HomeMy WebLinkAbout1370 VALLEY VISTA (13) i
�ORKERS'COMPENSATION DECLAR4TION 76H663 �0,8, pppLICATION FOR ELECTRICAL PERMI� {�
. ,Affirm that I have a certificate oF consent to seff insure, C68oeG ���
�frficf te of Workers'Compensation rance,or a certitie COUNTY OF LOS ANGELES UIL AND�F Y u
� a
' ��mpen�`-- FOR ApPLfG1NT TQ Fl�,IN JOB
f( C �fied copy ia her@by furnished. H NO. FEE ��E� �� �/ �• C
New Resiaemial Bltlgs.8 Pools �OCALfTY
� Certifisd mpy is tiled with the couMy � in � pect' 7&2-Eamily,Sq.FL � — $ 1
� depariment. Multi-family Sq.Ft. — NEIWEST
CR0.5S ST.-��� 4
Date�� Residential Swimmi�Pools . . . �
` aodicant owNEa oa
CERTIFICATE DF EXEMPTIO FWM hiat+fE ��
,� -� CAMPENSATtON � -- -- .. .. .. � Outlets Rec�Light�w.� C MAIL
First 20 I J O AODRE3S i i
(This section rreed not be completed if the work invol�ed by the GTY Tel.
permit ia ta one hwMred doilars(S 1001 w less.) Total Na�33 pdditional 5 �
1 certify that in the performance of the vark for whbh this permit PLAN C CK . �
is issued,i shall rwt employ erry person in any manner so as to APPLICANT
become subject fo the Wakers'Compensation Laws. LiOMifg Fiztures First 20 I� O AD�RESS ,
Additional
" TMaI No. CITY Tel. ' „� �
Date Applicant Fixed Appliances Not O�er t HP PERMIT
N ":E T6 APPLICANT: If, efter making this Certihcate of �
� �10�I�YWI S{iC1UIO bBGOR18 SLI�1�6L�t01{IB YJOfk8F5�CORI�Elifidtlqfl APPLICANT
Ranpe._. Heater_ D.W. _
provisions of the Labor Code,you must forthwith comply with such Oven _ Oryer_ W.M._ ADDRES
prrnisions or fhis permit shall be deemed revoked. Tqp _ FAU _ W.H._
LCENSED CON7RAC70R9�ECLARATJON. Hood— Fan _ Other_ Ct7Y F I.N — E
�hBre6Y aBirm that I am licensed under provisions of Chapter 9 Oisp. — Room Air Cond. — uCENSE OR
(commencmg with Section 7000)ot Division 3 of the Buairress and REG.�tuhnsE .� �7/"� �
Professiorw Code,ard my ficense is in tull force ar�effect. Power ADParatus&Large Appliances �tSmiCf IJO aaOGESS Bv
License Number� ✓ Lic.Class �—� Size&Type HP,KW,KVA,or KVAR � � f
Up to 1 Incl. FINAL C� !
� �� � Over 1 to 10 lnc4. DA� / y l G YALIDATION � 111I
Contract � Dabg, Over 70 to 50 Incl. • � 1
❑ FINAL f
1 am exempt u Sec. Over 50 to 100 Inc. gy
B.SP.C.for this reason a`�t�� �"' �
Se�vices.Swbd..MCC&Panel6oards � � �
Date: 0-200 Arr�.UrMer 600 V ""
SignaNre 201-1000 Amp.Under 600 V �
❑ Over 1000 Amp.a Over 600 V �
Euemption far Reg.Mai�t.Elect.
!
SINGLE FAMILY Temp.Power Pofe&Appurtenances �
HOME OWNER-BUI�DER DECLARATION Sign wfth One&anch Grcuit
; :by affirm that i am exempt from the Contractor's License Law
i. ie folbwing reason(Section 7031.5,Busiriess and Prolessions ����Sign BrancF Cira:ils g
C.odel: }
❑ 1,ag owner of the property,will do the wak and the strudurc Misc.CorWuits&Conductors `, i „ - �
is rwt in[erWed or offered fw sale(Section 7044,Business Other(Sea Compiete Fce Schedule)_
arid Professions Code). � t a « � - .. �
CANSTRUCTION LENDING AGENCY � � -
I �.4:' .
1 he2by aftirm that there is a consMuction lending agency br the ��
p�fwmance d tha wwk tor which this permit is issued(Sec.3097, pERMIT FEE (SutrTotaq . . ., ,� , �
Civ.C.). ' �
PLAN GHEGKING FEE j �,� �— . j
Lerxler's Name � �_ �O �� i
PERMIT ISSUING FEE
Lender's Address - i
I certiry thet I have read this applicetion antl state that the aCove 'f�TN.FEE �
informatron is cor2ct.I agme tn comply wi all Counry ordinarices
and State laws regula[ing Electricat , and hereby authorize
2D2sentative�f ihi� unty toyr�t upon the a6ove-mentioned
property�foc'3 rpos a� SEE REVER5E FOR E%PLANATOHY LANGUAGE
� �f�/(O! �
na e W r dtee � �' �ate +�f��
,��•r
, . •
_ ,s : - - .. .
� `
N� D .. ' • .' ,� �
`� "�8 S'J 6J . " - _ � 1
� ,�� y - y �� s . . ���.
� N y C � � L3 � . ' . ' .
�s, f9 J
Y:=� �i 1� }+� t�'J -.0� O � �.. ' , ,
. ��'��1.O.� pj� '� '� � .Y U y,� T� C� 61 ' ' � .
.. " , ., ..��� � `r_ �cS��t�?. � o i �,. � P�*,' '� �', +,, .
N � �'e''q� � - 3m �a r� =� o3�m r
� o . a
• '� � _� Fb� �e- � ..� m Q� o'3 . , ._ . ,
Z `�s �i '"�Q r. Y'!r - n �v °'� ° G� �•�� + /�
t
.. . � -c� ,�i'�`^ �grn .�'��.�� : mU 4 `�t N��3.. • , -. .
� '4 .0:'-�.� m � en 5� �, E: v� �� F . � ,
� � Ur- �� ��?� y� �n �w�p'�� 'r�\' � E _ .� G .
� ' � � C 7.�"i� 4j����C ,��,.^C.) Q�`o� O� O �.`4i `�' . ' t3 N ' . . f �
� . � P �' � � a � O Q m �� �
o ��sasc� .�"o ,� .�$ v+ co�t�'�s.3 � Ex-' � �
_W �._����..������� s °bc'E�'�� �l� � � � , - �
O X N �, ` ��i �� �N � O �x�.0 O���O � � ' � .
C
. .a 'C� N� V'di ' � � � � C+q w�}, � ��. L1 � .
d! � � ��:.a� 3 � dS�a o�cw, `cs A w -o aI iJ, G .
' � — �¢� ��ia� b' o � �5� @ � p F � c a%i Q- @ X .
�„�-!yA r� ... � ,y_ �..@ ra m G.,a � _4 � - ' o.bn Ct C� .
y � W-p �R � �� 1� ^ W
}y ' `O O�i6 ,j�¢�q£ K� �' y4 � �� ��� • � .
. � '(�} �'. �' ,e.�'�y Tn F- �"J � � Q '^ C � �j � � '
� �y `rn��K�+ � :.� � .�� ��� �.LLc�c,�. � t' . " � .
A�y .q� ��.y`� ry,� L9I'-o. .,�
' . A o�c?. N��Y c� `U � '� N"� .
�, " d � gRs"S`�'� Q ,
. i ��
� r
t
1 ,� {' _ � .
��
i �.
,�, +
� . .t
t '
. _ ��, � 1 � �� j °�
• r.3� ' ; � i �`i 'ti j�
��Q � �{
�� �� � � �` � � � � � t F � �
C t } � � � ' � ;
. � �y • w '� ` � � � � 'i '� � � ; ��
w t y o � �� � � i � � � '' ��, � ,',
� � � �" � �+ . 1 �� � �i , � � � ' �' �
� � � ; � i � 1 �1 1 ' �1 �
�`� '"" ' S ` � � i
, w `,�'—_'y `,� . ' ' ' .l � � t � ,
� n, � a ' � �� ` �� '� � � � `� �
, Q c� r_ � z � ,� ', ' ' ! '
� �j `� � ° �� � `; ,�� k' ,� � 1� � ��, j � t �1 �
.�
' ,,' �- � a � � � �� '��, � } '� �� , �� � � ��', . �� � �� � �} �
. , �, a � � 'Z ,�. �`"-rj.; �, u �, ' ., � , 1 � ,1
. , �n, p a �. x ,a � �� ��� ,'" A .� �t � �
. ,� � ¢ W � `� . 1�, ; � ' � i
�-Y� . . V'�,�. ' . . '':r . '`�, . ;, j � � ;� , ,
� ,. � � . ';� �� . �� , � � ��
' �.. ' . .` . ', �j ' � .
• . € � '' , ` � ...--�---.�'—~'f~
' . � � ' 1. � _----�"
.. , �t ,� �
' .' _ �'� . . , _ �-.�-
; , - .
x �
: � __---
, . . f-."—�'—__ ..