HomeMy Public PortalAbout10554 DANBURY ST_Electrical_7/17/1984_electric panel TICFN
WORKERS' CI lh. Ne AT sfffi to of const CE-806 10/81 A PPO ICA 4�AR�N FOR 12LErfA'1i MIC p p f�l�lm(,1G14T
I hereby fifi4m tYat I have a ci:rJFficate of consent to self CE-806G F'6 IL PV Od1 prl FOR IG '4+ 0 0l WsY9lL Ir IS IIl9VY II
" insure, or a certlflc.re of Workers' Compensation Insurance, COUNTY OF LOS ANGELESC BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C.) T,
Policy NoJOB
❑ Company FOR APPLICANT TO FILL IN ADDRESS f IU1/ V
Certified copy is hereby furnished. New Residential Bldgs. & Pools EACH NO. FEE
655-0 P. DF-1Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. $ — $ LOCALITY 7& e m
fu
tion department. Multi-family Sq. Ft. — NEAREST '
CROSS ST. Mal I
pn Date Applicant Residential Swimming Pools OWNER OR .a/�
FIRM NAMEell
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: RecLight_Sw. MAIL �e,,
COMPENSATION INSURANCE First 20 ADDRESS 54,o Q X15 44 V
(This section need not be completed if the work involved by Total No. Additional CITY 1 L L Tel. No.
the permit is for one hundred dollars ($100) or less.) PLAN CHECK
I certify that in the P7"9"<
ert once c he work for which this APPLICANT
permit is issued, I shall of employ a y perso any manner
so as to become subji e to the Wor er 'Co pen a wi; Lighting Fixtures First 20 ADDRESS
�, / f�' ✓ Total No. Additional
Date D A lican CITY Tel. No.
Not Over 1 HE PERMIT
NOTICE TO APPLICANT: If, a ter making this Certificate of Fixed Appliances a /L
Exemption, you should become subject to the Workers' Range_ Heater—D.W. _ APPUCANi �^ & {c Co.
Compensation provisions of the Labor Code, you must forth- Oven _ Dryer — W.M.— ADDRESS SO-a O—v ' 3
with comply with such provisions or this permit shall be Top — FAU —W.H. —
deemed revoked. CITY ,p s Tel. No. . -o7ue
LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_
Disp. Room Air CordLICENSE
. n� C ID
I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER OC �7 wC/ Class.
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCE$ D BY
and Professions Code,and my license is in fall force OIL)
,e`ffect. Power Apparatus & Large Appliances r/ ; d
$37a1 `-/V Size & Type HP. KW, KVA, or KVAR' .(7a O
License Number Lic. Class Up to 1 Incl. FINALr. V
c f
Over 1 to 10 Ind. DATE T"2;7-1 VALIDATION 0
Contractor Date❑ Over 10 to 50 Incl. V FINAL
am exempt under Sec Over 50 to 100 Inc. BY a
B.&P.C. for this reason Over 100 N
Date:
Services, Swbd., MCC & Ponelboards > Z
0 - 200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑ Over 1000 ATP. o/Over 690 V, -- 277.7 f{
Exemption for Reg. Mainz. Elect.
SINGLE FAMILY Temp. Power Pole&Appurtenances }, u n o 0 0
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit z a n 5
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the fallowing reason (Section 7031.5, Business and c c u 2 i J
Professions Code):
❑ I, as owner of the property, will do the work and the Misc. Conduits &Conductors d7 1 7- 2
4.
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)-
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name Q
PERMIT ISSUING FEE (�
Lender's Address //
I certify that I have read this application and state that the TOTAL.FEE a,v S
above information is correct. I agree to comply with oil County
ordinances and State laws regulating Electrical wiring, and
Qby authoize repesentatives of this County to enter upon
ve- �nTl; rty�for inspection purposes. -
SEE REVERSE FOR EXPLANATORY LANGUAGE
I
Signature of Permittee Date -