Loading...
HomeMy WebLinkAbout5653A (17)mmopwo-MVORKtP,3TMRMVOMNMD=fCMLAMPAWTIOMNL 76-0663 CE�06G APPLICATI© N FOR ELECTRICAL PERMIT corse -f hgteby pff p, that have a certificate of consent to self F -. insure ara cart ficate of Workers Compensati Insurance or a certified copy thereof (Sec. 3800, La ANGELES couNTr of Los ANG BUILDING AND SAFETY cy Ne ? Co y_1 FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished, - New Residential Bldgs. & Pools EACH NO. FEE ADDaE55 V - - ( Certified copy Is filed with the county building inspec- - I & 2•Family, Sq.,Ft, S _1111 LOCALITY i tion fie portment. ,. Multi -family Sq. ft — • ```'NEAREST CROSS ST. JeUf9&Az9 AOL .' Date Residential Swimml o s ` OWNER OR - Applicant �� FIRM NAME .. 1 1 . CERTIFICATE OF EXEMPTION FROM WORKERS' Outlero:Rec_^LightYS - .' � MAIL COMPENSATION INSURANCE � t - - first 20 ADDRESS .'(This section need not be completed If the work lovolved by f Ttal No o Additional .CITY el. No. j the permit is for one bundred dollars ($100) or less.} 1 certify that in the'performonce of the work for which this " CHECK APPLICANT permit is issued, tshall not employ any person in any, manner so. astobecome subject to the Workers'Compensation Law, Lighting Fixtures First 20 " r--, ADDRESS - ' ` Total No. Additional Tal. N EDate Applicant fixed Appliances Not Over, 1 HP PERM' NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers': Range_ Hedter.,,�. 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. -- To .^ FAU • '—'�`^'^—"'— -deemed revoked. ---,'- - ,.: ..�- HoodFan Other._ ` ,.� , CITY: I.I. No. ' LICENSED CONTRACTORS DECLARATION . Disp: Room. Air Cond. -LICENSE OR - s` I hereby affirm that I am licensed under, provisions of Chapter --, REG, NUMBEa - w,{ - Cl... i i (commencing with Section 7000) of Division 3 of the Business Power'Appdrotes & Large Appliances DISTRICT NO.- PROCES BY - and professions Code, and my hcemc is In full force and effect. - �� Size & Type HP, KW, KVA, or KVAR .License Number la Class ( - _ O Up to 1 Incl U Over 1 -to 10 Incl FINAL ' �7j�.., ) DATE �j ( -; VALIDATION Q t C❑ontrocr Date Over 10 to 50 Incl FINAL }}y.. 1 am exempt under Sec. Over 50 to 100 Inc. BY 0. B.&P.C. for this reason ;Over 100 i,.. 2 _ 'Date: Services, Swbd., MCC & Ponelboords - -- 0-: 200 Amp. Under 600 V.:. Signature - 201 .1000 Amp. Under 600 V - t - - M © Exemption for Reg. Mains. Elect.5 Over 1000 Amp. or Over 600 V ' a 6 CJ. - 3 A SINGLE FAMILY - - - ' Te . Power pole B, Appurtenances 1 ` # +.` +1.+1i 2 HOME OWNER BUILDER DECLARATION { - : - I hereby Sign with One Branch Circuit Q �" ; affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and AddlllonoP Sign Branch Circuits - rj1� ' i'+ 3 Q-5 Q I Professions Code): :._ - : 1i E �� S Q ❑ 1, as owner of the PraPer y, will do the Work and the Misc Conduits & Conductors [ structure rx not imended or offered For sole (Section Other (See Complete Fee Schedule)' 0 g' } 8 Q J'` 7044 Business and Professions Code) 1-1 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 - -(5u16-total) . (Sec. 3097, Civ. C.). - - -: PLAN CHECKING FEE Lender's Name -' - PERMIT ISSUING FEE . lender's Address_ I certify that I have ild this application and state that the - TOTAL FEE: -above Information rrect, t agree to comply with all Counry ordinances an S 1 laws requloting Electrical wiring, and - barehy a hon a resenYdtives�of this Counry so enter upo of props y for tnspectio f rpos - •:: SEE REVERSE FOR EXPLANAT4ORY LANGUAGE ` - - - OWNER-BUILDERDECtiAIZAFR)N•:, 'I hereby affirm that f`am exempt from the Coniractols > .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 ft -issuance, also re. -' quires the applicant 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 Secllort'M0) of DWISlen 3 of the.Buslness and Profes- sions Code) .,.that he Is ekempt therefrom and the basis for the alleged exemption, Any violation of Section 7031:5 by any applicant for a -permit subjects the apph- DATE SpECiLSk'S . `. SIGNATURE - TEMP: POWER. POLE'-. UNDERS1.0 WORK ROUGH CONDUIT WIRING Q - FIXTURES POWER'A>t1THORIZED UTILITY 'CO.` NOTIFIED - FINAL Gnfer on �ironf ' OWNER-BUILDERDECtiAIZAFR)N•:, 'I hereby affirm that f`am exempt from the Coniractols > .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 ft -issuance, also re. -' quires the applicant 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 Secllort'M0) of DWISlen 3 of the.Buslness and Profes- sions Code) .,.that he Is ekempt therefrom and the basis for the alleged exemption, Any violation of Section 7031:5 by any applicant for a -permit subjects the apph-