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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. 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