HomeMy Public PortalAbout6207 SULTANA AVE_Electrical__ 0 ' I '
WOrm that
I have
a certificate
DECLARATION 76A66CE-806 10/81 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self CE-806G
insure, or a certificate of Workers'Compensation,jnsurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY
or a certified cop thereof(P$ec. 3800, Lale-W-1
��s-� ,
Policy No. ompany S TIS rC FJru Ii FOR APPLICANT TO FILL IN JOB
Certified copy is hereby furnished. New Residential Bldgs. 8 Pools EACH NO. FEE ADDRESS (FI
❑ Certified copy is filed with the county building inspec- 1 8 2-Family, Sq. Ft. $ — $ LOCALITY
tion department. � Multi-family Sq. Ft. — NEAREST
i Residential Swimming Pools OWNER OR
CROSS ST.
Date Applicant I FIRM NAME 1"'
CERTIFICATE OF EXEMPTION FROM WORKERS' i Outlets: Rec Light Sw._ MAIL
COMPENSATION INSURANCE First 20 ADDRESS
(This section nood not be comploted if the work Involved by Total No. CITY
the permit is for one hundred dollars($lag)or less.) Additional �G M d'l-C L . Tel. No.
1 certify that in the performance of the work for which this PLAN CHECK t'14 `O c_,:,c_,:,�,
permit is issued, I shall not employ any person in any manner j APPLICANT U'S`- PLOY
so as to become subject to the Workers'Compensation Laws. j Lighting Fixtures First 20 ADDRESS fy C J-7 %3A1)AAV
nt If
Additional 70
( Total No. CITY L Tel. No. -73c)D
If,
NOTICE OAPPLICANT: f, y(�
DateA p , a after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT
�
Exemption, you should become subject to the Workers' Range_ Heater—D.W. — APPLICANT
Compensation provisions of the Labor Code, you must forth- Oven — Dryer —W.M.— ADDRESS IL�fG
with comply with such provisions or this permit shall be Top _ FAU —W.H. —
deemed revoked. CITY Tel. No.
LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_
Disp. Room Air Cond. LICENSE OR 7
I hereby affirm that I am licensed under provisions of Chapter 9 REG.NUMBER f li - Lj t«, �S Class. I L
(commencing with Section 7000)of Division 3 of the Business 1 Power Apparatus 8 Large Appliances DISTRICT NO. PR BY d
and Professions Code,and my license is in full force and effect. Q
Size 8 Type HP, KW, KVA, or KVAR 51 0/ Q
License Number�7 4' ]ZJ Lic. Class L 0 Up to 1 Incl. FINAL 13:
/Z `. Over 1 to 10 Inc[. DATE VA ATION
Contractor Date Over 10 to 50 Incl. FINAL
❑ I am exempt under Sec. Over 50 to 100 Inc.
B.BP.C. Over 100 to
,for this reason z
Date: Services, Swbd., MCC 8 Ponelboards
0 -200 Amp. Under 600 V /
Signature 201 -1000 Amp. Under 600 V ;2 4 1 1.3 A
❑
Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V # 0 0 0 0 0 2
1 - 255C
SINGLE FAMILY Temp. Power Pole 8 Appurtenances 0 0 o 2 5 J
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 02-26-86
1 hereby affirm that I am exempt from the Contractor's License 'Additional Sign Branch Circuits
Law for the following reason (Section 7031.5, Business and
Professions Code):
❑ I, as owner of the property, will do the work and the Misc. Conduits 8 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
Lender's Address
I certify that I. have read this application and state that the TOTAL FEE
above information is correct. I agree to comply with all County
ordinances and State laws regulating Electrical wiring, and
heruthorize representatives of this County to enter upon
the"e-mentioned pro ert for infpection p rpose
/ . SEE REVERSE FOR EXPLANATORY LANGUAGE
"
li ) - 6
Signature of Permittee Date