HomeMy WebLinkAbout1075A I hereby QORmERS�'COM�PE�NS�ACeONID�Ee`of colnOsent fo self «'�'°�81 APPLICATION FOR ELECTRICAL�PERMIT ��n'�
insure,or a cerrl(ico+e of Worke�s'Compensation Insurance, COUNTY OF LOS ANGELES BWL ING AND SAF TY ��
or a cerfi(ied copy Ihe�eC/of Sec.3800, ob.C.) �
��ye�� �'O�s'�R
Pnol�ity N ompa y FOR AP►LtCAM TO Fllt IN - ��B ,
Certiiied co is hereb furnlshed. EACH NO. FEE ADDRESS
LJ PY Y New Residential Bldgs.8 Pools
1 8 2-famil Ft._tS_y_�— f — S LOCALIN
� Cerfified copy is filed with rhe county building inspec- Y�59� _
lion deportme t. Multi-fomily Sq.FI. NEAREST
Resideni�ol Swimming Pools � � OwNeu Ou
Date �' ^ APPIicaN�Da , A . . . _
FIRM NAAAE
CERTIFICATE OF EXEMPTION FROM WORKERS' �� Oude�s:Rec_ligM_Sw._ ^�'41�
COMPENSATION INSURANCE - ADDRE55 -
Thi�saetien nwd net 6a cem I�I�d if tha work invelved b Firsf 20
� P y Tmal No.� Additionol CI7Y Tel.No
the pa�mlt i�for onv hundrad dollars(5100)or lass.)
I cerfify Ihat in Ihe perfo�mance of the work for which this . A 4PLICANTK
permif is issued,I sholl not empioy ony person in any mannar � � -
so os to become subject ro the Workers'Compensotion laws. Lighting Fiztures First 2C1 A�DRE55 � �
� � � Total No. Additional CITY ' Tel.No. �
❑ote Applitont - Fized Appliances Not Over 1 HP PERMiT
��OTICE TO APPLICANT: If, ofler moking ihis Cerlificale of AP���N
�empiion, you should become subjec� �o the Workeri Range_Heorer_D.W._
��ompensaiion provisions of�he Lobor Code,you m�st forih• Oven _Dryer _W.'M.— ADDRESS
wifh comply ith soch p�ovisicns cr this permit shall be Top _FAU _W.H.—
deemed revoked. � � Hood _Fan ^Other_ CIiY Tel.No. -
UCENSED CONTRACTORS DECLARATION �- Dis _Room Air Cond. —� � ��CE�� Class.
I hereby aHirm Ihal I am licensed undar provisions of Chapter 9 P' . REG.NUMBER
(commencing with Secfion 7000)of D�vision 3 of the Business power Apparc�us&lorge Appliances DISTRICT NO. PROCESS BY }
and Professioni Code,and m I¢ense is in(ull force and effact.
Y Size 8 Type HP,KW,KVA,or KVAR- �� s.���� �Q
License Number��''.�_Lia Closs——� � � � FMAL V
Up to 1 Incl. t �
Controc�or � Do�e Over I to IO lncl. �AtE �Q � � VALIDATION �
Over 10 to 50 Incl. FINAL V
❑ I om eaempt under Set. � Over 50 to 100 Inc. BY {�n G�� . . . a
B.BP.C.for this reason Over I00 '�'"- Z
�� Date: � Servicas,Swbd.,MCC 8 Ponetboa�ds � , - � . �
, 0-200 Amp.Under 600 V �
Signolure - 201-1000 Amp.Under 6W V ' - - , --
❑ Over 1000 Amp.or O�er 600 V � ?� O 7 5 A
Exemption(or Reg.�Maint.Elect.
SINGLE FAMILY Temp.Power Pole 8 Appurfenances #� � � � �2
HOME OWNER-BUILDER DECLARATION Si n wi�h One B�anch Grcuil �
Zreby of(irm tha�I om e.empt from�he Controctor's License Additional Sign Branth Cirtui�s I • •7 2 3 8
.1 for ihe fallowing reason(Section 7031.5,Business ond • s •`]`�,3 a�
Professions CodeJ: . ,
� A1�sc Condoirs 8 Conducton � �
I,as owner of ihe property,will do ihe work and the ��,1�8—8 4
siructure is not imended or oHered for sale(Sedion Oiher(See Complete Fee Schedule)_ , -
7044,Business and Professions Code).
CONSTRUCTION LENDING AGENCY � � � ����
I hereby ofiirm Iha�ihere is a construction lending agency for .
ihe performance of the wark for which Ihis permit-is issued pERMIT PEE (Sub•Total) � -
(Sec.3097,Civ.C.). � . - .
PLAN CNECKING FEE � - . -- _. .
lender's Name � - �
. PERMIT ISSUING FEE
Lender's Address �
I certify that I hove read this oppiicotion and s�ote that the TpTAL FEE a,.�
above information ii correct.I ogree fo tomply wilh oll County
ordinontes and State laws�egulaling Electricol wiring,and � � , .
hereby authorize represenlatives oi Ihis Counfy lo entgr upon . � �
the obove-menrioned p�oper�y 1or inspettion purposes. SEE REVERSE FOR EXPIANATORY LANGUAGE �
r�.�O�c
�`ignature of Permittee �Dote -
. . . � _
. . .
. , ...
; � , . . , '-
y :
.+ `., . .
. ' . �
" -� T � oa �
. � �. , � T �, � � �% � � � �'-� .
c 2 s
"- , , � Z r, e�`� �0 4� n � O�Z ��"
' .N r � �. N O � p �G '
' Z O � p o 9�
. O �° •
a � M
o � '
- � , .
. ?„ , o
. � �
� m
? ,
�
�
�
$,' N
�l .
Zn
_ �
G
�
rn
. . �
, . �� �;.s •_'
. , . _ . p O af'N o c� .
_. �,C�3c coN � -
' . N
� � n v O O �?����p Q N p 1 " '
� � ��•o�w w .o�o �y N o�'" p�p''� O .
� .. � . '^ ' . � �[. p m���.� .O t7��'Cl� 4 �m �a D ... ,!L . ..
�.-� � � � O O �t O 0'9 O- .,� .
� .=�q m F� N r�D�Q K Q �O u�O'�K-a � �� '.� �
o cr= n_ �n o r. �=.�3 0 �' �A
ao � .�� " a n.T � �� mQ o�,c p� �.m ^ ?cr � m � �G
� Q " � a N� W ..O : O G-? a O �O N
p o "a x o.c c ° ,�. e-M „ 4. '.pv oc�a M C o � oo Q
`c 'm (� A �o o,� o '^° Q a � a m'�°,< �-� r.a �o N N o� rt�
� , � _� � - � f o �� anAo �. oa.N _ n4 �, �o
� o 'Q 3 £ '^ � �3 o N j.o, ,{ �9 N � c C T� n.� m a
- G '� �on.p� o � o xwnN,po . �.� 3 ('�
� � �7 . � 3 O- m O N O-a C� �...p� !i p S Q O p �9
'" � `° < f.^ °"N a,z'�'9 o c v 'o �3 ° D Ko 0 7c
m oo �.o� o°.0 .°4 ""p �' m° `o ` N? ..� 3 y�. '.
' p A �' o � eo ov� � 3 ^'cmm.o�.o a .� p
7 � � cr o =,c o -c o°".� � a. t a N�� �'��O o n n � Z �
• ' - a�o�zs� oNm �. � co° a3o ° � � 000 --•
- . v ?'`ia f 3�a � o o"� e �s 3 �, � " '^ � >> ?.
. . ' O, �OW'07 � 0.0p 7070 � Ou1j .6 ,vp
- . . . �- �'O �,,,� <� �� �' S < �' O n"G-�N �-�,O � W O
' , . No O-^ ° �,m.��m., � 5.... =..ro� �=p ..?.,an�n'
v-3 o m° 4. �'o m° o o zT-
• _ oa,-3ov3°o-vn .° 3n _^.om��r4i9 ��
, O� N O � � �'�O O � N T�
" �' � , �T .� -' O N 0 � O Ci C� °' ./��
� .. . . � . . . . _.p� � � C � C/"�'q. O..
. �, , O-T p +�..4 '//.
. q'O � /
' /
�1.
�.�
: //�./