HomeMy Public PortalAbout9435, 9437, 9441 BROADWAY_Electrical__ i
.� Wm that I have a NSATION DECLARATION 76A653� to/et APPLICATION FOR ELECTRICAL PERMIT {�
1
hereby affirm that I'have a certificate of consent•to self insure,.
CE-906G L1
or a certificate of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
Pcpthc.38000,,Laab. C.)
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FOR APPLICANT TO FILL IN JOB -
_❑ Certified copy Is hereby furnished. J EACHNO. •FEE ADDRES13 jam(/
�I,_ -. ", _ New Residential Bldgs.8 Pools !� _
1 & 2-Famil 'S F LOCALITY
• Cerhhetl copy is filed with the u y bmldin spectign y' q' t' $ $ 1 NEAREST �` , .T
deparhnent,- ��' Multi-family Sq.FL — L_ LQ L
'S '— �(/oily Residential Swimming Pools _ OWNE O l.�
Date Applicant t OWNER OR /�
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CERTIFICATE S OF EXEMPTION FROM WORKERS' 1. 02 MAIL
FlRM NAME G-(7,(,,S'�
COMPENSATION INSURANCE Outlets:Re Light S
' ADDRESS ''•
(This section need not be completed if the work Involved by the First 20 U
permit is/or one hundred dollars($100)or less.) Total No. Additional- 'CITY
,I,certify that in the performance of lhetwoWfor which this permit ' 'PLAN CHECK,
is issued, I,shall not.employ any person in,any manner 0 a5 to APPLICANT m
become-subject to the Workers'Compeon Laws. Lighting.Fixtures- First 20 -. ADDRESS -
Additional
Total No.� CITY Tel.No.
Date Applicant Fixed Appliances Not Over f.HP
NOTICE TO. APPLICANT:. If, after making this Certificate ofPERMIT �' C
Exemption,you should become�sublect to the'Workers'Compensation. Range_ Heater_ D.W. APPLICANT YL I C
provisions of the Labor Code, you must forthwith comply'with such Oven Dryer — W.M. ADDRESS 1�i �D Gj'
provisions or this permit shall be deemed revoked. To FA W.H. {�,
i' _ P 1 � CITY o m jzA de' -o 16 O
LICENSED CONTRACTORS DECLARATION Hootl�Fan Other_
.hereby affirm that I am licensed under provisions of'Chapter'9 - � h, LICENSE OR
(commencing with Section 7000)of Division 3 of the Business and •Disp. nom Air Cond. , REG.NUMBER - Class.
Professions Code,And my license is in full force and effect. -DISTRICT NOPROLE D Y
Power Apparatus&Large Appliances //���+
Size & Type HP,KW, KVA,orKVAR V V.
License Number!Yl J sr7 Lie.Class�� Up to 1 Incl. - FINAL _ - •• �+
r i Ski Tp./ _ 1-31-971
3/_97f .- _ Over 1 to 10 Incl DATE rJ�_ �
Contractor. JJJ "bate _- G VALIDATION Q
If—
El 'I
Over t0 to 50 Incl FINAL /�/ i W
I'am'exempi under Sec: r Over 50 to )CO Inc gy 1�// A_�.T.
B&P.C. for this reason - Over 100 / / ,`�7 j,/t j, N
- Services,Swbd.,MCC 8 Panelboards D - 1 1 I c� ZZ-.
Date: 0- 200 Amp.Under 600 V
Signature 201 - 1000 Amp.Under 600-V TOTAL ist 1 -46
' Over 1000 Amp.or Over 600 V rr���i 14 �4h
Exemption for Reg.Maint.Elect. - •- - - - f:
SINGLE FAMILY Temp.Power Pole & Appurtenances t: y NGE .00
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I herehy affirm that I am exempt from the Contractor's License Law - -
.for the following.reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits _
Code): 2/21/87
Misc.Conduits & Conductors f .2 - 1 AN 9'46
I,as owner of the property,will do the work and,the structure Other (See,Complete Fee Schedule) _
is not intended or offered•for sale (Section 7044, Business
and Professions Code). - - '
1 CONSTRUCTION.LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
i performance of the work for which this permit is issued(Sec.3097, PERMIT FEE - '(Sub-Total) _ -.
\ Civ.W.
PLAN CHECKING FEE - _ -
'; Lender's Name -
v, PERMIT ISSUING FEE
Lender's Address -Ary/jp
certify that I have read this application and state that the above TOTAL FEE
information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize,
represent I* of this County to enter upon the above-mentioned-' ' ' _• --- - -
ProPert fo nsPectidn P es. _.
SEE REVERSE FOR EXPLANATORY LANGUAGE
O'Sil ature of Perlilfitl Date .