HomeMy Public PortalAbout8606 GARIBALDI AVE_Electrical__ woC� an��pNx '°'81
hy affirm thatle ceconsent to -H APPLICATION FOR ELECTRICAL PERMIT
• Insure, or a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certlfled copy thereof (Sec. 3800, Lab. C.)
Policy No. Company MW APrl�l TO PLL N JOB
Certified copy Is hereby fumished. New Reside-i
Sq. Ft. LOCALITYLOCALITYtial Bldgs. 8 Pools EACH NO. FEES
1 d 2-FamllAD- _L:1.�.. s _ s
Certified copy Is filed with the county building Inspec-
lreax le (:W-
tion'department. Multl-fomlly Sq. Ft. NEAtEST
Residential Swimming Pools CRCSS T.
Date Appl Icant OWNU OR
FlRM
CERTIFICATE OF D(EMPTION FROM WORKERS' Outlets:Rec�Llgh1 ' Sus. ADDS c
zr
COMPENSATION INSURANCE First 2Q
(This section need not be completed tf the work Imrohred by Total No Additional CITY rZyeI. No.
the permR Is for ww hundred dollars($100)or less.) :t
Dick
I certify that In the performance of the work for which this APPUCANT
permit Is Issued, I shall not eMploy any person In any manner Lighting Fixtures First 20 ADDRESS
so as to become subject to the Works CompensatI6n g g
X2-22 Total No Additional
Date AT+pllcantICIT`y Tel. No.
NOTICE TO APPLICANT: If, after making As CertificaAPAr-ANT A.)te of Fixed Appliances Not Over 1 HP p�T
Exemption, you should become subjeto- .W
the orker} Range_ Heater_D.W. —
Compensation provisions of the LQbor Code, you must forth- Oven _Dryer —W.M.— ADDRESS
with comply with such provisions or this permit shall be .Top — FAU —W.H. —
deemed revoked. Hood — Fan _Other— CITY V Tel. No.
LICENSED CONTRACTORS DECLARATION Disp. — Room Air Cond. LKBqSE OR Class.
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business es DISTRICT NO. BY
and Professiors Code,and my license Is in full force and effect. Power Apparatus 8larpe AA
Size 8 Type HP, KW, KVA, or or K VAR' 51
License Number Llc. Class Up to 1 Incl. ✓" FINAL
Ovet 1 to IQ Incl. DATE i wDAT1OH O
&nhoctor Date Over 10 to 50 Incl. 0
FI
I am exempt under Sec. Over 50 to 100 Inc. BY
B.BP.C. for this reason Over 100
Date: Services, Swbd., MCC&Panelboarcii
0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Urk*600 V
Over 1000 Amp. or Over 600 V6 4 A
Exemption for Reg. Malnt. Elect.
SINGLE FAMILY Temp. Power Pole 8 Appurtenances # o o a o o 2
HOME bWNER-BUILDER DECLARATION Sign with One Branch Orcult 1 0 - 29.25
1 hereby affirm that I om exempt from the Contractors License
Law for following reason (Section 7031.5, Business and Additional Sign Branch Circuits o.e,0 2 9,2 5 Ft
ns Code}:
I,-as owner of the property, will do the work and the Misr- Conduits 8 Conductors 1 224-86
structure Is not Intended or offered for sale (Section Other(Soo 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, Cly. C-).
QCC� PLAN CHECKING FIE
Lenders NameS��'C � V
PERMIT ISSUING FEE
Lenders Address
I certffy that I have read this application and state that the I TOTAL FEE ,5
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 ve-mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
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