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HomeMy WebLinkAbout1348A R':�':Kl:liS'COSfI'rtiSATIO,:DFCLAI2AT10V 76A663 APPLICATION FOR ELECTRICAL PERMIT � CE�SO6G f2�801 I hereby atfirm thnt I hsce a certificare of cnncrn� to sclf COUNTY OF LOS ANGELES BUILDING AND SAFETV insure,or a cenificale ot R'orkers'Comprnsalion Insurancc,or a rr[ified copy ihereof(Src.3604 Lab.C.) � �ft L�CL��/C-��J��� �1 FOR APPL�CANT TO FILL IN JOe �Zp (1 I PolicY No. C�>mpan)�N� a'Z EACH NO. FEE ADORESS �o ��(,4�i ►a. rJn New Residential Bldgs.&Pools �� � Certified copy is herel�y furnished. 1&2�Family,5q.Ft. $ � — 5 LOCALITv Multi�farf�ily$q.F�, — NEAREST � Certified cnpy is filed w�ith the cnunty building insprctinn CROSS ST Res+d_e7 lial wimming Pnols !"t dep:inment. 5�i1� �. �IRM NAME�1..� Date_L—�.5.��nN����� �' S• '� o�uou RCa�Licht_S�v._ � MAIL / �^ FirSt 20 ADDRESS b CI�:KTII'IC:1TI:OI'G�F'�II'TION I'ROt1'.�'OKI:1:R5' Tot�':I Nn. llrlciitionzl clTv ' Tel No. CO}1pGN5:1TfON IVSIIRAKCIi PLAN CHECK � } APPLICANT a (This section need nnt Iw cnmpleted if ILe u•ork im•olved � I�y the permit�is for one IiunJred dollars (5100) nr Ics�.) Li9hting Fixtures First 20 ,4DDRE55 V Aciditional � Total No. CITY � Tel No. D 1 crrtify ihsl in Ihe perfnrmance of the�cnrk fur�chich this Fixed Appliances No[Over 1 HP � �!CffI11I IS ISSUPC,I SIIpII not employ�ny persnn in any r:ianncr PERMIT '�� („) SfI�5 tn Lecume subjrct to Ihe A'orkers'Com�ensatinn I.awt. Range_Hr.ater D.W.� APPLICANT W� Oven __DryCC—W.M.— ADOP.F�S� i ���� 4) Uate ,aoruc�m Top _FAU _W.H,_ � Z HOOd—FA� _OthCf_ CITY I���,4, �� Tei No. _d YlL NOTICIC 70.API'LfCAVT:If,afler makinc this Certificalc nf Disp. _Room Air Cond,_ LICENSE OR ICxemption, you shnuW hecome suhject tu the A'orkrrs' . F7EG.NUMBER Glase � Compensatinn Frm•isions of Ihe I.aNnt Codc,you m�ist�orth- Power Apparetus&Large Appliances . OISTRICT NO. PR`�SSED BY u�ith compl5' H'��h xuch prm'itinn5 or Ihis permil Shsll he Sire ffi Type HP,KW,KVA,of KVAR �L' � deemed revokrd. L,/ , �'���r�Y� Up to 1 Inel, FINAL ii Ovr.i 1 to 10 Incl. pATE Z VkLIDATION LICI:�SI;U COVTRACTORS pF:CLARATfOY Over 10�0 50 Incl. �� �J� I hrreby offirm that I am licensed undcr provixiuns nf Chapter d�er 50 to 100 InC. FINAL � � d� �`� 7 (cnmmencing w�ilh Section 7000)nf Divisinn 7 nf ihe Rusi- OvBr 100 BY ncxs and Yrnfestions Code,and my license is in fuil force and � . . effect. Services Licrnse NumberG�_C_:11//D Lic.Clasx_`�–�ZLI� �'Z�'°�mp,Under 600 V '–'/ 207•1000 Amp.UnAer 600 V Contractor�s� Oete�=gZ Over 1000 Amp.o�Over 600 V !f0\iG 01l'NER�AlJ1l.UER DF.CL:IRATION Trmp.Powr.r Pnle&Appurtenances 1 herehy aflirm that ! om exemp[ fmm ihe Con�nctor'S Si9n with One Branch Circuit License[aw for Ihe follnu•inR reason (Secfinn 7031.5,Rusi- n��i[ional Sign Bronch Circuits nesa and 1'rofes�ions Code): h",isc.Conduits&Conductors � I,�x nwner M the Property,x�ill An the u�ork and the p�her(See Comp!ete Fee Schedulel— structure is not imendeJ or offered for sal� (Se[tion F� 3 4,$n ' 7034,H�isinrss�nd Profeasions Code). CONSTRLJCTIOV I.IiNDI\G AO16NCY �t� � • • •'� 1 herrby nffirm lhat [hrre i5 a c�nsiruction Iendinc ae^nty fnr the prrfnrmonce�>f Ihe���nrk for «�hich ehis permil is pERbq1T FEE ISub-Total) � • • •0�� issurd(tiec.3097,Civ.C.). � I.rnJcr'S1amr PLAN CHECKING FEE IOne•Fourth Permit Fee1 • � • •0� Q� I Lendcr's Ad�irrss PERq71T ISSUING FEE � � O�.Z 7��2 � I ccrtity thst I harr re�d this application and sta�r that thr TOTAL FEE above inturmetion i:correct.1 aeree�o cnmply�sith sIi Cnunty mdin�ncec and State la���s reFulatin6 ���ectrical �ci�inG, and . It^fehy authorire reprrsentati��rs nf this Counly fo enter upmt the abm�e�m ntinned prop ty for inspectinn purpnsrs. SF.Ii RESV F,RS[i 1'OR GXPLAV.\TORY I,ANCUACIi �l.Y�• i¢nature erminee Uate ti . . . . ' , ' � ` , �;, `� � ` . I � _ 'ry !��: -�� ` � . �.'� ��� ��;I��'�,': �`t , • ' . j _ _' �','� ;'! ',f,i`r 4-� -G � ' ' . i.: i�- < ;.: �� ��,� ;-� `, . ' �C'I�''Y.� �:'. ; :1 t 1� - � .I ' �iU �,� s. 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