HomeMy Public PortalAbout5833 RENO AVE_Electrical__ WORKERS'COMPENSATION of.C A 76-863 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of cW. 11 , C.E-e06G.
1;;or a certificate of Workers' Compensation;t�isVince, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.) ins ` 4kl
•0 1361im No. Company I ��! �N FOR APPLICANT TO FILL IN JOB . n v
❑ Certified copy is hereby furnished. ' EACH NO. FEE ADDRESS S$3-3 (t
New Residential Bldgs.&Pools �
❑ Certified copy is filed with the countybuilding 1 &2-Family,S Ft. $ _ $ LOCALITY �r'
g inspection Y' q'
department. �e'� Multi-family Sq.Ft.. NEAREST
CROSS ST.
G— 2 dt"'O (N�t;7�13Y �,LDrj, I Residential Swimming Pools OWNER OR
Date Applicant FIRM NAME
/
CERTIFICATE OF EXEMPTION FROM WORKERS' I Outlets:Rec I S Light r✓/� Sw. MAIL
COMPENSATION INSURANCE ADDRESS
First 20
(This section need not be completed if the work Involved by the Total No. Additional CITY Tel.No.
permit is for one hundred dollars($100)or less.) 14
I certify that In the performance of the work for which this permit PLAN CHECK
is issued, I shall not employ any person in any manner so as to APPLICANT
become subject to the Workers'Compensation Laws. Lighting Fixtures JO First 20 ADDRESS
Additional
Total No. CITY Tel.No.
Date Applicant . Fixed Appliances Not Over 1 HP
NOTICE TO APPLICANT: If, after making this Certificate of PERMIT
Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. _ APPLICANT 'w AV 0.1&W(S'Y `1 q)A.1>6 �S
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS r 5'1
provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _ CITYTel.No.
LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_ G. i l
I hereby affirm that I am licensed under provisions of Chapter 9Disp. — Room Air Cond. LICENSE OR
(commencing with Section 7000)of Division 3 of the Business and REG.NUMBER Class.
Professions Code,and my license is in full force:and effect. Power Apparatus.&Large Appliances DI$TRICi NO PROC D BY
Size&Type HP,KW,KVA,or KVAR ; Q,
License Number 4. 8
7.1 Lic.Class Up to 1 Incl. FINAL
/ Over 1 to 10 Incl. DATE i�rG VALIDATION
Contractor-10flW003, 1 140f Date:
v' �_ Z'�� Over 10 to 50 Incl. 0
FINAL i�%y�
El am exempt under Sec. ,, Over 50 to 100 Inc. Bl' W W
B.&P.C.for this.reason Over 100 N
Services,Swbd.,MCC&Panelboards ® Z
Date: 0-200 Amp.Under 600 V
Signature 201 - 1000 Amp.Under 600 V
El Exemption
1000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect.
SINGLE FAMILY 'Temp.Power Pole&Appurtenances 2
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit t~� e
I hereby affirm that I am exempt.from the Contractor's License Law I Additional Sign Branch Circuits ACC °8
for Code)following reason(Section 7031.5,Business and Professions .1
40.60
❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors 1 ITEMS EMS
is not intended or offered for sale (Section 7044, Business Other(See Complete-Fee Schedule) _ TOTAL.-
m
and Professions Code). _
60
CONSTRUCTION LENDING AGENCY CHECK 40.60
I hereby affirm thatthere is 'a construction lending•agency for the r CHANGE - - .00
performance of the work for which this permit is issued(Sec.3097, PERMIT FEE
Civ.C.). (Sub-Total)
PLAN CHECKING FEE
Lender's Name '(2 0000-0001 6/12/90
'PERMIT ISSUING FEE /.� 12335 1 AM 7��t
Lender's Address 1
I certify that I have read this application and.state that the above TOTAL FEE 46 PA
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 above-mentioned '
Property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date