HomeMy WebLinkAbout1232AwowEris COMPENSATION DL GLARATION
hereby 41 J.1 .I k I oi I filT, v a fl; ic:.: to, of coi i3oi i I to sell insure,
or ;i ,ulilioroo of Worke,,, Cooipollsnfion loji-iranov,, o! :I corliflod
,
001PY there .0 (,S,ir. (3800,1 A). G
fk Ii a [I—ma
'V N C.,lifir.xil.,.opy is lI(:rll)y lan,sh.d.
F1 :(xirlico,l copy is filod 'Wh 111,; my buildincl irwpoction
o", or
OF EXCE4110K.-IN F fHOM WORKERS
colvroEr,18AHON IN. IIIHANC�F
(This section need not be completed if the work involved by the
permit is for one h6ndred dollars ($100) or less.)
ce,kijy III -,,t in Hot; poilo1maw,,ro of the work for which 111r, ormuit
is Itjo?j, I clijil not employ ziy porson in any iniTn',00r so as to
bacdrr n,lj-(,ci to tho Wo,kon., Compensation
Dale_... Appl,�cwt--- -
NoTIGIL 10 Arrl-ICANL If, ;offer w!kHoq Ihis Cortih,;atc c!
•crovrnionu of The I Cob Godo, YOU ITILst forthwith comply with !;I;(;[)
plovitTors or firs shall be &.101TI(Al -O;Wd.
I LGETTSLD CONTPAGIOHS DELI ARATION
.'I 1,oteby affirm thol I w, p.n.,vir-Jo9
ns of Chiptor
rnncin{j MtI[�. 7000) of D 3 of t[,. ,,!(I
rrofrnisbns Go&% lily :icon.-I)l is if, :;111 and effect.
-cca.- Ntunl!-,trLin. Glass ---
-Con:—.*"A TLO-AJ
:E1 I wn -,xi,pt an:.'(:: 'Scc.
RAP.C. for this mason...
Data.. .
F1 Exor,ptwm 4;: Rog -%ii,n:. [Ecol.
8INGLL-. FAMILY
Oor".,j
q Ti, --)..VE ER -BUILDER —,
DLG' ARAI ION
NT:oh.; n'fi:'firmth;!t 1 Monipt hoo! MA coillloi .: I.J. 0 1,— 1
lor tho foil -A ig roason ( Se.:Joii 7031.-,1. Bunin,.;ss and rfof( a'io Is
Code)❑ :
1, .,., ollo(-r of ij,.-, ly, vjiII do li-�) .vork w,o 1ho) I. siIL!Ct(IrC-
m
, not intonded or oc;orod to- sile USI�do.'i 7( W1. Run -s.
anal Prol'I Godo).
(,ONS�RUGTION LLNIDING AGFN(.,Y
I ho).by Wo"I 'hat "j."is j� olpstn:,:tion lond,oil ago ley Too 1110
pol To( 01410C "I of the work [of which thin, o;v,nit is i!T;,wo-.f 1SHr.. 30(31,
(;i,.
r Lond—s Nano
ond2.i s, Addioss
o.,Wy Ii lel ; have resod .fld flu ap )J( otioll and state lie! .1
lhal lhbG-
'forout i c1, c 1. 1 ::pica
Lo c-lIIiy v,,ah a1:comiLy cidinnilcos
k)lId Slall! Wows 'c'Jul'Ifiliq Llcct.!caI ,Aring. ellj il(;I,:I)y 00101ill)
1Pro5Q:)L.jti,.,j ,I 111i,,I County I:, :,nlor ,pon IN,! ahl1—.-,w:*.or...
I oUri (Tsos.
sk; olFcr itto,",
76M.33
APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETYLl
FOR APPLICANT TO
FILL IN
—FEE
X)FT
New Residential 8 Pool!;LACH
LOCALII Y 1,11#0,1JO
Molli-Iiinily I;,,. ri.
NFARL',;I
Q K)FIS 1; it
losideniii! S.in,rning Poo!s
nvairn 0.9
Ootir,,ts: Re::-qh6Aq— Svo.
First 20
2d�
I ntV1 NA"11-
A
Tol.
(.-,fly No.3el -�o,6,
No. .. .. .... Additio,,w
I lijIltillt) FWL,wl;. First 20
• A,7 lilional
P AN C11 FCK
Al`;�LIGANT
ADDRLSS
refill No..
—
------
GIly TIT. No.
f7i.od App!ian-s Nol. — 1 HP
0
N AT --
I tvu CON
AL4,1
Wiricro— I cater-
'I
Oven Dryer W.M.
I
IADORES
Ann. ic,,.N
let) TAU
f
I lood Fa"
CITY 1-1 No -
RooAir Cona.
HLICUISF 0!ir l, g� I a 9
LL:IS 141 JMF?
Disp. m
Po—, ApTpzo,,Lto,. A Lkugo Aplpliaro��Tz;
rllt)Gi-s,`,L D Ry
Size TypoAI IP `(V,KVA, or KVAH
�w
I too I
-f4—
Over I to 10 no.l.
RATE a--) VALIDATION
O -r 10 to 50 Incl.
O -r 1�10 to 100 Inc.
FINAL
Lly1117
- ----- Over 100
Sv!Ld., MCC 5 Panobcanis
0 200 Anip. Undo, 600 V
() 11000 Amp. Under 100 V
?01
Over 1(.1()0 Anop. o, 0— 600 V
limil). R.-ar Polo & ApjkLrtc-,naT;ko.1
Sion v 0-1. Branch CAromf
At S,:jr, burich Ooru,,rs
Mi',i,-. CoNdUrts & (;0IV1iIcW!$
Oih,�, C,onploto Fa. S•:IIOCIUII)
r)CIJMII FFF
(SW) IoLaI)LoiZ-7
Jo�
PLAN CHECKING I t F
PFHMIT ISSUING FEE
r(Y-1AL FEE
37.
SEE REVERSE FOR EXPLANATORY LANGUAGE
t7
17
C. K"
73
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