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HomeMy WebLinkAbout0843A ORKERS'CO11Pi:15AT10NUfCLARATIUy 7GA663 APPLICATION FOR ELECTRICAL PERMiT \ C[�R06G 12�80) � y affirm th�t 1 have q ccrtificate nf cnnsent to srlf GOUNTY OF LOS ANGELES BUILDING AND SAFETY �r a certificnte N 11'orkrrs'Compensatinn lnsur�nce,or �r'c ed copy therenP(Sec.3300,Lab.C.) � FOR APPLICANT TO FILL IN �pg / •��, Vo. Compnny � New Residential Bliigs.&Pools EACH NO. FEE nDDRESS S�2.N.�,0 �t",y/�J � C :rtified co y is hereby furnished. � S — S LOCALITV � ���, P 7&2•FamilY.Sq.Ft. �//�riD.ra�C /Z F.'.ulti-(amily$q,Ft. N-A T A �,;; ertified copy is filed�cilh Ihr county builJing inspection CROSS S7 .SoN �� C ajf�•�• /c epartment. Residendtial Swimming Pools OWNER OR � ' ' ' u{'/� ,�� C FIR\A NAME �L(� Cf�AI�✓ '�� •a���'�a°� OutIMS:F7CC._L�9h�_S�v._ ADDRESS 'r/i7/�� ''� F�rst 20 :r 'liRTll'IC:1T1�:01'I:XE\1I'TION 1'RO?t\5'ORI:I�:RS' Total No. AiiAi[ional �� CO.`�11'i:\SATIO,J IYSl7RAVC1: CITY Tel No.sss•t 2G 1 } PLAN CHECK 0- �� APPLICANT O section need not be completeJ if ihe u•ork involved Li9hting Fixtures Fi�st 20 V .,� ic permit is (or onc hundred dollars (5100)or less.) Additional AODREsS � Toral No. � ify tlu� in the performance of the�eork fur�chich�his Fixed Appliances Not Over 1 HP CITY Tel NO. � t is iasur.d,1 shall nnt employ an3'Ptrson in any manner pERMIT !��f V 'r to become subject�o the�Yorkers'Compensation Lawx. Range_Heater_�.W._ APPLICANT .7iT�t y � � ��p OvEn _Dryp�_W.M._ ADDRESS N �, 1/'l0-Ql Applicant��'�!C���- TnP _FAU _W.H._ — Hood_Fan _Other_ CITY Tel No. �'� ClC TO APf'I.ICAYT:I!,attcr mskin¢this Crrtificale nf L�CENSE OR �� ption, yqu shnuld hecnme subjert to the R'nrAers' Disp. _Room Air Cond,_ RF.G.NUMBER Class � � ensation proeisions of the Lahor Code,you must fnnh- p��,�r Apparatus&Lnrge Appliances DiSTRICT NO. PROCE E�9V cnmpty with such proeisions or Ihis prrmit shstl he ,���P1.o�i� Size t4 Type HP,KW,KVA,or KVAR /� Up to 1 Incl. {�.�-�J1c� FINAL Ovrr 1 to 101nC1, DATF lr �� �L VALIDATION I.ICI:tiSIiD COVTR:ICTORS I>I;CI,.\RATIOV Ovcr 70 to 50 Inel. reby affirm that i am lirensed under f�roricions of Cheplcr Over 50 to 100 Inc. FINAL AV .ommencing with Srction 7000)of Diricion 7 of the Rusi- Over 100 ^ r�� s and,F'rofessions Cnde,anJ my Iicense is in full force and eC�• 5^rvices 0-200:.mp.Under 600 V :rnsc Vumbcr I.ic.Class 207-7000 Amp.Under 600 V ontrac�nr Date Over 7000 Amp,or Over 600 V li0lfii 014'NER-AUILI]CR D[CLARATIO!r' 7�mp.pc::�er Po!^&llppurtcnonces [ herehy affinn that 1 am exempi from the Contrsaor's Si,n with One Braneh Cireuit I.icense I.a�v for�he iMlnwin¢reason(5ec�inn 7031.5, Hiici- n���itionol Sign Branch Circuits n/, � . iess and Profeszions Code): � �c......,n h7isc.Conduits&Conductors �:. . . . .� � 1, ss owner nf the proprrty,u-ill do Ihe w»rk and[he Othcr(Sce Complete fee Schedulcl— structure is nnt inlendrd or offerrd for snle (Sectian �_• •2�Je� 7094,Businrss and Pmfecainns Codc). CONSTRUCTION LISVDIVG A(TEVCY •.^ ^L t;,J�� f hertb5' �ffirm Ihal �hrre is a construclirni Irnding aeency for ihe performance nf�hc w�nrk for w�hirh �his pennit is pEFMIT FEE (5uh-Totall � �.J�-d�� sxurJ(Src.JD97,Civ,C.). n( . Lendcr's Vnmr PLAN CHECKING FEE IOne�Fourth Permit Fee) Ixndcr's AdJress pERA71T ISSUING FEE certify that 1 have read Ihis appliratinn and stare that ihr TOTAL FEE !� �ho�•r infarmation is torrrct.1 aFrce to complY�+'ith all Cmmly xdinanres and State lau�s regulating tilecirical w�iring, snd , �ereby authnrire represent3�i��es of[hie Counly tu entrr upon hr aborc•mentionad properly for inspection purposes. SCG'RGVLRSIi I'OR EXPLAVATORY 1.:�\GUAG� /.SGL'�C�7.K. /�'1J-d/ Si¢natUre of 1'rrmittee Dnte ; ' a��:;\��'�,.\ , \ , ,;�-: �;:,:�. �,;1,�:�\�� �� ` ,` `\ ` iJ + � •;! � �:�� ... �\`�\: \ �. \ . 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