HomeMy Public PortalAbout6438 GOLDEN WEST AVE_Electrical__ TION
DEC
TION
WORKERS' CI have cerci cafe of corse � tonal APPLICATION'S E� ECTRICAL PERMIT
4 ihere�y affirm that I have a certificate of consent to self
nsure; ar a certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES :_ BUILDING AND SAFETY
or,a certlfled copy thereof (Sec. 3B00, Lab. C.)
Policy No. Company POR APPUCANT TO HILL LN JOB
Certified copy Is hereby furnished. New Residential Bldgs.A Pools EACH NO. FEE
F1Certtfled copy Is filed with the county building Inspec- 1 & 2-Family, Sq. Ft. $ — = LOCALr'TY ~
'tion department. Multi-family Sq. Ft. — N .�
C1205S ST`�
Date Applicant Residential Swimming Pools OWNER OR �
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw. ��
COMPENSATION INSURANCE First 20
(This section need not be completed If the work Involved by Total No Additional CITY s Tel. No
+o permit Is for one hundred dollars (:100)or less.) PLAN CHECK
I certify that In the performance of the work for which this
permit Is Issued, I shall not employ any Person In any manner
w as to om subject to the Workers Compensation Lighting Fixtures First 20 ADDRESS
Additional
Total No. CITY Tel. No.
Date ppllcant Fixed Appliances Not Over 1 HP PST /
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT rxa
Exemption, you should become subject to the Workers' Range— Heater—D.W. —
Compensatlon provisions of the Labor Code, you must forth- 40ven _ Dryer — W.M.— ADDRESS/;rb $ /
with comply with such provisions or this permlt shall be Top — FAU —W.H. — CDS Tel. No.
deemed revoked.
LICENSED CONTRACTORS DECLARATION Hood — Fan —Other— OR Class.e-10
I hereby affirm that I am licensed under provisions of Chapter 9 Dlsp. — Room Air Cond. REG. NU
(commencing
(commencing with Section 7000) of Division 3 of the Business Power Apparatus 8 Large Appliances DISTRICT NO, PKXMS§EDBY
and Professions Code,and my license Is In full force and effect.
Size 8 Type HP, KW, KVA, or KVAR
U
Up to 1 Incl.
License Number I Ic. Class FINAL ox
Over 1 to 10 Incl. DA 0 VALID ON r
Contractor Date Over 10 to 50 Incl. FI W
❑ I am exempt under Sec. Over 50 to 100 Inc. BY N
B.BP.C. for this reason Over 100 Z
Services, Swbd., MCC & Ponelboards
Date: 0 -200 Amp. Under 600 V
Signature 201 - 1000 Amp. Under 600 V
❑ Over 1000 Amp. or Over 600 V 'r /
Exemption for Reg. Maint. Elect.
SINGLE FAMILY Temp. Power Pole &Appurtenances
HOME OWNER-BUILDER DKLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contraclor's License
Law for the following reason (Section 7031.5, Business and Additional Sign Branch Circuits
Professions Code): 215 2 4,A
❑ I, as owner of the property, will do the work and the Mlsc. Conduit: 8 Conductor, `� o o o
structure Is not Intended or offered for saie (Section Other (See Complete Fee Schedule)_ , # o o 2
7041, Business and Professions Code). I a o 25,50
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for o o 0 2 5.5 0'Z
the performance of the work for which this permit Is Issued PERMIT FEE (Sub-Total) 1
(Sec. 3097, CIv. c 0 2.1 3-85
PLAN CHECKING FEE
Lender's Name PERMIT ISSUING FEE a d
Lendees Address
I certify that I have read this application and state that the TOTAL FEE S 0
above Information Is correct. I agrge to comply with all County
ordinances and State laws reg Ing EIectrI I wirin , and
hereby authorize representatly this Coun to an upon
the above-m toned prop Inspection u SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee le