HomeMy Public PortalAbout9006 GARIBALDI AVE_Electrical__ woPh t I'B have
a coSAcate of consent to 7e�sa°DPW,(,2-9t) APPLICATION FOR ELECTRICAL PERMIT
I hereby ■ttlrm that I have ecertlfloate of consent to self Insure, '
or a oertlticate.of Worker's Compensation Insurance, or a cerdfled COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy t[ofeof(Seo. 3800'Lab. C.).
Poky NO.�Comparry POR APPLICMT TO PILL IN JOB ��//
ADDRESS Q-G'ff
Certlfled copy Is Nwoby furnlahed. New Rseldentlal BkigL 8 NO. EACH FEE
` a ; LOCALM
❑ CerMW Is flied with the 1 &2+emlty,Sq.FL NEAREST
Dopy county bufld]ng tneQecifon
department Mutti-family Sq.PL Q088 ST.
Date Applicant Reeldentlal Swlmmtng Pools A68ESSOR
WP < - / PAGE P14 1AP1. 407
CERTIF1CAtE of D(EAIPTION FROM WORt0=R8' OvtSets:Rec._Light 8w. 05NtER
COMPENSATION INSURANCE NAS
iL-
R 20
(This eectlon need not be completed H the work Involved by the Taal No. Additionalpermit Is for'one hundred dollars(6100)or 1eq.)
I certify that In th performance of the work for which this permit GIT Tel-Na4
Is Issued, I shall of employ nny person I 'ny manner so as to PLAN ca-Kc
become su of t the W kers' C on we. Lighting Plxwree Rrvt 20 APPL�xr
Il Total No. Addtlonal ADDRESS
Date Appfl r
NOTI O A LICANT: If, after making this Certificate of FIE807ENTLAL APPLLANCE8 NOT OVER 3 HP. CRY Td Na
Exemptl , you• culd become subJaot to the Worker' Compeneatlon OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Libor Code, you must forthwfth comply with such PEFW7
provision or this permit shall be deem6d revoked. Power Apparatus S Large Appllanoes ttT
LICENsm CONTRACTORS DECLARATION Stze S Type HP,KW,KVA,or KVAR ADDRESS
I hereby affirm that I am licensed under provlsforle of Chapter 9 Over 3 to 10 Ind.
(commencing with Section 7000) of Division 3 of the Business and TeL
Profeselona Code,end my Ilcense Is I full force and effect. Oyer 10 to 60 Incl. LCENSE 04
over 60 to 100 Irwl. FEICL NUMBEB Class.CIO a
�J o
Loan"Number LIC.Clare Over 100 Df8TR1CT NO. BY
0-399 6 8ervtces, MCC S Pene0 V V' FINAL Contractor (/
0-386 Anrp.Under 800 DATE 0
400-1000 Amp.Under 800 V ~
EJI em exempt under Sec. VALDATION
Over 1000 Amp.or Over 600 V FINAL W
B.L,P.C.for this reason BRANCH CIRCUIT FEES BY �
Date: 1&A,or 20A,120V,LJghtlng or Reoept z
1 To 10 Srench Clrcufte
Signal 11 To 40 Branch greats
F] Exemption for Reg.Malnt:Elect 1s 20A,2DBV To 27N u Moro
SINGLE FAMILY Temp.Power Pols 8 Appur[enanoee M1.41 .JL
HOME OWNER-GUILDER DECLARATION Sign with One cia A plum t ��` Win! G
I hereby affirm that I am exempt from the Contractors License Lew 33G3 X04.6
for the following reason (Section 70L31.6, Business and Profesalons Addtlonal Sign Branch Cboufts 7 �
CodY I CI t�e): 1
❑ I, as owner of the property,will do the work end the structure Mise Conduits h Cooduatoro TOTAL 204 - 69
Is not Intended or offered for sale (Section 7044, Business Other jSee Complete Fee Sohedub) �' t
and Profesarons Code). pop- t,fC i Z11t.6�
CONSTRUCTION LENDING AGENCY — OffFiE .JJtJ
I hereby affirm that there Is a construction lending agency for the
pertormanos of the work for which this permit Is Issued (Sec. 3097, PERMIT FEE (Sub-TOtaf)
Cts. C.) 009D-0001 5/2619
PLAN CHECKING FEE �,t� O
Lenders Name / 1 1 19 r 7:,fit
PERMIT ISSUING FEE �` D
Lenders Address
I oertffy that I have read this spplloadion and under pan alty of puhury state TOTAL FEE �D b
that the above Information Is correct I agree to compty with all County
ordlnancee end Stade lave regulating DecLlcaJ wiring,and hereby eutt)ortre
this CouMy to enter upon the above-marrtloned property .
for SEE REVERSE FOR EXPLANATORY LANGUAGE
SWATuFtF OF Pe%vTTEE DATE