HomeMy Public PortalAbout9960 GARIBALDI AVE_Electrical__ WORKER'S I have
a coSATION°fc`�ent to 7aA&M °P`"`12 °'' APPLICATION FOR ELECTRICAL PERMIT
I hereby nfflrm that I have a certlflcnte of consent to sell Insure,
or a certfflcate of Worker's Compensation Insurance, or a certlfled COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Seo.3800 Lab. C.)
0 No. Company FOR APPL Arrr TD RLL LN A� �"l(,l� LI
Cerdfled copy Is hereby fumlehed. New Residential Bldae-S Pods NOoORFse. EACH FSE'' Akk BAl
❑ CerfM1ed copy Is fried with the county bunding Inspection 1 8 2 family,Sq.FL — = s LCA tMNEAREST
t�E 1T
departrnent Multl4amlly Sq.FL CFK)M 8T. CA L-0 t �I
Deb Appkent Resk$Mtial Swtmming Pods A88ESSOR
YAP BOOK PAW PARCEL
OWNCERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Roo._Ugh} F
Sw. IRLM N rw1OR
COMPENSATION INSURANCE FIRM E wA
First zo MAX
(This section need not be oompleted If the work Involved by the Trial No Addtlonal ADpfE68
permit is for one hundred dollars(s1DO)or lees.)
I oertlfy that In the performance of the work for which this permft GTY TOL No. VEL
Is Issued, I shall not employ any person In any manner so as to PLAN CHECK
become subject to the Workers'Compensation Laws. Lighting Fbxturee Fl ret 20 APPLK:Ar1T
Total No. Add kxral
ADDRESS
*DataAppl art RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this Certificate of CITY TOL No
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Code, you must forthwith oomply with such Power�� no
�Large Appllaee PERsatr �F 1AFuz
provlalons or doe-
mad permit shall be deeed revoked. APPL�Atrr
LICENSED CONTRACTORS DECLARATION Size S Type HP,TCW,KVA or ICVAfa ADDRESS 1994 C) _E
I hereby affirm that I am licensed under provisions of Chapter 8 Over 3 to 10 Ind.
(commencing with Section 7000) of Dlvlelon 3 o1 the Business and CITY �r.rT Tel.No. 'IS7C
Profesalons Code,and my license is In full force and effect. Over 10 to 80 lac! LrC oR }
Over 8o to 100 Ind. REri NUMBER (.>OSOSCL
•uoense Number
o Z Lfc.Clan L-1 o Over 100 DtSTRICT NO. BY
011A Ile
contractor Data l - -` /�0 TE o
400-1000 Amp.Under 800 V ZS
❑ I am exempt under Sao. over,000 Amp.or over 800 V VALIDATION LU
a-
B.SP.C.for this reason BRANCH CIRCUIT FEES By CD
z
Data: 15A,or 20A,12OV,Lighting or RecKC
1 To 10 Branch Chculte
Sbnohue 11 To 40 Branoh Ctraitls
41Or Mon Branch Clrctib
❑ Exemption for Reg.Metnt Elect. 18,A.20A,2OBV To 277V Br.Clraita
SINGLE FAMILY Temp.Power Pole S Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with one Branch CtrcuttACCT.
T
I hereby affirm that I am exempt from the Contractor's ucense Law
for the fallowing reason (Sectlon 7031.5, Buslneaa and Professions Addhkmal Sign Branch Clrcuf s - t� t��to
Code): ,7,7ih7 TT[�C 6-! OV
❑ I,as owner of the property,will do the work and the structure Misc.Condults S Condudora ry wl1 1 1 E S
Is not Intended or offered for sale (Section 7044, Buelnoss Other(See Compote Fee Schedule) , TOTAL 65 .60
and Professions Code). CWCK &5.60
CONSTRUCTION LENDING AGENCY � /-•� nr1nr�t
I hereby affirm that there Is a construction lending agency for the CHANE •w
performance of the work for which this permit Is Issued (Seo. 3087, PERMIT FEE (Sub-Total) Q
Cly.C.)
PLAN CHECIONG FEE 0000-0001 1/18/96
LandsWs Name PERMIT ISSUING FEE O 43 4 1 PM12:31
Lender's Let I h e TOTAL FEE G�Lo
I certlry that have real this eppllcadon and under penalty of perjury etsde
that the above htomuricn b oorreci. I agree to oomply with all County - v
ordlnanoes and State laws regulating Elacbical wtring,and hefsby authortre
repreeentaihee of this County to enter upon the above-mann ned property �l t•YV}R
V Lon PLrrPosaa• SEE REVERSE FOR EXPLANATORY LANGUAGE
�exarAru�Ot*--
DATE