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HomeMy WebLinkAbout1370 VALLEY VISTA (49) WORKERS'COMPENSATION�ECLARATION 7aA6a3 to/9i APPLICATIOfV FOR ELECTRICAL PERMIT S�G f� � 1 hereby affirm that I have a cerCrficate of consent to seif insure, CE-soaci � or a ce ate of wakers'Compensatbn�n ur nce,�or e,certitied COUNTY OF LOS ANGELES BUIL�ING AND SAFETY�. C.) �C! i . ^ �,p� ' � FOR APPLICANT TO FIIL IN pppRE55 � Certified copy is hereby furnished. New Residential 81tlgs.&Pools EACN NO. FEE � ��Certi�ied copy is Eiled with the nty �kting Ins ection 1&2-Family,Sq.FL � — $ LOCALfTY . depyr[msnt Multi-family 5q.PL — NEAREST � �� i �APPlican Residential Swimming Pools OWN R OR n ✓ �. ��� FiRM W1ME t � �� CER71fICATE OF EXEMPTION FR �Ryi � � �� � kwL � � QAlets:Rec LigM— w.— - ��� GOMP€NSATlON INSURA GE - � ( Q MOFiESS �This sacdon naed not be completed'rf the work inv ed by the ry First 20 permit Is for wie twntlred doilars($700)or lese.4 Total No.��`j qdditional CITY �� Tel.No.�-1 I certity that in the performarice of the wark fof which this permit P � aaaucaNr �issued,i shail not empby any person in any manrier so as to q � become subject to the V�Urlrers'-Compensation Laws. Lighiing Fixtures First 20 ��% ADDRESS �� � Additional pate Apdicant Total No.� CITY .No. t!' ':E TO APPUCANT: N, after makir�g this CortiEicato of Fixed Appliances Not Over 1 NP pEa ii _ � P��.Y�840u1d b9CAri1e suhleCt t�ttla Wp[ke[s Go6lPensation Range_ Heater_QW. AF'PLICAN _ � provisions of ihe Labor Code,you must forthwBh comply wi[h such Oven _ Dryer_ W.M.� A�ORE � provisiore or this permit shall he deemed rewked. 7op _ FAU _ W.H._ I e LICENSEP CpNTRAG70R5 OECLARATION Hood_ Fan — Other— CITY , �4� f 1 hereby attirm thet�am licensed under provi8ion� Of.Chaptcr 9 LJC SEOR � � � �isp. — ROom AiF Cand. _ REG.kl1MBE (commencing with Section 7000)of Divisicmr 9 of the Busirress arM � Professions Code,and my Vicerese is in full force and effect. pp��Apparatus&Larye Appliances �ISTRiG7 NO. PaqCES5E0 ev /y �/� Size&Type HP,KW,KVA,or KVAR Q (� � � License Num ic.Class_(,,....[_L1— Up to 1 lncl. FINAL ' � v 3 C.aniraCt te� . Over t to 10 InG. � DATE a-/�� .VALIDATION Q � � Over 10 W SO lncl. FINAL � 1 am exempt u er Sea Over 50 to 100 Inc. gy W 6.&P.C,tor this reason �-� Over 100 �' � Services,Swbd.,MCC&Parxd6oards � z 6-200 Amp.Under 600 V - Signature ,� 2�1-1000 Amp.Under 600 V ❑�� --- / Over 100�Amp.w Over 600 V ` Exemption or Reg.MaiqY.Elect. I __ __- _ . . .. --. -"SINGLE FAM�CY'_.."'_'.._.. .. -�. . Temp.Power Pofe 8 APPurtenances _-:. � :. � HOME OWNER-BUILOEF oECLARATiON Sign wRh One Branch Gircud � �by affirm that I am exempt from the Cor�tractor's License law � _ � i,. .ne toilowing reason(Section 7031.5,Business ar�d Protessions ����g�&ar�h Cifcuits r -- - - - - Gode}: y + ❑ Misc.Conduits&Conductors � �. � 1,as ownet of the property,will do the work and ihe structure , is rot iMenfed or otfered fw sale(Section 7044,Business Other(See Gomplete Fee Schedule)_ � ;, ; , and PmTessions Codej. CONSTFiUCTION LENDING AGENCY � J � � r .� I hereby affirm that thera is a consYruction lending agancy tor the perfamance of die work fw which this permit is issued(Sec.3097, pERMiT FEE (�b-Totaq Civ.C.�. . .PLAN CHECIUNG FEE. . . Lender's Name PERMIT ISSUING FEE � Lerder's Pddres - — I cerdfy that 1 have reatl this application and state that the above TOTAL FEE `�,Qa information is carect.I agree to compry with all County ordinances and State laws regulating EleCtrical iring,and hereby autFrorize represantatives his unty to �ter upon the above-mentioned property fo � ti rpo SEE REVERSE FOR EXPLANATORV LANGUAGE � l/;�l- � ,� I S' atyr rmirie Date ��� I / � . �J a � N N � N � CT y. G: y 41 b w.'w.. - • - . Y�i��c�`.� 4� � �;:� � 41 �G y '-� b � � � � � . • . r�' , Q ��y � y� �, y�. 'o -J y a � D �w�C SL J � N a� . _ ... _' ' �n � `tl � � � �' .� ,n � v �O t g �' �, • _ " . i� � v U 3 � '� o a _ Z ,� o� � a� E 7zq � c.� � s � �'�' c'g . . ' O R cLio mwo °' �' m •_ �, � [� -� . . . . ..'Q C� � �.V � +�C- 1� .,C,� « ~ FS� ���?.�'N � . 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