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HomeMy Public PortalAbout9604 GIDLEY ST_Electrical__ �t L WORKERS'00W'a c llON DEaLgRAT1oN 7 Q 10/e1 APPLICATION FOR ELECTRICAL PERMIT �l hbr8b�efftm that I have a cer@frfficara e conaerrt.to neK r>slue, or s oerifHcabe of Nbrkers, CorrX)Qrmation lnsuranoe, or a oertffied COUNTY OF WS ANGELES BUILDING AND SAFETY copy thered(Sec 3800,LQi C.) Pdloy Nn Comperly' FOR APPLICAlrr T4 Fit a JC6 ❑ CervTlgd OoPY thereby hrtrJahedNew Pmab rrtkd Bldgs d Poria EA£FI NO. ftE © NEAREST Certlfled cotry Is flied with•the county bullding tmp@ctlon 1 S 2-Family,84 Ft S $ TY depar")nt. Wdtl-temly Sq-Ft 11 Dem App[barrt Reelder,tlal SwtrnrAN Ppole' 0fl T y M1iI1£ r CERTMATE•OF b MPTION FROM WORKERS' Oudeta:Rec-9D—LJOI-t ;r` Z1 ►Mi GWPENSATIQN INSURANCE ,. ..f (ThW eactlon need not br..con�{eted K the work Uwdtyed by the Ftret 20+�f ` Tel.N0. p6rmit.ls for one hundred do4jry ($100)or I6a.) Total No.� w PLAN CHECK- I oertffy,Char to the performance of the worts for whloh,thhp,permit. APPLPGAN b Lane l I shall pot'employ ary person In.4W.rharro4r.09 as to become arlb)eot td the.Vrbricerahews, Lkpft Ftxtoroe First 20' ADDffESS- Date AP t' Total'No. Additional Cly .. Tel,No. �T Fixed Appllar c;me of Over T HP PEFfi GANf: K, atter rrakhiq tt7is CQr'tfflcale d F�rnpHon,you ahculd bec6me sub}ect to the.Wofkm'CtSmpermation - �— Heater. D.W. QroyWonp of tho Labor Code, you nkatoompfy with euoh Oven _ Dryer W.M._ ADDRESS prvJ)erorm or&ai Perrnh shall be deerned�, Top. — FAU -Wp..— _ CTT' Tel. LJCNSNoti fr�.y .� EED C VrRACTORS D.�CLWTl0�4 Hood �— F. L— Qther I hereby atTirm Chet-I.am l ense under.provtnlorn of Chapter 9_ DWCL Room Air,Coad. uCE�oe (¢ornrnenafng with Section 7010) of Dlvlelon 3 of the Btalneea and jr Protessfor>e Code,ancf my Ice,i is h1 to torte and'etfect PbwerM6Y paratue h.Large APp(fanceA '-. Stae d Type HP,KW,K1^or KVAR 4 fq License fJranber a- -' fl5� lk,Gsae Up to"T Ind, FINAL - GontrBctor pq}e Q1/ T O}w 1 to i D tn(l. M1 DATE Ovet 10 to 60 rx): FINAL © I em exempt under Sec. Over f�0 to 700,Ina Sy S,SP.C.!or t*,reason Over 1 Q0 Services,Swbd;MCC 8 PanEWboerda Tom, 0-200 Amp.Under,800 V i Slgrtature 201 - 1-000 Amp,Uncer`aoo V _ Over 1000 Amp.or Oyer Q 0 0 V ❑ E roon PC Rag.Mal rrl,J!Iact A . '• SINGLE.FAMLY Temp,Power Pole•�gQpurterrarloea -497 1, 1' HOME OWNER-BUILDER DECLAPXT10N 840n with 0e Branch Grcuft # o 6 o 0 02 I hereby afflrrn.that I.am,exwV fron'r ttre Contractors License Law for the Addttbrral SIQn$rerrofr CiraJtte 1 0 04675 f "&)g reason(SectfQn 7Q31,6,BuelnQde and P1dAeabrre (lode): ❑ I,.ea owner pf the proQerty,will do the worts and the atrtrohrre rJyec:Corrdlrtfs S.fora o 0 04675 b not 4f or atfered for sale (Seotion 704-4. Badness Other(See Conlple!$Fee 8ctieddS9) — arrd Pro"afone Code} c a 2.7-'8 8 CONSTRUCTK>N LENDING AGENCY I her9by a}(km tat there Is A 000atru ton lending agency fpr the. ,perfamarpe d the work for wNob ttrie.Permit In le-sued(Sec.3087, PERMIT FFE (Sub-Total) Ctv.C.). PLAN CHECKING FEE Leaders Name PEAMIT k5S.UM FSE _ Lenders Address I dertffy that I Neve reed ttds applbatlon and Vale ttrat the above TOTAL FEE IWO/ Aur knfo matlon fa.correct I agree bo-compty with all Carrlty Qrdrranoee and State iawe rdgpletlnp Electical wMrpa, and hereby authortze 7S representatives d 0:9aenth da Courrty to ter upon e eve- bomenft- d SEE REVERSE FOR EXPLANATOfrY LANGUAGE Date I �. a � WORKERS'COMPENSATION DECLARATION 7 loyal APPLICATION FOR ELECTRICAL PERMIT I herebyIrthat I have a certificate of consent to self -eObG 7� Insure, of a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY IL JI ora certified copy thereof (Sec. 3800, Lab. C.) Policy cy No. ~ Company FOR APPUCANT TO RLL IN r Certified copy Is hereby furnished. New Residential Bldgs. 8 Pools E`er NO. FEE ADDRESS ❑ 1 8 2-Fa Ft. f — $ LOCALITY Certffled copy Is filed with the county bullding Inspec- y Sq tion department. Multi-family Sq. Ft. — NEAREST CROSS ST. DateAprpIlcant Residential Swimming Pools 01R i C! Pp— CERTIFICATE OF EXEMPTION FROM WORKERS' `' '` •v FIRM NAME COMPENSATION INSURANCE Outlets: Reclght Sw._r �. AA eIL (This section need not be completed If the work Involved by FIrYt 20 Total No Additloaf' CfTY Tel. No. the permit bion one hundred dollars ($100)or leu.) ._ `� • I certify that In fhb performance of the work for which this - . ti -'' PLAN CHECK APPLICANT pefmlt Is Issued, I shall not employ any person In any manner ti* , to as to become subject to the Work Co on Laws. Lighting Fixtures First-20 ADDRESS r Total No. Additional Date cant CITY Tel. No. ft Fixed Appliances Not Over 1 HP NOTICE TO APPLICANT: If, aer making this Certificate of PERMIT I � Exemption, you should become subject to the Workers' Range_ Heater—D.W. Compensation provisions of the Labor Code, you must forth- Oven _ Dryer — W.M.— ADDRESS 3 with comply with such provisions or this permit shall be Top _ FAU —W.H. — U deemed reHood _ Fan _Other_ CfTY 1v Tel. LICENSKENS ED COfJTRACTORS DECLARATION Dlsp. _ Room Air Cond. LICENSE OR I hereby affirm that I am licensed under provisions of Chapter Class. �a (commencing with Section 7000) of Division 5 of the Buslneas DISTRICT NO. Y and Professlons Code,and my license Is In full force and effect. Power Apparatus H 8 Large Appliances �f r, � Size 8 T HP, KW, KVA, or KVAR' fJr S Llcerse Number �`�/�D! Llc. Class`/�� Up to 1 Incl. FINAL � Contractor Yc�s� pate /l ,�� Over 1 to 10 Incl. DATE � V� 0 r-1 Over 10 to 50 Incl. FI W I am exempt under Sec. Over 50 to 100 Inc. BY 0- B.BP.C. for this reason Over 100 Z Date: Services, Swbd., MCC 8 Ponelboards c �} ► 0 - Amp. Under 600 V Signature 1 - 1 000 Amp. Under 600 V ❑`` Exemption for Req. Malnt. Elect. Over 1000 Amp. or Over 600 V it SINGLE FAMILY Temp. Power Pole 8 Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch ClrcuIt I hereby affirm that I am exempt from the Contractor s License Additional ne Branch Circuits `- Law for the following reason (Section 7031.5, Business and Professlons Code):❑ 3 4 3 A I, as owner of the o Mlsc. Conduits 8 Conductors pr party, will do the work and the structure Is not Intended or offered for sale (Sectlpn Other(See Complete Fee Schedule)_ , # 0 0 0 o 0 2 7044, Buslness and Professions Code)_ ( 0 0 2 rSS Q - CONSTRUCTION LENDING AGENCY 1 hereby affirm that there Is a construction lending agency for o 0 0 2 5 Q the performance of the work for which this permit Is Issued PERMIT FEE (Sub-Total) (Sec. 3097, Cly. C.). 1 1. 13-85 PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE Lender's Addreu I certify that I have read this application and state that the TOTAL FEE above Information Is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the a-me rty for spectlon purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE gnature Permittee Date