HomeMy Public PortalAbout9441 1/2 LAS TUNAS DR_Electrical_2/15/1989_Three Amigos Temp Power Pole AP.PLICATION..FOR ELECTRICALPERMIT
s WORKERS COMPENSATION DECLARATION` -C6A6663 10/81`
E-80 G
I hereby affirm that I have a'certificate of consent to self Insure;.
cr.a certrflcate'of Workers' Compensation Insurance; or a'c 'fieii x,. COUNTY OF LOS,ANGELES BUILDING`ND SAFETY
opy thereof(Sec: Lal C.
.;Policy No`.. IOmpany - aFORAPPL(CANTTOFILLIN,' t+ ,' .JOB - /� -
Certified copy Is hereby furnis d RTG „��L!'•" New'Residentlial Bldgs:& Pools
EACH Nb.,I, FEE
. 1:&,2,Family,Sq:'Ft a.
,.Certified copy Is filed,with t e'county,buil n -in5p Toa
DRESS': e
"departmeht:"+' i ).' _ Multi 4aamily Sq Ft.
-
: NEAREST.
�1 Residential Swimming Pools
j // _ _ ROSS ST
B�p
..APPIIC � OWNER O
'FIRM.NAME
vb s•
CERTIFICATEtOF,EXEMPTION FROM;WORKERS: MAIL
Outlets Rec Light
-`COMPENSATION INSURANCE• F''S ADDREss• GG P
,,
(This section need not befcompleted'if'the work involve_d•by.the First 20 a ;2 CITY"'- Tel.No:'•'
permit is for one hundred dollars($100);or jess) Total,No, Ad'dltlonal,,.`
.. 1:certify,that, ' .PLAN' HECK �
'�
P y; Y p y
is Issued„l.shall not,em to any,person In an manner;so as.to • ,,
become`+su6ject to the Workers'Cofnpensation Laws Lighting Fixtures First 20 .,ADDRESS
s,
� Additional,
Total No:” CITY Tel.No:`
Date Applicant
Fixed Appliances Not'Over 1 HP PERMIT
NOTICE, TO APPLICANT:'-.If, after y.makingi:this :Certificate, of
.,- , ' .. •.APPLICANT.
Exemption,-you should become subiectto the,Workers'Compensation Rarige'_ Heater_ D.W.
provisions.of the,:Labor Cod_e,,you must forthwith comply.with`such< :. Oven _•Dryer W,M ADDRESS S�
-,p, - P II be deemed revoked., Top;:.—;.FAU
.57
N ore
or this ermlt shall r: i
-,pr visions L .— w CITY
LICENSED,CONTRACTORS
dDECAROood Fan, Other
Tel NdP {'
' .,• H
herebyaffrmhatI mlcenu sof Chapter 9
LICENSE OR
(commericing with S,ection�7000) of Divisiom3'of`the Business and Dls Room Ar C
p'�- - REG NUMBER
Professions Code;and my license is in""full'force and effect .Power DISTRICT NO PR CE EDB
„. L 'Apparatus&Large App lances 0
ra
9
Size&Type HP;KW KVA,.0r KVARl
License Numper
/ Llc.Class S d Incl FINAL
` G Over 11 to 10 Incl VALIDATION
Conttact0 - pate m�'� `' / 0 -
Over 10 to 50 Incl.,.
.
TE
FINA
I am exempt"under.Sec. :, z + Over 50 to_100 Inc BY L
-
BAP.C.for this reason'
Over 100 d'
Cn
Services Date MCO&'
Panelboa s
Swbd„ rd Z'
' 0- 200 Amp.`'_Under.600 V
Signature201 '1000 Amp,Under.600 V-,
Over 1000 AMP.L or Over 600 V
❑ Exemption for Reg.Maint Elect:
SINGLE FAMILY -Temp Power Pole& Appurtenances
HOME'OWNER-BUILDER DECLARATION Sign with-One Branch Circuit` Q -
I:hereby-affirm that-`Fm exempt from the:Contractorjs License Law.:
for-the followin reason(Secfion 703:1.5,Busine'ss.and Professions. Additional Sign Branch,Circuits'.
g
.Code) awl l� f
I;as owner of;the ro ert Mist Conduits&'Conductors
p p, y;will do the work and`the.'structure"
T 0
,i
-is'not intended'or'offered for sale (Section ZO4:4, Business '' Other(See Complete Fee Schedule)
•
and P,rofesslons Code). fffAl 50
CONSTRUCTION LENDING AGENCY p ;
N i 4 `a 0
I Thereby affirm that_there is:a.construction lending,agency for the
performance.of.the' for which this permit is issued(Sec,3097, .. PERMIT FEE (Sub-Total)-
CHANGE
lf, `
�. PLAN,CHECKING FEE d
Lenders at i i 9` �1 �� 9
t I i _t ea
PERMIT SUING;FEE _
Len ddre's`s 1 a w°
1, tlf -that I ha ::rea this application.and state that the above: TOTAL FEE t� ` '�O
i for tion is co ect. agree. comply wdh'all County ordinances ?
rid State,law reg ting ctrical.,wring, and hereby, authorize;,:
. enter upon the above;mentioned.-
e esentatives of h is Co t to ent
y
J.
ty for Ins . h p..po s
L
SEE REVERSE FOR,EXP ANQTORY:LANGUAGE _
Iria
'g tore of P rmittee, . I. Date
,