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HomeMy Public PortalAbout10952 FREER ST_Electrical__�� �� J WORKERS'COMPENSATION bEG AFiATION ' 10'81 APPLICATION FOR ELECTRICAL PERMIT {�� I hereby aM n that I have a OKWIcate d ns ooent to self Hare vLJ ce a certffioate d Vubrlcom'" COmpeneatbn Insurance, or a certltled COUNTY OF LOS ANGELES BUILDING AND SAFETY copy thereof(sec.3800,Lab.C.) Posoy No. cornParry FOR APPLIC-M7 TO Rl IN' .109 Q' CerUfled oopyJl.hereby fid" New%eldenttal Bldgs.8 Pula EACH NO. FEE Q' CerdW oOpy b fled with the county binding kwpecdon 1 b 2-FsmDy,Sc��Ft.Z NEAFEST ����rnt" M3  s I oc�v1rY " �� depulti-family Sq.Ft CROSS ST. Dabs ARPlbent Reaidentiel&m.- ing Pools OWNER OR Ff#1 NA AE CEMr{ . r-- OF EXF1v1 QN.FRO M WORKERS Oft&Roo LIVA  Sw. Alii s COMPENSATION INSU ANOE ADOFtE88 S'��' .S Ghia Motion.need nQt be cortrpieW If the worly Invotved by the First 20 Z 6t peimtt M for ane l undr.d dol In r.($100)or i.M.) T��Na" Addftlonel ��YCA a T.I.Na CVECK I certify that in the performance of the work for whbb thio permit PLAN iQ beued,I aiW rpt ernpioy any Person.In arty manner so as to bwxxm skoct tp4he Wbrkard Clore ieaticn LJghtlng FM First 20' ADDRESS Totnl Na Addftlonel CRY Tei.No. Dflta Ap~ Fboad ApOLE.tr es Not Over 1 HP PEFMT NOTICE TO ��, It, after makft thio Certfticate at E, ,,you"Id��ne���boot to ttae.VrbrkKe C4apen a[bn  Heater D.W.  APax'wT _ provwone Of the La" lode,you must "-b- th=npty wdth such Oven  Dryer W.M._ ADDAE P �� or.V*pry 0-11 be deemed revoked Top  FAL1. WJ-L ' Tel. LIOErI$ED CONTRACTORS DECLARATIOt( Hood Fan. Other_ I Nvpby.pTam that I-am I ense�� under prwktdorg'd Ciapter 8 DI :Room Air Cond. REQ NUAB R - CkwL . (mnmenoYp with Section 7000) d Dfvlebn 3 of.the Btgsess and R4mabOde,and my DOerrse 6 In full force and-effect ������ Power Apparahm 6 Large Applhncee otsrraCT N0. oe Code, " Size d Type HP,KW,KW,or KWRAV ez 47 ucerlee Number Lic Cieea C '��O Up to 1 Incl. FINAL _ Over 1 b:),10 Ind. COntractDrDate ��'.����''��1 ����4 ��������. NOIJIDATIO b. Over 10 to 60 Usd FINAL ry} p1 em exerrifr)under sec Over 60,to 100 Inc BY BdP.C.for this reason Over 100 Cl) Servloe4 Swbd M(>?'S'Paneiboerde Z Dem 0-200 Arte.Under 800 V 201 - 1000 Amp,Under 800 V Over 1000 Amp.or Over 800 V Q' EMmpoon for Reg" Maint.Eied 1 s SWOLE FAMILY Tamp,Power Pole d Appurtenances 2 HOME OWPER-BUILDER DECLARKIl N Sign with Or*Branch Glnu t I h6reby affirm that I am,a)empt from the Contractoes Lloenae Low Addltbnel'SlgrTBranch Ciradts 171x41. for the ibllowing reason(Seotlon 7031 b,Bu*oM and Protest " Ccxje):. 3307 123.90 Mieo.Condutts A Conductom Q'. I,ab owner of d-m property,vAl do the work end the atruxsture attnAr(sera Cortrpieta Fee Schedule) 1 is not'Intended or offered for ease (Secti)n 7,044, Business and Profeeslons Code). TOTAL 1 V 1 AL i2:y 90 CONSTRd1CT10f4 LENDING AGENCY QECK 123.* I hereby,afitrm that there is a bonetruotion lending agency for the ����iiAt�� performance of the work for whJch this permit Is issued(Sea 3087, PE-RMR FEE (Sub-Total) " w CIV.C.). PLAN CHECKI1`40 FET - ������ Landau's NamTh e 'PsWrr ISsum FEE p 41r1.tYy11JV"1J1 l 154 �� w Iry p7 Landers Addraw I oertlfy that I freve read thie appDmdm and sWie tflet the above TOS FIE. d Ymiormatbn b oo aoL I agree to oompty with al Courtly ordtnaaoee end Stela Tawe regulating Eieofrbnl wlrtrQ and hereby authortze reoresor s County tc eater upon the above-mentioned SEE REVERSE FOR EXPL-ANArORY LANGUAGE ` stf��o(Pernittee Date