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HomeMy WebLinkAbout1102A . . . . . . . � 4 + . WORKERS'GOMPENSATION DECLARATION 7eAes3 t0/at � CE-806G APPUCATION FOR ELECTRlCA�L.PE}�M1T . I hereby altirm tha[1 have a certifica[e ot consent to Self insme, {� �,. [-" r or a certiticate ot workers'CompensaCan�nsurance,or a certitied COUNTY OF LOS ANGELES ( �!F,�lZll.`�I�G�AL�D�BAE�TV � �.� eopy ihereot(�c.380QLab.G) ` ��j L�l� G! },� � !, [, '- � ;,' .�f ;: p�u Pplicy N0.��1�� COmpany ��� `V' "Np FOR APPI.ICAN�TO Fill M d08 �y ❑ Certified copy Is herehy furnished. Nev+Residential Bldgs.&Pools FACH NO. FEE pCDFESS 1 � �F! ►.} Q►J � LOCALIT Cerlified�copy is filed with the county duilding inspectipn 1&2-Family,Sq.FL $ ' � �� � depar[ment. - Multi-tamily5q.F1. — t�E7+nEST � �^��` �G 4�g� �,Q�'��y�(.,� Residenlial Swimming Pools COWNER oR w I� Date Applicant . FIRM NnME���.-f\N^�C. -f Li CERTIFICATE OF EXEMPTION fROM N10RKERS' p��lets:Rec—Lghf_Sw._ �'''A�� 1 �� C��,V���� � COh1PEN5ATIONINSURANCE � ADOREss �Thls soctWn need irot be�omple[etl if the wak Involved by the Frst 20 permil is fw ooe huntlred tldlere($100)or IeasJ, Total No. q�itionai . CITYCj��` 'D C� Tel.No.� 'I certity that in�he pertormance af the work lar which this permi[ APPLICAN7 N x �fy� .,uvv• is issUed,I 5ha11 rwt employ any person in any manner so es to _ �become subject to Ihe Workers'Compensation laws. Ughting Fixtures First 20� ADDFiE55 ����'��Q'3 Additional ` ,�� i�� ' � Total No. CITY��� Tel.No.`-'�`n- Date � Applicant Fixed Apv��ances Not Over 1 HP pERmrt (+ NOTICE TO APPLICANT: If, after making tNs�Certiticate ot AaPUCAM l,0��rjh..15.�-��� Exemption,you shauld become subject to the Workers'Compensal"an Range_Heater_DW. � � �provisions of lhe Labor Code,you must torlhwith compry with such Own—Orycr_W.M._ � AD�RESS g �..�03 � provisions or this permit shatl 6e deemed rewked. Top _FAU _W.H._ LICENSEDCONTRACT�RS�ECLARA710N . Hood_Fan _Other_ �� CRY�� L (�(� �Tei.No'"'�`71;5�'� I hereby affirm that 1 am licensetl under provisions o(Chapter 9 -Disp. —Room Air Cond. _ t-�CENSE OR A35�p�� /„t� (commencing with Section 70001 of Divis�On 3 0l the 8usiness and � fiEG.NUMBEF"T Ciass�" � Prolessions Code,and my license is in fuii torce and efFect. power Apparatus&Large ApD�iances � �isT�i�T NO. `� Pa eV�,p - �Q�I�` Q Size 8 Type HP,KW,KVA,or KVAR v � C!'�--"'� �Q License Number- wU`� L�.Class -��C' 1S - � - Up to 1 Incl. FlNAL � �+ �t� _,nD�(�-_,l A, AA Over 1 to 10 Incl. DATE S. �-o VALIDATION .. �. ContracteL������� ��-�V Date�T l6� pver i0 to SO lnci. FlNAL U ❑ I am exempt untler Sec. Over 50 l0 100 1�.. BY . . W B.SP.C.far this reason Over 100 � N �Services,Swbd.,MCC 8 Paneiboards '- ► � � - �_� Z �Oate: p-200 Amp.Untler 600 V � Signoture � 201-7000 Amp.Under 600 V �� � � �� - " � ❑ � Over 1000 Amp.or Over 600 V : Exemption for Reg.Mainc Elect. - � SINGLE FAMILY Temp.Power Pole&AOPurtenances . .. . HOME OWNER-BUILOER�ECLARATION Sign with One Branch Circuit I hereby affrm that I am exemot from the Contractor's License Law qdd�tlonat S�gn Branch Circuiis �� a�'2 A for the followinc�reason(Seclion 7031.5,Business and Protessions " � � - � � CodeY #��.�� ���2 Misc Conduits 8 Conductors -' � - ❑ I,as ovrner ot the propCr(y,will tlo the work and the slrucNre OthC�(`xe Com lete Fee$chedule{` � .l'�y�5'�0 � Is not intended or o�fered for sa�e(Section 7044,6usiness P antl Protessions Cotle). ► , •N 1 2 J�,Q Q� CONSTRUCTION LENOING AGENCY �- � � . Q Q Q S!'S 9 I hereby aflirm that thcre is a construction lendirg agertcy for Ihe pertormance of the vrork for which this permit is issucd(Sec.3097, pERM1T FEE - ISu6-Totap f s U � -� � � - �� Civ.C.L PIAN GHEGKMG PEE -� -� � � ������-� � �� -� Lender's Name }� PERMIT ISSUING FEE .. . ( . . . . . .. . Lentler's Address � I eertify that I liave read this aDPlication aM state that 7he above TOTAL FEE _ ��-U , . _. . _. _ . Information Is correcf.I agrce to comply with a�l Counly ordinances . - and Slatc laws rec�ul�ting EleCtriCai Wiring,antl hereby aulhoriZe _ . . . , . _ , _ _ , repmsentatives of Ihis Counly to ente�upon the a6ove-men[ioned � (xoperty for inspecti pur ses. SEE REVERSE FOR E%PIANATOHV LANGUAGE �'�.�,. � �/-S 8 � Signature of Permittee Date � _ _ . . . -,-,.. ,-,. ,._ , _. .. . _ . , . .. '� 4�. . C-. . . . . ... �.. . .. .., . ..,. � � . ., . . ._ ... � ..... . .... .._...._ � .....___.� ... ..__.... .. .......... ..._.... .. . ....._.. . -.- _ ' . _""" .... � "_'".._. ...._ . .. . .. .. r..;. ��� . ��.� naPao�c�.s .-. ' . -DnrE---� ir�saecroRs�.�. _: .-.'__ . ._._._. . � _ �,'.�..-.`.OVJNER-BUILDERDECLARATfON �.��, . t�,._//1 . _��_. � - SIGNAtUf7E , � . . -- � ����.` �f ,JEMP>P�'+'«��'4�E � � " -� � I hereby affirm tlu�t 4 am exempt from the Gontractor's Licensc .._____ . . �� . . . � ; '.. , . . i �..law for the fatlowi .__. _ .__ .. _._ _ �- . . . . , rg mason.(Sectia�r 7031.5,8uslncss�arxl � UNOERSL.P,B YJORK '_._ . . � ' ._,.._- . .___ __... - '- "� ��� . Anlessions Cade):l+rry city a eounfy whicR.iequires a permit ;: :��. .. . - •-� - - � - to con;tvct aiter t��mrove drno7isA w rcpair aoy s�n2fine Fr�or ., + J qOUGH CONOUIT " � �-- -,-� ---- - - � � ' �-- to rfs%ssuance,aLo�eqv�rcs(he eppGcnnt la 5(rcn pennll to!!lc ..��_/: _ , ) �. ._ ._ _ �� i^lIR1N � - � � i; a signed sfatemen:fAa(he-is licen�d pLrsUr✓rt to fhe prwisfons :,, f(� r � � .'_�. �� . . ._�� :�. . .�� �' 07 the Con7acta's ticense Law��(Cnapfcr 9(cannrerrcing wifh 'j..:r:�f - I . ' � _ . , � .' . _ . ___."FixiURES�... _ ... . . . . � �, � • � � � ' � �--��' �i� �-��- ' , -';Sectron 70D0)o(Div+s�an'3 oi thC Fkalxss snd Profossions ''�:.i.� .__.. �._._._.-pOWEF�AUTHOR�ZEO.. . .. . --.i. .- ; . ��.� �.... .. i Cadol a that hc'is excmpt fherelian and!hc G�tsis�/a�fhc ' ..�;;i-. ..;,: '�" .s. . .. . � . . : � a�leged exemp(iaa Arty vidotion o/SecGorr 7031.5 6y aoy � ---- . . .- . .-- .. UTILI?Y COIA7°J,TIFIED� I � . � �applicanf!or u Permif sublecfs fhe apP;:canf ro a�eiN(Pmalry { ` , , � � . ._. ...� __. ' . , .,�. . � ; . . . . _ ' .'_ '/ .- . -.. .. . : o!irot mac fhan flvc hunWetl tloH.vs(3500J' .. ' . � � �,_ ___ ••��NOTES ; � 'C�ttel'011 J'YOIII . _ , . : ❑I,as owner of[he pro0erty will do�he work,and the _. FItiAL - �---- �-. � � � - � , � i . ,. , ' — strucWre i5 not intentlell or offerfd far sale.. ___ ..- � _,�' =;_�,,,. -� �I , � ; . . � ' � � � � (See.7044,�Busincss mW PrWessid�COCc:�Are Cdr'vactor's ' - � � � - - Lkense Lax does na(eppty to en avrter of property wfio burtds � ._ .., , ' ' . .. � �_.., . .��.. ._�.,. , . -."�.. _—. � .__ � . or i�nproves thercon,ai�d who daes such viwk himse.�f porked _... . ��_. . _:.. .. f.. .._ . ._ , -.� � , . , '� � th3t such fmpro�remenfs am not intendetl or oflered lor sala 17, -f l.i i : 1 _!.i: . � �'.�:_•• . __.� - _. �� � havevei.the 6urrd�n ar �� ..`. - __. -\ . . ,.., ,, .. ... � NnlrovCment is So/d withrn a�e Yea�01 . . � ,.: .,•, �'"'• - . _ . ___.. _.._.. .. ___ . � �eanPlefion,thc owner-builder wifl have thc bur�cn o1 p�oving lhat �. .._�_..__.. ._...__.. .. .,._.. _.. '_�'_'_._:.. �__.._' , . � . .. . - . , ��be did not bui�d a Impmvc!or tM1c pu7wse o�sak.)- ' W _ 4 . � i . ! � , �.. ' �. - . .. � l .�1: .. ... � , ... .._ ...i .. _ ., , .. ..., -,: .. :1 : -, �. .. .._. . ... .. . . . . . ._._ + . . __ ... .... r.; . . . .�., ' . ' .'; � . ---� ' . ' i am exempLunder Sea � .- ' ^. . , ._ ______ .._.._. .. . ,. . .--...... . � _. 8 B.P.C.for.this mason � � �__._ . _.i . .. � �� -.r. � � .: S �-Date .____._ .. � _ _ .__ . �. : � ��� � .:� i . ' i ', � Owner . .. . , � � ..-� �;�� � �= ' .. . � . �, . . .. : � ..,. . .�. � ..� .. , . . �-� :t 1 �. . � . ,. .. . . r _ ,_ __, _ OOLS• • t -_ . - - _ ;.. �; .�� . . . . ,_ � � '�:= . �