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Home My WebLink About1703A . WORKERs�oMPENSAT�oN oE�LAaAT�oN� � 76A6B3 APPUCATION FOR ELECTRICAL PERMIT � {� . � • CE$OBG(2�60} I hereby atfirm that 1 have a certiticate:o�consent to selt COUNTY OF LOS ANGEIES BUILDING AND SAPETY 11 insure,or a certificate ol Workert'Compeasation Insurance,ar . ' � � �. a certified copy thereof(Sec.'3800,Lab.C.) � � � Yolicy No��ompan¢—��[—� '�� FOR APPUCANT TO FILL IN DDHESS oZ 4��SSF LGo� U�Ew I�� New Ra�dential Bldgs.&Pools EACH NO. FEE �� Certified copy is Aereby turnished. ,, i&2•Femily,Sq.FL S — S LOCALITY �0i(! � Certified copy is filed with the county buliding insPection Multi•family Sq.Ft. CROSS ST � �department. Residential Swimming Pools . OWNER OR � � � FIRM NAME L� ! Dute Applican Outlets:Rec._Li9ht_Sw._ MAIL QC- A (�'d fC!V l4-(-�� First 20 ADORESS �ClJ �R •�� CERTIFICATE OF PXEM ION FROM WORKERS' j Total No. Additional CITV N Q e o. � L � COMPENSATION INSURANCE . � , �' � � PLAN CHECK � d APPLICANT � ' O (This secdon need not be completed if the work imolved - V � by the permi[ is Por one hundred dollan (5100)or less.) Lightin9 Fixture:. First 20 AOORESS � � Total No. Additionel O I certify[hat in the performance of the work for which this Fixed Appliances Nat Ovar 1 HP CITY T�1 No. � .permit is issued.I shell not employ any yerson�n any manner PERMIT V � so as to become subject to the Workers'Compensation Laws. Range_Heater_D,W._ . qVP ICANT a ' � � � Oven _Dryer W.M._, AODRE55�� 6Dp�,("L'{f0� . Z , Date APPlicant ToP _FAU � H.,_ .--y CITY O(�///�� Tal No. {p '— d Hood_Fan�ther_ � � NOi'ICE 70 APPLICANT:If,after mxking this CerNficate of Disp. _Room Air Cond�_ / LICENSE OR �v , Exemption,� you should become-subject to the R'orkers' REG.NUMBER C�n+ '� ComOensallon provistons of the Labor Code,you must forth• power Apparatus&Large Appliances � �ISTHIC7 NO. PROCESSE. D 8V , � with com0�v with such Drovisions or this permit shall be Size&Type HP,KW,KVA,or KVA � � , �� deemed revoked. - � �C �¢��u' , . Up to 1 Incl, FINAL Over t to 101nc1. oATE (� � �./ VALIDATION ; LICENSED CONTRACTORS DECLARATION . � p�r 10 t0 50 Incl. - - �'O �- � . ' 1 here6y afflrm that I am licensed under provisions of Chapter Over 50 to 100 Ine, By A� . , � 9 (commencing with Section 7000)of�ivlsion 3 of the Ausi- Over 100 � � � ness and Nrofassions.Code,and my license is in fuli force end � effect. � Services � - . . - License iSumber �Z� � L . �ass �v 0-200 Amp.Under 600 V �. � . . � A �� a� 207•1000 Amp,Under 600 V . . � Contractorl-7�� O Over 1000 Amp.or Over 600 V . � 1 �"' 3 HOME OWNER-BUILDER DECLARATION Temp.Powa�Poie&Appurtenancez �� Sign with One Branth Circuit �. 1 hereby a(Firm that 1 em ezempt trom the ConiractoPs qdditional Sign Brench Cirtuits . � .��£3�a'�Q . ' � License Law for the following reason(Section T031.5,Busi- � - ' : ness and Professions Code): � � � '`� Misc.Conduits&Cnnductors ' � �` � � •�SQR � � I,as owner of the property,will do the work and the Other ISee Complete Pee Schedule)_— � ��b,Z,L�i�+g Q� � structure is not intended or offered for sale (Section _ �� 7044,BusinessandProfessionsCode). �. ��I�� . � CONSTRUCTION LENDWG AUENCY . , I hereby atfirm that there is n construction lending ugency . . for the performance of the work far which this permi[ is pERMIT FEE (Sub-Totai) . `7� � � issued(Sec.J097,Civ.C.). , . ' Lender's Name ' PLAN CHECKING FEE (Oae-Fourth Permit Fee) , � . � �� Lender's Address � PERMIT ISSUING FEE� � � �' � � � � 1 certiry that i have read this applicatlon and state that ihe TOTAL FEE . - �7 � . � a6ove inPormatlon is torrect.I agree to comply with ail Coimty . . . ' ordinances and State laws regulating Plectrical wiring, and . . . hereby authorize representatives of this County to enter upon , , . . . ��the abov-me foned properly fo inspectlon purposes. 77�Q SEE'REVERSE FOR EXPLANATORY,LANCUAGE - � � Signature of Permitree � Date �, . � . OIVNLP.-GUILDLI:DLCL:IRATION � - � � - , � I hercUy'�aYlirm Ihat 1 am eccr.ipt from Ihe Cuntractoc's . .. _..._ . . - ..._. J .. _ . . . . � - - '�APPROVnL" � DATE iNSPECiUR'S - - Licc�SC l.atti•�(or.ttie�foll�n�inp rcac�n(Se[;iort i0J1.5, � � .SiGNA7UFE ' .. _ . . . � . Businrss��mrd A�<if:ssioru CodcJ:.,lr.y riti��or raurtr�� T[MP.POW�Ft POLE�� -- � - � � - wd�ich requires a permit to rnnstrtic(, alter, inrprove, . . . .. . .. . _ . UND[ASLAE3�JVORK � . � ' � �- dernofish.or�ep�r�any stn�tfure.Prior 7o its�iss4'ancr. � , . . .. . � alsn rcquires thc appliccnt jor suck pcnnit ro.fiJe c . ROVCH COM�UIT — �� - ' � � � -� � . � - . SiAned smtement�(lict !ie is litrnsed p:iraunnr.to thc . � �� . . , . �. -.. � . �•-:....:proricio+�s ol tl:e Contra:tor's I.icensr La�� IChnpter'9. � .. . . . 4VI�RING'� • � . � . , �_(roh:nlPrtcing �ci(1�%S:rtion 7000f of Uirisiurt 3 of 7L, ' . . � -� fIXTURES` � . . . .. � � . � � - flusimess m:rl fYofesriur�s Codcf or rGon c� is e.eempl " � -� PONJF-Tt AUYHORI2ED . ' �' '- � - ��C1'PfYD1n C^d tlie LPst.t fa'f11i atfc,�Fd CXCitlJ�fiat.rir:y� . . .. . . -. . ��iula!iwt oJ Secfion^0?I.S bl'a��)'aPplicc+v fora P�'rmit ' uilu7v Co.noTiFieo�� ' - � � subjects tl�e applicmv to c ciril penafry�ojnot rr.nrc rLan � - � � � . � �� fire htn:drrd doflcrs($f00f•' . . . . FiNA� ...� �e:ttvt 6M �2a�:� � � . � � ��O I.as o�t�ncr oi tl:c property��ill do thc�cork,and � � No765 � � � � � � � � � _ , tlre structu�c is not intcnded nr offcred Por s:+lo. � - _ _ � . � � ' � � (Sec. i0J-l. �3iesiness artd ProjescinrCr Cud�: 7'he Car� �� . �j � , � � . - � . , tractor's Lire�ire Luw dues�rot apai�' 70 0:� ok'ncr of �.,� propert}��clio builds or irnprnres tGereort.a��d wiro doe.s . � �' ,=`. �. �, � . , ��. �� - �: � . � � �� sudi icorA f�imreff proridcd th.at sudi iniprorcrr.rnrs . � . . _ � . , ,. - Qre imt infendrd or oJfercd for sale. I/; howiver.'!f«� .- - . .. . �.. , . � ' � � _ ' ' . hui7ding or in:prorerr�ent is so!d �.dthin nnc rear of , _ . . . , conrpletio.v, d+r�o�rner-Li�ifAe� x�i!(�l�m�e d�e Lurde�i ... . . . .� . . ."... .. . . � � . . .�af proring tlm� l�e did �rot 6+iild or rn,ororc�fur;dre � . � , . . . . . . Purpose Of Salc.) . . . .._. , . I.am exempt under S^c. . ' l3��P.C.for this rcason :ll�tc ., Owner . "' ,� .'.i'1;i,i n.Ca