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Home My WebLink About0785A (4) `"°RKERS'`°^^PE"SAT'°"°E""RAT'°"_ '°'�3 '°,e' APPU�ATIQN FOR ELECTRICAL PERMIT I hereby a`r`irm thot I hove o certificote of consent to self ��"e�� . . .. _. ,,,,. ,,._., , , ins�re or a certifimte oP Workers'Compensmlon Insurance, ' � � COUNTY�OF L6S�A13`GElES � �� BUILDING AND$AFETY or a certff�ed copy thereof(Sec 380D,lob C) � � � � - P�olityNo. Company FORdP7CICXN7TOFILLIN� � " �� -� "" JOB � AJ � �� - - � Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADORESS OV � Certified copy is filed with rhe county building inspec- 1 8 2-Fomily,Sq.Ft. $ — S LOCAIITV �� tion deporiment. Multi-family Sq.F. NEAREST �� '""" " '-"'�--" "�"' """ " Residentiol Swimming Pools CROSS 57. Date AppliCant OWNER OR ^��d - - FIRMNAME �/Vll GERTIFlCATE OF EXEMPTION FROM WORKERS' �,j j MAIL Oodets:Rec_Light_Sw._ q � COMPENSATIONINSURANCE� �� First20 � '�' ADDRESS ��. (Thie secfion need nof be completed if fhe work involred by ��/ CI7Y Te.N � ,3,j Q� fhe permif is for one hundred dollars(f10D)or less.} Total No.�f(L— qdditionol � PLAN CHECK ...................."'......,,.... I cenify rhar in the perfo�mance of the work for which this qPPLICnM permit is issued,I shall not employ any person in any manner � --�- -�- �� - -��_----��--� so as to become subjeci to the Work 'Com ensation I�s. lighting FixNres pirst 20 ADDRESS Additional . . _.. ..........___......_ ....._:.. / Total No. CITY � Tel.No. Date �( ApplicoN Fixed Appliances No�Over 1 HP PERMIT NOTICE TO A PLICANT� If, after ma ing ihis Certifimte of Exemption; you should become subject to the Workers' Range� Heafer_D.W. —, APP�iCP'NT � ^ � Compensation provisions of the labor Code,you must torih- Oven �Dryer —W.M.� ADDRE55 � � � with comply wi�h such provisions or this permit shall be Top FqU W.H.— CITV NJ Tel.No �z deemed revoked. Hood�Fan �Other_ LICENSED CONTRACTORS DECLARATION '�" � i hereby affirm ihot 1 am licensed under provisions of Chapler 9 Disp. _Room Air Cond. —, �� REGNNUMBER Class. (commencing with Section 7000)of Division 3 of the Business DISTRICT NO. PROCESSED BY � Power ApporoNs&Large Appliances ond Professions Code,ond my license is in full force and effec�. Q O� {�/�� Size 8 iype HP,KW,KVA,or KVAR �J License Number � Lic Class u Up to 1 Incl. FINAL ,� � �' � �ATE �'ry,.�'� G.%/' O Over 1 to 10 Incl. i t�J i„� VALIDATION I— Conirocfo a1e Over 10 to 50�ncl. FINAI - � W ❑ I cm exempt under Sec Over 50 to 10,0 Inc. BY �� y-`` �� B.&P.C.for this reason Over 100 _......__...__......_...... ........ __. .._. .. 'L Dqie: Services,Swbd.,MCC&Panelboards ► � ��-� � , �-�,�� - 0-200 Amp.U nder 600 V Siqnoture 201-1000 Amp.Under 600 V ..__....,__. _. , ❑ � Over 1000 Amp.or Over 600 V Exemption for Reg.Maint.Elect. SINGLE FAMILY Temp.Power Pole 8 Appurtenances HOME OWNER-BUILpER DECLARATION �r 7�� Sign with One Brqnch Circuit I here6y affirm that I am exempf from rhe Contracfor's License Law for the following reason (Section 7031.5, Business and �+dditionol Sign Branch Circuits 1y c o a c� e L _ Professions Code): � Misc.Condui7s 8 Condudars � `�`"`5$�'� I,as owner of the property,will do the work ond the strocture is not intended or offered for sale ($ection Other(See Comp�efe Fee Schedule)_ ► e c „�.,✓`v'` � 7044,8usiness and Professions Code). � CONSTRUCTION LENDING AGENCY - - ..__ Q 6,�I 9`-�6 I hereby affirm ihat�here is a mnstrudion lendinq agency for . -. ... _ . . . . ihe performonce of rhe wo-k for which this permi�is issued PERMIT FEE (S�b-Total) a8' i� (Sec.3097,Civ.C.1. PLAN CHECKING FEE Lender's Name � �� '"�"--"� PERMIT ISSUING FEE d Lender's Address I certify Ihot I have read this applicotion and sta�e thof ihe TOTAI FEE � � above informotion is correct.I agree fo comply with all Couny - �- �-� � ��...--,...<,.,,,.•,.,.,:,,R,.,.,..P„.r.,.�..,,...,...,.,,...,...,.,�._...,.,w„ ..:.w.....,...._....,.,................... ........�.,.... ..,... ordinonces and State lows reguloting Electricol w ring,ond y epreseniatives of this Counfy to enter upon ihe aba e c e er ed prop y for inspection purposes. S�E�REVERSE.FOR EXPLANATORV LANGUAGE .,_..... . __. .. . ... . ... .._.. ..._ , ._._... .. .. . . ...,.. ��`�� .-� __.. . .... � � ttee Da�e � . . ...... ....... . . . .. .. . .,_ . . 9 � ..�- ....� �.. i .' _. .i_..... ..,_..i,.._�. .... .,, __ . ..,.<.�.- ..Y! ,. ..__... ..�__� .,�...._......,_...e�..± � . � . . � ._...:.�.,r.. _ .:,�. ::xr.�. •S.f;'�:' ..'t''Cr.': . . . I . . K_ . . . � , ... . .. ' . . .... _. .. . . 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