HomeMy Public PortalAbout10870 FREER ST_Electrical__ IOR that
I COMPENSATION of,con erit to
� 1081 APPLICATION FOR ELECTRICAL PERMIT {�
that I t,ave s�certiflcate'of�eeneerd to serf kmrie, Ll
of Mbrkena' Compensation Inmrance, or a certNbd COUNTY OF LOS ANGELES BUILDING,AND SAFETY
(Sec.3800q,Lab.a) v
i-,• OS O J Ty 71��1 +1 1�P FOR APPU(.ANT TO,RLL N JOB R V `
0 Certified copy Is hereby furnfatued. —� New Redderrt Brigs.& Poda EACH NO FEE ADORES D
CertHfed copy Is filed wtth the dY building h,epeetton 1 & 2-Famlty,S4 Ft. t S _ S LOCALm LTr G[T
NEAREST
departrnent n Mufti famCy sq Ft ST. d 14
Date Q9 Am t Residential 3wtrnnilng Poole OWNER OR
FYN MAME ilir
CERTIFr_ATE OF EXEMPTION FROM WORKERS', Outs Ree—Light—sw. MAL —
COMPENSATION INSURANCE ADDRESS C
{This section need not bo completed If the work lm-ot by the Total No. FIretAddl2nel �Y Tra W+ �� TeL Na 7
permit Le for one hundred dollars(=100)or k4m)
EtX
I certify that In the perform ,the ch th
erpe of e work for while permit SANT
is issued, I shall not alnploy arty person In any planner so as b
become subject to-the VNbrkera'Combn pereatLowe. Uphting Futures Brat 20 ADDRESS
Total No. Additional �_y TeL No.
Date APP�errt �.. Fixed Appoances Not Over 1 HP PERMFT
NOTICE TO APPLICANT:. If, after maklilg this cerlifioate of
ExempOw,you should became 8ubJeot to the Workers'Compensation Range_ Heater_ D.W. T, APPLI[•.�fJ'i �'
provisions of the kabor Code, you must forthwtth oompfy with such Oven _ Dryer _ W.M._ ADDRESS
provisions or this permti&hail be deemed revoked. Top — FAU W.H.
LICENSED CONTACTORS QECLARATION Food Fen Other CITY $ >�� p� Tel.Na $(�
I hereby affirm that I an Ibersed under provisions of alepter 9 D+qp- _ Room Air Cond. aWmmyt�3 r
(corrimendng with section 7000) d Dlvtskxi 3 of the Brlslness end
Profeaaiorm'Code,and my Ibenae Is In full force and effeot Power Amwutus& Lalw"Wx�ao DL9TR)CT NK). r y �g�BY
c etre d Type HP,KW,KWt or KlAR `U O
Llcenee Number 8 t J Lb.sass V Up to 1 Ind. FINAL (�
C Over 1 to 10 1ncL DATE D 0.'
to t Over 10 to 50 Incl.
(J� FINAL
❑ I am exempt under Sea l i Over 60 to 10b Inc BY
BAP.C.for fids reason Over 100
Services,Slvbd_MCC S Penelboerds ,
0-200 Amp.Under 600 V p
201 - 1000 Amp.Under 600V
Over 1000 Amp.or Over 800 V
❑ Eaemp6.for Reg.Meint Elect.
SINGLE FAMILY' Temp.Power Pole& Appurtenances
....
HOME OWNER-BUILDER DECLARAnON Sign wkh One Brash ChcL& , 3
I hereby affirm that I am exempt from the Coat aotors License Lave ,Addttbnal Slgn Brenoh ara�ta - - AMA for the folbwirp reason(Section 7031.6, Buakxm and Prdeselone 1f1v41■t
`ode): M7 78.80
❑- 1,as owner of the property,wt➢do the work and the atr acture Mlao.Cordrutts&Conductors-
la not tritended or offered for sale (Section 7044, Buelneas Other(See Conplete Fee Shcod ) 1
and ProfesabT�fna Code). ," 1 V 1
CONSTRUl I, N LENDING AGENCY ['Kl^ 78.5D
I hereby affirm that there is a conetruotbn lendtrrg agency for the `^'�Y
performance of the work for,which this permft Is issued(Sea 3097, PERMFF FEE (Sub-Total) .00
Civ.C.).
PLAN CHECIONG FEE
Lenders Name �" 1 7�19/89
PERMfT ISSUItJ(t FEE
Larders Address Ta1 AM11148
I certNy that I hhve read this appkat4m and state that the ebav+e TOTS FEE ft
krformafbn Is oonect I agree to comply with all County ordklanoes
and•State iews ragi&rbN Ebotrioal wlrfrp, and hereby authortze
repreaertthYfvea of this County to enter upon the above-mentioned
for Inspection pu w SEE REVERSE FOR EXPLANATORY LANGUAGE
re of PermRteebete k