HomeMy Public PortalAbout6035 PRIMROSE AVE_Electrical__ 9• °, WOrrK'AS'Cl K P8ve }emit DECLARATION CE-W61 ,D,B, APPLICATION FOR ELECTRICAL PERMIT
.: I"hereby affirm'Ahaf"I have°a certificate bf'consent to self CE-W613
insure, or'b tertificate,,.of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified copy thereof(Sec. 3800,'Lab. C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB 9 y
Certified copy is hereby furnished. New Residential Bldgs. $���oQQI�� EACH NO. FEE ADDRESS
❑ Certified copy is filed with the county building inspec- 1 $2-Family, Sq. Ft. LQ_1_O..iv_ $ —Is LOCALITY
tipn department. Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools,
CROSS ST.
Date Applicant , OWNER OR J"
FIRM NAME
CERTIFICATE OP EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL
COMPENSATION INSURANCE ADDRESS
(This section need not be completed if the work Involved by First 20
the permit-is for one hundred dollars($100)or less.) Total No. Additional CITY ✓ Tel. N
I certify that in the performance of the work for which this PLAN CHECK
APPLICANT
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Date pplicant a.F-L� Total No. Additional CITY Tel. No:
PPL
NOTICE T AICA 7: If,. after making thiFixed Appliances Not Over 1 HP' PERMIT
Cert' icate of ��rr �
Exemption, you should become subject to the Workers' Range_ Heater_D.W. APPLICANT bt 4U4- ZCX b,
Compensation provisions of the Labor Code, you must forth- Oven —Dryer _W.M. ADDRESS
with comply with such provisions or this'permit shall be Top _ FAU —W.H:=.
deemed revoked. Hood Fan Other_ CITY `.LS Tel. No.
_ _
LICENSED CONTRACTORS DECLARATION LICENSE OR
Disp. _ Room Air Cond. Class, �-4Q
Z .
(commencing with Section 7000)of Division 3 of the Business. DISTRICT NO. PRO BY
and Professions Code,and my license is in full force and effect. Power Apparatus$Large Appliances ` 0
Size 8 Type HP, KW, KVA, or KVAR' (J �
License Number Lic.-C)ass C —111)
Up to 1 Incl. FINAL (�
V LI
+ Over 1 to 10 Incl. DATE DATION
3 / 1.;
Contractor L--L,14 �•4's•'�• Date
❑ Over 10 to 50 Incl. FIN All
I am exempt under Sec. Over 50 to 100 Inc. BY p;
B.$P.C. for this reason
Over 100 Z,
Date Services, Sw.bd.,MCC$Panelboards b b 1
0'-200 Amp. Under 600 V ► # 0 0 0 0 0
Signature 201 -1000 Amp. Under 600 V
Over 1000•Amp. or Over 600'V ° 7 S 2 4
❑ Exemption for Reg. Maint. Elect. o o o7524'
SINGLE FAMILY Temp. Power Pole$Appurtenances
HOME OWNER-BUILDER DECLARATION 0 3 1 7-87 '
1 hereby affirm that I am exempt from the-Contractor's License Sign with One Branch Circuit
Law for the following reason (Section'7031.6, Business and Additional Sign.Branch Circuits
Professions Code):
❑ I, as owner of the property, will do the work and the Misc. Conduits.$Conductors
structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ , -
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
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
PERMIT ISSUING FEE 1 10
Lender's Address �'-
I certify that I have read this application and state that the TOTAL FEE 7S2
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 i
the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature.of Permittee Date