HomeMy WebLinkAbout1370 VALLEY VISTA (47) . WORKERS'COMPENSATION DECLARATION CEAs06G ���81 QppLIC�.TION FQR ELECTRICAL PERMlTs�'i-S� J'j
I here6y afiirm that I have a certiticate of conserit to self insure, y ' :
Cor a certlfi ate of Nbrke.rs���pensatio - ra��orra;ertifie COUN7Y OF LOS ANGELES BUILDING AND U I
�Py� � �
� �. G Compan FOH aPaLICANT 70 FlLL IN JOB �
Cer'ied Copy is hereby furnished. New Residential BIdBs&Pools EACH ND. .FEE ADORE55 �
Certified copy is filed with the county buildinq inspection 1&2-Family,Sq.Ft. $ — $ LOCAL Y�
d itment. MUI[Ffamily Sq.Ft. — NEAFEST
CF105S 57<
Residential5wimmin Pools
Date AppliGan �> 9 OWNER OR �
�� FlRM NAME
CERTFFICATE OF EXEMPTION FROM WO KEflS' Outlets:Re�Light?�1 Sw.�L t� MAIL
CAMPENSATION INSURANCE � nooae
(Thla seciWn�d not 6a com�led q!he work im by Yhe First 20 �
Total No.� qdditional CITY Tei.N
parmit is lor one huntlretl tlol�rs($100)a less.) ��
4 certify ihat in ihe performance pf}hy work fw which this permit PLAN CK ' .
is issued,I shall rat em APPLICAM
ploy arry person in any man�er 50 25!O _
become subject to the Workers'Compensation Laws. Lighting Fixiures .+7 First 20 I 5 ADDRESS .t
� Total No..�L �ditional
Date Applicant CITV Tel. �
�-� Fixed A liances Not Over 1 HP �
�E TO APPLICANT: It, after makina this Certificate of p� PEatnlT ��,
� JtiOn,You ehouid Gecort�e sutl?ct[e ths Workers'Cqn�BnSfltiOn �^9e— Fieater_ D.W. _ APPLIGANT .
pcovisians of the latwr Code,you must£orthwith cwnply wi�h such Oven_ Dryer_ W,M._ AD6RE$LS � �'� 1
provisions w t�is permit_ehal!be deertieU revoked. - Top _ FAU _ W.H._ ( 3
LICENSED CONTRACTORS DECLARATipN C�T �' � Tei. �
Hood--y Fan _ Other_ .f
I hEfCby aff�m that t am.Icensed under prrnisions Of Chapter 9 / LICENSE QR
(comrtfenCing wiFh Section 7006)of Oiv�vion 3 of the 8usiness and Disp. Y— floUm Air Cond. _ t7EG NllutE3eH ��
ProFessions Code,and my license is in full force and effect. oisiatCr ra0. PHOCESS D ev �
Pawer Apparatus&Large Appliances i �?
�T � Size&Type HP,KW,KVA,or KVAR 1 O � ��.� "+� �
License Num� Lia Class �—� Up to 1 Incl. FINA� � g
Over 1 fo t0lncl. �ATE � a. �
ContraCt 'Date ���—e �v�t>� VAUDAiF�N � �
Over 70 to 54 Inci. FINAL
❑ I am exempt und r Sec. Over 50 to 10�Inc. BY W
B$P.C.for this reason Over 100 �..�� a� �
� Services,Swtrd.,MCC&Panel6oards � Z �
e 0-200 Amp.Under 60�V �
Signature � � . � 201-7�00 Amp.Ilnder 600 V ]
/ Over 10�0 Amp.or Over 600 V �
❑ Exemption ior Reg.Mai �eCt. {
SINGLE FAMIIV Temp.Rower Pole 8 Appurtenances �
. HOME OWNER-BUIIDER DECLARATION Sign wilh Oe�e Branch Circuit �
` :by affirm that I am exempt from the Contractor's License Law
`n .ne toilowing reasar(Seclion 7031.5,Business arnt Professions Add+tionai Sign&anc�Circuits
�1: �
❑ i,as owner of 1he property,will do the work and the structure Misc.Conduits&Conductas �
is not iMernied or offerad for sale(Section 7044,Business Other(See Complete Fee Schedule)_ _; ,� -
and Professi�ns Code). - � " -
CONSTRUCTION LENDING AGENGY � �• � ` " � .
I hereby affirm that there is a construction lending agency for the � -
perFormance of ihe work tor which this permit is issued(Sec.3097, PERMfT PEE � �u`�
Civ.C.). / (�b-Totap
/ V ��� PLAN CHECKIN6FEE � E " ` �
Lender's Namel•Es
�/f PERMIT ISSUING FEE 1� � ,•� `' �� ��
Lender's Address���!f��j j��
1 carti(y that I have reatl thls application and state that t� TOTAL FEE 1
information is correM.I 8gree to Comply with ail Cwnty ordinances
tp
and State laws regulating Electrical wiring, and hereby authorize
represeMatives of tbi� ounfy to enter upon the above-mentioned
property tor� p y
SEE REVERSE FOR EXPLANATORY LANGUAGE I
Signaty of py 'te j ^�/Date `� !
� / i
" � � �= �;:�� �� � " "�
� � - :..�:�, = o� . -. . _
�
m
J'�.��o ,� a,�� .n'a � �� �' °° , . -
�% GJ Rf J _
C �i �
Z .�� £� 0.� � ��M .V O ���'�Cl;� " � ' , . �
A N
. O i � U O F �.�a N.. 3 y4i � � �i { p � r
�;Q ��i �'' N a �� R o .. w ~ �{o � a�i h ,� .
0
'�q �o � � '� �q' � b.� � o�° � �,n� Sa� ° - , ,
' •U �� �� � �,Q�.w � ��3 vi C.> � � a� � ly • � , f , ' .,• r: � �"��
ti
. . �WO o � � `o �� U ���i 't� m� ''`' � .�¢ g " y � � �$ , r� . ' ' . , ' � ' 4*,
�w _ � U o � � � c � o Q� � c � c � { � . + .
�- � .v 3 � o 'c a ro 'e
� � c � � � Y �� o � a n G� �g � Q �� ( ; , ' . ? .
x
� d � U � �j� � � �'�� �-o � 02, ? m �A g v C , .
� � c � trm �'?'� c".� a � �'a n o .,�o E , c�i � � ' - �
� � m
�-W '- c Q'� � L � L�;.h ¢ €:� � '� Y? p c� pi � �N
� m '3 .. . G �'1 y� a di t � F c_ � � ' • . '. _�. .
� O ���i'�0 � � p � � S"1 C 7 C � (Mj � p� � 5 � � f�
O � J.
� � N IV p] � g N '._., � C a L ��] N ': � ° �. . . .
'� `_ Lyc m & �co � X � L `" N �' -�` v� � � � � Q. � , , ' "�''
� Y ,O �I� � O !� i 43 O = ' � ��.I j .0 _ � �'O � '
� �� y �.� bv = ° � � E� �� �, � � �, � � y U . ..
• � 3 � �� .y�� � �.� � ` � � `^ �i r�,A . � � a � �.
� r �� .�� m ov�i' L�+ � �o v,�:� o = o � � _ � m •..�� Q O �'
�
, ,•.r.' '
r . +
� ? .•
' � ! � �
. � � i � E ' ,
r
o� I i ; � � , � t � � (
�E i € f
�1z , � f , i � � i
� � � �
z� � ; � , �
, � � ;
- ` � � � � ' � ! � � � �
� ! � � � ! � . . '' � +
w � ��! � � � � � � �. I
1� fi' � � � � ' � � j
� N �.� ,l:; �� ' � � � + iI ' � � � �
, .�. �I � �� �� � � I ' '
- v � � 1
.... , �. �
� ` ; � 3
o � � , . ; I
� VJ. � � � 'N ii / ' r � . �
-' a o '- r: r= . J � � , �
� > p � j � i
, � O b � . � �• Q � 'i'` ..� � ( � � i
.y ' I � �
a a o �.,z �� � .r�_- :� w�` ' ;., •` ` (f i I � �
`ui z O '�,'x�� � z n �' � '� �} � ! I (
_�� �. � _v � j � '� w a i � I
` r , ' - -- A . :. ,� � - ! , I
.; . ^ . . r � ; � � I
, , . ,� � � (
_ , . i �
. I ' ' - ^ , r�� - � �
.� f i �
. . . . . , � � � I I