HomeMy Public PortalAbout6333 ENCINITA AVE_Electrical__ ORhat I have
a certificate
DECLARATION 75A6e5 10181 APPLICATION FOR ELECTRICAL PERMIT {�
that I have a Certificate of consent to self insure, CE-806G LJ
of Workers' Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
ec.3800.Lab. C.)
Ppb.. Company FOR APPLICANT TO FILL IN. JOB '^
❑ Oe L. opy is hereby furnshe,: EACH NO. FEE ADDRESS
New Residential Bldgs.& Pools _..y-.�
Pf711 8 2-Family, Sq.FG S = 5 LOCALITY
Certified/AJ eretl copy is tiled with the County building inspection
department. Multi-family Sq.Ft. NEAREST
CROSS ST.
Residential Swimming Pools OWNER OR
Date� gpplican //� 'n`, FIRM NAME
CERTIFICATE OF EXEMPTIO FROM WORKERS' Outlets:Rae 2—/ Light �✓ Sw. -MAIL
COMPENSATION INSURANCE ADDRESS '
(This.section need not be completes if the work Involved by the First 20 -
permit is for one hundred dollars($100)or less.) Total No. Additional
CITY Tel.No.
p:Lcertify that in the performance of the work far which this permit _ PLAN CHECK
is issued, I shall not employ any person in any manner So as t0APPLICANT.
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS _
Additional CITY Tel.No.
Total No.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Fixed'Appliances Not Over 1 He PERMIT
Exemption.you should become subject to the Workers'Compensation Range_ Heater_ D.W. _ APPLICANT
provisions of'the Labor Code, you must forthwith comply with such - Oven Dryer _ W.M._ ADDRESS
provisions or this permit shall be deemed revoked. Top _ FAU _ W.H. .
CITY Tel.Na
' LICENSED CONTRACTORS DECLARATION Hood — Fan 1— Other_
I hereby affirm that I am licensedunder provisions of Chapter 9 LICENSE OR +1 [y�
(commencing with Section-7000) of Division 3 of the Business and Disp. —,Room Air Cond. 4 O Class.
REG.NUMBER
Professions Code,and my license is in full force and.effect. DISTRICT NO. PR EO BY
Power Apparatus 8 Large Appliances , o
11 / Size & Type HP,KW,KVA,or KVAR
License Num erg.- J 7!' Lic. Class •Up to 1 Incl. FINAL - V
0��1���i Over 1 to 10 Incl. DATE V130#1
f Z� VALIDATION
Contract - C/��"'•�—.Date dJ / 7 Over 10 to 50 Incl.* FINAL d V
ElI am exempt under Sec. Over 50 to 100 Inc. BV I W
B.BP.C. for this reason Over 100 N
..Services, Swbd.,MCC&Panelboards D _ Z
,Date: 0- 200 Amp.Under 600 V
Signature . 201.- 1000,Amp..Undei 600 V
❑ - Over 1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect.
-SINGLE FAMILY. Temp.Power Pole& Appurtenances 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law �`�T�a
for the following reason (Section 7031.5,Business and Professions Additional Sign Branch Circuits •
Code): _ 3307 _ .. 22.00
❑ _
I,as owner of the property,will do the work and the structure Misc.Conduits.& Conductors 1 IT
Other(See Complete Fee Schedule)
is not intended or offered for sale (Section 7044, Business D
and Professions Code). . - 1 1 TOTAL
22 a 00
KG1 nL
r•�.
CONSTRUCTION LENDING AGENCY 1 C y 22M
I hereby affirm that there is a construction lending agency for•the A�N�fE�-� •,r
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub:Total) �ra�1� .00
.Civ.C.). /-
PLAN CHECKING FEE V
Lender's Name 0000-0001 8/24/89
PERMIT ISSUING FEE
Lender's'Address 7... . -. .. 5277 1 QM D
1 certify that I have read this application and state that the above TOTAL FEE V�5J
information is correct. I agree to comply with all County ordinances
and State laws regulati g Electrical wiring, and hereby authorize "
representatives of his ounty to enter upon the above-mentioned - ^• - -- -
prope y-for ins ti erposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature o Permi tee Odle