HomeMy Public PortalAbout9002 GARIBALDI AVE_Electrical__ `"°�I'e have
&'ceSATION Of consent to 7&-0018°x"(12 a" APPLICATION FOR ELECTRICAL PERMIT
I hereby ittlrm tpet I haw a'certlflaate of consent to self Insure, 7�`�
or a cortlfl*a of Worker's Compensatlon Insurnnoe,or a certlfled COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereoldSec.38W Lab.C.)
PWcy No. Company POR APPUCAMT TO MLL IN neo se D4
CertfM1 cdpy M hereby furnished. New ReetdsntdaJ Bldgs.A Pobfa p NO. EACH FEE L /
❑ Certffled coped with the county building InepactSon 1 a 2-Family,Sq.FL-,�9T/ — i moi' im
y,b tot
departrnsnt Multi-tanOy Sq.Ft ST.
Dai► Applloer t Residential Swimming Pooh ASSEBBOR
MAP B OCK �d Ptu3E ��
PAFICa
CERTIFICATE OF E�9fPTION FROM WORKERS' Outlets:Rea_LIgM Sw. rR O
COM PENSAT10N INSURANCE _
(this ptlo
cn need not be completed If the work Invotvsd by the Total No. Addrdonal JdAILF1 rut 20 t 1
permit Is for one hundred dollars($100)or Isar.)
I oeftlty that In the performanoe of the work for which this permit CrrY T■I.
Is Issued, I sh&JI not employ any person In any manner so as to PLU1 q.{ECK
become sU eat he Workers'Co mail '[laws. LJghUnp Fbdures FUet 20 APPLICANT
Total No. Addttionel
ADDRESSER
De1e RESIDENTIAL APPLIANCES NOT OVER 3 HP.
P10TICE ,Q A C NT: It, after making this Csrtlflcate of CITY TOL No.
E;emptb ,you eYlould become eubJsat to the WorkAre'Compensation OTHER APPLIANCES NOT OVER 3 HP.
proylslons of the Labor Code, you must forthwith comply with suchPower S�� � � 7 (�
provisions or this permit shall be deemed revoked.
LICENSED CONTRACTORS DECLARATION Stze 8 Type HP,KW,KVA,or KVAR ADDRESS
I hereby'afflrm that I am licensed under provisions of Chapter B Over 3 to 10 Ind.
(oommenoing with Section 7000) of Division 3 of the Business and TOL
Profesalons Code, and my license Is In f II force and effect. Over 10 to 60 Ind• LODEW=OR /�]7 }
Over 50 to 100 Ind. RECL rrt%63aR
/ y Over 100 D03 RJCT NO. BY ;t
LJcenee Number LJa Class-` B O cc
Services,Swbd.,MCC d Parwtboerds i d CC
Contractor�1; 0-399 Amp.Under 800 V DATE
400-1000 Amp.Under e00 V �- .a V
IaexemptLrKVALIDATION ILLI
Sea Over 1000 Amp.or Over 600 V SAL d
B.BP.C-,for thisBF{A 4CH CIRCUIT FEES BY CO
Date: 16A,or 20A,120V,Lighting or RecepL
Z
1 To 10 Branch arcuns
Signab 11 To 40 Brsrbh Ctroutb
41 Or More Branch C►cultn
❑- Ecwgtkon for Reg.Matrt.Elect. 16A,20A,206V To 277V Br.ChcYdt$ '}
SINGLE FAMILY Temp.Power Pole' h Appurtenances r■+s
HOME OWNEI�BUILDEA DECLAlaAT10N ,�y� 1[
I hereby afflrm that I am exempt from the Contractor's Llcenae Law Sign with One doh aroun 7 'lit■67
for the following reason (Saotlpn 7001.6, Business and Professions Addidonal Sign Branoh Ctcults �j � Ut
Code):
1 ITM
I, as owner of the property,will do the work and the structure Misc.Conduits S Conductors lU
Is not Intended or offered for sale (Seotlon 7044, Business Other(See Complete Fee Sohedukj) , TOTAL 204 - 69
apd Professions Cods).
_ C�EM 2N.6?
CONSTRUCTION LENDING AGENCY �tl�lirt Oct
I hereby affirm that there Is a construction lending agency for the CRiTUG
performance of the work for which this permit Is Issued (Seo. 3097, PERMIT FEE (Sub}Total)
Cry.C.) � 5/26/94
PLAN CHECIdNG FEE rAMJt!-t.f1JV 1
Lenders Name PERMIT ISSUING FEE 1 Ah 9'
Lenders Address
I certify that I have read this epp5cation and under penafty of pudury state TOTAL FEE
that the&boys Information Is cared. I agree to comply With aJl County
ordtrrances and State lam regulating EJaoirlcal wiring,and hereby fturft t a
this County to enter upon the ed
I SEE REVERSE FOR E)Un AMATORY LANGUAGE