HomeMy Public PortalAbout9033 CALLITA ST_Electrical__ WOtthat I have
a certificate
RATION DECLARATION 20-0019 DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT
6-001
I hereby aPi7[;that I have a certificate of consent to self insure,
or a certificate�of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
codythereof(Sec.3800 Lab.C.) v ,lw, '
Policy No. Company r FOR APPLICANT TO FILL IN JOB
ADDRESS
Certified copy is hereby furnished. .t New Resitlential Bldgs.&Pools EACH - NO. FEE � LOCALITY
❑ Certified copy is filed with the county building inspection 1 &2-Family,Sq.Ft. $ — $ 3 --
t NEAREST ✓a 1�
department. - Mullifiamily Sq.Ft. NEARS ST. ylk�F�V
Residential Swimming Pools ASSESSOR /"a PAGE !/�t�/ PARCEL 4
n
Dafe Applicant MAP BOOK
CERTIFICATE OF EXEMPTION FROM.WORKERS' Outlets:Rec.iL_Light J_-L___Sw.L OWN R OR ..
1 COMPENSATION INSURANCE, T1)_0 FIRM-
ME
First 200--rprMAIL
(This section need not be completed if the work involved by the Total No._4�111_ Additional ADDRESS
permit is for one hundred dollars($100)or less.) '
I certify that in the performance of the work for which this permit S -- - CIT. Tel No.
is issued, I shall not employ any person in any manner So as to PUN CHECK
become sub act to a Workers' Compensation Laws. Lighting Fixtures First 20 - APPLICANT -
� _
Date Applicant r maks g -"�^ti���C' Total No._15OR20A;120VBRANCHCIRCUITS
Additional ADDRESS
NOTICE TO AP LICANT: It, after making this,,Certificale of CITY Tel.No.
Exemption,you should become subject to the Workers'Compensation 1 TO 10 INCLUSIVE EACH
provisions of the Labor Code,you must forthwith comply.with such -11 TO 40 INCLUSIVE EACH PERMIT
P -� - - APPLICANT
provisions or this permit shall be deemed revoked. 41 OR MORE BRANCH CIRCUITS EACH }
LICENSED CONTRACTORS DECLARATION _ ADDRESS
I hereby affirm that Iam licensed under provisions of Chapter 9 150E 20A,208V TO 277V LIGHTING EACH O
(commencing with Section 7000) of'Division 3 of the Susiness,and _ _ _,_ - _ - _ CITY T.I.N_
Professions Code,and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR 7 � Ctxae_
.p!.�•.rry�' x1 Power Apparatus 8 Large Appliances REG.NUMBER 7
License Number `'` ` — , Lia Class C- 1y Size 8 Type HP,KW,KVA,or KVAR DISTRICT NO. p PROCESSED BY
Up to 31nc1. - — �CO ZLA�6 z�cJ a
�� �{���{� Over 3 to 10 Incl. FINAL
Contract o Yr �. - Date _ _ - _ _ -❑ DATE Z Over 10 to 50 loci. - VALIDATION
I am exempt under Sec. Over 50 to 100 Incl.
Over 100 - _ " - FINAL -
8.8P.C.for This reason- BY
Services, d.,MCC&Panelboards
Date: 00 Am Untler 600 V _ Q Q -
Signature __201 Tip.Under600V - -
❑__ Over 1000 Amp.or Over 600 V -
Exemption for Reg.Maint.Elect.
9
SINGLE FAMILY Temp.Power Pole&Appurtenances ACCT i
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit .T
I hereby affirm that I am exempt from the Contractor's license law - 142.29
for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits _ .-. 3351!1 7
Code): - 1 T4eN
❑ Misc.Conduits&Conductors - - -- - - 1 I I MS
I,as owner of the property,will do the work and the structure 142 - 29
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule)
_ D TOTAL
and Professions Code). -
CHECK 1422B
CONSTRUCTION LENDING AGENCYCHANGE .00
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec. 3097, PERMIT FEE_ --._ - _ - (Sub-Total)_,
Civ.C.)
PLAN CHECKING FEE _ _ OOW-0001 8/25/92
Lender's Name
PERMIT ISSUING FEE _ �1�7 1 AM 8:59
Lender's Address - -
I certify that I have read this application and state that the above TOTAL FEE t
Information is correct. I agree to comply with all County ordinances
and SLa.to laws regulating Electrical wiring, and hereby authorize
r resen ativ f t ounly to enter upon the above-me boned " ' -" -- - --
rapert or nsp ction p, f SEE REVERSE FOR EXPLANATORY LANGUAGE
� 7 ars
R AGENT
SIGNATURE OF APPLICANT 0 oAT �L