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HomeMy WebLinkAbout1059A �1'ORKi:I{5'C0114'GNSATIOtiOLCL:IRAT10�1 7GA667 APPLICATiON FOR ELECTRiCAI PERMIT � CE�606G f2�80) 1 hcreby atfirm thst 1 h;ne o certi�ic�te of conscnt tn sc�t COUNTY OF LOS ANGELES BUILDING AND SAFETY insurc,or a certificate ol R'orkers'Compensatinn suran •,`r� a cerli�fie(�A�rqpy I�iercqf(Sec.3R00 Lab.C ��IYr`O��J � C FOfi APPLICANT TO FILL IN �pg (� � P� y V�. Company � � �� '�� EACH NO. FEE AODRESS � 1' �0( ti ❑ Ne�v Residential Bidgs.&Poois C ified capy ia hereby fumishrd. 1&2�Family,Sq.Ft. $ — g LOCALiTv ��ya.Oh {� P.":ulti•iamily St�.Ft. NEARE 7 Certified cnpy is fiied�rith the c nl� �uildin ins�rclion � CRO55 ST dep� tme . Residential$Wimming P0015 OWNER OR ����.�!- 1 / FIRM NAME � r ��3�•7 r ( `��������� Oulle[5:Rec..J.�L�91it_S�v._ � A�DRESS � fc7$ ttOr � r First 20 CIiRTII'ICATE OP LXL�11'TIOV i :1 A'ORKGRS' Total Nn._{�. Additional CITY /(�µ.� el No7�4 Sq�r CO."•tf'E\SATIOV IXSUNAICI! �, PLAN CHECK a APPLICANT Q (This section need not be compleled if the w•urk in�•ohrd L� htin Fintures First 20 U by the petmit is for one hundred doliars (5100)or Icrt.) � � nooaE55 Total No. A,���ional � I certify that in Ihe perform�mce of the�enrk for ivhich this CiTv Tei No. p permit is issued,f shail n�t emplo>•any prrs�n in any m�nner Fixed ApPliances Not Over 1 HP U PERMIT sn as to i!ecome suhject to thr.N'nrkers'Cnmpensotion La��•s. RangC_Heater_D.W. APPLICANT ��e pµ •i 5 Phj W Ovan _DryCr_W.M._ ADDRESS 7 t2l1 Uate Applicant ToP _FAU _W.fi._ �� � — f � 4 3 2 Hood_Fan _Olher_ CiTv ��q Q�� `Tel No'�� �S � NO�ICii TO AYf'1.IC:1NT:If,nftrr m�kinp,this Cer[ificalc of Disp. _Room Air Cond._ UCE SE OR —f(�1 C -711 S�L ISie tip�ion, y�nu shouW hecome suhject m the N'nrkers' REG.NUMBER S C4ss Li/ 1 Cm lensalinn pmcisionx�of the I.�bor Code,you must forth- p��yer Apparatus&Large Appliances DISTRICT NO. PROCESSE BY �cil fomply n�iih such prorisinnt nr this permi[ shail be. ��HP,KW,KVA,or KVAR • /O / dce� �.1 revokeA. / Up to 7 Incl. � � Q�'�� FINAL LfCI:NSf'D CO�TRACTORS nECLAR:\TIOy ��er 1 to 101nC1, ��+TE ,_ ��_�Z VALIDATION Over 10 to 50 Incl. 1 hereby affirm Ihat I am licensed under prncieions of Chapirr Over 5010 100 Ine, FINAL B 9 (cnmmenCing�rith Sectiqn 7000)of Division J of thr pusi- Ovcr 100 ness and 1'rofession5 Code,and my licensr is in full fnrr�and rffect. ���' `�y1 �.�O l�rZ I Serviccs -�Y�� 7 0�200 Amp.Under 600 V License Numarr � Lic.Clacs — �;✓2�h—�-p�'r 201.1000 AmP.UnAer 600 V Cantracror 1 ��'[�'pate � �� � Over 1000 Amp.or Over 600 V ❑q�1f 0�5'VI{N-RUII.Df!R DICCL.4R:ITIOV Temp.Power Po�e&Appurtenancr,s 1 hercby nffirm that [ am eeempt from �he Cnntractor's Si9n tvith One Brar.ch Cireuit l.irence I.aw fm�hr follow�ing rn•on (S�ctinn 703L5,Ausi� a�ditionat Sign Braneh Circuits � 7�� O 7�C!A nrss and Pmtrsaions CoJc): INisc.Canduits&C�nduttors tt���� �'���.� � 1, as mrner of the prnprrty,���ill dn Ihe�rork und thr p�her ISee Complete Fee Schedulr.l— structurr is not intenJeA or offereA for sale (Section ' •�� , 21 O 7044,Auaineax and Pmfessions CuJe). COVS7'HUCTION LIiVD14G A(71S1CY 1 hereby af(inn ihat Ihere is a comtruc[inn IrnAinc actn[y � � � � ?� Q u for thr performmee of the �cork fur �chich this permit is pERMIT FEE (Sub?otall iscurd(Sec.3097.Civ.C.). �2� 7�8� Lender's Namr PLAN CFIECKING FEE IOnc-Fourth Permit Fee) . I.rndcr's:�Adress PERMIT ISSUING FEE � 1 certify that f hasc read this:,r�u��r��and ststc that the TOTAL FEE � � nhm•e infotmation ix correct.1 arree 10 cnmpiy ieith all Coun[y ordinances :md State I�Hs reguiating Clectrlcal n�iring, and hrrcby su ize reprrsentatir s of ihix Cnunty to rnter upnn the aha� enlioneA pr or in rctinn purposcs S81i�R1iVk:RSC 1'OR HXPLAN.4TORY LANGUAC[ , . - , ,� � Z /� � Signature of Prrmittre � Uale � ` ' - . ' ` � .. .l. �• V` \ ` ! C•�f.' ` ��: �� �, C� G\ y� `•\�'(1 �...• •.:.\�"� \ i i ' i� i• a:'l �,Y �„\ r; ..` i .. %; �: `��,�`:- � \(' \ „\v_ . 'i � . ,� ` \� ,ti•• .�',.\y �C: '% 1 • �� �" �C; �: �� ��; !:\ .� `(:i \ � . ! `�y,\�,�\ ,� t�C-�\��! 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