HomeMy WebLinkAbout0962A (5) „�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 �
I lr r_, ' .
--• Q 'J .�: -
(X; �L' CJ • . �
1 .,. � • . .
ti l' • •
G' • • •
N : = 1. ��'
I , � .
I . I I _ _ r _ �, � �_1
.I I � �' ' I r' Y I i• �1 ,1 I
I I I I ' ` '. f � I � � � C) �f I V ,�' ..
i i J� i �� • ,I C) I I C:
I I � � � � � �; � - . _ i C; i r; � T I .
II � I i - i .C� �% � ii i
I I I I � 1 h ` G i i I ! i I I
I I I I �^ .�. :....� ._.�..-�:.-� -!- -'--
i I I ' I _ . t.I i , ; I� i ''-
I I I I I I ,� I I � � I ;1 I I
� j . ; I . � I � I ' � I ; ;' , ��-;
I �� I -�---- -�- -
; � ; � '_ i , I , '
i � i � ; � I � � � i � ��--1
� � : , � ���
� � ; , � � � i-
� i � i ; ;
� I � I I � � ��:`_';
� � , i
. ; I � � � I I i I I ��.� l_.
� i � I � _ .
. i i � i ; � . �
i � � � ,
i ' � ; . � � i
; . I� ! I , , '
� � � , ; .
j � I � ' j .
I
� i i � i . � �
j � � . � i I
i ' ` � . �
� ,
I � �
, i � i I �
I .I ! I � , ! I i I � I � I I
� `` _ ` _ - `�,- �1 ` ` _
. _ - f �- � �, . � _ � _ -�_ -. -`�� - � _ _ _ � _��:- �
• I� I ' r � .. ` ` _ ' _ - -_ _ `.'_ _ , , .. ` ' f
I _ _ ^ _ - � , � - _ = = .. -.. `` tl.- [: _ ` ' � _
,- _ � �, - . c'-
_ ✓, _V - _ �i_= _ .. � -•`' _ _ ` _ c ,� _ � _
. - � ;'_ _ � . � _ _ i . : -
_ ' �: - � - ' �. - �
' '' �__ � �' � -. /
" _ i: _.�, � � •, ti i:.� r�1_ _ � � -_ i
, , . ' , _ _ • -- �;- + ` ., . e - r' �
�. _ _ - [: - i. ` . ' .i
,• `, ; _ ` �' • �- _ - �
' , ` .� �'. .� C � _ � .. � .� . � [': . . � _ .