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10_26_1987 - 21073 PATHFINDER RD
I.�- WORKEAS�COMPENSATIONDECLARATION �.' ,. �CEsasa ���B1 � /-�PPLICATION�FOR ELECTRICAL PERMIT '�'�I hereby affirm that I I�ave a certificate ot consent to self insure,- .. . . � or a certiticare of',Workers'Compensafron�nsurance,ar a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY copy ihereof(Sec.3800.Lab.C.) Q� �� r.$� �� � PoIiCy No O#,�' COmparry"-��a��Z-�L`�� FOii APPLIC�NT TO flLL IN . .... ... _.. JOB J�� .❑ .Certified co is hereb turnished. . �. - EACH NO. ..�E_ �D�ess �l f�Z 3 I'W I F�r��1��.1L . PY� Y �. ., . New Residential Bldgs&Pools 1&2-Fami LOCALITY Certitied copy is-fiied with the county huildirg inspection y�Sq.FL S — S y� 5��' ti � depaffineni:' "- ' �J' ',n " :� " MUIfI-fefllily$p.Ff. — NEAREST . yr c=�"'—� Residential Swimming Pools CRO55 SL �t.`S o�tel�^2�-X7� APplicant-/� • _ owNeROR �(�/� . . . .. . . . . . . . .. _. FlRM NAME .[�:^i P � . ,� CERTIFICATE OF EXEMPT�ON FROM WORKERS'. � � putlets Rec�Light�-Sw.��- �'u`�� ^7�` . - � � ��,-�COMPENSATION INSURANCE - - � � - � �-- �,'] '- �-�2• ADDRESS� �L O� �2-� '�1 TCF�r�� SV. �This sectbn need not be compieted if fhe work�involved by the Flrst 20 CITY f Tel.No. permit Is for one hundred dollars(5100)or less.� Total No.� Additional��-� r�L��L ri- I cerNy that in ttre performar�ce of tFre wnrk for which this permit � _ . wN cNECK _�_ � � � �is Issued,I shall rwt em I .an � Ae�1J�AM , _ p oy y person In flrn/manner 50 as t0 . _ become sublect to the�Workers Compensation Laws.. � Li�htirg Fixtures First 20� �•� �- - ---�-S� ADDRESS -- -- -- �� � , ..... ' ' ... .'... , . .. TOWI No.�` Additional.. . CITY . . . - Tel.No. Date� � Appticant � � �' - Fixed Appliances Not Over 1 HP � �NOTICE'•TO APPLICANT: It; alter makirg this-Certificate of PERMIT ( �( Exemption,you shoultl become subject to the Workers'Compensafan Range_Heater_ O.W. _ '���M`--�S'` �`'�L�-���C-' provisions af ihe Lobor.Code,you must.forthwith comply wiih such . Oven_ Dryer_ W.M._ � ADDRESS `��l.t'Z, wC�re H��-�-� � .provisions or this permit shall be deemed revoked. ,. � . ..Top _ FAU _W.H._. .. .. . � LICENSED CONTRACTORS DECLARATION � '- CRY TyZj,���j�-` ��Tel.No.C�.'�i�-�T7 -Hood_Fan _ Other_ I hereby,aftirm that I am licensed urMer provisions of Chapter 9 ,. ' P . LICENSE OR .-� ��.,7� . L, �b (commencirg with Section 7000)of Oivision 3 of ihe Business and . Dis — Roan Air CoM.� -- � � -�� REG.NunneER 7 ���T'� ` Pfofe55i0n5 CAdO,and my IiCBn52 i5 in full fOrCe and e(feCt. ' OiSTRl�7 NO. PROCESSEO BV. _ . .Povrer Apparatus 8 Large Appliances_._ .. . ._ . . � . ... . . . . .. . _.. ... . (� ��q��� Lic.Class C-'t�- .Size 8 Type HP,KW,KVA,or KVAR �•:� � License Number. � ��---�� �� - - — UPto�1-Inel.__.. ._. .-.. .._ ....._... . FlNAL. _ _. ._. __ .___ ___ . _.. .___ .._._ . L�S�rC �L rrCT��CDate I� '-Z..G�FI7 - ___ Over 1 to 101nc1. DATE _ _ . ._ . _ VAUDATION_ _ � - .�-Contiactor Over 10 to SO IncL � � FlNAL I am exempt under SeC. � � ���� � - - _. Over 50 to 1 DD Inc.. _. gy _-. . ._ .___.__.. ____. .. .:. V .. . . ....- W 8.&P.C.fOt this r223o0 � � Over 100 N . .Services,Swbd.:MCC 8 Panelboards.. ._. . .. .......__ _� ►-........_. . -__ ..____ ._ ... �2 3 C.7�._ Z -- . .._ . . . _ ._ . .__ . . Date:._. ._._ _. . D-200 Amp.Under 600 V - � Signature � �201-�1000 Amp.Under 600 V- ' � -� � -� �-- --- " • 3 o c •7- . n _ � -�-- � -��� � � - � -� � "� Over 1000 Amp.or Over 600 V ❑ Ezemption for Re9.Maint.Etect. . . -. - .- . -. . . . . . . . - . -. . 'r 1 � , � 25 � � �� �� ��- � ��SINGLE FAMtLV. - � �-��-� � _ Temp.Power Pole 8 Appurtenances � HOME OVJNER-BUILDER DECLARATION Siqn wi[h One Branch Circuit -.._.. � -- -�:--�---.. .-..--- . . ...---. ...•'• .-�Q?S� I hereby aifirm that I am exempt from the Con[ractor's License Law p,dd8bnal Sgn Branch Circuits� . tor the tollowing reason(Section 7031.5,Business and Professions � - --- --- -�� -- �-- � �� - �� � Q 2 7-a 7 �-� Code�: ' � �Misa Corduits&Conductors �-�� '�' � � ��- � ���� � � -�� ' - - �� � -- � - I,as owner o1�he property,will do the work and the strucmre . ' is not inteMed or offered fa sale(Section 7044,Business _ Other�See Complete Fee Schedule)_ Q.0 t and Professivns CodeL � �/ U S L�� � � ��� CONSTRUCTION LENDING AGENCY �� -� � �--- � � � - -�- � I hereby alfirm lh�t there is a mnstrucfron lendirg agency for ihe �/� pe�formance ol the wak For which this permit is issued(Sec.3097, � PEqM1T FEE�- ---�--��-���-�--���-�-- -(Sub-Totaq- � �� �� �- �- -� �-�ps��r�� -� �%v'��" Civ.C.). � ��O � �. � -PLAN CHECKWG FEE -�. -. . . . . �. . .. .-.. . . -. . -. . Lender's Name � � . -PERMIT ISSUING FEE:. ' � ��.����_ LerWer's Address � 1 certiy that I have read this app�ication and state ihat the above TOTAL FEE _ . p,;�z'_ ''Lj� .InfOrmation is correct.I agree to comply with all COunty ordinanCes . C� . .and State Iaws regulating EleCtriCal widng,and hereby authorize _ . .. __.__. _ _ ___..._ . . . _. _ . . .... . .. . _ . . . .. ._ representatives of this Counry to eMer upon the above-mentioned . �-- �� proper for ins tion pwposes. ._ -SEE REVERSE FOR EXPLANATORY LANGUAGE. _. _ . . _._ . ..-. _ ...- _.._._.___.. ... . . � l�~ZL -�� _ Signature ot Permit�ee Oato � i ;..+, .-r�,- > _..._ _._ . . . _., . ;`"_._.., i_ _� i= '.,\_ -__,i'----I-- `,=i__i.._ i ,, � ' � I ��i � i ��. �t . . I f ` I 1 , ; I I ` :._i i ! �� !� , ; , a � �i .�t- ; I I i i� � i ' ._ � - . �il.\ _i � 1�. 1 � _ � +�•� � ��, �.�. �- _ i i ,� � �' j` � � ` j ,+ j - � '�' I - i ; �. .�. i �` �-'r i c -- t � ' ' - � � I�_ :_ i j � I r�� , I� j-i• i � ._. i r - --i — ,-- - i` I j �_ �.r�i i I i ..-� /'� ! i , � ?; . ` � t I 1 f- � i f V �'� ' � . ' J ; i ' � ' i i , . 2 T C 'O T s�i �7 .t -1 � -. 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