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HomeMy WebLinkAbout1218A (6) �5'ORKI:RS'C0�1I'T:�SATIOV DEC[.AftATIOti 7FiA6fi� APPLICATION FOR ELECTRICAL PERMIT � CE•806G f2�801 � I herrby uffirm �hat f ha��e a crrtifintc nf rnnxem to sclf COUNTY OF LOS ANGELES BUILDING AND SAFETY insnre,or a crrtific�t^nl N'orkers'Compcnsstion Insunncc,or � a cerfi(ird tnpy thtrenf(Sec.J800,Lsb.C.) FOR APPLICANT TO FILL IN JQg I 1'nlicy Nn. ' CnmF��}' A�DRESS ��j_�4� �J�(� `� LL�l{ � Nr.w Res�d¢nti�l Bldps.&P00�5 EACH NO. FEE �e�l � Ceriified cnpy is hereby furnished. 7,@ 2-Famiiy,Sq.Ft. 5 — S LOCALITY a iU� ❑ M1'ul[i-family Sq.Ft. NtA T Certilied cn �5(iled�vith Ihe count�buildin ms..ctinn CRO55 ST ��� j�n depuhnentrY } s r� Res�denti�IS�vimmi/igPools OWNERORr�vT�,[�[�(� I^, FIRM NAMEC��Lf�`[_�� �)� C�K�1�- Ihic .4pplicant Outlets:F^e/_.._/L��t.�Tw�� � 1 MAIL �` G ADDRESS��fti�t-/(�c �AYLr CIiRTIPICATF.Oi'I;XGSfI'TIOV FRO�i R'qRhi;it5' Total Nn.�iZ_ Addlt�onal B CITV ��� Tel No.� ,.� CO>1YI:\S:\TIUti 115URA�CL PLAN CHECK } , APPLICANT • � a (Thit section necJ noi be compleled if the work im•ol�•rd - � hy� Ihe permit is fnr one hundred dollars (5100) or less.) L'9'�ting Fixture First 2D qooaEss n V Total No.�" Additional �v rlY��1 � 1 tertify thit in thc prrfnrmancr ot the wnrA fnr u'hich this Fixed ApplianCes Not Over 1 HP CITV��� g�� Tel N :; y 0 prrmit is iccued,I shall nnt employ any person in sn}•manner VERMIT ~ � sn as to become subject to Ihe R'nrkers�Cnmprnsatinn Lau�S. Ra�ge_Heatr.r_D.W. APPLICANT A� (� Ul (� ' Oven _Drycr_W.R1.._ �ppory� 'r L ` y ���� �.1�. T�p —f-AU —W.H._ .��� Z na��1��8�.,���u�om� �-- Hood_Fan _Other_ CITV ��2 n� Tei���U_yc/ p �.ln r NOTICii 70 AFPI.IG\`.T:If,sftcr making thia Crrtific:�te nf Disp. _Rnom Air Cond` LICENSE OF 1?remption, ynu should Necnme xuhject to Ii�e N'nrkers' REG.NUMBER Claes C�mpensalion pmcision5 nf Ihe L�hor Codc,you must forth� power Apparetus&Large Appliantes �ISTRICT NO. PROCESSFO E3Y u•ith cnmply ailh such prnrisions ot �his permit shall be Siir.&TVPe HP,KYV,KVA,qr KVAR d^emed rrvnked. Up to 7 Incl. � ��{� FINAL Over t to 101nt1. oATE 2 � VALIDATION LICCYSLD CUtiTR:1CTqRS UliCl.,\RATIOV Over 10 to 50 Incl. �� r� 1 hrrrM1y affirm that I am Iicensed undr�pmvisinns of Chapter Over 50 to t001na FINAL 9 (mmmrncing with Srctinn'700f1)nf I)ivision 7 ot the Husi� Ovcr 100 BY nesc and Pmfrssions Code,anA my licensr is in f�ill force anJ effrcl. Serviccs Lirrnsr NumNer Lir.Claas 0�200 Amp.UnAer 600 V 201•1000 Amp.Vnder 600 V Cnntractnr Date Ovcr 1000 Amp.or Ovar 60(1 V . I10\1G OR'YER•pI111,UGR DECLAf2:�TfON 7emp.Pnwer Poir.&Appurtenancrs ;,� p�,g q 1 Ircrch• a(firm th�t 1 am ezrm t Gnm lh? Siqn with Orv!9ran[h Cir[uit . y p C��ntnctor i ����tional Si9n 8ranth Cirtuits ti• • ° •L I.icense Law Gir fhe follnk�ing rca�nn(Sec[inn 7031.5, Rusi- ness i ProTescinns CoJe): I � •2�.3� Misa Conduits&Cnnductors 1,as maner of the�r�����n�•,w�ill do Ihr u�ork and thr Other(Sce Compiete Fee Schedulr.l— • •2']TJ Q� s�ructurc ia nnt intended or ofkred (nr sale (Srqinn 7044,Businesc and Profcssinns Code). C015TIiUCTIOti LF.NDI\C.4QICtiCY D�.O 7—S Z I hereby affirm Ihat Ihrre is a ronsirunion Irnding aerncy ' (nr the performanre of the �cnrk for .shich this pennit is p���11T FEE (Sub•Total� C ' issurd(Src.3097,Civ.C.). LendrPs Namr PLAN CHECKING FEE (Onr.�Fourih Permit Feel • LrnJcPs Addrcss PERP,71T ISSUING FEE ,� 1 trrtify that 1 Ivee read this�pplication and stnte fhal thc TOTAL FEE ?j,� abnvr infnrmation is correct.I�Free to comply�eith oll County ordin�nces anA $tale �sus re¢�daling 81eclric;J �ririnc, and � � hrrcby au�hmi�e reprrsentatierc of this Cnumy to enlrf upon the� orrmentioned property for inspec�i^n purPoses. SICI?'It1iVf;RSG FUR EXI'L:INATORY LAtiGUAGG � A� �PP/l S� I Sieniture of Pcrmipre atc . � . . , . �., �'� }. \ •� . . . �.� ` _ � \ ,,: .. ". , � � _-'- �`. ��: �,'�_ . \ \ `•, \'•, �� ,' `\ ,\\ � ..\ ����, ��� ��. �\;.1` '`,ti' .`'. \ \ ' +• � � �� " `' � . ' ' .�� . \ . ` '\ • \ ,\i . �' �' . \ \ \ ;. r - �� � , � _� ` . . . � �. ,, �� � l::. '' , ,• � �\ \ ,, ; . , "i. :,,.— ��`: :� .� \ ,,\ \, \ �, \ \ `.\ '� \5� ', \ � \ \' \. 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