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HomeMy WebLinkAbout0962A „�aRK�;�ts•�o„�E`SATIO\DI�CL.IRATIOY 76A663 APPLICATION FOR ELECTRICAL PERMIT � CE�806G 12-B01 1 hereby affinn ihat 1 have a certitiatr ot consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY inaure,or:�certificate of�Corkers'Compensation Insuronce,or � a crrtifieJ copy Ihereof(Sec.3800,Lab.C.) FOR APPLICANT TO FILL IN JOB /� ,Q/ �` � Yolicy No. Companp AD�RES5 New Residential Bldgs.&POO�S EACH NO. FEE � � H d” � Cenified copy ic herchy furnislied. 1&2-Family,Sq.Ft. 5 — S LOCALITY d d ❑ �"ulti-family Sq.Ft. — NEARE '", Certified coDY is fikd�vith ihe couMy building inspection CROSS ST y�/ ¢ ,� ,/ Q Jeparlment. Resid�tial Swimming Pools DWNER OR �Lf� . 'LG CU FIRM NAME��!�)� T✓I Y Date Applicant Outlets:Rec._Li�h[_S�v,_ y1A1L Firxt 20 AD�FESS P C1;HTfFfC:1TG OP F;XI[S1PT10N iR0�1\l'OHKEHS' Tntol Yn. Additional CITV Tel No. CO.'�11'LV5.4TlOti 1NtiUR:1YC6 PLAN CHECK / } APPLICANT 1 (w,�(Y _ Q (This section need not be completed i(the w•ork im•olr•ed Lighting Fixtures First 20 AODRESs V by ihe permit is for one hundred dollars(5100)or less.) q��;�;onTl Q � I cerlif5'th�t in the Total No. prrforr�ance n(the���ork(nr�•9iich this Fized Appliances Not Over 7 HP CI7V 7ei No. O permit ic issued,1 shali nnt employ any person in any manner PERMIT (~j so as to hecome subjcct to the N'ork s' .0 pensation La��•s. P.angP._Heater_D.W._ APPLICANT � a �J/����, Oven_Drycr_W.M._ ADDRF.SS tn Ualc/irj 7�Applic:nt ToP —FAU _W.H._ Z HoaJ—Fan _Other_ CITv Tel No. NUTfCi[TO APFLICAtiT:If,after makinF ihix Cer� icate r�( Disp. _Room Air Cond.^ LICENSE OR lixemption• you shquld M1ecome suhject to Ihe l4'nrkrrs' REG.NUMBER Class C�imprnsation pro•'isions of�he Lslor Code,pou mu5t t��rtll- POwPf Apparal��s&Large ApplianCes . DISTRICT NO. PFOCESSEC BV 1 w•ith compiy with such prm•iainns or this permit shall �+e Size&Typr.HP,KW,KVA,or KVA iJecr.ied rerokeJ. .� 7��.���/ Upto 1 Incl. FiNAL � o,m�1 to 101n[I. �ATE VALIDATION LICfVSGD CO;VTRACTORS DECLARATIO� Over 10 to 50 Incl, 1 hereby affirm Ihal 1 am licensed under pr���iSions of Ch�pler Over 50 to 100 I�c. FINAL SV 9(mmmencing with Secti�rn'.000)of nivision 3 ot the R��si� Over 100 ness nnd 1'rnfrssions Code,and my Iicensc is in full torce and . eftect. Services � �, Licrnxe tiumber Lic.Ciass 0-200:+mp.Under 600 V 201-1000 AmP•Under 600 V . ��' Cnntraclnr Date Over 1000 Amp.or Ovnr 6D0 V HO�1f;OL1'YISR�Bl11LUfR DL•'CLAFtATfOV Temp.Po�vcr Polc&f4ppurtewnCes � /��,� -1 1 hcrehy affirm th�t I am e<emp� from ihc Cnntracinr's Si,n with One Branch Cirtuit � . License Law fnr the follow�in¢rcason (Seclinn 7031.5,Ruci� n��itional Sign Branch Cireuits ���' , l , lICSS.lfl(I Pf(1fPSS1n115 Cfl(IL'�: � y O(�[�^ hlisc.Conduits&Cnnductors i� � ��a �'� � i, as mrner ot the�ro�r��y...•�n ao�ne u�ork snd the pther ISce Complr.te Fcr,SchedWcl— � ' � stnicture is nnt in�ended m offered for sale (Sectinn #� ��� � �2 70a4,Rusinesxand ProfessionsCode). COVSTIiUCT1C)N L1:1nING�1()I:NCY �•���Z�SQ 1 hrreby affirm that [here is a tnnstruetion Irnding aeency for the petformsnce af ihr wnrk (or �vhich this permit is pERMIT FEE (Sub-Total� Q� • � �2 a`5 Q� is5ved(Sec.J097.Cir.C.). • � Lrn:ler's�smc PLAN CHECKING FEE (One•Fourth Permit Fce) ►2 0 9=8 1 � LenArr's AAdress P[R111T ISSUING FEE ,.Y S�' 1 certity thnt 1 haee read this applicalion and state Ihat the TOTAL FEE ��'��' aboec infnnnalion i�correct.I aKrre lo cnmplY�cith���Counly orJin�neec and Statr la�vs reF��lntinq lilertrical �cirinF, and herehy anthori�e reprecent��ires of tl' Connty�o enter uC��n � the abo��ey�eptio pro ty r i tion purpoces. SGC•.'R[tVF.RSG FOR�XI'LANATORY LANGUACG _ X . C/ (�(�'' /� �1 �/ ..i�nature of Permittee Uat � ` r�- • �� i• � ' �: j, c',��{�.\.. \ � C, .• ,. f�\'�, y\\Y - f '� , . �; .v � � ,; c\`. �� ���\�\�. � ' �` ♦ :� ��,• ^:� !� �f � � � �.. `, L.,\�' \ tt� . �� ;: \�. 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