HomeMy Public PortalAbout9560BISBY ST_Electrical (6) r` "'� "" " °"°E `°" � '°'81 APPLICATION FOR ELECTRICAL PERMIT '
I, atry e}Qrm that I fire a outs of consent to sett 4)PLae,
ora of Wbrkera' Compereatlon Ineurance, or a certtM1ed COUNTY QV LOS ANQELi;S BUILDING AND SAFIr=TY
oopy ffiamd(sea 3800,Lab.a)
Pnfily N& CornoarryFW APPLJr'AitT t0•FAL W ibB
Q• CorffiW copy b hereby furnWied. New Rsaldentke Bldgs. FUoie EACHNO. FEE ADR� _I s n
rm—
Certtfled copy b fl lea*with the'ooartty bu6ding triepeation 1 d 2-Femlly,Sq.Ft $ — 3. LOCALITY >C/ `7
Muft1-femay s4 Ft COD96 8T.
Reefdentlel Swimmlrb Puol�r CJS J NAA1E �� �Y
Date�CMTrrATE OF EXEMPTCN FROM WORKERS' buttals;Fier sw. r'
COMPENSFWN INSLRANCF AL7DFtES$ O'
(lhk oecbpn need not be coovkkipd If the work Irlmofwd by the First 20 ,
Pah 4 for one twrld»d do7leri.(i900).or ieM) C{FY Tel.lfo. 'fib
Total No. Addltbml �h' � � �•� / .
••I oertfly abet to the peFfortnarr¢e o{.the.work for Which thle.permR
b-fasted, l dhell
V=
employ arty person In any Ii--{uter eo to i
berme oyb)ed to:#he Wbricern' LaAt- Ughtlnp Fbduree Flint 20 ADDRESS
Tel.
Gate r� APPllcant �No, AM". CITY
NOTICE TO APPIICANC .It„ After makJN .ft-daof Ftked Not Ctier 1 HP PEFJ4T r�
. "
' Etgflrnptlort,ypu etiaukf become 1�u b}eot tQ the WiSrkem', FieQte f_,_ D.W. ADDRESS
ti N tvke{orre of the L.abor.0ode, Y moat torthNfth comply tiAth a�oh O�err _ pryer r— W�1
provlefo{ia or"P07*shall .deemed revoked. Top T F60', W.H. __ _
LICENSED CRKy PFyCTOR3 DECI AR,4ther
lON Hold — Fan O _ Te).Nb y
I hereby eifirm tha I-am IKensed uwi4�nder prof �pter 9 Disp, T- Room At-Gond. REa NL
rxnenoiPF3
(corng wfth Seodon 7000) c$Dlvielon 3 of the &*pees-and
Profeeak-Coda aN Try wee'fe lh full Rx-oe and Affect Power p Apk L mw Appllerpee. txslTaCT W.WEB
BY
Size•A TiPA HP,KW,ICV or aCus,Ft J .
poerm NL Tber uc_Clash — Up bo 1 Imo. FINAL
T�Over i to 10 b6L DATE
Data O%W to f0-6o hol Fl
L I enl dWTpt U>d-$0-6• Over 60 to,100 Inc.
BhP.0 for th(s reason Over 100 N
' Swvbee,Swbd.,MCC 8 Par"boerde
Date 0-200 Amp.Uhtier 600 V'
201 - 1000 Amp.Under 600 v 4 7 9 Q,7 A
Over 1000 Amp.pr,OVer 600 V
Fmmplbn fbr RAg.MapiCEVeof
$WOLF KAMILY Temp.Power Pole S *rtenen '
HOME OWNEA--SUILD�R b5CLARATl4N glgn with One auricb.Clrouh' - r,
I here0y dorm that I am exempt from the Contn�a Lberme I-Aw Addttlona!1iJP BrarOrtW�
for'#*fllowingreason(Salton 7031.6,Buafneea and F'rofeeeloira.' r'
I
an owner o the Prowty,'wlir66 the work end the etnx�{e M100- a.Candr s
is nd Intended or offered fo{ sale (Sectba 7044, 11mtneee OttiW(See Co Toebe Fee Sot-due)
and ProfeebSore Co(JA).
CON�I}CTION,LF_NDIN4 A(AEa CY
I hereby afflrm that there Is a conslrixbon {er>�nq' >oy fol the
perfprrrrarxe of the Work for whldh Wa perm Rle Yr#eued(sea 3097,•. - PERMIT FEE- (Sub-Total}.
Ctv.C.).
PLAN CHEC+040 FEF
L brlder'A Name -
PERMIT ISSU.NG FEE Q
Lerdera Addr9ae FEE 14
I oertffy.that I have read thle appilpat$pn and stets that bV above (f -
Information la ouTect I agree to =Toy with ala County ordhian6ee
,and StMe Veuve regiukting F}eot11oa1 wiring, and hereby autliortre
rQpreserrtativee of County to enter.upon the abo►e-mentlpoed
Property InepecifOn purposes rJ� SEE REVERSE FoREXPL.AN,QOHY LANGUAGE :.