HomeMy Public PortalAbout9811 HOWLAND DR_Electrical__ ION
WORKERS' I havaSAT'°" cate of once "A�3 '°'°' APPLICATION FOR ELECTRICAL PERMIT
I hereby atf itr�i;{hpt I hovr3 a certificate of consent to self CE-806G
insure, or a certificate'of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
ora certifi��edpp c�ZZop99y77thereof p(Sec. 3800, Lob.(C.) �+ p
Policy Nonp,ls,&�Co�p1 42 J1 14
any�`�"a FUh� FOR APPLICANT TO FILL IN JOB
ADDRESS q i Ow
IC��I Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE
❑ 1 8 2-Famil LOCALITY '
Certified copy is filed with the county buildin inspec- Y. Sq. Ft. S — $ 'e
tion department. MultifamilySq. Ft. — NEAREST
CROSS T.
ARM lzzesl-
Date �'1 ]l1 Applicant Residential Swimming Pools OWNER {
FIRM NAME q R r
CERTIFICATE OF COMPENSATION
I N FROM WORKERS' � MAIL
Outlets: Rec�Light Sw.
COMPENSATION INSURANCE First 20 S' DDR A: yl
(This section need not be completed if the work involved by Total No. Additional CITY TeleZ4.,l ill . No.
the permit is for one hundred dollars ($I00)or lass.)
I certify e that in the performance of the work for which this PLAN CHECK
P U
permit is issued, I shall not employ any person in any manner APPLICANT
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS 18o-7 f ,.--
Total No. i Additional
CITY lA/P ry Tel. No. i.7._68�
Date Applicant Fixed Appliances Not Over 1 HP , PERMIT
.Exemption,
NOTICE TO APPLICANT: If, after making this Certificate of APPLICANT D rem 2
zemption, you should become subject to the Workers' Range_ Heater—D.W.
' rs
'Compensation provisions of the Labor Code, you must forth- Oven _ Dryer _ W.M._ ADDRESS O C
with comply with such provisions or this permit shall be Top _ FALL —W.H. —
teemed revoked. CITY Tel. No.
LICENSED CONTRACTORS DECLARATION Hood — Fan _Other— G V L N q
Dis _ Room Air Cond. LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 p' REG. NUMBER 3 Q Class. r
(commencing with Section 7000) of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT,NO. P SSED BY d'
and Professions Code,and my license is in full force and effect. a U
/ Size 8 Type HP, KW, KVA, or KVAR 4
37871 c0 Lic. Class FINAL
License Number Up to 1 Ind.
(�
p Over I to 10 Incl. DATE �`' r VALIDATION O
Contractor Q n♦in [p-�r 'd7/r's Date Over 10 to 50 Incl. t '� L5
ElFINAL "" W
am exempt'u oder Sec. Over 50 to 100 Inc. BY
B.BP.C. for this reason Over 100 Z
Services, Swbd., MCC 8 Ponelboards ' CJ
Date: r�
0 -200 Amp. Under 600 V �`""'
Signature 201 - 1000 Amp. Under 600 V
❑ Exemption for Reg. Moint, Elect. Over 1000 Amp. or Over 600 V
SINGLE FAMILY Temp. Power Pole 8 Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and �� CAS
Professions Code):❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors
structure is not intended ar offered for sale (Section Other (See Complete Fee Schedule)_ gggggg ,,,ppp 5 p/�
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY I U S f5
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued PERMIT FEE (Sub-Total)
(Sec. 3097, Civ. C.).
PLAN CHECKING FEE
Lender's Name i
PERMIT ISSUING FEE d
Lender's Address I
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 abov -mentiop.d roperty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
1 a-ZqI S6
ignature o Permittee Date