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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 . . � � � � � i i � � ' I �,a -�, �; ; � _ . � �, i f � i i . ; ' • � ; �_ : s "• � , . �� i _. � :�= � . ; ; .. � , : � ,�_ . I ! I �, zr � o ;, i� -� � � � ( I I I . � : 0 7 , I x . o ,z � . i � � I � � � � a I � I � i I ( � t , . .. vi ��' < � zi I � G�: = I� Iv � a � I I I "� i . �, n D ' rn � �7 � � O I,� . I ` I '_..� :.:. . , O Clmi O y. � O -. - � � � I I � i I ' �I z t � ' I I o �'I� � � � � I I I � � . I i �, 'O � �c l� �"v D � i i i..� ;.{ ,� _ x � � �� to � � � �' .. ` m -N _ I� I.,-r� , � � , f.�,. � � � J_ r � � � I; � , , . - . . 1 .. , . ,. �; � � ; ; ` � . , • . � : ... 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