HomeMy WebLinkAbout0790A (4) �� `°°RKERS'�°"'pE"S"7'°"DE��^K"T'°" '6"683 APPLICATION FOR ELECTRICAL PERMIT �
CE$06G 12801 ' �,
i � herehy eiflrm tnat I ha�•e a certiticate oi coneent to sclf COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure,or a certificate of Workers'Compensalion InSurance,or
a certified[opy ihereof(5ec.3800,Lab.C.) � �
FOF APPLICANT TO FILL IN � Jpg -7 �!
i - Nolicy No. Company EACH NO. FEE A�DRE55 ��I/ W�.��'�
/
� New Residential Bldgs.&Pools .
� Certified coOY is hcreby furnished. 1&2-Famiiy,Sq.FL � '-" S LOCALITY � �R. ��-2
❑ MUlti-fBmilySq.Ft. — NEAREST '
Cer[itied copy ls filed with the county building Inspection CRO55 5T � n
Residential Swimming Pools �r�� wN�
depariment �FIRM NAME-/JYl/"F' �
'Date Applicant Outlets:Rec�_(,Light�Sw.� �,� ADORESS 7/ u'//"�"0��� �
First 20
CERT[FICATE OP EXEMPTION FROM WORKGRS' Tota�No. Y �
CO`�1FGNSATION INSURANCE Additional G7Vv�A �jt/L Te�No.S'9•�3�03
- � PLAN CHECK �'
APPLICANT � �'
- (This section need not be completed if the work invoh�ed Lighting Fixtures Firzt 20 � U
' by the permit is for one hundred dotlus (S1Q0)or IessJ Additional aooaEss
�� � Total No.� �
� I certify that in the performance of the work for which this GTY Tel No. � O
ermit is issued,1 shall not em Io Fixed Applia�ces Not Over 1 HP
I p p Y any person�in nny manner PERMIT ,,/ /
� so as to become subject to the VJorkers' mpensati Laws. Range_Heater_D.W.�� APPLICANT�%7�G r/ �N'��� `� ' W
f � O�en _Dryer_W.M:_ ADDRESSS-}��/ �d;�� 'LE UI
Da[e� r/ APClicant � � ToP —�AU _.W.H..__ Z
Hood_Fan _Other_ CITY��yY/�jr,Q Tel No.�`--NG�B
� NOTICE TO APYL[CANT:[f,after maAing this Certificate of Disp. _Room Air Cond._ LICENSE OR
Exemption, you should�become subject to the Workers' FEG.NUMBER��� Clms�d�
� Compensation provisions of the Labor Code,you must forth• Power Apparetus&La�Be Appliances � DISTRIGT NO. � PROCESSED BY
� with comply with such provisions or this permil shall 6e
deemed revoked. � , Size&Type HP,KW,KVA,or KVAR \� ^�
� , , Up to 1 InoL �-i
� Over 1 to 10 Incl. � pq7� �
. LIC£NSED CONTRACTORS DSCLARATION .Over 70 to 50 1ncl. 4���2 VALIDATION
� ,I hereby affirm that 1 am licensed under P�ovisions of Chaptec Over 50 to 100 Ine. FINAL �
BY
9 (commencing wi�h Section 9000)of Division 3 of the Busi• OVer 100 � . �
ness and Professions Code,and my license is in full force and �
� effect. � .` Services - �
Lirense Number�'3�'�T � Lic.Class B/ 0-200 Amp.Under 600 V
201-7 D00 Amp.Uncier 800 V
. Contracte�,�_ Da[e �� f� Over 1000 Amp,or Over 600 V � •
HOb1E O�VNER•BUILDER DGCLARAT[ON Temp.Power Poie&Appurtenaaces .
; I hereby affirm that I am exempt from the Contractor's � Sign with One Branch Circuit
_ License L¢w for the tollowing reason {Section 7031.5, Busi- . Additional Sign Branch Cireuits ,
ness and Professions Code): . � � �
. Misa Conduits&Conductors
� I, ns owne� of,the property,wilt do the work and the pther(See Complete Fee Schedule)— -
structure k-not intended or offered for sale (Sectiun , � S'p�]9.p F
7044,Business and Professions Code). � .
� CONSTRUCTION LIiNDING A(3ENCY �t• e • _�2
I hereby affirm that there is a construction lending ugency
' tor the performnnce of ehe work for which this prrmit is pERMIT FEE (Sub•Total) � ��'• •2�.3 Q
issued(Sec.3097,Civ.C.). . . �
Lender's Name PLAN CHECKING FEE IOne-Fourth Permit Fee) � • • i 2 g.�Q=
U
Lender's Address PERMIT ISSUING FEE . � , � �.2 L�—8.� .
1 certity that I have read this npplication and slate that Ihe TOTAL FEE `�C6
ebove information is correct.1 ngree to comply with all County .
� ordinances and State laws reguleting llectrical wiring, and . -
� hereby authorize rrpresentatives of this County to enter upon � � � � � �
the abov-me i ed r Inspection purposes. SEGRL•VGRSL FOR GXPLANqTORY LANGUACH
_ � �" /� 6�
Signature of armittee � D�[e - � �
\ — - _ _ _-. _. _
�
. . . 01ti\'Efi-BUILAEI:DF.CL,AP.AT10\
� . I hertl;}�a1Grm th�t 1 am e�entpt frnm tlic Contcuctor�
.... .... ... . ._ .._ . . _ .. . . .
� . APP,C70.VO.LS . DATE INSPECiVf;'S � Liacn.: Las tor iha�fofio�rm�rcnson(Seclian 7011.5.
. � _ - StctdaiUR� . 6usineo�s end F'�nfessions'Ccdt/: Any tiiy or totnr7},
- . . 7En,^�.eOwE�POLe� - --. . . - �' . . . . irl�ieJ� reqiriies a perntit !o Cnn.rmret. after, in:pro��c.
� � � � UNDERSLAR WOFiY. � dc'�'!nliYir, n�rCJ.'�rr cl�l•sfntct+/r�^,r�jt�r(o j12 isst/arlcr,
� � _ , - � clro rrr;::ires d�e e,�plicmrt fo� such perrnit !o�fNe a
. � � FlOUGH CO^SDUIT� - -� - - ' � . s'i;ned staten:ent tlre7 he i� Ircertscd p+�orr;:r!! tn !!rc
� �- ' ' - . rrnrisions of tt:c Coanvctor's Liceiuc /nic/Ci;aptcr 9
.. - �"JiFli�dG -Z,,,-22j-�'$�7 � � � (eorrvner.ci:�g ttitli Scrtiw+ 7fi00J of Diri�imt 3 of tl.�e
' � �IXTURES � � ' _. _ . R:?^uress m1d 1lafestion.r Code/ nr 1Let !re ic crempr
' - - • . _ — __ _ �� � � tlaCmfrmm�ad d�e 6usit fnr t{ic Rli�grd e_i�r�npfiun.Anr
. - . . � POl'J[R t�UT}10RIZCD � '
�, rialcrim:of Srt�inri 7011.5 GJ'a�ry applicmu Jor a Pcnrrit
UTI�ITY CO.NOTIFIED . a'+hj.°ets drC applirmtl tu c cirr!pCrt,:!q•of r.o!rnnrC thcn
. . �_ /7 . fhrh:�nr!rc<ldo!Icrs(C500J.� .
. - - - - . _ FINAL �'i:.�:2 6�^ 'P�C^� . � . ❑1.ac oicncr of thc p�o,cr[y��cill Jo ihc�rod..an:l
No7ES � � ' �th��svuctu:c ic not in[cnded or offcrcS for salc.
� � - . � � /Scc. iO�N. l,utrr,css nud Profrrsinr�s Cad�•_ Tke Coo-
. , .. . . � . trr.ctnrir li:cnr�� Lai��dnrc nnt r.pplr ro n„ awner nf
.. . . . _, , prop.rtt� i.lto hui!:Ic or imymrrs ti;crcon.cn:/x'hu doer
'- - `� ' ' _ s!rcir �erorf �Lin!�elf proridcd tlm7 audr,'Ir,!�+rorcuanrs
� . . , , . .. . . nrt° r:nt�inreurt�l nr oJfared fo�sa(c.dj.�Ao�oei�crr tR:
� � � huil<!ir!;; or int,ororernertt ic so7d �ritGnr nne reer of
con:p?e;irrr.. 71::� nwnervb«rld�r r:rlf liar� t'tc hivde•n
.... •.-. ... ....� . .. .' .��. .
. � � � , . . , . of p,or&;�• lAr,t !ie dr;l not buill a'improrr for !he
.. ,. F:rrpa^e r;f sslitJ .
1 am e�:empt undcr Sec. ,
C£P,C.for This rc:�son
Utde
• Or,tt.r .