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HomeMy WebLinkAbout0850A (6) 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 a certifico�n of Workers'Compensation Insuronce, COUNTY OP LOS ANGELES DEI�T.OF Pl1BLlC WORK$ or a cenlfied copy thereof(Sec.3800,Lab.C. j Polic No.�� '-� Com an �� �� €-� - FOR APPLIChNt 70 FILL IN 10B /� 1 . Y P Y AooRESS �3J� �J�Y'iit�ot,(�'�4•r� �`�I�:t� �f�. �Cenified topy is hereby furnished. � New Residenlinl 81dgs.&Pools EACH NQ FEE . Certified�copy is filed with the�county building�nspec- 1&2-Fpmily,Sq.FI. $ — S LOCALITY j iC�. �,. "�a,�^ ' �tion deparimen�. Multi-family Sq.Ft. — NE,4R[57 , CRO55 ST. Oote�-F� �f4�-f�V,x` ,/ Rasidenfial Swimming Pools OWNER OR Applicanl. FIRM NAME .:�1h� .�I • - ���/g„-�_CERTIFICATE OF EXEMPTION FROM WORKERS � OuHets:Rec�.Ught_Sw._ � qoDRE55��!��'a °s. ' t�P. i..�k�.fa� 1!� ` kt��f � QY COMPENSATION WSURANCE First 20 �� ,? (Tbis secfion need not be completed if}he work involved by �Total No. Addilional CITYS ,�:� �L� Tel.No!C _,!!• the permit is for one hundred dollors(S10D)or less.) PLAN CHECK . I certify Ihal in ihe performance of ihe work For which�his APPIICANT permit is issued,I shall not employ any person in qny mariner ��Lighting Fixtures Firs1 20 ADDRESS � sa as io become s�bject ta�he Worker.z'Compensmion Lows: � � � . Addition�l � To�al No. CITY Tel.No. Date � Appli.cont � ��Fixed Appliances Nof Over 1 HP peaM�T . NOTICE TO APPLICANT: If,'after making ihis Cerii{��a�y o{ APauCa.TION 12Q -- ''64 xr'R�(:�+. � Exemption, you shoald become sub;ect �o ihe Workers' Ronge— Healer—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� "- . ,� z � Hood —Fan --_-Other.— •' , � ��i �� � : LICENSED CONTRACTORS DECLARATION �. Diso. _ Room Air Cund. — <<CEPJSE OR ly„^-;.F�� . I hereby affirm th�t I am!icersed urder provisions of Cnapler 9 y , REG.NUM9ER "L 9 � Class.}3 ��W �' (commencing with$edion 7000)of Division 3 of.the Business �Power Appawtus&Large Appliances DISTRICT NO. P OCESSED Y �} ond Professions Code,and my license is in full force ond effect. _ �a �yQ .;.� , , ���-�/ � Size&Type HP,KW,KVA,or KVAR License Nomber_�r�aa t.��lic Class � ��;� i Up to 1 Ind. fWAL .. . . / t r Over 1 to 10 Incl. DATE�( {:� VALIDATION A d Coniractor ���'���✓/,�� �. Daie �` . F'��� < < `� ;.F- . r �' Over iQ b 50 lad. FINAL ❑ I am exempt under Sec. ; Over 50 to 100 Inc. BY j�` r ,°;a B.8P.C.for this 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 B,Appurtenances HOME OWNER-BUIIDER DECLARATION ��Sign with One Branch Circuit 1 hereby offirm'hm I am exempt from the Comroctor's ticense i: � Law{�r the following reason(Seciion 7031.5,Business and �Additional Sign Branch Circui�s _L1 •?i.C/�. Profec.sinns Co�:) �� '�Misc Conduifs&Gondudors y7�- a a 4 u 1 � ❑I,as owner of the propeity,will do�he work and�he `Other See Com lete Fee Sthedule °, h strudure is not intended or offered for sale(Section 7044 � P �— � m e � 2.l ( Business and Professions Code). CONSTRUCTION LENDING AGENCY `.'� '��G,'� 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-Total) �P�� � �—U� f (Sec�3097,Civ.C.J. ': � ', . � PLAN CHECKING FEE � , ' Lender's Npme ,s� . ' � . PERMIT ISSUING FEE � � Lender's Address O �'� � -�� I ceriiiy that I have read thls application and stoie tha�ihe TOTAL FEE Q; . obove information is corren.I ag�ee to comply with oll County ., ordinances and Sta�e laws regulating E�ecirical�Niring,ond hereby au�horize re�resenidtives of ihis Cou.nty to enter upon . ihe above-�pentioned property for inspection purposes. � SEE REVERSE FOR EXPLANATORY IANGUAGE 1�.�'�'����r��'' �.�' �� �, Signature�Permitlee � � Qale �� �'._' � � � � � � � � �t � G � +� 1.; t: � � �" .� -n z p � � � � � 21 � -�° � � � � y° .d q. � � ' � .:: � m�i��'t�, m�m � n fv�� p� g t � ti � � � ! �,o`� .ca�'� �v z�� v� � � � �. s �c o : o u�� � � , � � �o �� � "' �.��, , �. 4 , a� � � � �" � � � so � 5 � � � o � � � � ' t � , �� � � S � � a t � .�. � {` � � � ,� � � � � � � � � } m4 � F � �1 yF i � � . 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