HomeMy Public PortalAbout9221 GARIBALDI AVE_Electrical__ 1p10HKER'8COMPE7J3ATIONDEVYAFIAT10fJ 7BAOM (12-01) APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have ■ certificate o1 consent to self Insure, 7tL1EE3
or a certificate of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT. 00 PUBLIC WORKS BUILDING AND SAFETY DIV.
thereof(Sec.3800 Lab.C.)
Poi k7y Company POR APPIJC.Vrr TO PrLL IN X88
copy Is hareby fu iW d. New Reskla al Bldgs. .Pools NO. EACH I FEE
LOCALITY
❑ 1 S 2-Fam6y,Sq.Ft. — _
ed copy M flied with the ty ding Inepeerion Mult famlry Sq.FL — NEAREST
ST.
Date Rider
eertial Swimming Poole A69689OR
MAP BOC4<
PA 3e PAACa
CERTIR TE OF EXEMPT10 FROM WORKERS' Outlets:Roc._Light Sw.
MPENSAT10N SURANCE �NAHE ~�
Fhet 20 u&■
(rhls section need n be comp) H the work Involved by the ADDRESS s
permit Is for one hund doll■ (E100)or less.) Tool No. Additional
I certify that In the perfo an of the work for which this permit CITY TeL No
Is Issued, I ah all not amp ny person In any manner so as to PLAN CHECK
become subject to.the Work ' Compensation Laws. Ughting Ftxturee First 20 APPUC.,wT
ToW No. Additional ADDRESS
Date RES DENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICA : If, a or making this Certificate of CITY TeL No-
Exampdon,you should auN to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the La Code, you at forthwith oomply with such Power S�� �� T dyf t� LSo�
provisions or this pe It shall be deem revoked.
LIC CONTRACTORS TIOFN Stze 8 Type HP,KW,KVA,a KVAR ADDRESS -7, I LD/ ST
I hereby affirm t I am Ilcensad under rovlslona bf Chapter 9 Over 3 to 10 Ind.
(commencing Section 7000) of Dlvlelo of the Business and CffY1N �! e�N0 �oJ 6
Professions and my license Is In full}or and effect. Over 10 to 60 Ind.
LICENSE OR
Oy r 50 to 100 Ind. WAABBER 0� a
Over 100 Dt8TR ICT 40.
License N L8o.Class 8
Dam 34A� DATE1O o
❑ I am exempt under Sec. 400-1000 Amp.Under 800 V A 0
Over 1000 Amp or Over 800 V VALIDATION
R3NN a
B.SP.C.for this reason BRANCH CIRCUIT FEES to
Date: 15A,or 20A,12OV,UghUng or RecepL Z
1 To 10 Branoh Clroultn _
ro 11 To 40 Branch Cta�ts
41 Or A{ore Branch Ctaiib
Exemption for Reg.MalnL Elect. 113F,M&200V To 277V Br.CtalIs
84NGLE FAMILY Temp.Power Pole S Appurtenances ACCT.i
HOME OWNERBUILDER DECLARATION
I here-bych affirm that I am exempt from the Contractor's License Law 8$Gn with One BranClrcult 33M —L7 45
for the following reason (Seotlon 7031.6, Business and Professions Addltiof a.Sign Brarwh Clrouite — -
Code): 1 ITS
I,as miner of the will do the work and the structure Mlso.Conducts h Conductors
pry, fIYTAL ` 63 - 45
Is not Intended or offered for sale(Sectlon 7044, Business Other(See Complete Fee Schedule) , rh� -- '-
and Professions Code). LAff7-I- 63.45
CONSTRUCTION LENDING AGENCY l� - . _ .. .00
I hereby affirm that there Is a construction lending agency for the
performanoe of the work for which this permit Is Issued (Soc. 3097, PERMIT FEF (Sub-Total) ��}�y G
CN. C.) 1 S/ 4/93
PLAN CHECK]NG FES 0000 .1 O
Lenders Name PERMIT ISSUING FEE t..�� d 1093 1 AM 3:iS
Lenders Address
I oerttfy that I have reed this appl an under penalty of purJury state TOTAL FEE
&ad the above Irrformaflon he correct. I agree to oompty with all County
ordlnanoss and State laws regulating Elsobical wiring,and hereby authortre
rspreeerrtativee of this County to en upon the above erttloned properly
lnepeotlon purposes. mSEE REVERSE FOR EXPLANATORY LANGUAGE
4KIINAruRE OF PB49TTEE DATE