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1580A (9)
W°KKERS'�°^'YE"'S"'�'°"°L�LAR^�'°" '6A663 APPLICATION FQR. ELECTRICAL PERMIT � � . . CE-806G 12-801 a � . � . I hereby uPfirm that i huve a certifs;3te of consent W self COUNTY OF LOS ANGELES � . BUILDING AND SAFETY � insure,or e cerUficate oF Workers'Compensa[ion InsW'a�tce,nr� . � � . . a certified c�py[hereof(Sec.3800,Lab.C.) ' � FOR�APPLICANTTO FILL IN J06 ` ;� ] ( � I� policy No. CnmpunY � EACH NO. � FEE ADORESS�yiJ \.�C�aY�n.:;� r��x;,Y ��C.\ � New Residential Bldgs.&Pools � -� � Cer[ificd copy is hereby furnisiieA. 1&2-Family,Sq.Ft. � — $ LOCALiTV i,���L��,u_ ��Z - Multi-family Sq.Ft. — NEARE T l � -❑ Certified cupy is filed with the county builJing inspection CROSS ST ��Y'u Y-.c'1 �ry.V E--- � iiesidential Swimming Pools . Jcpartment. . OWNER OR � FIRMNAME �� L;r� • �� ��C__, Date AP�licant Outleis:Rec��iqht 7 Sw.�� MAIL ,_ . . Fiist 20 C7(1 ADDRESS _ _ _ " __ . CERTIFICA'PE OF EXEhiYTION F'HUM WORKF.RS' �.�L° C� — --- - Total No.�_..— Addit�onal CITY Tel No. � r � �COMVENSATION INSL'RANOIi � - - . PLAN CHECK ,__ � �� � �APPLICANT � (This section need not bc COmpleted if tlte work involved ��Lighting Fixtures First 20 �"���t" � � ADDRESS ' .by the permit ie for une hundred doilars ($]00)ur IessJ Additional J%� � � �`� L�:��I cer�ify[hat in the performance of Ihe Wtirk for which[his ,F zed ApplianCes Not Over 1 HP CITY - Tel No. -'� ; � perinit u issued,1 sha11 not employ any perton in any manner � PERMIT (• � �� 'so as tn become suNject to e Workers'Comp nsution Laws. ;. Range_Heater_O.W,_ APPLICANT�(��. C. .�t..'�' � c.� _ p;�� � � � ���� � � Oven �Dryer_W.M._ ADDRE9S C.j�!, �,i>�t_. 1 . > ' Dat;� l�b 7..-A lican . ,ia..�.+:.�iy.� ., -V;_ i ToP .—FAU � _- . m� PP - . , _W H ._ CITV. Tel No. ..L"(' ! � ; Hood_Fan. —Other_ ��_�_,�\�(L _..����J���> : , _ NUTICE TO APPLICANT:i(,�tter ma mg[his Certificate of `� pisp. _Room Air Cond._ I.ICENSE OR Z���+ �, 4_,t fi-� 7 . Exemptiun, you shuuld ryecome suuject to the Workers' REG.NUMBER R� l.,�..7 Class ��Compe�sation pruvisimis nf the�Labor Code,ynu muct furth �Power Apparetus&Large Appliances DISTRICT NO. PROCESSED BY � - �� with comply with such provisions or !his pecmit bhnll bc* r � { � deemed revoked. . . Size&Type HP,KW,KVA,or KVAR r'(� ,/� ����1 .. � ��.' a =� Upto1lncl. rfi -- n� i I� t - FINAL � ic � � g ��Over 1 tpt0lnd. DATE � Q VALIDATION �� I��� -'LICRNSI•:ll CONPkACTORS UF.CI,AI2ATION pver 70 to 50.Incl. l� v� ,'. 1 hereby:iffirm that I am lice�ued under pruvisions of Ohapter - -Over 50 to 700 Inc. � FINAL � � , � . - 9 commencin witfi Section 7000 of Division 3 uf the Busi- BY . ( S ) �.Over 100 ��L2�✓�-' � � ness and 1'rofessions.Code,and my license is in futl force und � . - �y` � � � ef'fect. ��Services . � _ . k _ '��L;'��:�� , �,,., � 0-200 Amp;Lnder 600 V . - � - f: License Number U' Gc.Cl�ss � � . . 207-1000 Amp.Under 600 V - ��. Cnntracto�.��-C'.���'�'���C. Uate � �� ��--�--�- � Over 100U Amp.or Over 600 V � . �. s = tiOME OWI31ilt-BUILDF,R DEL'LANATION �Temp.Fower Pole&Appurtenances � . i �� I hzceby aff'vm that I am exempt from che Contractor's �Sign with One Branch Circuit �;¥ � '� Lscense i,aw f'or the followine renson lSer.rion. ?03!.5,n��si_ - •Additional Sign Branch Circuits �--- . ness an�Profesaions Cnde): �.�, ��{ �J&�J{� K ❑ �`Misc.Conduits&Conductors . � i, as uwncr nf the property,wiil Jo the work•ind thc tOCher(See ComplEte Fee SChedule)— �• ° • • •2 structure is not intende�3 or ofPered fpr sale (Section � � 7044,RUxiness and Profzssions Code). - . -�—� . �-o m 5 q,q p � CONSI�RUCTION LIiNUfNG A(3ENCY ' 1 hereby uffirm that there is a consttuc[io��lend�ng agency e.a e S Q,<](�� � � �-fo� [he perfnrmance of the wvrk for u��hich t6is permit �s pERMIT FEE �Suh-Total) � `'.issued(Sec.3097,Civ.C.). .. `�'i� �� � �?.� PJ.L'Q�2 �. . �, Lender's Name � . pLAN CHECKING FEE (One-Pourth Permit Fee) y �` Lcnder's AdJress - � ' � � � � PEAMIT�SSUING FEE Q' � `.��I�certify that I hnve read this application and.st;ite that the TOTAL FEE �`>�rj�l,�� � ,t above information ie currect.I 3,ree to cumply with all Cuunty � �� � �`,ordin;mces xnd State lawa regulating F]lectrica] �viring, anJ � •rcby autho�ize rep�esencatives of this Counly tu enter upon ' - � e ab ve me tioned pr •r for inspection pur�oses.�� � gtE�RF.V1iRS�FOR EXPLANATORY LANGUAGE � �, ; r , ?r' ,l�(+t,,�,at,�.� � �' �l. y� Signatui�� 'er ittee Dete � ,�,�. \ ' � , , � � � � � � ` _ ' �. � � _ ` . :.: � :, • , \ � , ` 9 � � ' ,: � ` \ ; , - � \ .. ,, . .: , . �� - ! , � �. ; �� �.m.b ,va .. 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