HomeMy Public PortalAbout6202 SULTANA AVE_Electrical__ ,;uyOiKKER�S COMPENSATION DECLARATION DPW 9/89 APPLICATION FOR ELECTRICAL PERMIT
I,h'ereby affirQJhat I helpe a certificate of consent to self Insure, +
or acertificate`-of Worker's Compensation Insurance, or a certified COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING:AND SAFETY DIV.
copy thereof(Sec.3800 Lab.C.)'
P❑CPicy No. Company ti FOR APPLICANT TO RLL IN �ADpppES3
Certified cop hereby furnish..ed.., 1'New Residential Bids &..Pools EACH NO. FEE �
}, 9 :LOCALITY
❑ 1&2-Family,Sq.Ft: .rte®'', lG
Certified copy Is:filed with the countybuilding Inspection NEAREST
department. + Multi-family Sq.Ft. CROSS ST. DitJ
Date Applicant Residential Swimming Pools ASSESSOR
MAP BOOK PAGE PARCEL
CERTIFICATE OF EXEMPTION FROM WORKERS' � g OWNER OR
Outlets:Rec. Light Sw. FIRM NAME /T`,eA/.
COMPENSATION INSURANCE 0 1dU�W _-
r-.�+
First 20MAI .
(This section need not be completed If the work Involved by the Total No. 3.3 Additional ADDRESS 2-d 2- 15 cthlaotr�. .
permit is for one hundred dollars($100)or less.) _
I certify that in the performance of the work for which this permit CITY Tel.No.
Is Issued, I shall not employ any person in any manner to as to p+ �
become subject.to the Workers'compensation Laws. Lighting Fixtures First 20 • 0 O Q APPiICCAHK
Total No. Additional
e9r� c��ri
Date Z ADDRESS
Applicant � �- %
15 OR 20A,120V BRANCH CIRCUITS, P
NOTICE TO PiPPLI.GANT.:. If, after making .this Certl.fioate of. CITY ds Tel.No.f/ 1
Exemption,you.should'become subject to the Workers' with such 11 M40 INCLUSIVE EACH Compensation 1 TO 10 INCLUSIVE EACH
You must forthwith comply provisions of the Labor Code, , PERMIT
P Y' APPLICANT % �(G
provislons or this permit shall be,deemed revoked. 41 OR MORE BRANCH.CIRCUITS EACH
LICENBED'CONTRACTORS DECLARATIONADDRESS
I hereby affirm that I am,licensed under provisions of Chapter 9 15 OR 20A,208V TO 277V LIGHTING EACH
(commencing with Section 7000)of Division 3 of the Business and CITYollZZ T� Tel:No*V2
Professions Code,.and my license is in full force and effect. RESIDENTIAL APPLIANCES UP TO 3HP LICENSE OR
GPower Apparatus&Large Appliances REG.NUMBER �y��.Ud CIS C`�D Q
License Number Lic. lass e 0 Size&Type HP,KW,KVA,or KVAR DISTRICT NO. PROCESSED BY I..
TBS 6p to 3 Incl •lf� W
Over 3 to 10 incl. FINAL
Contractor a DATE p
❑ Over 10 to 50 Incl. O- 2 �2
VALIDATION
I am exempt under Sec. Over 50 to 100.Incl. FIN ✓� �
By
Over 100
B.&P.C.for this reason
' Services,Swbd. MCC&P.anelboards.
Date: 0 _ rrA Under 600 V
Signature 201-1.000 Amp.Under 600 V
❑ Over 1000 Amp.-or Over 600 V - -
Exemption for'Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances stly
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law -3-
for
v_for the following reason(Section 7031.5, Business and Professions Additional Sign Branch Circuits.
='Clr
Code):
❑ I,as owner of the property,will do the work and the structure. Mism Conduits&Conductors 3- Zr
Is not intended or offered for sale(Section 7044, Business Other(See Complete Fee Schedule) �. ._
and Professions Code). ® ': C=K =`i
CONSTRUCTION LENDING AGENCY ; +` `��=• ��t:
;I hereby affirm that there Is a construction.lending agency for the
performance of the work•for which this permit is issued (Sec.3097, PERMIT FEE (Sub-Total)
r
CIV.C.) �I'.I ...r9 0 '15/9 r
�-31.1 L.,� �i:' lv s.
PLAN CHECKING FEE
Lender's-Name _�.:.3�'• t-:c.
PERMIT ISSUING FEE
Lender's Address
I certify that I have read this application and state that the above TOTAL FEE
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 u n the above-mentioned
propert inspection ur oses - / SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGMUURE OF APPLICANT OR AGENT DATE
CiYf OF TEMPLE UV I Y 113
CES06 IG_S, APPLICATION: FOR ELECTRICAL • PERMIT - -
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING AlBUILDING AND SAFETY DIVISION ADDRESS .G O2. Al SVAI /09 V40
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,SU,P'T OF BUILDING LOCALITY T MPI-
. NEAREST
FOR APPLICANT TO FILL IN CROSS ST. wRRI,mj_z)1,
ITEM NO. EACH FEE -
OUTLETSs (FIRST 20) 11; $ OWNER G9 0A 6 C. /.% T/fR D
LIGHTS RECEPT. SW. MAIL / d/y,
OUTLETS: (ADG'L UNITS) ADDR6
ESS .%02.
LIGHTS RECEPT. SW. .10 ..� _ r
LIGHTING FIXTURES: (FIRST 20) 2O -.CITY I �i MRI. Cf TEL.NO.Ar 7:.'�c7�I1
LIGHTING FIXTUREBs (ADDITIONAL) .10 ELECTRICIAN 0W W
RANGES . CLO.DRYERS WTR.HTRS. 1.00 l.AD'D' RESS
GARB.DISP. STA.COOK CITY _ TEL.NO.
DI.SHWASH. .AUTO.-WASH. STATE
SPACE HTRS. STA.APP.(V.H.P.MAX.)" .50 ',LICENSE NO.
MOTORS, OVER NOT OVER H.P.
DISTRICT 0.' GROUP ZONE PRarESSED BY.
0 1 1.00 5, a 6
t1.5o s }
s 8 2.00
a 1s 2.50 W
1s
50 3.00 '
50 100 1 Imoo i
SIGNSt NO.TRANS. t•'rYNO.LAMPS S •Lr W tv�. Y
SERVICE 0.600V.NOT OVER 200A r 1.00 d PY V1
SERVICE 0-600V-OVER 200 A. 2.00 ✓ J /I
SERVICE OVER 600V 5.00
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT ISSUING FEE Loo
TOTAL FEE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS .DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY �+ CONDUIT i " _
WITH ALL COUNTY ORDINANCES AND' STATE LAWS REGULATING
ELECTRICAL WIRING. .f: WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/GR /
LICENSED AS REQUIRED.BY LAS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY.. POWER � ,{
OF PERMI'1TESIGNATURE y� UTILITY CO.NOTIFIED
3: FINAL.
MDATION AR HUR C. VEIT
CK MO CASH SUPERVISING ELECTRICAL ENGINEER
U_'•a•! 7 5 G%_o APR 2 7 2 D 3.0 0