HomeMy Public PortalAbout10121 GREEN ST_Electrical__ hO-N
WORKER'S have
a oaBA oats Df aonsATION DPW f,2-o,, APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a oertlfloate o1 consent to sell Insure,
or a certlflchte of Worker's Compensatlon Insuranos, or a oertlfled COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS BUILDING AND SAFETY DIV.
copy thereof(Seo..3800 Lab. C.)
Polloy No. Company FW API"tx7 To PI11 tw �8a D
❑ - c,;m ed copy Is hereby fumMhed. Now Resk3e-ti Blips.&Pooy NO. EACH FEE
_ 8 LOCN_ffY G✓T
Certtfled Dopy to mea with trp I 1 a 2�amlty, _,Sq.Ft. NEnAEeT
Muitl-fatuity Sq.Ft. CNOSB ST.
Date APel Resldentlal 8wlmminp Pools MAP
Bcc*� PAW PARCa d
TIM COMPENTE OF IX)(EZA=FROM
D detx Rec.—Light Sw. O .UE S iQ
(Thls se0on need not be oompieted H the work Invoived by the First lb / ABB (>� g
permH Is for one hundred dollars($100)or less.) Total No. Addftibnal
I certify that In the performance of the work for which this permit G T«'No
Is Issued, I shell not employ any person In any manner so as to PLAN qE:a<
become subject to the Workers'Compenaatlgn Laws. Lighting Rxb— FUsi 20 APPUC NT
Total No. Addltionel
ADDRESS
Dete Applk�arrt RESIDENTIAL APPLIANCES NOT OVER 3 HP.
NOTICE TO APPLICANT: If, after making this CBrtIfIcate of CITY TeL Na
Exemption,you should become subject to the Workers'Compensation OTHER APPLIANCES NOT OVER 3 HP.
provisions of the Labor Code, you must forthwith comply with suoh rs[uPEFWT
provlslone or this permit shall be deemed revoked. Power Appaa S Large Appliances
ANT
LICENSED CONTRACTORS DECLARATION Size 8 Type HP,KW,KVA,or KVAR ADDRESS
I hereby afflrm that I am Iloeneed under provisions of Chapter B Over 3 to 10 Ind.
(commencing with Seotlon 7000) of Division 3 of the Business and CrFY Tei
Profeaslons Code, and my Iloense la In full force and effect. Over 10 to 60 Ind. Ixt7t8EOR d
d.
Over 60 to 100 InREI Nu1Z. � ��
License Number7/ Llo.Clens Ovsr I00 otsTwCT 40. t 8
Servioee,Swbd.,MCC 8 Penotboerds D�
�� Deis 0-399 Amp.Under 600 Va,T
❑ 1 am exempt under Seo. 400-1000 Amp.Under 800 V 1 LU
Over 1000 Amp.or Over FWAL
r 600 V VAUDATION
LU
�
B.SP.C.for this reasonBY
BRANCH CIRCUIT FEES Cn
Z
Date: 16A,or 20A,120V, Ighting or Reoept
L
1 To 10 Branch Ctrcufte
Signature 11 To 40 Branch CITou is
41 Or More Branch Ctra its
❑ Ekemptlon for Reg.Maim Elect- 16A 20A,208V To ON Br.Giallo
SINGLE FAMILY Temp.Power Rola 8 Appurtenances
HOME OWNER-BUILDER DECLARATION S��with One Branch Circuit r r!T ;.
I hereby affirm that I am exempt from the Contractor's Llcenee Law tt441 .r
for the following reason (Section 7031.6, Business and Professions Addtfonal Slpn Brnnbh Carcufts -:��:,
Code): 3K3 T7 37.213
❑ 1, as owner of the proper,w1ll do the work and the structure MMD.Conduits S Conducta7
Is not Intended or offered for"to (Seotlon 7044, Business Other(See Complete Fee Schedule) , TOTAL 3-7_ ��
and Professions Code). ClEo3-7
CONSTRUCTION LENDING AGENCY `'r 3 -20
I hereby afflrm that there Is a oonatrudtlon lending agency for the .00
performance of the work for which this permit 1s Issued (8ec. 3087, PERM IT FEE (Sub-TotaD Q Q W
CIV.C.) �}�-�-y-� ���.,,,
PLAN CHECKING FEE ` RJ1 ,} `2
Lwrdet'e Name J�n�lr� ��94
PERMIT ISSUING FEE �y nri i �1�ry7
Len(Wa Address
I certify that I have reed this applkbiton and under pmafty of purjury state TOTAL FEE
that the above Information Is oorred. I agree to corrpty with all County
ordinances and State laws Mating Eieotrkal wiring,and herby authorize
of this ty to enter upon the above-mentioned property
Pu SEE REVERSE FOR E)RLANATORY LANGUAGE
OF DA
wuRKERs CQMPENSAl10N DECLARATION 76-&09 10/e1 APPLICATION FOR ELECTRICAL PERMIT —,—
•I,h wby afArm)tial I have e cwffi oatf✓ orrse
of ont to eeff treffe,� CE 6060
or a certiHoate of vvtxkere' Coupe watiw renoe or a certifled COUNTY OF LOS ANGELES BUILDING AND SAFETY
o )
Cohperry FOR Appucm-rto FRL WADDRE„pH
❑ Certified id
oopy le herd tumWvxi New ReaerrHal Bidga.a Pools NO. FEE S'
b (fled tY buGdFng inepeotlon .'• — S LOGALJTY 1 C_,
I"3r 1 a 2-Ferry.sq.Ft" —
Fasl6NCM-amfly 3q Ft . CFKmHr.
v�?aite d epdberrt ReafderTHel BrvrnmJrp Pooh OYNER
FFOA
O OF EXEMPTJON FROM Hr CEFiB'.. Outlets:Rec—Light — 3w.
COMPENSATpNINSURANQE
010! nied:not be campietid tf the wgrk lrrvotved by the Ftret 20
pwpr t is for on*hundred dollar*(S 160)-or bras.) Tow No. Addttbnel CITY ��� TPl'*
I certify thet,ln t*,perfon.Tonps of the work for whIchJ".permit PIAN SCK
p baued, I Phall not en*y anY pQreon fn erry manner.so ea to r APPIJGA[T
6e�rire br�hJeat to the Ytibrkere'Corflpertsat)on Leven Llg tt Fhtxee first 20 ADDRESS
Total No: Additlorlel CITY Tel.No.
Date ApFfked Applanoe¢Not-Over 1 HP
NOTH�E TO ADPL ICANfr; If,...atter. making (hla t;ert}M1oflte of P�
Exemption,you atardd beoorrre mint to the,Work"'Compe(natbn Range—'Heater— D.W.
provfaions of the L4bor Code,xw must b rVVvtth oompN with such oven — Dryer T W.M.— ADbRE r
provtabrra or thia permR,shell be deemed rwkkedr Top — FAU WJ-L T CITY
LI FE y Gwmk(l DEGL_AFR k ON Hood — Fan O&W— Tel.No:
J hereby aM m,that I am iloerteed 'under`povfaiorq-of Chapter 9 DIsli — Room Air Cond. LJCENSE OR
(oormiandng-with Section 7000) of DtAsbh 3 ofthe Qrrehness and REO.
Professions Ccde,and my license Is In'full force and effect Power AppWahe.a Large.Appflerroee °UMICT 88ED
&ze S Type HP,KW,K)*,or Ku4R
Llbenee Number Lb Clava Up to 1 ltwl. DRNAL
t�
I VTI�
Over 1 to 10 Ind
Contractor — Over 10 to 60 Incl.
FINAL
❑ I am exempt under Sep. —Over 60th f00 ho. ` BY
BJi P.C.for tt,}a reason — Over 100
vv
Servbee,Swbd,'ACC a Penefboarde ,
0-200 Amp.Under 600 V
201 - 1000 Amp.Under 800 y -
Over j000 or Oyer 80O V
❑ ExerTption for Rep.MaInt-Elect-
84NOL.E FAMILY. ' amp.Power Pole a Appurterrencee 2
HOME OWNER-BUILDER DERLAFWIION G
I hereby affirm tftat f am exerrgt from the-Contrac a License Law es Slgns�anch{lFartte ACCT.i
for the.1dbw V reason(Seetlon 7031.6,Bunlneee'std Profeesiorts
Code): 3307 25.`D
` . ❑ 4 as owner of the property,'wHI do the work and the st uArre (See B Fee Sghedule) 1TG fa
eea
Is not bterded or offered for sale (Sedbn 7044,Brlelneea
and,Pr6fbr,e Code). . TOTAL 25 m 5b
COWTMCrION LENDNG AGENCY M4n 25.50I Nwoby afm m that there is a construction Iendlnq agency for the I+L�Atys M
pwki rrnanpe of the work for whloh fhb permft lalsaued(Seo.3097, PERMrr FEE (Sub-Total) ' ■tJr!
CtV�C.). r
PLAN CHECKINCr.FEE
L b Name PERMIT 0,9UNG FEE 0044—MOI 14/16/89
rte+g Adaraea 6235 i AIM a 53
I,oartffy I have reed this aW8cabon and state that the abo4e T07AL FEE �5
oonra I agree to conpfy with all County ordVancom
pnd SAe Efeotrlcal wiring, and hereby authortre
Of to.wter upon the above-mentioned
SEE REVERSE FOR EXPLANATORY LANGUAGE
Date