HomeMy Public PortalAbout5953 SULTANA AVE_Electrical__ ION
76A
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WORKERS'. I have a cerci DECLARATION , E-8 61 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self �E-806G
insure; or a certificate of Workers'Compensation Insurance, :( COUNTY OF LOS-ANGELES BUILDING AND SAFETY
or a certified copy thereof(Sec. 3800, Lab'. C..) �
PolNew Residential Bldgs. &R
icy No. Company FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished. EACH NO. FEE ADDRESS L
EACH NO.
❑ Certified copy is filed with the county building Inspec- 1 &2-Family, Sq. Ft.- -�–�-- $ Q — $
tion department. Multi-family Sq. Ft. — NEAREST
Residential Swimming Pools CROSS ST.
Date Applicant OWNER OR
i ight Sw FIRM NAME
OutlRe
CERTIFICATE OF EXEMPTION FROM WORKERS' �J J a MAIL
COMPENSATION INSURANCE e : c LADDRESS
( completed if the work involved
P Y This section need not be com b First 20
Tota No. Additional CIT�� rG` T Tel. No
the permit is for one hundred dollars.($100)or less.)
I certif that in the performance of th rk for wh' h this PLAN CHECK
Y P APPLICANT
permit is issued I shall not employ any 'e on' any er
so as to b co subject to the Work e ws. Lighting ixtures. First 20 ADDRESS
i
Total N Additional CITY Tel. No.
at pplica Fix6d Appl nces Not Over 1 HP PERMIT r
NOT E: TOAPPL CANT: If, aft r a g this tificate of APPLICANT S
Exe ptio you should become su ject to a Workers' Range Heater_D.W. A�
Compen tion provisions of the Labor Code, you must forth Oven _Dryer W.M.. ADDRESS
with c ply with such provisions or this permit shall be Top AU 'W.H. CITY Tel. IVo. S
deem d revoked. Hood n Other_
LICENSED CONTRACTORS DECLARATION LICENSE OR
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. Ro m Air Cond. REG.NUMBER ® Class. '-�
(commencing with Section 7000)of Division 3 of the Business power Apparatus Large Appliances DISTRICT NO. PROCESS BY
and Professions Code,and my license is in full force and effect. A,
Size&Type HP, W, KVA, or KVAR•
License Number AVI Lic. Class /[�. I p to 1. Incl. FINAL W
Over to 10 Incl. DATE F� o„� VALIDATION
Contractor Date Over 1 to 50.Incl. Cy
FINAL � U
❑ I am.exempt under Sec. i Over 50 100 Inc. BY �_�"i0 of iL
B.&P.C. for this reason t Over 100 U1
Date: Services MCC&P nelboards ► �O
0 2000 p. Under 6 V
Signature j 201 X000 Amp. Under ., 'V =4 F 9,8 A-
❑ ti Over 1000 Amp. or Over V F+ o o:o o
Exemption for Reg. Maint. Elect.
SINGLE FAMILY Temp. Power Pole&Appurten ces G o o 44.97
HOME OWNER-BUILDER DECLARATION r Sign with One Branch.Circuit
I hereby affirm that I am exempt from the Contractor's License / s
Law for the following reason (Section 7031.5, Business and P Additional Sign Branch Circuits L 5
Professions Code): 1 k_€-7
ElI., as owner of the property, will do the work and the j Misc. Conduits&Conductors
Other See Complete Fee Schedule
structure is not intended or offered for sale (Section ( P )— ,
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
!I
Lender's Address PERMIT ISSUING FEE GO ,
I certify that dve read this application and state that the TOTAL FEE
above in ati is correct. I agree to comply with all County
ordina es and tate lawsr ulating Electrical wiring, and
e re sent a of this County to enter upon
t -men r y ,or inspection urposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
ignatur rmit D e