � ', . _• . s . . .._ ' . _. . ' ., . . � . . . � � � ,: ,. I� . . � � .,�- . .. llrchmoteinte�ded ror�jfe�red forarale.clj:tkowever�eiH , , . ��. � .. � .�-. . --. . . ..-;`. .�', �� � � ..... . -,' ; . hutlding.or improvemenr.�Es sold wi;htn one Year;o, �� q � � , . �� ',�� . , �, 'f '�� Coinpletion, the. owtterfiutlder w!f! ha've the.���burden : . ......,._ , ,. . .. . ...w..... .... . ' ,_ . . . _;; . :� ��-- .f.P S, . . . ; . � . � � � . . � o �. rovin ,th<et he.did.:a ot 8ui�d or improve jor:�the . � , .. , ,. � , : � ,. . �� � . . . �.:�..purFose af sale.J��. .:; , �. .. . . " . , � • � ' T am exempt under Sec. , -.. � ..,,. , .., _.. _ i _ ; _ ....' -- > $&P,C.for t6is rea�on _'.. _. _. , � �, ; . . . , . . �. P,. � E_..:. ' ' DaYe—��. ... ,. ��. � � . �. ;_._ _.. .�... ..._ ' � ���:. ...' r . . . . ... _ . . .. , . . . ' ; . , _ r Owner � � . � . � ., . � I. ' ' . .. . �� _ _..�. , .... ... ._ . .. AC.t7{� ' _. , — ' � ^ , �. ,:, � ,, „ _ S:....,}g � _ ; _ _. _ ; ,: � ,. , _. _ OP,�C•i• ! • ,� , `�0�->;s �, �. _.. _ . .._.�_ _. _ .__ ..... ._ � C., f8—�t , , S 1 ' <, ; � , . , , �. . . • . . � . .. i .. �. . . � .. . .. . . �. . . , ..4._ .,.. . �`� . . . � ' ( ",` . � + ... ..S. �. .