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HomeMy WebLinkAbout0787A W°R"''`2s'�°"�F"5"T`°N°f;"'."R"T'°" '6Ass3 AppLICATION FOR ELECTRICAL PERMIT � � CE-806G(2-B0) � I here6y affirm thut I have�a certlficate o;consent to se�f . . COUNTY OF LOS ANGELES . � BUILDING ANp SAFETY� . insure,ur a certificate ot Wurkers'Compensation Insurance,or � � � � � - a certified cnpy thereof(Sec.3800,I,:ib.C.1 � ' FOR APPLICANT TO FILL IN J06 �� Policy Nn. Uompany_ — �EACH NO. fEE �+OORESS ���� //}- ; New Residential.Bldgs.&Pools �� Certified copy is hereby furnished. 7&2-Family,Sq.Ft. 5 — � LOCALITV 4�''�/$yyj.a�� ��rj . Multi-family Sq.Ft. — NEARES7 � �� Cer[ified capy is fi]ed with the County building Inspection � CROSS ST �/j,�. deparfinent. . Residential5wimmingPoOls OWNEROR � yy ,} � FIRM NAME (�P(� /L[ 4 Date � Applicant OuUetS=Re � � MA1� / /! . �LiQht_Sw ADDRESS _C��� '���'��•`e� F�irst 20 ' � � CER7'IFICAT1.01'EXEMYTiON[�ILOM WnRKF:ItS' Total Nn.� Additional -✓ CITY �S�l� 7�� � TefNd. " _(p�? � COMYBNSAT[ON WSURANCIi - PLAN CHECK � (This section need not be completed iP t{�e wock involved �� � APPLICANT _ V by the permit ia for one hundred dotlars (S100)or less.) : ;Lighting Fixwres First 20 A�oRESS � � �. Additional � [cerlify that in thc performance of the work fnr wltich[Itis ; �� TOtai No. CITV Tel No. - � ;Fixed Appliances Not Over 1 NP _ ._.. permit is issued.[shal]nnt employ any person in any manner � � PERMIT ;� ,t �7 w. �su us ro becotne suNject to the Wurkers'Cnmpensution La�vs. : j Range_Heater_D.W._ APPLICANT ✓/G�L�/��CG PE1 gy. � Oven _Dryer_W,M._ ApORESS ��,(�.J��s�/ ', -� � �' . Date�I -APPlicant��'��C-f'°�✓lLB�� ' Top _FAU� _W.H._ ciTv��_�,a�.a ��__ Tel No. __,— ' Hood—Fan _Other_ ,PE.� �: NO1lCG TO A]'I'LIC.4NT:IT,xfter making ihis Certiflca[e of = pjsp. _Room Air Cond._ LICENSEOR G/ } lxemption, you should become eUbjecC to [he Workers' REG.NUMB.ER � O t"�� Class C7 ��� �Ci>mpensxtion provisions�S[he Labor C:�>de,you mu.t fpr[h- 'zpower Appafatus&Large Appliances DISTRICT NO. PROCESS BY . )�. with mmply with such provisions or ihis permit shall be .� Size&Type HP,KW,KVA,or KVAR �j��� �deemi•�rovnked. .�P i; �Up to 1 Incl. . FINAL � a ��� � '�. � � � Ovcr 1 to 10 Incl. DATE / ) /p VALIDATION L[CENSiCDCONTRACTORSUliC1,ARA'fION l�,7( /Q �� s� �� �Over 10 to 50 Incl. ; � � �� I hercby affinn ihE�T I am licensed under provisions.of Ch�pter -Over 50 to 700 InC. By A� � .� � . .9 (commencing with Scdian T000j of Divisiun 3 of Che Husi- 'Over 100 �,y. _ ness and ProfeSsions.Co�e,end my license is in full Force and - '� . etfect. �r��/� � � Services . � � � � � � � I.icense Number�✓ Lic.Class� � 0-200 Amp..Under 600 V . � . /���J / / /g ` 207-1000 Amp.Under 600 V - Contractor +�/L�4'�LL� Date_l.lF�'��/ �� Over 700D Amp,or Over 600 V `. � � € � HUME OWNER�BU[LDER�F.CLARATION �?emp.Po�.ver Pa�e&ApFurtenanczs - I ticcph➢ ufficm that L am exempt from the Coat[actor's z Siqn wiih One Branch Circuit � � ��Licensu I.a�c for the foltowin reasun (Snction 7031.5. Busi- Additional Sign Branch Circuits. . g 2�)%� ]� g 'ness ancl Yrotessions Code): � � - �Misc.Conduits&Cnnducmrs i,e g,� �'e � . ��.�� i, as owner of ihe property,will do the work and the �Other(See Complete Fee Schedule)— — # � ( � s[rutture is not iatended or oSfereJ for sale (Section ��o m L J, �Q � 7044,Busine,s ond Professions Code). . CON57'IiUCTION LIiNDING AGENCY — ��I herehy affirm [hat therc is a consvuctimi lending ngency e.'� o�F'��(�_.. � -tbr [he perfurmance uf the work for which Ihis D���r�� '� PERMIT FEE � (Sub-Total) � x �.issued(Sec.3097,Civ.C.). � ��G�—�i) . Lender's Name PLAN CHECKING FEE (One-Pourth Permit Fee1 i Lnndcr's AdJress — FERMIT ISSUING FEE . h I certify thut I have re.ad this application and state that tiie TOTAL FEE � ii ��� � � abnee infurmutCon is correct.f agree to cumply wiih all County ' � ,I ordin:�nces and State lam�s regWating 1?lectrical wiring, and , hereby autharize represcntxtives of fhis Cnunty to cnter upon . �thr,ab ve-mentioned property for inspection purposcs. SiLli-REVERSI?P'OR L:XYLANATOI2Y LANGUAGF: ' � Q'�,t� L� v�"�i' l i.�� , :� . . Signatucc of Perm'sttee ll�te ` � s ' � � . . ` ' � • ''J ,, � � ' - � � .. ` � :• ,:�. - % ; > � �.,,-, 1 . L' . ' � J� . .11 ��.",� , '.� 1 .D 1 � �, ��. 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