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HomeMy WebLinkAbout0913A � , ,�:��K��scc!�r[rlSATIC�JD�CLARATION �«.�,3 ��,81 qppLICATION FOR ELECTRICAL PERMIT � I har::y�IS:rn 1!•et I h,�ve a err�i"es�e cf eo�sect tn s^If i�,urn, CE-FORG � cr a cer�il�cay:ct�';^�kors'CCmP!`�"�ion In,ura!rc,or a ecrLficd COUNTY OF LOS ANGELES BUILDING AND SAFETY cnpr�Ihorvf(S•,�a 3aC0.Lab.C.) f'0'.ity ND. COT�nny FOR APPLICANT TO FILL IN JC6 1 ❑ CcrFfctl c�y is I,e�:•hy tumis�^d. N^w ResiCenf�^I B'��qs.&Pools GhCH t:0. �E[ FD7RE55 4�j✓���` � Cort9inn ce(r�is I�i�;f wPu btin county bui�Cinr� in?c^ttion �A 2-r�^'�'v,�n.n. s — s LOCALIT���rn a.�/D �� doa,•��^•t. r.r����.t.,m:iysa.rt — r._c�csr WJLLhI��- CRp„5 ST. fl^^;C^r;�,l S�v:nming Po^'s �::;Eu Cn / p.�� q��i,_,�� Ql���-/V v:mn�:nr.�� CCI7TIFIC:.T[CF Ec[1.'�TIO.`J fR017 IYOFKERS' � � � !.•A!L ! CC"!PGIJ..ATID�!I":SL'�iA�dCE Oal'c!s-Rec Lir,�t Sw. ` rD^�ESs <Y (This section neecf not be tompleted il the work involved by Ihe First 20 � permit is for one hunAred dollars(5100)or less.) Tc!�ItJo.�_ f.Cy:!i�^cl GITY ���� �"d� 7 I ccilify Ih;!1 in!h?po�'ttm+ncc cf Ih�wcr4 lo�w�ch!hi,pnrm�t ItiPN CnECK 14 I.S;;^;!.I 5�+:I M�f'^��O A'f'!'LICf.`JT y,'m,�p�rscn i:�nnY manrnr so as 1 LeCe'�^subjoct ta 1!r.':;;1rMrl5�CCT(!^ryx`tion L��r:,. Li;h'inq fiatures Fi•st 20 ADDF.ESS Ad::tip�;:l J Tc!.=.I No._�_ . CITV Tel.F:�. D�'c J� ���;.'':c.T. Y fixcA Ap,^.'i,sees�:ot Ovrr 1 HP IdOTICC TO A' 'LICA�JT: I�, ritrr r:.^.4:n h�.. Cer!:6c^!e ef �.=�,••'� A [rnmC'io�.S•ou�.::nil.i hn¢.mc s::hj^d b Ihc crkcrs'Compc�s�tion �•'.n;o_ Hcalcr_ DSY. _ �'�'���'��� F[ CfpViEiO95 0�IhC Lrh^r CCCr.v^u mugt fo!t:•:i'h cem�'y v:i"1�;,�h O�rn_ Drynr_ 1'!!d._ hDCR�SS Pr.�(/ %��_ �•� � pr.n,.iq�ons or;hls Pe•r"ft qqpl::-e c�er,�d rcvc4�d. TCp — fAU _ 1'!H._ LIi,E�;SED CCNTR:CTCRS DECLARl.TION H^od— Fen _ O'her_ CITY J�n� � Tel.No 1�' 1 F.nrc''y���•ir:�:�'t I;^..I:c.^�^,a,u�:'.,•,^,ro•S;ier.s c:Chn�;�.�� L'L:':S[C!t L`i�P. — Roen Air Ccnj. _ G-G Nu�.klER Closs. (cenmvnc�rv��..,4 F ;on 70001 c'D-: ;^n 3 c`.!^Ru,i�^ss,^.nd . - prc'ess�ons CcC^.z�^,r^y r^^osc is��!u!i Icrcr.a�d Mrrc;. � n•,TmCr�:o rnceess[o nv I'n•r.r�r A-��r^tus R L�r�c Ar�'���crs �". � 0 ��0,.�4 " Sizr R Typ^H�,Kl"/,KVA,er KVAR O Licec=_c�f�TCor lr.CL�s L?to 1 Ind. FINAL �• � p�r�r 7 to 701n�i. D:TE�_ � VALIOA71pN O C=n!r:c!ar D-!� p;rr 10 to 50 incl. � H ❑ FI':AL („) I::m c*^r.,,^,t u�C^*S^c. Ov^r 50;0 100 Inc. py _ W� ❑&PC.for Prs rra�;�.n Ovcr 100 . N Sr!v'res.Swhd.A�CC R Pan^�bo^rdg ► Z D`:'Q: 0-2C0�mp.UnGi:r fv0 V Si��^tcm 201-1000 11r„p.Und�r f?00 V ❑ O�rr 1000 l.^,.or Ovr.r 600 V Err.r:C'i_n fa,R_,�.�':.n!.Eletl. ^•'+GLF F,".',"!Y Temp.Povier Pele 8:,px�r7n+�c�s Hi':'C:Y'.'=R-GU'LCER�ECLARA7IC`J c����;;y C^^['.r..�[h Ci•cui! I h^rchy�^ ir^i Ihat I e�n orr^pt N�m!h�Ce�Nn�!or's Lice�sr La• � -C C��. .•1; __.. �r^:..on( c.,00?C3: � ...,.^r.s.,....d Pro,__.,..,., Add+icnal S�^.�E2.r.h Circvi!5 I I • G�Cn�:�,. _ � � +�• . • . .2 � _ h1�sa Co�Cui!5 8 Conduders 1,as ewrv�r c`.!�c Frr erly,wi�l do Ihe v^rk an4 ihe,!rudure is ncl ir.trn_".�d cr c:4.•ed Icr s.^.'^(S^e!�n 7044,R•.i�mcss Olhcr(Sc^Ccrpb'o Fcc S=hod�'^)_ , � : •L 7.��5 ..�d Prd�__�^�s CoCe). . T e i i'.�!J`i CC!1STRUGTIC."!LE�JL''.":G AG[hCY G�, , C_E� I hereby al.'Erm;h�l lhere is a cons'ruclion IeMing a.^,ancy lor the pM'Cimanc^cf t"^v�ork Ipr v:niCh this M«^4 is iSs::CA lirtC.3037, FER.`.'IT FG[ (Suh•Tc!^p . Crv.C 1. " � ��/� PLAN CHECKI.`JG FEE Lcrv,7or's N-�^�r,� PER�•IT ISSU!!JG FEE 10 LrnC!cr's A:'AmSs � � I cer•;�Y��,t I h,.,-r r•�:1,�:s,,r.n';cr.�:.�,nd•;�,••,��,�•�e,hoy� TOTAL F'eE in!amr,Pon is ecrrccl.I r;�c^to crTpiy with a'I County orCi�:nces ,-��tl 5:5•p�-.r•q r=^,_i9•;n9 EI>ctric:.l�irin�. 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