HomeMy WebLinkAbout1671A (10) - .. WQRKfR5'GOMPENSAi40AkUEGtARATlfqN� - 76A663 t0/81 - APPLtCAT10N-�FQR EL�CTRICAL PERNIIT �
� f heraby pffirm Ihat I hove o certificate of tonsent to self �-� . ;
insvre,or a certifiwte af Workers Compen_sation Insuronta, COUNTY OF LQS ANGELES BUILD{NG AND SAFE7Y
- or a cerfified copy thereof-�Sec.38Q0,lab.C.) � . _ � � �
. .. ._.__.__ . _..._
P❑ollcy Flo. CS:�77t1(I�mpany Ti1A -� --�� POR APPtICANT T4-FHt IN � ' .... JOB - � � .
erh4ied copy is.hereby furnished. New Residantial�Bldg -P7 �5 � �FA�H-_= NQ. � fEE� ADDRE55 '
� �""�erNfied copy-is-fited witkthe:counry buffdfngJnspac- i&2-Fnm�ly.Sq.-Fr��`� � S — E IOCALITY •
'� tion department. Muhi-famity Sq.Ft NEAREST �
� � �� �i - - � . Residential5wimmingPools� ' ��SL .� -
�ate-• 7-�i�-pS - Appticont.�._� �'Y'rF�•::F'i-+'Y�fTRFC . . OWNEROR� .
fIRM NPME
� - CERTIPICAT€OF E7(EMPTIONfROM WORKERY �- pvtlets:Rec_tigM_Sw._ ��� V• 201
' COAhPEM5AT10N fNSURANCE � AD6RESS
. _. .-. - - First 20
. (T6ts soction waed iwt b►complNed�iF tM work-{nrohed b� ..Total-No. Additienal CtFY . . .. . TeI.No
� tiva p�rmtt is 4or mro Itundrw{dellu�s(i1663 ar-len.j.__...... P�N .. . . .. � . - 3
!certify�tFwt Fn�ihe performnnce of the work 4or which this. App���AN� -
� per�7f is issued,{sFwtl�not employ arty perSort in any manner � �- .
�so ors to becc�me subjett to the Workers`Compensofion fawg. Li4hting Fixtures , First 20 ADDR€�5 � - �,
- � � -.- Total No. AdditionnL. - .
- - Date�-- .. appijcant -- . ,: CIFY Tel.No.
Fexed Applion<es Na��ver 7 HP pE�R
� �NOTtCE iO�APPtICAM: if, pfrer making this Certificate of . A��� �. -�
- Ezemprion; you sbould become subject to tF�e Workers' Ronge„�Heater_D.W._
- �Compar'sWion�ovisiorrs of thetnboreode;yoU�must-forth-� �ven _Dryer —W.M.�. � ADORESS 1��
with.mmply.with such�.prarisions-dr this permit shal) be ..7op _...FAU —W.H.— �
. deemed revoked. � � � � � - Hood �Fon ._Other_ . GFY. Tel.No. �
�� - -���� tICEHSED G4NTRAE�OR3�D€CL�ARATION�-- � ��µ�pR ��
- I hereby affirm that t am licensed urxJer provisions af Chapter 4 - Disp. � Room Air Cand_ — REG HUMBER ��, _�, .
� -{commer�dru�-with-$ectian-700Q)of Division 3 of the&usiness �� . 4fSTBICT NQ. PROCESSEp&Y
-- nnd?rofessions Cade,and myticertse�is in 4vfl-tarce and effett. Power Apparatus 8 Large Appliar�ces r�
- - - - � - - -Size&7ype HV,.KW,KVA,or KVAR� -� �� �
lteense Number�2074R-_- Lic.Class C-10 Up fo t I�cL fINAL V
. . - Over 1 to 70 Inc! DAT€,.. _._...-.--� � . Ot
._. Y�bntracfor. "P.lEet"rit'.�Ll Oate 7�z��$�J . . . '' _' -..,-,' . VAtJaAIWN �
.� � ,. . Over 10 to 50 Ind. R
-f am exempt under Sec Over 50 ro IOQ inc - BY��� _ �
- 8.&P.C.for ibis reason Qver 100 _ y
� .� Services,Sw6d.,MCC 8,Ponelboards - . �-_ � - Z
Qata: - p-ypp Amp.Under�00 V � .
� Signat�re --�201-iW0 Amp.Under 6W Y � , � z� 6�.� A
�Q . - Over 1 WO Amp,or Over 60p Y , �
Exemptioa for Reg.N{oini.Eleci. _ �� � � ` ��
SINGLE FAM11,Y Temp:�Power Pole&Rpportenonces
_ HOME QWPtER-BUILDER DECLARATlON Sign with One Bronch Circuit . �-�•������)
I hereby affirm that I am exempt from the Contrador's License p�iironpl Si n Branch Circui�s " �
. � 4aw for the iolbwi*rg reoson(Sediort 703}.5,Business and . . . g � � - • � s��,�(��
. ❑Professions Codej: � �7,2 5��$5
I,os awner of the ro r,wi11 do the work and the Misc.Conduirs 8 Condudors -� � ��
p ��Y Other See Eom late Fee Schedule_ -
shucture is not intended or offered for saie($ection � � P- f � _ .
- . 7p49,Busirtess ond Professions Code j.� � � � .
� CONSTRUCTION LENDING AGENCY - -� - .--
4 hereby affirm ihat ihere is o construction landing agency for .
the performance of fhe work for which this permit is issued � pERMIT FEE �(Sub-Total)� � �
(Sec 3097,Civ.C.). . . . . .
. PLAN�CHECKING FEE� � - � . . _
Lendei s hlame -
� PERMlT ISSItIWG fEE
... lendefs Address - - � �
. 1 cerfify thaf 1 huve reaf this oppliwlion and state that the TpiAE FEE.�..
above information is corred.I agree to comply with alf County -
ordinances ond Stota�ows��egulating E�ectrimi wiring,and - . � _
� he�eby aolhorkze representatives of fh{s Gwintq to mier upon �� �
fhe.bbove-mentioned properly for inspetlion purposes. � � - �
A:�� �( /J/�I ���S SEE REVERSE FOR EX►'LANpiORY IANCaUAGE
� I�� Signarore.04 Permiifee C�te . -
a n;�.c m d m� N N c .� v -o ;, �..e � ma
. , _ �o �.� a � a� 3�� pin O Q� CO� ,p � N � ��'p �,.. . . , � � .
. O^ �3 � y "� C '6i�. N� O � -�C C O �b [�'_ . . . .
� c =m°oc �' � �.c o tga $ ° • o
. . u y �p a V C7„ m�p C ° � i � ai,C C�c,�p p-"_" . .
� s ,c m ` p.O O O �,�n E � N C L �^ ~ C'C �'� � C p .
r- '��, a�;!! c�;c o 'a�� v°,o-a o.D 'o �,•,.. °.,". .
Q E � '� �.: m`:;'Nr-`o h — o � � y o 40
' J" w N T` + C y�Q.,�m � � � � '��y O 0 Or.Q� �O y . �.
U a�'f � ° E` �_ ` c `m E �� °� ezL >.� Q ,
� m a� ° L m` o o.� QQ a a° ��m 5r. c � �
- � R' x��O Y 0 a q� O E = O C O a ti 4 m � �-O Q ' ' .. -
W °1 3 � y� �...,r� k o o av o o�b m t m�
� E°� N „ a; c °t.a"-o m�aoN� „s� ` y c
� o,oco m �voo� Ec >. "� uc „ >'a ., b ° rn �
, m — ° � �,� Y�l~I� ibmo� „- � amo �o ; Q"- �
� m N oTi.. c m >.c x� o o c N o �a 'ar m y m
. . '. GC 6 L � 7 G O y,Q m q C C � ��3 � �� N� � C N . .
. !JJ S y` ,�„ M a V C � � . � .
Z w ��.��= �,�-�'ao , � = ' '- ; 3E � «
3 �� o m ., • 3 6 � a�
� G" y >.G.'-��Q �dl.>^�O 'r" �� O� O 01
.� � 3 C �y O O.�G h;Q Q� D y N p V 00 n i^ N 0 m� p � �.�- . . � .
. , T� a �n�+ C w6'1�p �.G���-+':.V� m��Tl m-p�O x . .'
sm«o.�mmvLo ,,eoc=� mm�.°c�`omac'° E � � 3
_�m 0 `a vEUv�i N°n $'o° -��Q 3 3 �E o c a m [i O
�
Q
cZ9
y .
w
�
o � �
� o
c�' �
w
�
d yQj
. IA J a, � � LL ''
a g o � � '`
o � 3 Z � z
� � g o p� ' ,
Q � � a �
a � � z � � � a � '
- ' ' W � �', �� iL O. � tl. OZ � ' , �