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HomeMy WebLinkAbout1043A �•.b�KE�s������E�:s:,,,�'!D[CLAR�T���, 7E���3 ,o-�i, qppLICATION FOR ELECTRICAL PERMIT {� � I hmchy a'!i�m Ih�t I P.�v^a ccrti'ir.+!e c�Consent to 5^'f in5ur^, C�.���,C ar n ceni:�.=.!e cr l'.L^rk�rs'C^m^eosrib��nsur,�c�,oi n cerr��ed COUNTY OF LOS ANGELES BUILDING AND SAFETY L� cenv�hr.ecr cSee.3Geo.L::b.c.1 �1`CY�:'�,. Cert'p�:ry FOR APPLICANT TO FIIL IN JCO ❑ Cer.�l�cd cep s h�rr.h h;mis�=d. EACFi NO. �EE r,00a=55,r i Y' Y �!r.:v Res'"^nti�l Eld.^.s.R Por,'s ❑ �&�_��,�,:� LOCALITI Cert!ied C^^y is fi'�d wi:h Ihe erninty Miil�irv� insDeet�c� . y,Sq.Ft. S — S � I.EAfEiT c!r^�rtr!+�tt. R'ul:i•f,�mi'y Sq Ft. — / ReSiAentir.l Swirrr..�rg F'Oo�3 Cti055 ST. Du!c ApP'ic:nt ' C^:r:!i�O!+ ' FI!i�.11.4!.fE C'cRT`.FICATL OF EXGAPTIC�J�RC!.1 VJOFKCRS' Q,��,��:R����h�,� ��v.� r,•n�� cc��rr-n�snncr�visur�arice � er,r,�F;;, (This section need nol be tompleled if the work involvetl by the ` FiKt 20 permil is lor one hundred dollars(S700)or less.� Tc'�:I�Jo.�V A:!^:ti��+l CITY 7eI.No. I ccrti!y th-!i�!h�Fr!1rm::ncr.ef thc wcrk for whi;h t'�i5 Gcrn�t PLFN CIIECK is is,::ed,I sha'I nr.t eTp'r.y�m�/pPrson in nny m]nner So,^.S t0 `1 t�FPL�C7•NT h^tomc s�bi^d lo C�r.19cikcis'Ce.maon en Lev.s. Lin�'in9 Fixtures Firet 20 �L'y ADDaESS - A^dit�onal I` Tctr.i PJo.,�_ CITY Tel.tJo. Y p,!� �App!icnn� Piretl A.p,^,'i;nces�Jet Over 1 NP tJOTIC� TO Pf'L.CatNT: If, a'.�r n:kin th, Crrti'ica!e ct pPfiI�F4T [xcr.^.;hao.Yron shahl bor.r.�n�+su.",;ecl;o Ihc rkcrs'Cempens^•ion Rin;e_ Hr,ter_ DIV. _ previyons of IhC L.her Ca:e,yau must feriFHi!h co�ply wilh�uch Oven_ Dryer_ 191d._ AD�RESS prcvi;:ns cr I�:,ccrm�[sh.a!I be Cec:^r,A rmo:cd. T:p — fAU _ \Y H._ LICE."JSED CO"lTRAGTCRS D[CLARATIO`J ��TY � T:.I.No. Hxd_ F,+.� _ O:h^r_ I he.�,�.y rq,..���„r I r^��,��,.�,.n i..;..,r p.a,:,;o.^.s pt C�.,�.�r 0 urc�;q.c CH (ccmmcn[i�q v:�;h Srcfrn 70001 cf D'n^�icn 3.C(IFn Fiu,�nr,es,,,q� D'sp. — Pcem lir CeM. _ p�Q:�?en[R �""s. F'rc`r55��n5 C�Ac,.^.n�r.r.rv I�r�nqn is in fu'I lorcc.M eflcCt. Ci5TmC7 r:7. �npCE55ED HV . I'0':h?f A()p.'t.•:�US R L^.fv=Ii��i.?�C(`5 �� � Q P,ize 8 Typc li�,KL%KV�,ar K\'�fi Lir.vnsc N�.i^�.hrr Lic.C'..'.55 L�p to 1 Ind. �I"JAL n � U O�rr f tn 101nc1. �TT[ ]/ / Contnc!or D.^.'^ � Q �b YAL�DATION � ❑ O�cr 10 to.ri0 Incl. FI�JAL I am rrr•^^I cMrr Soc. O��^r 50 to 100 I.�c. py W F3SP.C.'_r t��s ma,o� O•mr 1C0 n. 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