HomeMy Public PortalAbout5004 FIESTA AVE_Electrical__ 76A66
h .« WO,m that
have cerci DECLARATION CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT
I ltet'lyFiy affirm that I have a certificate of consent to self CE-806G
insure, or•o certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof (Sec. 3800, Lab. C.)
PQoItc %o. 50Company Tom"ON FOR APPLICANT TO FILL IN JOB
Certified co is hereby furnished. EACH NO. FEE ADDRESS _500"iIL E•
PY Y New Residential Bldgs. & Pools
LOCALITY— (f
Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Ft. g $ C ... ICA
tion d partment. Multi-family Sq. Ft. — NEAREST
CROSS ST. f��
Date Applicant Residential Swimming Pools OWNER OR ,
FIRM NAME /"_� ��
CERTIFICATE OF EXEMPTION FROM ORKERS' Outlets: Rec�LightASw.� MAIL ��
COMPENSATION INSURA CE First 20 ADDRESS
(This section need not be completed if the work involved by Total NoAdditional CITY Tel. No.
.
the permit is for one hundred dollars ($100)or less.) PLAN CHECK
I certify that in the 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
Total No.q Additional
CITY Tel. No.
Date Applicant Fixed Appliances Not Over) HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT AASVL P.04v1D lftJ vlLOElff
Exemption, you should become subject to the Workers' Range_ Heater—D.W. — ,"'�J
Compensation provisions of the Labor Code, you must forth- Oven _ Dryer — W.M.— ADDRESS 311;f U_ G fir, AVO.
with comply with such provisions or this permit shall be Top — FAU —W.H. COU/
deemed revoked. Hood Fan _Other_ CITY Tel. No. r
LICENSED CONTRACTORS DECLARATION LICENSE OR dd
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. REG. NUMBER s Class.rl�I
(commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESS D BY
and Professions Code,and my license is in full force and effect. Power Apparatus& Large Appliances �•
Size & Type HP, KW, KVA, or KVAR' U
License NumberT J� Lic. Class UP to 1 Incl. FINAL
tv Over 1 to 10 Incl. DATE VA✓I I �+
Contractor Date CJ
Over 10 to 50 Incl. A a
FINAL
I am exempt u der Sec. Over 50 to 100 Inc. BY # 0 0 0 0 0 'Z LU
Over 100 ( 0 ° 4 200
B.&P.C. for this reason � '
Date:
Services, Swbd., MCC & Panelboards b ° 0 0 4 2 0 0 5
0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V Q 4,2 6=8 5
OOver 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect.
SINGLE FAMILY Temp. Power Pole &Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Low for the following reason (Section 7031.5, Business and
Professions Code):
I, as owner of the property, will do the work and the Misc. Conduits& Conductors
structure is not intended or offered for sale (Section Other (See Complete Fee Schedule)_ ►
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
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
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and state that the - TOTAL FEE
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
hereby authorize representatives of this County to enter upon
the above-me ed p�r�t for inspection purrpooses. $EE REVERSE FOR EXPLANATORY LANGUAGE
G6
Signature of Permittee It Dat