HomeMy Public PortalAbout6343 TRELAWNEY AVE_Electrical_7/24/1986_service amp • WORKERS COMPENSATION cats of once T� ta,et APPLICATION FOR ELECTRICAL PERMIT
I ereby affirm that I have a certificate of consent to self D:�'
ins e,:
oro certificate of Workers Compensation Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY
ora rI fmd copy thereof (Sec 3800 Lab C )
Policy N Company FOR A/PLIGM TO FLLl W lOB
Certs copy is hereby furnished New Residential Bldgs 8 Pools EsCH NO FEE ADDRESS
CertiCot iii p;.q of
fied y is filed wdh the county budding mspe< 1 8 2 Family Sq Ft s — S LOCALITY
hon deport nt Multi family Sq Ft — NEAREST
CROSS ST
Date beam Residential Swimmmg Pooh OWNER OR
FIRM NAME
CERTIFICATE OF E TION FROM WORKERS' MAIL
Outlets Rec_light_Sw_
COMPENSATI INSURANCE ADDRESS
(This section need not
b•coin 1•f If the work Involved First 20
P �' Total No Additional CITU Tel No
the permH h for ono hundred dolls 100)or Ins )
PLAN CHECK
I certify that in the performance of the rk for which this APPLICANT
permit is issued I shall not employ any person in any manner
so as to become subject to the Workers Compensation Laws Lighting Futures First 20 ADDRESS
, iso Additional
Total No CITU Tel No
Dote pPlicom J Fixed Appliances Not Over 1 HP PERMIT -
N01KE TqVAPPLiCANT If, after making this Certificate of
Exemption you should become subject to the Workers Range— Heater_D W _ APPLICANT
Compensation provisions of the Labor Cade you must forth- Oven _ Dryer —W M — ADDRESS
with comply with such provisions or this permit shall be Top — FAU _WH _
CITY Tel No
deemed revoked Hood _ Fan _Other_
LICENSED CONTRACTORS DECLARATION uCEN
I hereby offem that I om licensed under provisions of Chapter 9 Dap _ Room An Cond REG NUMBER Clas N
(commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO D BY a
and Professtons Code and my license is in full force and effect
Size 8 Type HP KW KVA or KVAR 6 a S8
t-
O•
License Number Lic Class L 0 FINAL K
�..++��/� Up to I Incl F
� oCOve 1 to IO Incl DATE i2� G Gj ATION U
Connecta Date r -/ Over 10 to 50 Incl
❑ " FINA i d
I am exempt under Sec Over 50 to 100 Inc BY N
B 8P C far this reason Over 100 Z
Dote Services, Swbd MCC 8 Panelboords
0 -200 Amp Under 600 V
Signature 201 - 1000 Amp Under 600 V
❑
Exemption for Reg MaiOver 1000 Amp or Over 600 V
Maim Elect
SINGLE FAMILY Temp Power Pole 8 Appurtenances 1115 1 2 3 A
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit
1 hereby affirm that I am exempt from the Contractor s License # • • • • is 2
Low for the following reason (Section 7031 5, Business and Additional Sign Branch Circuits
Professions Code)
Mix Conduits 6 Conductors ) • • 3 2 5 0
El I as owner of the property will the work and the
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ pis - 32505
7044 Business and Professions Code)
CONSTRUCTION LENDING AGENCY 0 7 2 4-8 6
1 hereby affirm that there is o construction lending agency for
the performance of the work for which this permit is issued PERMIT Fff (Sub-Total)
(Sec 3097 Cv C ) j
PLAN CHECKING FEE
Lender s Name
PERMIT ISSUING FEE (/
Lender s Address
I certify that I have read this application and state that the TOTAL FEE
above information is correct I agree to comply wnh all County l
ordinances and State laws regulating Electrical wiring and
y authorize representatives of this County to enter upon
thea ve mentioned pr arty for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
ignoture of ermittee e