HomeMy Public PortalAbout9000 GARIBALDI AVE_Electrical__ KDN
WORKER'S coMPENBA cato Df consent
to .7UM DPW(12-91) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I haw a certificate of consent to self Insure,
or a certlfloate of Worker's Compenaatlon Insurance, or a certlflad COUNTY OF LO$ANGEJ.-ES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV.
oopy thheyrwf. Seo.3800 Lab.C.) J 1
p��Q r,..,rn 6 !�[q roe Araucatrr ro r�o+ .119111 ✓Q� 1
❑ Certfled copy le hereby furnished. �—%�)�. New Rekidentlal BWga.8 Pools NO. EACH FEE
— i $ LOCJUJTY
yis MQd whth 1 S 2 lenity,Sq.Ft NEAREST
Muftl-4anh4y Sq.Ft CROGS 8T.
Reald frtlal Swhnmhtq Pooh ASSE680R
MAP B" PAGE PAFKXL
CERTIFICATE OF EXEMPTION F1BOA1 WORIOR8' Off;Reo._IIght Sw. GwHE7a
6OMPENSATFON INSURANCE
(This sect] ri d nH nseot be completed tisk work Involved by the Total No F � ADpRE88
nis <_
�1
pelt la for one hundred dollars(3100)or less.)
I certify that In the performance of the work for whloh this permit CRY Tk
la Issued, I shall not employ any person In any manlier so " to PLAN CIC(
beoome subject to the Wprkers' Compensation Laws. Llgh&c Rxtu roe Rrat 20 APPLICANT
Totd No. Addtttonal
ADDRESS
Data ApQHoarrt RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CfTY T@LNo�
Exemption,you should beoome subject to the Workela' Compensatlon OTHER APPLIANCES NOT OVER 3 HP.
PE3i1fr
ptovlslons of the Labor Code;you must fortthwtth comply v41th such Power App—tus l4 Large Appaar—
pfovlilons or this permit shall be downed revoked.
LICENSED CONTRACTORS DVCLARATION St ra d Type HP,KW,KVA,or KVAR
I hereby affirm that I an licensed under provisions of Chapter 8 Over 3 to 10 Ind.
(commencing wtth Section 7000) of Division 3 6f the Business and CITY TK leo
Profusions Code,and my license Is In full force and effect. T— ter 10 to 69 Ind LKA34SE OR C� a
Over 60 to 100 Ind. Rte.NLa�
License N umber(�L 1-5-272— LIo.Claes or.r 100 DfBTRICT NO. EY
Servfose,&wbd.,MCC 8 Panelboards •��
cc.wa_ , � 0-399 Amp.Under 800 VDATE O
❑ '--I am exwnpt under Sea 400 1 DD Amp.Under 800 V
U
Over 1000 Amp.or Own 900 VVALIDATION W
FINAL a-
-B,&P.C.for this reason BRANCH CIRCUIT FEES BY f)
Dear.
18A,or 20A 120V LfghtbV or Rsoept Z
1 To 10 Branoh Clroutts
Sigrudu re 11 To 40 Branch Ctoufs
41 Or More Berth Ctrctfs
❑ Exemption for Req.Mnlnt Elect 16A,26&209V To 277V Br.Ctcuws ?
y
HOME OWNER-BULDERILDEC✓.ARATION Temp.Power Poo S Appurtenances ACCT.lr
I hereby affirm that I am exempt from the Contractor's Llownae Law ��0ne Branch CfrouR 1 {nry�6 rry�
for the following reason (Seotfon 7031.8, Business and Professions AddTdccW Sign Branch Germ 3307 i T 107•u'
Code): �— ,v 1 ITEMS
❑ I,as owner of the property,wIll do the work and the structure Mtfso. a��cre
Is not Intended or offered for sale (Seotlon 7044, Business Other(See Complete Fee Saheduie) , TOTAL iQ
and Professions Code). £�
) 109.Utii
CONSTRt1CTION LENDING AGENCY �t Iw11rr � l
I hereby affirm that there Is a constructlon lending agency for the
perfounanos of the Work for which this permit Is Issued (Sec. 3097, PERMIT FEE (Sub-Totao
Chi.C.) PUN CHECKING FEE LOM-"l 3/15194
LerxWs Name PERMIT ISSUING FEE 4347 1 AM10:2
Lenders Address
I certify the I have reed this applioatk n and under penally of pudury state TOTAL FEE O .
that the above Infomwbw M oorroct I agree to oomply with al County
ordlnancee Lane regufafing Eledrlcal wiring,and hereby authortxe
Is County to enter upon the elbove-merttloned property
for I C SEEFEVERSE FOR EXPLANATORY LANIQUAGE
�J
OF
WORKETr8 coMPEN8AT10N DECtARLATICM �;°°x"`12 91) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm thgtJ have a'oertlflcate of consent to calf Insure,
or a oertiflpa(p W Workers Compbnaatlon Insurance, or a certlfled COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
ocpy therdof{Seo.380(Y`Lab.•C.). .
Ponoy Nb- T Company Fon APPLICAMT To PILL IN X88 OCQ 1 L
El.--. Cert!W copy b hereby fumlehed. New ReskWetW Bldgs.A Pooh NO, EACH FEF
Q d = LOCALITY
❑ .CertMed copy Is filed wRh the cornty budkjng Inspead n 1 A z-Famfly,Sq.FL
d�partTnertt Mufti a"Sq.Ft geese ST.
Date Appkant Reeldentiel SW m hV Poole 11/P B00f( a 7 PAOE� PARCEL
OR
CERTIRCATIr OF EXE)AP-RON FROM WORKERS' Ovtists:Roo._LIgM Sw.
COMPENSATION INSURANCE Rom��
AIL
(Thla section n"4 not be completed tf the work Involved by the Add oral 4ADDRESS
Parrott is for and hundred dollars($100)or lees.) Toted No. Addltbnal
Icertify that In the performance of the work for which this permit CITY TK
Is lasued, I shall not employ any Person Ir any manner eo as to PLAN CHECK
become, blect,t the Workera'Compen Lave. Lighdnq Fixtures First 20 APPLICAW
Total No. AddRional ADDRE8Pwp�T. N -d" RESIDENT8
APPLIANCES
NOTKCE TO,A Pl_ICANT: If, after mitking this Certificate of d NOT OVER 3 HP. CITY Tel.No.
Exemption,you should become aubfeot to the Workero' Compensation OTHER APPLIANCES NOT OVER 3 HP.
pro"ons of APPt.t the Labor Cods, you must forthwith comply with such Power A Large Apprlancee .NT 1
prbvlAlons or this permit shall be deimod revoked.
LICENSED CONTRACTORS DECLARATION Size A Type HP,KW,KVA,or K(VAR ADDRESS
I hefeby atfTrm that I aryl Ilosnabd under proylelons of Chapter 9 Oar 3 to 10 Ind y Tr No 3 3
(commencing with Seotlon 7000)of Dtvlsron 3 of the Business and
Profaeslons Code,qnd my Iloense Is In full force and effect- Over 10 to 80 Ind. i rFNWOR
CAO
Over 50 to 100 htid. REQ NLNBr=R Com' d
Over 100 Dt8TR1CT NO. PRql jEDBY
Llowrse Number Llo.Class �y f S
Services,Swbd.,MCC A Parmilba ds (/U I
contrsoc�r . _L')'AC—Oa4��4 4 - . . -- DATE 0-3QQ Amp.Under 800 V
El I am exempt under Seo 400 1000 Pmp.Under 800 V J1 — VALIDATFON W
Over 1000 Amp.or Over 600 V SAL d
- -B_AP.C.for thltBRANCH CIRCUIT FEES BY to
- - Data: 18A,or 20A,12OV,Lfghttng orReos t. Z
_- 1 To 10 Branch Clrcutts
11 To 40 Branch C#u>ib
41 Or More Branch Ctoubs
❑ -Exsrhption for Reg.MahrL Elect. 1&A,20A,2C6V To 2TN LVittno Br.CIrmIts
1
HOME OWNSINGLE AM DECLARATION. Temp.Power Pole A Appurtefwnoes _ —— _� y -
I hereby affirm that I am exempt from the Contractor's License Law '" One Branolr ClrmdY Al CT■i 294.6?
I for the following reason (Section 7031.5, Business and Professions Additional Sign Branch Circuits 3303
Code):Code): 1 ITE7
❑ I,w owner of the property,will do the work and the structure Mico.Condutts A Conductors
Is not Intended or offered for We (Seotlon 7044, Business Ottw(See Complete Fee Schedule) , TOTAL 204 . 69
and Profsnlons Code).
CHECKS X4.69
CONSTRUCTION LENDING AGENCY �
I hereby affirm that there Is a construction lending agency for the l.r�-*GE 'w
performance of the work for which this permit Is Issued (Seo. 3097, PERMrT FEE (Sub-Totao
Civ.C.).
PLAN CHECKING FEE Oen—WW1 5/26/94
Lenders Name
Pf7gA117 I83UING FEE C4433 1 AM 9; 7
Lender's Address
I certify that I have reed thb af"odion and under penalty of purlury sfaLe TOTAL FEE �L► �j�
thcd the above hformafion la correct- I agree to compty with all County
ord nences and State law+regulattng F]eotrical wl rtng,and hereby authortxe
nPreesntstt.w 5County to enter upon the
�r lnfp SEE REVERSE FOR EXPLANATORY LANGUAGE
4806M1TURE OF PfR1KrTM