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No Permit Number (25)
WORKERS'COMPENSATIONDECLARATION 78A683 ,o,e, qppLICATION FOR ELECTRICAL PERMIT � �j � I herehy affirm ihat t have a certificate of consent to seM insure, ce-eoec � or a certificate of Workers'Compensation Insurance,or a certitied COUNTY OF LOS ANGELES BUILDING AND SAFETY copy ther�eoTf(Sec.3Q800,Wb.C.) P❑ol�iCyN� �I��0�6��omparry1�0US�R.IAI �NQ FORAVPLICANTTOFlLLIN, . . . .. - -- JOB - .. Certified copy is hereby furnished. . New Residential Bldgs.S Poois EACH N0. FEE. AooaESS- Q u �� p��(j� �� '�- Certified bopy is filed with the county�buitding inspection 7 8 2-Family,Sq,Ft.,�Syz S D — S LOCALITY`� �S!6'U LO� ^ 17 . depariment -� � � - '-�� � Muiti-famity Sq.FL � — NEAREST - . �Date 3� Applicant � f Residential Swimming Pools � � - �� � -� pWN R oR Qn . � CERTIFICATE OF EXEMPTION FROM WORKERS' � � ... � � M�AL�ME T�'C1R l3'1H- C-A `` ' �- �.. ��COMPENSATION INSURANCE � - . Outlets:Rec—L'ght_Sw.'�— ��� .� . . ApppESS. I S I RW UC. � . . . . .. . ... .(Thia section need not be completed if the work imolved by the Frst 20 permfl Is for one hundred dollars($100)-ot less.) -� Total No. Additional -�� �� � � - - - ���' � CITI��'�a. �� . � �Tel.No. .. �p .I cerfify that in the performance of[he vrork for which this�permit • . __. � '_, . PLAN CHECK : is issued,I shatl not employ�any person in ary manner so as to " APPLICANi� _ 6eeome subject to the Workers'Compensation Lavrs.. . Llghting Fiztures Flrst 20� - --- - � �-- ADDRESS � � � - - - .. .• . �. . ... `. ... :- Total No. /�dditional . .. . . . ..._ .. Date . . .ApPlicant � . . . - . CITY Tel.No. NOTICE TO•�APPLICANT: If,�aker. makirg this CertAieate of Fzed Appliances Not Over 1 HP pEqMii y Ezemptbn,}rou should become subjeei to the Workers'Compensatbn Range_ Heater_D.W. _ APPUCANT �G�r- � L C �lC _p.ov�c�ons ef thA Lati,..,�ne,��,.,���,��r e„NM.,��h cam.^!Y;•r.!h�=h P.�^n_Q'l,e._�u��,— ACCP.ESS . provisions or.this permit shall be deemed rewked.. .,. . . Top -_FAU ._W.H._ ��• �O .,. � .. . . .__.__ . � . LICENSED CONTFlACTORS OECLARATION.. .�. Hood_Fan _Other_ � ��N O 70 Tel.No. .6 6� I hereby affirm tha[I am Iicensed under pmvisions oi.Chapter 9 .. D(sp. -_Room Air Cond. �CeNSE OR . . - -..... ..... p - Class. �� (cOmmenCing vnth SeCtion 7000)Of DNiSi0f1 3 Of the Bu5inE58 dM — flEG.NUMBER�- d O p� �, 'Q PfOfE5S10nS C.Ode,atid rtly liCen50 is in(UII}OfC9 dlid BifECS. DISTRIGT NO. PRpCESSED BY _ Power Apparatus&Large ApPliances .. ..._ __ ... _..._ .^.1. . . _ � /� ¢, � Size 8 Type HP,KW,KVA,or KVAR 1 V m Q�Q�� a License Num6er 7���0� ��,Class C-�d � " ��- " � ��� - Up to 1 Incl. -. . .. .-.. �. - . .. .. FlNAL � . -.... � U ' Conhactor EIEC�`�ZI C R L Date� . . �r 1 to 10 Incl. DATE �y,��d� _ .. -.' O - . VALIOATION � ❑ . Over 10 to 50 Inct. FlNAL� - - V I am exempt under Sec. pver 50 to 100 Inc. __ gy _ __. _ , _ W Over 100 B.EP.C.for thts reason N � �� Services,-Swbd:,MCC 8 Panelboards"- -- - �� � � - �-- - -- - �- �� --�- Z . ' .. ._ _Datei- ..-_.____ _ ' . . ^ - 0-200 Amp.Urber 600 V - Slgnature 201=�1000Amp.Under600V � ������ - -- � -- � �� ' -� �� �-� �� - �- - - - � � _� _ _ _. .. _ o���000 nmp.o�o�.soo v �1 1 S 7 A -- Exemption tor Reg.Matnt.Etect. - �- � -- - - . ._ . _ _ _ _ � � � ���� � � - SINGLE FAMILY � � � � . Temp.Power Pole 8 Appurtenances. _. ' �• • • ° •C HOME 05NNER-BUILDER�ECLARATION � -- --- �' '�� "-- �-�-"� -� - "� - � - �- �� I here6y affirm that I am exempt from ihe Contractor s License taw Sign with One Branch Circuit , I�� .� .� 2,� 8 for the followirg reason�Section 7031.5,8usiness and Professions Add�tional Sgn Branch Circuits - �� - -� - _.... ._. _ . ,_ . Codel: ' e ^ � � 2� �'J c2i � Misa Conduits d Condoctors"� '� � �- -�� -� --" � � � �-� �,as owner or tne oroperty,wt��do tne wo�k ana tne structure 0 8 2 6—8 8 is rwt intended or olfered for sale(Sectian T044,Business Other(See Complete Fee Scheduie)_ .. . . . _ , __ . . . . _ . and PmFessions Code). � � "� . ��- �� CONSTRUCTION LENDING AGENCY ' -- � � - - -- . . . I hereby affirm that there is a construction lendiry a�ency}or the . performance of tho vrork for which this permit is issuetl(SeC,3097, pERMIT FEE--� � �-��� � �- -�� (Sub-Total) � � 6 - � � - � � � Civ.C.). ' ... . . .. .. ' PLAN CHECKING FEE-�� - � �� -�� � . Lenders Name - PERMR ISSUING FEE ._...- .. . l Q. s _ . ... _.- �. .. _ . . ___ _.. Lender's Address I certify that 1 have read this applica�ion and state ihat tha a6ove --- .TOTAL FEE . f.!��� ._ ._ . . _.. .. ...._. � . . .. . . . in(ormation is Corred.I agree to compty with ail County ordinances -� arid State laws regulating Electrical wiring,and he2by aWhorize _ . represen[atHes of this County to entef upon[he above-mentioned ��� � �� � � �� ' �� - -- '"�" - � �� � - proper y for tnspection purpp�s. - ���nL � � �� � - �� �SEE REVERSE FOR EXPLANATORY LANGUAGE . . _ - -. . . _ _ . .. - _ %��% .Signature of Permittee Da e . 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