HomeMy Public PortalAbout9552BISBY ST_Electrical (2) • "' "E C°"' "°"°ERA"'°" �A° APPLICATiSON�OR ELECTRICAL PERMIT
I hereby affirm that I,have a certtlioate d consent to eeff haur ,
or a e d Vrbr.ers' Campeneabon Insurance, or a oerb'%d COUNTY OF LOS ANGELES BVILDINO AND SAFETY
�tr c.eroc,i ° r c.._.o w3 Co^�
� N° FOR APPLICANT,O FILL 11V q
Certified copy to hereby furnw-ed. New Reaiden-tial Bldgs&Pis EACH NO. FEE
LOCALITY
'❑ Certified copy Is filed with the oou bufldl 1 d 2-Fanlly,Scl.Ft
$ — S NEAREST
} - Muttl-femfiy Sq.FT.
Data6—41 C8068
� Swfmmin0 Pools OWNER OR
CERTIFICATE OF EXEMPTI M FROERS'. S ""A'�
COMPEN,vnoN INSURANCE Qrtlets Rao IJ�rt — SW.
ADDRESS C7' b• / !�,� l^
Fust 20 (�^^�
perm9his t to for need rat be completed If the work trxotvr d by tlne Total Addflional, Cf1Y �v 6 ny. Tel.Na -7
perm It hi for one hundred dollars(;100)a loss)
I certify`that-In the paff o of the %;"* for whloh U* permit PLAN CHECK T L S e k-S a'�-' �7""�rv'• 6
le baued, I shall not employ any person In any manner ao as to
become eub)ect to the VAx* ra'Corrp9naation.Law&, Llphtlro Ftx Urso Brat 20 ADDRESS
Total No. Addttbnel C Tel.Na
Date Appiloant—
NOTICE TO APPLCANT: If, after., making this Certificate d Rxed AppOencee Not Over 1 HPPEFMT
its Q
Exemption,you shook become subject to the Workers'Compensation Vange— Heater D.W. T r l
Provtsic-of the Labor Code,you must fDr hwRh comply wt h auch Oven — Dryer _ W-M.T ADDRESS
provWcne Pr,the permit,shall be deemed revoked Top — FAU —. Win —
L1C�NSED C09 TRACTORS DECL"TiON Hood Fen Other_ CFFY Tel No.
I hereby affirm that J am licensed ur)der provision of Chapter 8 LICENSE OR /
Dlep. — Room yr Gond REO.NLa,6ER
, (corrurlendnp with Section 7000) dDiv"Dlv3 d the Business end
Professions Code,and my MDanae le In full,force and effect_ Power ApAeratus S Large Appllanoes Dt8T:tCT NO. PROCESSED By _
�j Stze S Type HP,KW,K%P or KVkR
License Number C�d Lir_Claes Up to 1 h(-,L FINAL a
�«rtreotor r S� z SC--r Over 1 to 10 hnci.
Over 10 to 60 Ind.
❑ .dam exempt under Seo. Over 60 to 100 Inc. gy R,0.0\1.�_!/1
B SP.0 for this reason
vlcee,
Over 100 # ° �'�1.�[2 N
SQrSwbcl,MCC S Panelboatds Z
0-200 Amp.Under 600 V I o 2 5
ShMature 201 - 1000 Amp.Under 800 V
❑ Exempdon for Req.Matnt Eleot Over 1000 Amp or Over b00 V o 0 0 a 2 5
SINGLE FAMILY Temp.Paver Pole a AppUrt&wjp4% c628—. 8 8
HOME OWNER-BUILDE(i DECLARATION• Sign wIth Cne BrarK h Clmu t
I hereby afflrm that I am eft from the Corrtraot s Lloenae Law
for the following reason(Section 7031.6,Bualneae and Pmteeslata Addhlordd Sign Branoh C1rcuRa
Code
El as owner d op
the property,w0and 1 do the work the structure
Wisc.Cor iia 8 Canductoro *0,0 1, 1 A
'
le rpt infarcted or offered for sale (Secrion 7044, Buetrlees Other(See Complete Fee Sdiediu;le) , Wo o•0 0 0 2
and Profeea na Code).
CONSTRUCTION LENDWG AGENCY I o 0 1 Q,2 5-
1 hereby affirm that there Is a cornstuction lendtrip agency for'the 0'0 0-14,2 5
performarre of the work for whloh this permit is Imus d(Sea 3087, PERMIT FEE (Sb-Total)
Ctv.C.).
' Ofi28-88
PLAN CHECKING FEE
L a der's Name
PERMIT ISSUING FEE
Landers Address
I certify that I have read this appkabon and state that the above TOTAL FEE i
Inforrnatlon is correct I agree to corr#y with all County ordlnartoee
and State ting Electrical wiring, and hereby authortze
this ebov�merttloned
8EE REVERSt FOR EXPLANATORY LANGUAGE
red ee Date