HomeMy WebLinkAbout1673A "'°RKERS•`°""�"S"T'°"°��R"T'°" '°"� ,°,e' APPEKATION FOR ELECTRiCA! PERMIT �
- I hereby affirm that P have o certifimte of consent to self CE-806G
insure, or a certificare of Workers'fompensatio�Insurance, COUNTY OF LOS ANCaELES �IlD1�l�`s AAID SAPETY
or a certified copy thereof($ec.3800,ta6..C} . _
. ^Policy No.�'.�i%74f1��'ompany T�1A � - fOA APPLICANT TO Rtl fN - JOB � " ...-..
,�ertified capy is here�y furnished . New Residential Bldgs.-&Pools �CH� MO. FEE ADDRE55 '
Certified�topy�is filed with the coonty.buitding inspec- 1 8 2-Family,Sq.Ft.�7�i E — f �OCA��n
tiandeportment.` M�Iti-familySq.Ff. �N�ST �,f,.
- � � CRQ55 Si.
�- �ate,-7-7.7.-rr5 APplicont . �r'r�� RYY+F:r: F:C1T'-�PRT Residential5wimmingPools OWryEROR . .
� � � FIRM NAME
, � �CERTIFICRff OF EXEMPTlON FROM WORKERS' � Ouflets:Rec_Light_Sw._ .. � ��K
� - COMPfNSAT10N fNSURANCE �- - � A�ORESS
- bfa cacflon npd.ect 6t co iQ6ad iF tha work-tarotvad L � First 20
' R � �' Total No.- � CFFY Tel.No
� . tho p.ermit is for on�hundrRd dollarr(5100)or IQsa.j Additional PLA�C ' � .� 1
.� I certlfy that in the perfwmance of the-work for wkich this . � app���,qM- � -
- �peimiE is issued;i shatE not employ ony person 4n any manner - �
� so as b�become�subject fo ftie Workers'Eortipensation taws. � Lighting Fixtures First 20 AQpRES$
�� . . .. � � - � � Totat No. Additionaf - .
_ Date nppiicant -� - � CI7Y TeL No.
� NpFtC€.TQ APPCtCAMr-tf, ofrer m6kin `this�Certificate of Fixed Apptiances Not Over 1 NP - pERMFT
Exemptioq you sF�ould become subject to the Workers` Rarx,�e-_Heoter_D.W._ _ A�.iCANT�� n -
�-- Compensatian provisioro of the tobor-Code,�yav�mvst fwth- Oven _Dryer _4Y.Ak.� AD6RE55
wilh.comply with such pro�iswns or this permit shall be �Top �—FAU -_W.N.— � � �
- deemed-eevaked.- .-_, � ....:. .._...._ ... � CITY �o r�i.No. 591-646 �
- - � � tl£ENSED COMRAL'fORSflECtARRTtON � . HO°'� --Fan _Other— -. �,
D9 ._.='Room Air Cond. — LICENSE OR ,
1 hereby affirm thot t nm f�censed'undef provfsian3 of CFiopter 9 -�' a�G.NUMBER 4Za74$ E�O�'�'-].�
-��- (tammancing with Section�7Wffjaf bivisiorr3 of-tfie Butiness- - - ���A��Qtus&Large AppHQnces DISTRICT NQ. } � PR4CE BY y, ;
. and Profsssions Ca#e,-aad rrrydieensff�n-:n{nFf fdree and aHeef. . rn
� -- . . Size.&Type HP.KW.KVA,or KYAR F`�' Q �
-.. Licertse�Num6er - �?���A� Lic.Closs �'--�n � Upto f fncl. FINAC . .. U �
.. Over i.to 10 IncL �'TE � "�"`-. - �� 7
- Contractur � Flarf�rit�11. __p�e .:7-�Z-$S - �-���"•""�,-'«:.. YAU6ATION � d
- Q - - Over 10 Fo 50 Incl. FIN C � ~ �
I om exempt under Sec. Over SQ to 106 I�c. BY uVt
� . 8.8P.C.for this reasen - . Over!00 - y
- - . Services,Swbd.,MCC 8 Panelboards � � - Z
� � Date� 0-2IXJ Amp.Unde�600 Y � . i
�- �Signature . . .261-t000 Amp.Urxler 600 V . . . F
a � Dver 1000 Amp.or Over 60D V � �
Exemption for Reg.Maint.Elect �
:� - -� �� SINGLE FAMiLY . Temp:Power Poke&Appurtenances� . - �� (�7,3�i
HOME QWNER-BUILDER DECLARAAON � 5�9�w�th One Bronch Circuit � �'
'� i hereby a#firm iho�I am esempt from fhe Contraclors License - A�Fionat SignBranch C�rtuFts�---�- � � - - - �� � � ��2
._... . ..____.._ . ._._ -_-
law 4or�the folbw'rrtg-reasom�(5ection 703t:5,�$vsinas5 and � � -
Profeuions Code}: � . � f • •8},5 d
❑ I,as owner of ihe property,will do the work and Ihe Misc.Conduits 8 Conducbrs _ - - � � - � S
. strodure is�noY intended or offered for s61e (Section Other(See Complete Fee Schedule)� � � • + •Pi�.Jr Q c.
7044,Business and Rofeuions Code). _ . . - �
07.25-85
.CONSTRUCTIQN LEND WG AGENCY �-� �
I hereby affirm lhuf there is a consfNctFon tending agency for - . .
the performance of the work 4or wF+ich this permi�is issued ��"-�� pERM1T FEE--��- -� - (Sob-Totol) - � - �- . .
(Sec 309T,-Civ.G).. . � .
�` . _._ ._. . . . � � PtAN CHEGKING FEE - � . � . . . . '
lender's Nwme . -.. � . -. .. . .
` ... _ . . . . ._... , RfRMF�i-SSki{NCif-EE - --� -- �
� lender's Address�- � -- . - _.. . ... .. _ � � �
. . . .. . -�._. . . .... ..__.-- -�
� t certify thai i hove read fhis application ond stafe that the� TOTAL PEE
ahove infwmation is correci.l agree fo mmply.wEifh alt County . . . � - � .
ordinances and Srota.1aws regulming Electekal wiring,and -. _ . . . . .... .. ____ . ._
_-...---------__.
hereby aushorize reprasenrptires af-rhii CouaTy fb enter upon � � -� - �
; the ve-mentioaetl operty f r inspection purposes � � - � - . �
i`/�� � ��s„;�(�,����'� SEE REVERSE FOR EXPtANATORY IANGUAGE _ _ _ _
LXolL7 �
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