HomeMy WebLinkAbout1672A (10) '"°"KERS"`°^^�"SAF"'"°�`"��'°" '�� '°'8t : APPlICATlON �OR fLECTRiCAL PERMIT �
I hereby affirm�ha�t have�a certifimte�of cansent ro self �'��
insvre,or a cerrtficote o€SN«keri Compensotion kasurance,_. CQ�JNTy(OF LOS ANGEtES-" BUILD{�►G AND SAFEfY
�• or a certi#ied�copy thereof-(Sec.3800;-�abr-G) . .. . ..
Policy Pb. O�ti2 J�It(I�S�mpony �I� F4R 14PPlKhNT TO PILI�N.-, � !OB -
�Gertified copy is here6y fvm"rshed: � _ New Residential Bldgs.8 Pools . ��H NO. FEE ADDRE55 �j2'].
"� Certified copy is filsd vrith the coumy bo tdmg-inspec-� 1 8 2-Famtly,Sq.Ft�775 S — f LOCALITY • �
ficn departmenL --- - --.- ----- �Maki-fami�y Sq.�Ft.--- � � — �MFaRE57 �,/�� �
____.
--.... � - Residerttial Swimmin Pools CR05557. 7'•c�
Date , �.^7�-55 APp4i<anE_N�'H 1�{'''�.�T'�'RTC g OWNER OR . .
- FIRM NAAAE
CERTIFICATE OF EXEMPTIOtd FROM WQRKfRS'��- � � � MWfL � -
� - � � CQMPENSATION fNSURAfVCE� � Oudets:Rec_,Light_^Sw._ Ap��
This sactWn n�ad pot ba�c et�d ff sb�work imeolred b First 20 �
� O1^p� Y Total No. LtTY • Tet.N 1 I
tiw pwmif is for ons hqnArRd doHncs(SIOOj or iass:j _-... Addit'ronol - �-
_ ___ ____-- __-__ _- PlAtd CHECIC
1 cerfify iRpi in-fhe perfwmance af tkte.wcrk'f�pr�which this . A�ICANT ..
permit is issued,I shaN aot employ a�y persart in anV manner - - -� � -
sa as to become subject to zhs�lrYorkers'-Eompensation€crws. Lighling Fixt�res First 20 � AQDRES$
. . . . � . - Total No. Addit'rona{ - .. . -
CITY Tei.No.
Dote applimnt �� Fixed Applionces Not Over 1 HP � PERMIT
M114TICE TQ APPLICANT: I€,ofte�.mcWng_this Certi#icate�af n u� �
Exemption, you should�6xome-subject to ihe Workers' Ronge�_Heote�_D.W. _ - a����T
� Compensation provisipos of�he Labor Code,you must forth- Oven �pryer —W.M._ ADORESS
� wRh tomply wi�h suth provisians or this permkt sholl be Top _�FAU —W.H.— . -�• � 1111
f deerned revoked. � - � -�� Hood _Fan _Qther_ - CI'fY - . Fel.No.
� LtCENSE6 COtfTF2AQORS�tlECLARATION - �
ti�NSF OR
aE�. _Room nk.co�d. — a�c.rvuMaEx 420 48- �i°S'•
F-heFeby sffirm rhpt i nm ficensed under provisions of Chapter 4 . . -
� (commeritistg�w'rfh 5ectron 7000}nf-f)ivis"rorr-3of�ike�Business � DISTRICT NO. PROCESSEQ BY
..and FrofessiensCode.�and my licerne is�r+tutl-#orce and effect. -Power Apparotus&�targe-Appliances . . Y
0.
�- - -- - . 5ize&Type HP,KW,KVR,or KVAR d -- - Q
� €icense Number ,�?.,n_�7�$ lia Cfoss �-],� Up to 1 ind.-� FINAL . � - � �
, ;��1��_ Over 1 to IO i�d. DATE�1v�� .�,,J YAtIDAflON - a
Conl�actor Date �7-22-RS Over tp ta 50 Md. . � -
FINAI ~
. ❑ i am exempt onder Sec. - - Over 50 io 16p Inc BY � . . . _ �
�� B.&P.C.far Ihis rensort �ver 100 �
Oote: Services,Swbd.,MCC&Panel6oards � �� �
. _ . � 0.-2IX}Amp.Under 600 V �
' Signature - . �201-14)00 Amp.Under 60p V � �
� Q - - Qver 100€}AmR or Over 60p V �-- . .
Exempfion for Reg.Moint.Elect. � - ��� �7�A �
�� �SINGLE FAA441Y Temp.Power-Polr&Appurtenances
�- HOME OWNER-BUIIDER DECLARATION Sign witfi.One Bronch Circuit � � �_� '` '���
I hereby affirm ihot I am exempt from the ConhacFor's License Additional Sign 8ranch Circoits
. Law for fhe following reason{Section J031.5,-Busirtess and � - � . ,��•�•�}�.J��
�� Profassiarts Coda): � . . . .
- ❑ I,as owner of the praperty,will do the work arid ihe Misc.Conduits$Conductors - . °.� 4 u l.J��J�;
structure is not in�ended or offered for sale Section Other{See Complele Fee Schedule)_ �-
. 7044,Business and Professions Code�. - ( - � � O Z G 5�$S
� CONSTRUCTlON CENDWG AGENCY � � � � �
1 he�eby affirm tFwf there is a construcfion lending agency for _ - �
the perfwmance of the work for whith this permit is issued � PERMtT FEE � �-- �- �- . . (Sub-Total) - - -
- (Sec.3097.Civ.C.). . .
- - PlAN CHECKMG�FEE - . � _
Lender'S Npme � �- -�� -
� . PfRMiF ISSUING FEE . . . - . -
� . Lender's Address � - -
I certify ihoR 1 have read�his applico�ion and state tfiot the T07AL FEE . .
. above infamation is corretl.I agree to comply with afl County . - .
ordinances and Sla�e�laws regulaF'rng Eledrimf wiring,and I . � - . _ . . � - . ..
, hereby auth9rize:rapres�ntatires of ihis County to enter upon � . �
tbe o ve-menrioned property�for inspection purposes. - �- -
-`�° _ ���,�^ , `�� SEE RBVERSE£OR EXPLANATURY IANGUAfsE__-�-- - .
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