HomeMy Public PortalAbout5827 OAK AVE_Electrical__ ION
2D.0019
A40,11
WORKER IS have
a certificate
of consent to 76ABS3 DPVII(12 at) APPLICATION FOR ELECTRICAL PERMIT --r
76A663
I hereby affirm that I have a certificate of consent to self Insure
or Ncertific4to of Worker a Compensation Insurance or a certified COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
copy thereof($ec 3000 Lab C)
FOR APPLICANT TO FILL IN JOB r q -OAK
of o Company. J �[
ADDRESS
Certified copy is hereby furnished New Residential Bldgs &Pool NO EACH FEE
1&2 Family Sq Ft ���'V — $• $ LOCALITY
❑ Certified copy is filed with the county building Inspection NEAREST
department Multifamily Sq Ft — CROSS ST
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERSi Outlets Roo _Light Sw OWNER OR
COMPENSATION INSURANCE FIRM NAME s
(This section need not be completed If the work Involved by the First 20 Q
permit Is for one hundred dollars($100)or less) Total No Additional ADD O r O
I certify that in the performance of the work for which this permit CITY -T Tel No gS—2 0
is issued I shall not employ any person in any man so as to PLAN CHECK
becom subjec tot orkers Comp do a Lighting Fixtures First 20 APPLICANT
Total No Additional ADDRESS
X DateApplic RESIDENTIAL APPLIANCES NOT OVER 3 HP
NOTICE!TO APPLI ANT If aft making t Certificate f CITY Tel No
Exemption you should become subject to the Wor rs Compensation OTHER APPLIANCES NOT OVER 3 HP
provisions of the Labor Code you must forthwith comply with such PERMIT
provisions or this permit shall be deemed revoked Power Apparatus&Large Appliances APPLICANT
TMA:0 WA
LICENSED CONTRACTORS DECLARATION Size&Type HP KW KVA or KVAR ADDRESS v
I hereby affirm that I am licensed under provisions of Chapter 9 Over 3 to 10 Incl
(commencing with Section 7000)of Division 3 of the Business and CITYM Tel No a
Professions Code and my license is in full force and effect Over 10 to 50 Incl
LICENSE OR
Over 50 to 100 Incl REG NUMBER 3 Off° a
6 r 0 Over 100 DISTRICT NO SED BY 0
License Number Llc Class �D 0
JLf _ Services Swbd MCC&Panelboards
(,(�Ci 0 399 Amp Under 500 V FINAL 0
to DATE
Contractor V
E3400 1000 Amp Under 600 V 1'L
1 am exempt under Sec VALIDATION 0
Over 1000 Amp or Over 600 V FINAL III
B&P C for this reasonBRANCH CIRCUIT FEES eY
Date 15A or 20A 120V Lighting or Recept Z
1 To 10 Branch Circuits
Signature 11 To 40 Branch Circuits
❑ uits
Exemption for Reg Maint Elect 15A 2DA 208V To 277V Lighting Br nCirrch Circuits
girlJL
SINGLE FAMILY Temp Power Pole&Appurtenances kmv
HOME OWNER BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor a License Law
for the following reason (Section 7031 5 Business and Professions Additional Sign Branch Circuits
Code) ` 'i I r72
NU
❑ I as owner of the property will do the work and the structure Misc Conduits&Conductors
is not Intended or offered for sale(Section 7044 Business Other(See Complete Fee Schedule) ► -f
and Professions Code) 237.30
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the ��r
performance of the work for which this permit is issued(Sec 3097 PERMIT FEE (Sub Total) ONGE .00
Civ C)
PLAN CHECKING FEE
Lender a Name
PERMIT ISSUING FEE
Lender s Address •�-=1 9/18/99
1 certify that I have read this application and under penalty of puq ���
ury state TOTAL FEE �3 1PH Se¢2
that the above Information is correct I agree to comply with all County O
ordinances and State laws regulating Electrical wiring and hereby authorize
represent9pyes of his Count to enter upon the above mentioned property
fo n SEE REVERSE FOR EXPLANATORY LANGUAGE
SIG RE OF PERIATTEE DATE