HomeMy WebLinkAbout1172A .,.� ,rlORKERS��o���r,NSA����oNOE��R�tAT�<>�- - -- '.. =6A663�� . -qppLICATfON FOR ELECTRICAL PE�RMIT � � �
. CE-806G l2-80) �
�.;'hereby at'firm that 1 have a-ceriificate of consent to s�ts- � �COUNTY OF LOS APIGELES ; � BUIIDING AND SAPETY .
insure,or n certificnta of Workers'C'ompensation Insurance,or -
a cerdfied cupy thereoP(Sec-3800,Lab.C_)
},�.�'��,t��s . FORAPPLICANTTOFILLIN JOB '
w �A N t�-cir G'.Si',=a �#• . ��r�:�.,�
� Yoltcy o. Compeny — �. EACH NO. FEE A�DflESS Y"�•"�e'
New Residential Bldgs.&Pools —
� Certified copy is hereUy furnisf�ed. J&2-Family,5q,Ft. � — $ �OCALITY� �t w.r��� �Cy- �(�/7Ee:�j-
� NEAREST f ' - �,/�„t���
Multi-familV Sq.Pt. CRoSS ST ,`r �
�Curtified enpy is filed with the camity builJing inspection � . — ��"�����-� �
Residential Swimming Pools OWNER OR � �� } tI'�
department. �
) FIRM NAME i pWtiN„ph lNa�� ��"���
Da[e1Z^ ��� Applicanl ��/���i:ti"'�� I . MAI� .
Outlets:Rec._Light_Sw._ '�i � (o� ADORESS �z�i�.�� ��,�/
First 20
CERTIFICA'fB OP IXEMPI'ION FROM Wf)RKfiItS' Total No. � Addrtional _ CITv Tel No. `
CnMP(�:N5.4'CIONSMSURANCE � ����
PLAN CHECK p�., �
. APPLICANT __ � Q
(This section need not be completed if ihu wotk involveS � Lighting Fixtures First 20 AooRe55 �
by the pccmit is for one hundred doltazs (5100)or lessJ Additional � - '2
Total No. c�Tv 7el No. � :�O
I ccr[ify[hat in the petformxnce of the wnrk tor which this pjxed ApplianCes Not Over 1 HP
permit is issued,T shull not employ any pe�rson in any ma�ner PERMIT � U �
so as[o become subject to the Workers'Cumpensation l.a�vs. � Range_Hea[er D.W._. APPLICANT 'Qb./Y'�.S,J;J!-�� .S � �
� : Oven _Dryer_W.M._ qDDRESS)7 '� � .� �a_�_. .r� '
1 c..(ft.�_ �.lc;i�,n �2.-.r. � 2
Date Applicant__.-- > Top _FAU _W.H._ cl7v�� / Tci C�y �-��t,"�
� Hood _Fan —Other_ '+�GLLa��•r"7 � 1a��
NOT[CF,TU AI'VLICAN7':If,a(ter muking this Certificate of pisp. _Room Air Cond� � LICENSE OR-� � !>
I�;xemption, you should YrecurYie suhject t<i [he 1V�rkcrs' REG.NtJMBER Class �
Compensaliun provisions oV the I.ubor CoJe,you mu�[fur[h- power Apparatus&LaYge Appliances DISTRICT NO. PROCESSED BV
with comply with such provisions or this permi[ shall Ne $iz.&Type HP,KW,KVA,or KVAR .
dee�ryed revol:ed. f :c.7 f lfl.�C.1'*���'��=" ; . �
,g � � ' GS Uptollncl. � f_
FINAL
� Over 1 to 10 Incl. DATE � ai' �� VALIDATION
� r LICISNSICD CONTRACTORS DECLARATION :Over 70 to 50 Incl. }
I hEreby xff'irm[hat I am licensed undcr prnvisions of Chsspter Over 50 to t001nc, qy AL �
H (commencing with Sectiort 7000)nf Uivision 3 of the Uusi- ;Over 700 n�`�(���'�'��..
� ncss anJ Prufessions.Code,a�id my license is in fWl fo�ce and -
effect. ,.f�j ����;�G'i G.Z.� Services , '
G�' !� c 0-200 Amp.Under 600 V �
� License Number.�P�_i_� Lic.Class_4..���—�--��y Y ' y01-1 DOD Amp.Under 600 V�
� Contractor .P`Pk . ^�+ llate_�� 1 � Over 1000 Amp.or Over 600 V �
190S.4E OWMER-BUILUER LIECI.ARA'fION remp.Power Pole&Appurtenances
I hereby affirm tl�at t am ezempt from the Coairactor's �S��n with One Branch CirCuiT . - '
�. License Luw for[he fulluwing reason (Sec[iun 7031.5. Auwi- �Additionai Sign 6ranch Circuits �j � 1,[({ [
ness und Vrofassiuns Code):
�Misc.Conduits&Cnnductors �s •w a e 2 ,
� 1, �s owner nf the property,wilt do the work and the ,pther(See Complete Fee Schedule)— s
structure is not intendeJ or offered fur sule (S�ctiort � � m� 2,� Q
7044,Ausiness xnd Professions CoJe). -�— - � :
CONS�fRUCTION LF,Nf]ING AU}iNCY "— � 'y o °�I Z� O� i
. 1 hereby affirm tiiat there is a constructimi lending agency '� �
for tlie performance uf the work for which this permit �s pERMIT FEE � (Sub-Total) S ��). 1?3 0�8 i �
�� issued(Sec.3097,Civ.C.). �
. LcndePx Name � PLAN CHECKING FEE (One-Fourth Permit Fee� �
' I,ender•s qddress PERMI?ISSUING FEE ZC� F i � _
z
' I certify thal 1 h;ive read[his xppticalion und sta[e thn[ the TOTAL FEE �z ��
� aAove informetion is correc[.7 agree to cnmP�Y w�th all Connty �— "— �. ' � '
; ordinances nnd 5ffite laws regulating F.lectrical wiring, and
��. hercby authorire repcesentatives�if[his County[o ente�upon- .
� the�ub�orve-mentianed pruperry for inspectiun purposes. SlE"RLVF.1L51?POR EXPLANATORY LANGUAGH . <
> 1/Y� aL.L�IJL.S' t��� /ZS G � ..
Signature of Permittee Dute . .
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