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HomeMy WebLinkAbout5653AD.0 „*�NORKrR ON cafe 76-0663 1D/9t ' CE�06G APPLICATION FOR ELECTRICAL PERMIT of corse f hgteby pff pi that have a certificate of tarsent to self f -. insure ora certfitate of Workers Compensati Insurance or a certified copy thereof (Sec. 3800, La couNTr OF Las ANG ANGELES BUILDING AND SAFETY /� t icy N -�J ` Comp an - : FOR APPLICANT TO FILL IN - JOB c� ,•�f Certified copy is herebyfurnished,New Residential Bldgs. &Pools EACH NO. FEE ADDRESS - - Certified copy is filed with the county building inspec- i & 2•Fam11y, Sq,Ft, ' - S — 5 LOCALITY -: fie i department., ,. Multi-fomily Sq. ft — ```'NEAREST CROSSST. .' Date - Residential Swimml o s ` OWNER OR Applicant I_ ,. ^^ FIRM NAME .. 1 ( . CERTIFICATE OF EXEMPTION FROM WORKERS' Outlero:Rec_^LightYS �1.7 - MAn COMPENSATION INSURANCE I - fist 20 ADDRESS .'(This soctlon need not be completed If the work involved by f Total No Adduiano l CITY el. No, j the permit is for one hundred dollars ($100) or less.) 1 certify that in the'performonce of the work for which this APRIUNPUN TA It pe mit is issued, tshall not employ any person in any, manner so.as-to become subject to the Workers' Compensation Laws. Lighting Fixtures First 20 " r-, ADDRESS Total No. Additional Tal. N EDate—Applicant fixed Appliances Not Over, 1 HP FERMI NOTICE TO APPLICANT: if, after making this Certificate of Exemption, you should became subject to the Workers' Range_ Heater.,,. D.W. — • APPLICANT '- Compensation provisions of the loborCode, yoU'muat forth- Oven .._._ Dryer _ W.M,-- ADDRESS with comply with such pfovisionsior this permit shall be TopW H. -- o — FAU P • '—'�`^'^—"'— i -Tel. -deemed revoked. ---,'- - ,.: ..�- Hood` Fan ,.� Other._, CITY: No. ' LICENSED CONTRACTORS DECLARATION . Disp: Room. Air Cond. -LICENSE OR - J` I hereby affirm that I am licensed under, provisions of Chapter --, REG, NUMBER i i (commencing with Section 7000) of Division 3 of the Business Power'Apparotas &Large Appliances DISTRICT N0.- PROCES BY - and Professions Code, and my hceme is in full force and effect. Size & Type HP, KW, KVA, or KVAR - -� V .License Number la Class ( - _ O JQ Up to 1 Incl Over 1 -to 10 Incl FINAL ' ,��7yj��., ) DATE -; v YALIDAf10N Q i Contra Date peer 10 to 50 Incl FINAL 1 am exempt under Sec. Over 50 to 100 Inc. BY 0. B.&P.C. for this reason ;Over 100 2 _ 'Date: Services, Swbd., MCC & Ponelboards - -- 0-: 200 Amp. Under 600 V Signature - 201 .1000 Amp. Under 600 V - t - - M © Exemption for Reg. Maim. Elect. Over 1000 Amp. or Over 600 V ' a .(- 5 6 CJ. -SINGLE (� 3 A FAMILY- - - Temp. Power pole B, Appurtenances 1F'-�. ` # +.` +1.+)i 2 HOME OWNER BUILDER DECLARATION { - : - !hereby Sign with One Branch Circuit - %V Q ; affirm that I exempt from the Contractor's ss n Low for the following 7031.5, AddillonoP Sign Branch Circuits � ' i'+ 3 (ZJ� Q I g r reason (Section d Business and Professions Code): :._ - rj1� ,+ + E �� S Q 1i"13 ❑ 1, os owner of the PraPer y, will do the Work and the Mise Conduits & Conductors _ ' [ 2 structure is not !mended or offered for sole (Section Other (See Complete Fee Schedule) J 0 g' } � 8 4 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued - -, PERMIT FEE - -(Sub-total) . (Sec. 3097, CIv.-C.).. - - -: PLAN CHECKING FEE Lender's Name - PERMIT ISSUING FEE lender's Address 1 certify that I have ild this application and state fhm the - TOTAL FEE: above Informori n rrect. 1 agree to comply with all Counry ordinances an S t laws regulating Electrical wiring, and. barehy a hot a resenfatives�pf this Counry to enter upo d props y for tnspectiod rpos _ •:: . ': SEE REVERSE FOR EXPLANAT4ORY LANGUAGE ` - - ', ' OWNER -BUILDER DECtiAIZAOC , - 'I hereby affirm that f`am exempt from the Contractols > .Licensq,I.— for the following reason (Section 703h6. - - Business and Professions Code): Any city orcountywhich. requires a permit to construct, alter, improve, demolish, )' or repair any structure, prior to Its -Issuance, also re. -' quires the applicanf for such permft to file o signed stdte- - - - - ment that he is licensed pursuant to the provlslons of the 'Contrador's License Low .(Chapter .0 (commencing with S.Olort' M10) of DWISlen 3 of the.Buslness and Profes- sions Code) .,.that he Is ekempt therefrom and the basis for the ralleped exemption, Any violation of Section 7031:5 by any applicant for a -permit subjects the apph- DATE SpECiLSk'S . `. SIGNATURE - TEMP: POWER. POLE'-. UNDE{S1.0 WORK ROUGH CONDUIT WIRING Q - FIXTURES POWER'A>t1THORIZED UTILITY 'CO.` NOTIFIED - FINAL Gnfer on �ironf ' OWNER -BUILDER DECtiAIZAOC , - 'I hereby affirm that f`am exempt from the Contractols > .Licensq,I.— for the following reason (Section 703h6. - - Business and Professions Code): Any city orcountywhich. requires a permit to construct, alter, improve, demolish, )' or repair any structure, prior to Its -Issuance, also re. -' quires the applicanf for such permft to file o signed stdte- - - - - ment that he is licensed pursuant to the provlslons of the 'Contrador's License Low .(Chapter .0 (commencing with S.Olort' M10) of DWISlen 3 of the.Buslness and Profes- sions Code) .,.that he Is ekempt therefrom and the basis for the ralleped exemption, Any violation of Section 7031:5 by any applicant for a -permit subjects the apph-