Loading...
HomeMy WebLinkAbout12_16_1985 - 21015 PATHFINDER RD (2) - WORKER$'COMPENSATIONDECIARATION - 76n663 �o�a, qPPLICATION FOR ELECTRICAL PERMIT � I here6y�a(firm �hof I have a ceriiiicote ot consent ro sej[ /�� . � � insure,or a certificoie of Workers'Compensation Insuran�eJ � COUNTY OF LOS ANGELES � BUILDING AND SAFETY � or a certified mpy ihereof(Sec.3800,Lab.C.) � � . . �. ��ol'�cy NoG�Y{) r"j�ryCompany S�i"j!i�� ���'y:% FOR APPLIUM TO flll IN JOB - _ �7 p�.. , ADDRE55 `. �:..• ( '�. ,.,t . �1,(, �:: �;� Certified'copy is hereby furnished. New Res�dential Bldgs.8 Paols EACH NO. FEE - � � Cerfified copy is filed with the toumy boilding inspec• 1 8 2-Family,Sq.FL f — s ��'0'��N .�/;1 . '�ia �) l� '' �w tion deparfinent. _, �.y / Mu���-tamily$q.Ft. — NEAREST -��� 'f�.• !rt �r'� • � �/j f ReeideNial Swimming Pools CROSS 57. Date Applimnt -�^L' 4 � - OWNER OR �.� CERtIFICATE OF EXEMPTION FROM WORKERS' � ��' FIRM NAME � ; • ��,: 'V'r��;� ;•.� , � COMPENSATION INSURANCE Dutle�s:-Rec_LigM���Sw._ 't, �r� r�, ;t, �'�� � AODRES$ Firsf 20 (Thfs s�clfon nNd not be tomplefsd iF 1h�werk fnrolwd by Total No. 'r�� � Addilional ' ` ) i�) CITY Tel.No. � tM pvmif iz for ona hundred dollars(5100)or los�.) . RAN CHECK I terfify that in the performance af the work for which Ihis � � � - -pe�mit is issued,I sholl not employ any person in any manner � y '�,. A���NT - so as to become subject to the Workers'Compensa�ion Laws. Li9hlinq Fixtures� First 20 �� � }�-' �� � ADDRESS � ' iotol No. rr . Additionol '-' I' '4 r ; � CITY Tel.No. Date Applicoot Fixed Applionces Not Over 1 HP � pEgMiT '" NOTICE TO APPLICANT: If, after making ihis Certifimte of � . �+ qpp���p,NT'�`�`�l� l�%f.-��� !;.'l l � � Exemption, yo� should become su6ject lo the Workers' Range_Heater_D.W._ . Compensotion provisions of Ihe Lobor Code,yoo must forth• Oven _Dryer —W.M._ � ADDRE55 j 1�U f S j!j�: �;., with mmply with such provisions or this permil shall be Top _FAII _W.H. �_ � deemed revoked. � � � CIiY,��;j�,���.. �;..., : Tel.No.7 J )���/ � Hood _Fan _O�her_ LICENSEO CONTRACTORS DE<LARATION �' � � } IICENSE OR Disp. _Room Air Cond. —� � '��4 J!! . . C�ms.C/ ,/.� n- I hereby offirm thot I am licensed onder provisions of ChapMr 9 REG.NUMBER i �'S p - - (commencing with SeUion 7000)of Division 3 of the Business power Apporafus 8 large Appliances DISTRICT NO.,, PROCESSED BY C3 and Professions Code,and my license is in full(orce and effed. ,,,r, �� � '-t �,! � J�� � /i1 Size 8 Type HP,KW,KVA,or KVAR � ,1 ' • license Number -' Lic Class UP�o����� � FINAL �+- ,1� !- � ..� � � Over 1 fo IO Ind. . . � . Contmctofr•./'S� �.`-�!-lC. Dote��� �' ' � / ` )U DATE VALIDATION � ❑ � Over 10 ro 50 Ind. - FINAL . . I om exempt under Set. Over 50 to 100 Inc. BY _ � ,�_�y;�'`�jy' �� 6.8P.C.for this reason - O°a��� . � g . . l ' i ' Servites.Swbd..MCC 8 Ponelboords ��. � . � .�i" i i � ;r' � W Dpte: " - 0-200 Amp.Under 600 V � . ' r- '�'�- {� - . Signolure �� ''� '"!'�� 'F� 201-1000 Amp.Under 600 V i���.��!-..'�:Z li i... ❑ � ' Over 1000 Amp.or Over 60p V �+�R;�;/`i-.;��� Exemprion for Reg.MoinL EIeU, ' ..� � SINGLE FAMILY Temp.Power Pote 8 Appurtenances � � � HOME OWNER-BUILDER DECIARATION Sign with One Branch Circoit - . � � � � I hereby offirm that I am eiempt from the ContraUor's License qddiiional Sign Bronch Circuits - � � � law for the foilowing reason(Section 7031.5,Bosinass and �� � Pro(essions Code): . - - , � � � � � Misc.Conduits 8 Conductors . � � � I,os ownei of the property,will do the wo�k and the . � strocture is nol intended or ofiered for sale(Setlion Other(See Complete Fee Schedole)_ , ' � 7044,�Business and Professions Code). ' CONSTRUC710N LENDING AGENCY I here6y ofiirm tho't fheie is a tonstruction lending agency for � ' � ihe performance ot Ihe work for which this permit is issued pERMIT FEE . (Sab-Tatal) ��j ; ' � � (Sec.3097.Civ.C.). . . . - � PLAN CHECKING FEE • ' � Lender's Nome �� ' . - PERMIT ISSUING FEE � ��� � . lender's Address � - � ` � I cerlify thot I have read ihis application ond stote ihaf tha � TOTALFEE j ,jl,l � obove inlormalion is co�recf.I agree to romply with oll County , , . ordinontes and Sta�e laws regulating Eleciricol wiring,ond ' : � hereby w�horize represeMotives of ihii County 10 enler upan . � . � � the obove-meniior+ed.properry for lnspection purposes. .� SEE REVERSE FOR EXPLANATORY LANGUAGE %���, .. `;,,,:s�''.,:� �y'� �'-� �� ' -l 1 Signature ef Prrmiuee Dme , ' ' - � i ; . . . � �_ __�_._. .. `_ �., .. I_ I._ . ... _i_. �..- I. : ; � i : � ; ; I i � I i ; ! ' � � j � ; I I � � i �. . i � � ! ' � ; ; + � I 1 I , { � i . i i ; + i ' ' ; I � { , i i i I � , i I � �, ; -. ; ' ' ' i ! " j � ' ' �I f f , � � � , � , . � � � , : � �� � s � . ( I�---- -I __i ` � � ` ; ; i ; ' � ; ; k � i � � I i i � ; , , ; ' � : ' i � I I ! � � � � ! i � ; c. " ' h ' • i ' I i ! � : � �, ; . i ; ' j ` _ � ' � ' � ' � ' i I, I ,y ' I � 1 ; � ' I ' ' I i � -`� � .. � i � ; � _ ' . . � . - � ' t i � � ,� . . � r : , . ; . . . - , i ;_--_,� - �--, •�- - �--, __ _ __ _ _ � _ _. �.__�'.f.r I.._-�' __ _ I , ' .. . _ . � i � - . - � � ' i i , � : , i � , � � — - — - — -- -,_ _. _ . .. , : { �I t' •� I~ � � ' � � i �- - ! — i� I�-'_ -i -I ; -- ----�- --' -- I- -i�- - i . ; i i i n f I I � � i � I � i , ' � � , � I . { ' I , ; i , , t � � I I ' � � I � . ' - i -- - ^ - -- - ---- .�_ ,_ �. . .-- � .. � I ' : t � , i '� ' I �. ._ , .I._. I t ' �i ' . . i � i, - I .� t . � �, � . _ _ _ . . � j � ! ' � . { .I i � ' � ' .:. - -; -^ --: ,. ;' _ � � .. ' ,_._ _ __ • .__ ---- — � —� - ' - : `� . � , � � � i I ' i I � � : _` I. '.- ' � ' '— , _ � , � i ; I � � � � � I I � � t i _. . I ' . . ' � , I I I ' i 1 . ; I� I � � � . � '� - � S . � i � i . i .' ' �- ; � � , . � 7 �i :, � I � , , I . � . I . . i I .t � � � ' . ,___ . ____.._. _ . . __ _..___.. .__ _ . __ .. __'___...__ . '�..'__. .._... ..... .__'.-.. ._.«. 1 � � I I • . ' C�f L. � _ � � I� � � ; .� .' - { I � ' . �. . � �; � � � 1 � � . � � I I 1 _ .. � j � _'9 f f i, I >: i _ : , I , �t . `- ( � - _ ; - � y _ � �, �; �.. , . , ., , , _ . , _ _ �, .., � � � , _ � � , . .. , �I � _. . - . ,- ' �.' � I ' .. = � _ _.. �� _ , . � i + , t,,� . � : • � � ' � _ � ` . . �,� � � ,: � , . - _ � +, . , _ ;� i ' . i �` � � � . :• 4 _ � ` ' . . - � •,. �` ; � . L j I` �' i = i ! , -� ( � _ � e. � � � � � ' � � • . _ � . � I I � . � � � t� - - �- �� { � � � _, -� � �. �� � . � , . .. � i '- � . . .. �._...r.-......�.._��.�I_. _.._�..-......�.�._.__�___...�._._.....�M.......__...�.. ...___._�_^__.'___^�_..._...,..�..._..`.�.-"' ._�. _._,—__... _..�_..� . . .. i _ . 3 I _ � � �'� - _ i ; i I � i i ' •Y' i � ; � � - _ i ( . - - , � � � . � - � _. � � _ - I . E � � I = I i ; I I _ _ I _ - I j ; � I � - I ; � i I � _ � _ '� � ' _ � .I � -� _ _ , � " . � ; . ; , i - - ! i � � ; � �r - ._. `. _ � i , _ . � - ... i, � i ; . I. . . ,. , I ` _-i I y � ` i' �. , i ' � �- ;` I C�� ° , I = ) - . _ I _ � I � � �` I �:� - . i - _ - � I - _ _ _ , ; � � . � — �. , `% ,: _ '_ � I f � C C. _. . _ . . i- f^` _ l ` ' , - , ; � � ` ' - - � � � j � _ � _ ;' - f _ _ � `; � _ _ ' - � � _ . �;� ! � i �, ,. � -; ` _ �� _ - _ . � _ � - , � ; �� - � � -- . : _ ; - ,� _ . - � -. _� - I � - i =t ' � - _ ' I - - = -c � , '. , � i : �• , , , I " ,� �.. V � _ . . _ � J � ' _. _ '. _� . = -J � '' :_ _ _ . . _ :_ _ �� L i�_;_.