HomeMy Public PortalAbout5532 PARMERTON AVE_Electrical_1/2/1990_outlets, light fixtures 'WORKERS COMPENSATIONDECLARATION7eA663 ,n,B,
CE eoeo APPLICATION FOR, ELECTRICAL PERMIT
1 I hereby affirm ythat'l have a Vrtrficate of consent toself
e,- '• `
ora certdicate',of Workers Compensation Insurance, oras certified �' COU NTY,OF L'OS ANGELES `BUILDING AND,SAFETY lul
copy thereof (Sec•3800 Lab C) - v -� + r \ , f ,� - ', t' ,
` 1 Policy No r ' Company^+ r! T 'T + FOR APPLICANT TO FILL IN•' T `yw 'JOB•
+) ❑ Certified copy Whereby furnished ` ' �, ,f- + New Residential Bldgs & Pools Q + o EACH,, NO s 'F,EE - . 1AOORES9 T
t. ❑�� , , , k, .` t1 r'Jf>. r v , 7�k IS s — $ , + LOCALITY +fin
t ,Certified copy Is bled,with the+county building msPection 1 8 2-Family Sq Ft P �- (�. - T 11• ,
" N` department + - ; ', .,,p I'V% _ Multi-fam ly Sq Ft 4 n = 1"� NEAREST ,
d 'CROSS'ST NP$ e
y rDete&Ik n 1 (cant r ' `+ 'Resdential Swhming Pools
OWNER OR
,APWa1'T FIRM NAME r K ° '
4„+d +CERTIFICATE OF EXEMPTION FROM WORKERS `+''i Outlets Rect^' Lght I' Sw �'E I 'e MJJL p ��L r \ " "
1 , a COMPENSATION INSURANCE L,�'u,d , A A }r , y ADDRESS , ya'-•Qc� It,
„(This secfiomneed not be completedirf the work involved by theZ . ` i First 20
Total No �� Atldihonal ,d? 20 'CITY aj T v q. ^+ =;Tel'No ,`� �'! ' A
1permrt is for one hundred dollars ($100) or less) _
-f, 1 t '. t ``c 1' , A ' } }` r'Y 'RAN CHECK>J
tie.Icertify that m,the+perlorms;6 .1�the Swork for•which This permit rt• F y 5 r. fdS,ft�,, �'•` 7AppLK:gNT
��Is Issued tl shall riot employ any,person In arty menneriso,es to ,yry ,� a+ �,� `S ti r� y, „ fy ' +, `q•�1 ,
,'YLbecome subject to the Workers Comp&aIahon Laws `^' Lghtug Fixtures Fust 20� - - 1 + ADDRESS
',. rl • , t r +r ,v ' 3, , Addaional 5'al' '' , "•.' ..v`�' 6 r u+{ �� r
f
Date " , +• a "r,Applicant f r Fixed tAPPI antes Not Over 1 HP F of,�J '�„ CITY ,� r' r Tel�No • - '
h: NOTICE.TO APPLICANT If°'after�makin this Certificate of , t- PERMIT
Exemption you should become subject to the Workers Compensation' ` Y —r, } 1+' + APPUCAN7
Range_ Heeter_;DW `
{.I ppvlsors'of the Labci Code, you must'fortM.rlth comply wdh such'k 'j Oven Dryer W M,_ ` - t�l� ADDRESS
C
,pro Rerors or ifiisipermibshall be+deenred r""evokeE ` ° .Top 7 rFAU WH' — •�
,, „ LICENSED CONTRACTORS DECLARATION ' IL' - Hood Fen L Other_ , ,f ti' GIT.V'' ^ d,1' Tel No
b, d _
hereby+aNurri that I,am.licensed urxier provsrons ofChapter9' .� - Dlsp — Room Au Conti '_,a REGNNIJ B R Y •' Class`
�(commer+cng %nth Section:7000)of Dmsion 3'ofaha Business and
Professions CadO and license Is m full forca 1 1 effect ' [' ° ; DISTRICT NO b P E V + _ ,
. w _ + >,+n, +Po.�er Apparatus 8 Large Appliances . . ._d u - , ,
'I', t. rax Size &'Type HP KW KVA or KVAR 4^ or
License Number^ Lie CIE ss Up to i Inch ' ' . ' '" lti ' FINAL '''- r 'C�ttt•
} r� !+. r . '•3�. A Over 1 to 101nc1 , L DATE ,7_'7 :.meq 4
, Contractor Dater�f '�" ^ S•^' OvVALIDATION , r0 ;
' er'/0 to 50 Ind FINAL
,,; ,E] rr exempt under Sec ', + _ Oyer,50 to 100'Inc BY,
T +, BVC4or thistreason y` , a i ,+ Over 100 r H + N
2eR'S • I `-- '•� Date - 'M'z' - Services`Swbd^tMCC& Panalboards .4t -. (rr� ► r+ • ref•+ t' + Z'
T , • r , + + �'` Or- 200 Amp'Under 600 V
r Signeturs ^ • t T ., ^ '+201 - 1000 Amp Undei 600 V
�.', Over 1000 Am Over 600,Vd,
,r- Exeption for Reg Maint',Elect , ' �- 'fp' p or m "4
1 , m� j^ : ' y r `•er
SINGLE FAMILY '4• ^� v ' Tempr Power Pole 8,Appurtenances 'ei
* �' • HOME,OWNER-BUILDER DECLARATION 'SI n with One Branch Circuit .a: ' • i �,1 ` °` "^+ < r' ,`'2 o*+y"°+'•
' hereby affirm that Iram exempt from the ContractOrsd-icanss Law T g' a y. _ r•' `•ar - M�.��A a " '1 1
for the,fdlowing reason(Section 7031 5 Business and Professions T ` IAdditinal Sign Branch Circuits �� ^t + _,,,,. , AC t �• a,r7
Code .j G ,
.f �I' "e "?t . + ; . r7 94'.20,
M. Conduits 8 Conductors, 3• 'r• r �,_ ^5. ` -,,;1, ,it • -. -a+4 r
`, •, is n owner of the pofferey for do the work and the structure,
� Other (Seer Complete Fee Schedule) -
: is intended or offered for sale (Section 7044 Rosiness _ _
and Professions Code ri �+ r• ,,, +"• ."� •.+' �• �" r
"`, r., + r 'TOTAL �`: .94' .20 + ,
y CONSTRUCTION LENDING AGENCV,,j • ?' - ' - a ,°b �, r- -i- ,%^•�- +a gi', CEI
+hereby,affirm'lhat'Aere Is econstructron Iendlr+g'agency for the - d. ' r • ' + '�`t
t pertomnarxie of the;work for which'this permit is issued(Sec 3097' �, -'PERMIT,FEE Total ..• k .. � ,,. yFyq�y�,y r +tet p.p, �]
-PLAN CHECKING FEE r, I . _ r,.i3 _ ♦ I'} '� /'^ "f' R
Lenders Name ¢ _ 'ea' r , ' rnJ '�LreDrr�-fir
.� v• ,'9 tPERMIT ISSUING FEE _ +, w _ _ c• u_ _ • Y +, •00-0001 - 1/-2�9CI bra
t Lender Address ' '� 7916e� 1 ; "AH'8:42r`
I cerFay that I,have'read this application and state that the''above ,TOTAL FEE, T,- a'I + _ ,L S4' _
information is correct I agree to comply with ell County ordinances
• 'and State laws regulating,Electrical wmn9 and-herabY'euthonzeM1 !- ri . z hr�;• �t 4ay a N ,� , +
re'presentatives'of this County to,amer upon the above-mentioned
'property forfor It_on Wrposes _ • i ' . c^"
r s I 4 r SEE REVERSE FOR EXPLANATORY LANGUAGE r ,,,h r ,•ir f ji_ tir' ,
t d ih r1 t i _! rd4 'fd
Date
,Signature of Permittee 1° ' •' -0'. +_ „ 'T+*'+r „ ' }.