HomeMy Public PortalAbout9015 ACASO DR_Electrical_7/8/1980_outlets ctc� i.vmraiv�t�ttvry vn�.t,rt t,..-lrrvty �o,y000 - - - APPLICATION FOR UIECTRICAL PERMIT-
CE-806G (2-80)
I. hereby a.firm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY
insure,or.a certificate of Workers'Compensation Insurance,or
a certiltd copy thereof(Sec. 3800, Lab. C.)
U FOR APPLICANT TO FILL IN SOB
Policy No. Company EACH NO. FEE ADDRESS O�� A 1 �,
ONew Residential Bldgs.&Pools
Certified copy is hereby furnished. 1 &2-Family,Sq. Ft. $ — Is LOCALIT �. �� •�-�.
Multi-family Sq. Ft. NEAREST
❑ Certified copy is filed with the county building inspection Residential Swimming Pools CROSS ST T"iA JA
department. g OWNER OR j
FIRM NAME n1WAC1D Lour3dnl$4cYC.
Date Applicant Outlets: Rec. LightyMAIL
�i First 20 20 16 ADDRESS V 15.- AC-13 -So 2
CERTIFICATE OF EXEMPTION FROM WORKERS' Total No.—_7 Additional 3o CITY''
COMPENSATION INSURANCE �= ��£ `— r �� `�`��
PLAN CHECK
(This section need not be completed if the work involved APPLICANT O
by the permit is for one hundred dollars ($100) or less.) Lighting Fixtures First 20 ADDRESS
Total No. Additional OC
I certify that in the performance of the work for which this Fixed Appliances Not Over 1 HP CITY I No. 0
permit is issued, I shall not employ any person in any manner PERMIT W
so as to become subject to the Workers' Compensation Laws. Range_ Heater_D.W. APPLICANT LU
to
Oven _ Dryer_W.M. ADDRESS Z
Date Applicant Top _ FAU _W.H.._
Hood Fan _Other_ CITY Tel No.
NOTICE TO APPLICANT: If, after making this Certificate of Disp. Room Air Cond.— LICENSE OR
Exemption, you should become subject to the Workers' REG.NUMBER Class
Compensation provisions of the Labor Code, you must forth- Power Apparatus& Large Appliances DISTRICT NO. PROCESSED BY
r
with comply with such provisions or this permit shall be
deemed revoked. Size&Type HP, KW, KVA,or KVAR v
Up to 1 Incl.
FINAL
LICENSED CONTRACTORS DECLARATION Over 1 to 10 Incl. DATE VALI DATION
Over 10 to 50 Incl.
I hereby affirm that I am licensed under provisions of Chapter Over 50 to 100 Inc. FINAL
9 (commencing with Section 7000) of Division 3 of the Busi- Over 100 BY
ness and Professions.Code, and,my license is in full force and
effect. ', Services
0-200 Amp. Under 600 / S
License Number Lic.Class; 201-1000 Amp. Under 600 V
Contractor Date Over 1000 Amp.or Over 600 V
HOME OWNER-BUILDER DECLARATION Temp. Power Pole&Appurtenances
I hereby affirm that I am exempt from the Contractor's Sign with One Branch Circuit
License Law for the following reason (Section 7031.5, Busi- Additional Sign Branch Circuits
ness and Professions Code): 1 1 3.6 A
Misc.Conduits&Conductors
II, as owner of the property, will do the work and the Other (See Complete Fee Schedule)— # 0 0 0 0 0 2
structure is not intended of offered'for sale (Section
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY 2 0 0 30, 1 0
I hereby affirm that there is a construction lending agency 0 0 0 3 0..1 0 C25
for the performance of the work for which this permit is PERMIT FEE (Sub-Total)
issued (Sec. 3097,Civ.C.). � 07. 08-120 Q —U i)
Lender's Name PLAN CHECKING FEE (One-Fourth Permit Fee)
Lender's Address PERMIT ISSUING FEE
I certify that I have read this application and state that the TOTAL FEE ®
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to ente on
the above-mentioned roperty for inspectio p poses.
SEE'REVERSE FOR EXPLANATORY LANGUAGE
Signature of Pvrsi4te� Date