HomeMy Public PortalAbout5520 PARMERTON AVE_Electrical_3/14/1990_light outlets, switches, receptacles 0
WORKERS COMPENSATION DECLARATION 20W19DM3/87 APPLICATION FOR ELECTRICAL PERMIT
1 hereby affirm that I have a certificate of consent to self ce e�ow
wsure or o certificate of Worker Compensation Insurance COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS
or a certified copy thereof (Sec 3800 Lab C )
Policy Nomwh0-91.mpony 'CATE tNUQ FOR APPLICANT TO FILL IN JOB r n ��n • '
Certified copy is hereby furnished New Residential Bldgs 8 Pools EACH NO FEE ADDRESS 5520 P*V-m C-r&ToM Au e
✓1 Certified copy is filed with the county building mspec 1 & 2-Family, Sq Ft b — S LOCALITY M G Ty �7 b
N NEAREST
non departgment Multifamily Sq Ft
Date 3_13— `0 I QQ''_ Residential Swimming Pools CROSSOWNEROS nTA �\ 7r 1AVE-
App leant- �EOW FIRM NAME E6• ✓�L(r X3.5 $
CERTIFICATE OF EXEMPTION FROM WORKERS Outlets Rec
Ught_t 2 MAIL
COMPENSATION INSURANCE � Q First 20 ADDRESS
(Thu section need not be completed If the work involved by Total No Additional CITY Le a Tel No
the permit a for one hundred dollars ($log)or less ) PLAN CHECK
I certify that in he performance of the work for which this APPLICANT
permit is Issued I shall not employ any person in any manner
so as to become subject to the Workers Compensation Laws Lighting Fixtures First 20 ADDRESS
rr -\ Total No Additional CITY Tel No
DateApplicantApplicant �r0—�0 �N/ Fixed Appliances Not Over 1 HP PERMIT 1
NOTICE TO APPLICANT If after making this Certificate of APPLICATION V B�QOIV/
Exemption you should become subject to the`Workers Range— Heater—DW
Compensation provisions of the Labor Code you must forth- Oven _ Dryer —W M — ADDRESS gSS2 I{'/111Y5 [daN /}ue
with comply with such provisions or this permit sholl be Top — FAU —W H —
deemed revoked Hood Fon —Other— CITY 1•,1 ` Tel 631-
LICENSED CONTRACTORS DECLARATION Disp Room Au Cond _ LICENSE OR
I hereby off vin that I am licensed under provisions of Chapter 9 REG NUMBER 15 ZU$I Class A61
(commencing with Section'7000)of Division 3 of the Business Power Apparatus& Large Appliances DISTRI T NO �&/ PR $SED By Y
and Professions Code and my license is in full force and affect s ][ D_
152,081
�wQ I Size&Type HP KW KVA or KVAR (J 0
Cleanse Number J�i+CJ Lle ClanV
6 Up to 1 Incl FINAL
_) 3-13-1� Over 1 to 10 Ind DATE• VALIDATION \ ITO
Contractor v�g�• D to Over 10 to In
❑ Wcl FINAL ` H-'
am exempt under 5ec Over 50 to 100 Inc By r I W
B&P C for this reason Over 100 CIL
ZDote Services, Swbd , MCC & Ponelboards
n 0- 2030 Amp Under 600 V ,
Signature 201 - 1000 Amp Under 600 V i
❑ Os er 1000 Amp or Over 600 V
Exemption for Reg Maint Elect
SINGLE FAMILY Temp Power Pole 8 Appurtenances
HOME OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor is License
Sign with One Branch Circuit ACCT ''
Low for the following reason (Section 7031 5 Business and Additional Sign Branch Circuits �
Professions Code) V 3'SO7 39.+20
I, as owner of the property will do the work and the
Mise Conduits &Conductors 1 ITEMS
structure is not intended or offered for sale(Section 7044 Other (See Complete Fee Schedule)_ PON. TOTAL 39 - 20
Business and Professions Code)
CONSTRUCTION LENDING AGENCY CHECK. 19.tU-
I hereby affirm that there is o construction lending agency for CHAh1GE �(
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 0000'I]QG 1 3/14/90
Lender s Address PERMIT ISSUING FEE 1 9504 1 AM 909
1 certify that I have read this application and state that the TOTAL FEE -
above mformaiion is correct' I agree to comply with all County IRV
ordinances and State jaws regulating Electrical wiring and
hereby aut ri represent tives of this County to enter upon i
the f v pro rty for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
3-13-90
Sk6noture of Per7fifbe Date