HomeMy WebLinkAbout0850A i _---` \'-._'y�.. � '"°RKERS`�°"'PE"SAT'°"°E""RAT'°" `' ` p�'"°""�,87 APPLICATION FOR ELECTRICAL PERMIT ..76Afib3 `\. I hereby affirm that I have a wrtiffcate of consent to self �E.� �., insure,or o certifico�n of Workers'Compensation Insuronce, COUNTY OP LOS ANGELES DEPT.OF PUBIIC WORKS or a cenlfied copy thereof(Sec.3800,Lab.C. j � Polic No.�� '-� Com an �� �� €-� - FOR APPLIGhNT 70 FILL IN 10B � /� , Y P Y ADORESS I� •!�Y'iMor,t� Cik:^ �`111L'I� r�. �Cenified copy is hereby fumished. � New Residenlial 81dgs.&Pools EACH NQ FEE . Certified�copy is filed with the�county building�nspeo- 1&2-Fpmily,Sq.FI. $ — S LOCALITY � j G�. �,. "�a,�^ ' �tion deparimen�. Multi-family Sq.Ft. — NE,4R[57 , � CRO55 ST. ��4-f� *�,�, '/ Rasidential Swimming Pools OWNER UR Oote-`� Applicanl. FIRM NAME _:�1h� .�I • - ���/g�_CERTIFICATE OF EXEMPTION FROM WORKERS � Outlets:Rec�.ligM_Sw._ � qoDRE55����'a °s. ' t�P. i..�k�.fa� 1� ` kt��f � ��Y COMPENSATION WSURANCE First 20 �� ,? (Tbis secfion need not be completed if}he work involved by �Total No. Additionai CITYS ,�:� �L� Tel.No!C _,!!• the permit is for one hvndred dollors(570D)or less.) , pLAN�HECK I certify Ihal in ihe performance of ihe work For which�his APPIICANT � permit is issued,I shall not employ ony person in qny mariner ��Lighting Fixtures First 20 ADDRESS � so as to become s�bject ta�he Worker.z'Compensmion Lows: � � . Addition�l � To�al No. CITY Tel.No. Date � Applicont � ��Fixed Appliances Not Over 1 HP peaM�T . NOTICE TO APPLICANT: I4,'after making Ihis Cerli{�cate of qppuCATION t2Q -- ''�t` xr'R�ha+. � Exemptfon, you shoald become sub;ect �o ihe Workers' Ronge— Heater—D.W. _. �� � Compensotion provisions oi the Labor Code,you must forth- Oven —Dryer --W.M.— ADDRE55 ct�C' 'Sn ,�.• with comply with such provisions or this permit shall be ; Top — FAU —W.H.— deemed revoked. CITY �� , ��� ,� • ^Tel.No.t�(�-�ti,'�,�,�� z LICENSED CONTRACTORS DECLARATION � Hood —Fan --_-Other._ ' , : � Diso. _ Room Air Cund. — '�tC'cNSE OR �^-;-Fy�� i here6y affirm that I am!icersed urder provisions of Cnapler 9 ; , ReG.NUM9Ee 9 � Class,}3 ��� �' (commencing with$edion 7000)of Division 3 of.the Business „power AppowWs&Large Appliances DISTRICT NO. P OCESSED Y �} ond Professions Code,and my license is in full force ond effect. _ �a �y� .;� , , ���p�-�/ � Size&Type HP,KW,KVA,or KVAR License Nomber_�r�aa t.��Lic Class � ��;� i Up to 1 Ind. fWAL .. � / j r Over 1 to 10 Incl. DATE� ! �'� VALIDATION A d Coniractor ���'���✓/,�� �' Daie �` . F'�,�� < < `� ;.F- . r �' Over iQ to 50 lad. FINAL ❑ I am exempt under Sec. �; Over 50 to 100 Inc BY j�` r ,°;a B.8P.C.for�his reason Over 100 '�•1✓� ,�� � � Date: �'Serviees,Swbd.,MCC 8 Panelboards � . '+�,Z �0-200 Amp.Under 600 V �. Signature 201-1000 Amp.Under 600 V t O O�er 1000 Amp.or Over 600 V f-,!, Exemption for Reg.Mainc Elecc � � SINGLE FAMILV xTemp.Power Pole 8 Appurtenances HOME OWNER-BUIIDER DECLARATION ��Siqn with One Branch Cirwit 1 hereby offirm'hm I am exempt from ihe Comroctor's Llcense i: � Law{�r ihe following reason(Section 7031.5,Business and -Additional Sign Branch Circuils _(1 :;�.(,'F. Profec.sinns Co�:) �� �'�Misc Conduifs&Gondudors y7�- a a 4 u 1 � ❑I,as owner of the property,will do Ihe work and 1he strudure is not intended or offered for sale(Section 7044 �Other(See Complete Fee Sthedule)_ ', � m � � `,�h C Business and Professions Code). CONSTRUCTION LENDING AGENCY `.'? '��G,s I here6y affirm that�here Is a mnshuction lending agency for ' �he performanca of rhe work for which this permit is issued PERMI7 FEE (5�6-iotal) �P�� � �—U� f (Sec�3097,Civ.C.J. ': � ', . � PLAN CHECKING FEE �. , ' Lender's Npme ,s� . ' � . PERMIT ISSUING FEE � � Lender's Address Q �'� � -�� I ceriiiy that I have read thls application and stoie tha�ihe TOTAL FEE Q; . obove informa+ion is corren.I ag�ee to comply with oll County ., ordinances and Sta�e laws regulating E�ecirical wiring,ond hereby au�horize re�resentatives of this Cou.nty to enter upon . ihe above-fpentioned property for inspection purposes. � SEE REVERSE FOR EXPLANATORY IANGUAGE ��'d`����z��' �-,�' �-�- �, Signatur�Permitlee � � Qale � �'._' � � � I � � � G m � �. �� � t' T � O � � , .. "b G j 'T� C p- i� x7 1'�y�'-v �p. � � � � Q ��� ��� � xN�o -�`� ' � ' � � ��„ �` � � m � o � t2� o� � N 6�t T�. �. � �+ �;al ai z 7a r � y �c a�� ➢� � � i y o '' �1 r �' � i �� � � � ' � � ; � � � � � � � � � � b � 1m � � . � � . � � 4 t .. � , �t .� �� � . ��� � . , � .. � � �6 a� � f � � ' E � � � � jg1 , � � � � � � � ' � � ,� 'p � � t W �. . 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