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HomeMy WebLinkAbout1210A (9) "'°"K`RS��°""�`NS"T'°"°E°`"""T'°" 76"�E:' '°,�, APpLICATION FOR ELECTRICAL PERMIT � � I hereUy<dlirni th3t I h2ve a oertificate of consent[o se�lf insure, CE-8ose or a�certi':cai":of workers'Com�ensation�nsurance,or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY r.op:;-thereof(Sec.3SOO,Lab.C.) F'olicy No._ ,COmUany FOR APPLICANi TO FILL IN .10B ¢ y�� ❑ Cerlilwd copy is hereby fumished. . New Residential Bldys.&Pools EACH NQ FEE nroRtsg �. S 'r�. ��l����I� �P�'� ,� 1 8 2-F;trnily,Sp.FL S — S LOCALITY ,�y Gcrtificd copy is filed with the county huilding inspectian tlCp3YtmCn�..., . � MUlti-fBmlly Sq.F[. — � IJEAREST . � . � . - (;ROSS ST D<te ,�p���j�;�p� � Residential Svoimming Ponls U,N,uEH OR •--�" yy � , � � � FIf�iM NAME �'.�. ��✓�'� . CERTIFICATE�OF.EXEMPi"ION FROM WORKEPS' MAI� - � Outlets:Rec—light_Sw.— � �f�.`� � � � . COMPENSATIQN INSURANCE aDOREss First 20 �_,(This section need noY be completetl if the work involved by the CITY Tel.No, i��"�` .,permit is for aie hundred�ioliars($100)or less.) Total No. Adtli[ional �(7 p �� �. .1 certify}hat in the performance of 1hB wnrk�for which this permit P�aN CHeCK , � - � •� � Aop�IC.ANT �is issued,I sha0 not empioy any persan in any mannar so as to ��become sublect lo the�Workers'Compensat'on-Laws 'Lighting Fixtures First 20 ADDRESS ^r"'�" � �,/�� Addilionnl C`--'��J�`e"��—� Totul Na . CITY � Tel.No.e�"'!'�-' �Date �, �� ApP��c � -'� '" � — -Fixed Appliances Not Over 1 HP ptrtMir � NOT'CE TO APPLICANT�. I, at[.i aking ihis Gertiticatc of ' APPLICFlNT .Exemption,you should become suUject to th2 Workers'Compensation �� Range_ Heater_ D.W. _ �. �prav sions o!the Lthor Cotle,you must{orfh^raith coinplY with such Oven_ihyer!, W.M._ ACDRESS � Q'9:.J; f� �`��{I'.r7 'provisiunspr this permil shal!be d=e.med revoketl. � Top _ FAU _ W.H._ � � GI?Y �. 7e1.No. ��3�^—17 -�LICENSED GONTRACTORS D[CLARATION Hood_Fan _ Other_ � � �I hcreby a(fi�m th�t I'arn-li�e�•se�+ ^d3�p;Cvi3io�s J`�ChNpYer 9 LICENaC !-� ,.l� .. � �isp. — Room�Air Cond. — ,nEG.Nutv�eER ,S �4`� '! Ciass �' (commencing wi}h Section 70001 of Dimsion 3 of the 8usiness and� . ProfessiDn9 Gode,nnd my license is''in full force.�nd effect. - DISTRI(�T NO. � PHOCESSED�v ' .Power Apparatus&Larye Appliances /p'^� ,(1. ff �_,,.��'// Size&Type HP,KW,KVA,o�KVAR ` v � License Numbcr � ��'" / Lic.Glass_`'f•.� µ Up-to 1 Incl. FINAL ���� L Over 1 to 101nc1. DATE L f�Lq� VALIDATION O� Contractor_. - �Dafe�1�� - � ` � � Ovcr 10 to 50 Inc! FINAL � V' + �� ❑ I am oxeinpt uncler Sec. Over 5D to 700 Inc. gy � �'j. � G.I �� 6&P.C.for!his renson �. Ovcr 100 � � ,r"� � �. � � i Services,SwbU.,MCC�&Panelboards � � � `� --Date: �0-2U0 Amp.Unde�600 V Signzdure � 201- 1000 Amp.Llnder�600 V � Uver t000 Amp.or Ovr.r GOD V }}} � ExemPtion for Reg.Maint.Elect . . •'-"�� G �i��.'ri {� � SINGL�FAPAIf Y� � Temu.Powcr`Pole&AUpur[enanr.es . , E HOME OWNFFi-BUILDER DECLARATION � � � ��� t , Syn wRh Ou.Bran.h Ci�tit ,�� � 1 hcreby affirm that I 3m- empt trcm IFc Gontracbr s License Law � fo�the followino reasnn(:er:r in.;7,5,a,� _„_..,. .,,,�,,,,,,,, ArirGr�., i c a .. ' ',,,�;.l) Ulde). �o� .,,i o....o.,.......,. , , , .,.. I—i �Misa Contluits�8 Canduc[�rs A �'�'"�^��'� LJ I,as ov+ner nl'the properry,wiU do the work and the sYructum . is not intentled or offeretl For salo(Section 7044,Busincss �•Dfner jSce Compiete Fee Schetlule)_ ;� ���C)_.F;8 and Vmfessioris Code). � � ��� . CONSTRUGTION LENDMG AGENGY . . I hereby affirm that ther�is a cnnstruction lendin�j ae7ency for lhe " �. performance o(the work for whir,h this permit is issued(Sec.3097, pERMIT PEC (SuA-Talal) � . .. Giv.G). "� �a' . PLAN CHEGKING FEE i:t���. Lender's N�ma: � ;��� PERMIT I.SSUING FEE !fJ I '�' LOnder�Address n�� G �: I certif thaT I have.read this aUU��cAtion and statz thal Ihe ubove TOTAL FEE �c. �� inPormatlon is correct I�pree to cornply with all County orAinpncos- q I�� and State laws repu!a?ing Electrical eviring,and hewby authorize � � reprr-.sentatives of this County lo enter upon lhe abovo-mentioneA . ' � property for inspectitin p rpose�. . +��. �� �,y�/,�_ -.�- � � `` SEE REVERSE FOR EXPLANATORY LANGUAGE � �7( M � . @ Sign wf PmrNttee i Date g . ", ,,`„ , ., . . �,, • , � ; i�, . � ` `} , ; ' . t '� '` �, �`� t`4 .'t, t , � �'�3 � i` �` ��:. ` ,� .�,F 4 � . . � t--u� ,i� �,, � � '• ' :; ;,t �t �` },i 1,, �} � t � E, , ��`, fN�..�}� �� ��'� ?� ; ! � �� � . 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