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1210A (11)
"'°"K`RS��°""�`NS"T'°"°E°`"""T'°" 76"�E:' '°,�, APpLICATION FOR ELECTRICAL PERMIT � � I hereby<dlirni th�t 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 SAFE7Y r.op:;-thereof(Sec.3SOO,Lab.C.) Policy No._ .COmUany FOR APPLICANi TO FILL IN .10B q� ❑ Cerlilwd copy is hereby fumished. . New Residential Bldys.&Pools EACH NQ FEE nroRtas .7. � �. I�r°��1�'�'i� ��p�2''�` ,� 1 8 2-F;trnily,Sq.FL S — S LOCALITY ,�y Gcrtificd copy is fi4ed with the county huilding insUectian dopartmonl.�., . � Multl-family Sq.Ft. — � P�EARE57 . � . � . - (;ROSS ST D2to pPl�licant Residential Svoimming Ponls ��,nJ��EH OR .---� yy . , � � � FIf�iM NAME '(„',�. ��✓�'� . CERTIFICATE�OF.EXEMPi"ION FROM WURKEPS' MA(� - � Outlets:Rec—light_Sw.— � �f�.`� � � � . COMPENSATIUN INSURANCE �DOREss � ' First 20 �_,(This section need noY be completetl if the work involved by the CITY h Tel.No, i��"�` .,permit is for aie hundred dollars($100)or less.) Total No. Adtli[ional �(JJA�I�JitJ/a K, (?(P}' ,��_����7-� �, .1 certify}hat in the performance of 1hB wnrk for which this permit P�aN CHeCK , A�PLC.ANT �is issued,;st�ail not empioy any persan in a�y inannar so as to ��become sublect lo the�Workers'Compensat'on-Laws ��j��' 'Lighting Fixtures First 20 ADDRESS ^�"'�"' � 'd�''��'�' Additionnl C='�^J� 7 Totul Na . CITY � Tel.No.e�"'!'�-' �Date �, �� AnD��c � "'� '" C �Fixed Appliances Not Over 1 HP Ntr„virr � NOT'CE TO APP��ICANT�. I, aft.i aking �his Gertiticatc of = .Exemption,you sliould become suUject to the Workers'Compensation � Range_ Heater_ D.W. _ APPLICFlNT � �pravisions of the L ahoc Code,ycu must(orlh^raith complY with such Oven_ihyer!, W.M._ ACDRESS � Q'9:.�; f� �`��{I'.r7 � 'provisionspr this permil shal!be d..emed revoketl. � Top _ FAU _ W.N._ � cr:v ,q r�i.no. i��3�3--/� -�LICENSED GONTHACTORS D[CLARATfON Hood_Fan _ Other_ � � �I hcreby a(fi�m th�t I'ain-li�e�•se�+ ^d3�p;Cvi;io�s J`�ChapYer 9 uCENSC !-� ,.l� .. � �isp. — Room�Air Cond. — .nEG.N���tv�eER ,S �4 a '! Ciass �' (commencing wi}h Section 70001 of Division 3 cf th^9usiness and� . Professions Gode,nnd my license is'in full force and effect. - DISTRI(�T NO. � PHOCESSED Ov � �.Power Apparatus&Larye Appliances /p'^� �.� ,Q ff �_,,,��'� Size&Type HP,KW,KVA,o�KVAR ` v L License Numbcr � ��'" / Lic.Glass_`'f•.� µ Up-to 1 Incl. FINAL ���� L Over 1 to 101nc1. DATE L f�Lq� VALIDATION O- Contractor_ - bafe_�1'�"� - � � � � Ovcr 10 to 50 Inc! FINAL � V' + �� ❑ I am oxempt uncler Sec. Over 5D to 70D Inc. gy 'j. � 4.1 �� 8&P.C.for this�enson �. Ovcr t00 � � ,r"� � �. � � i Services,SwbU.,MCC�&Panelboards � � � `� —Oate: �D-2U0 Amp.Under 60D V Signzdure � 201- 1000 Amp.Llnder�600 V � Uver t000 Amp.or Ovr.r 60D V }}} � Exemption for Reg.Maint.Elect . . ,��� � �j,{;-;�y {� � � SINGL�FAPAIf Y� - Temq.Powcr`Pole&,AUpur[enanr.es E HOME OWNFFi-BUILDER DECLARA710N � � � ��� t Syn wRh Ou.Bran.h Ci�tit ,�� � 1 hcreby affirm that I am�xempt trcm IFe Gontraclor s License Law � fo�the followino reasnn( :r:r ,m.,7,5.a,��o��;;�;!o.,,.�,,,,,,,, A�1rGr�., i c a .. ' '��,,�) Ulde) ....o.,.......,. , , , .,.. I—i `Misa Contluits�8 Conduc[ors A �' ''�^�'� LJ I,as ovaner nl'the properry,wiU do the work and the sYructuro . is not intentled or ofteretl For salo(Section 7044,Busincss �.�ther(Sce Compiele iee Schetlule)_ ;� ���C)_.F;8 and Vmfessioris Cnde). � � ��� . CONSTRUGTION LENDING AGENGY . . . I hereby affinn that ther�is a cnnstruction lendin�j ayency for lha " . p�rformance o(the work for whir,h this permit is issued(Sec.3097, pERMIT PEC (Sud-Talal) � . .. Giv.G). "� �a' . PLAN CHEGKING FEE i:t�.�. Lender's N�ma: � . ;d�� PERMIT ISSUING FEE !4� I '�' Londer�Address n�� G �: I certif thal I have�read this applicA[ion anci statz thal Ihe ubovr� TOTAL FEE �c. ' information is correGt I�pree to cornply with all County orAinpncos- q �� and State Icj,ws regula?iny Eledrical eviring,and hereC�y ciuttwrize � � . reprr-.sentatives of this County lo enter upon lhe abovo-mentionetl . ' � j� property for inspectitin p rp�Ps. • SEE REVERSE FOR EXPLANATORY LANGUAGE � - �� ���� � d7� � n . Sign wf Pmrnittee i Date 4 i � � � i � ' i � + ' __ _ .= k i � , �, i i i... i � � j i � � . • : - . . � r, � � ; � ; I , ; ' I� 1 I � . � ( i i � � j i i ( :' � i , . ; � � � � ; ; ; ; i ; � ; � i ( i � 4 I . 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