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HomeMy WebLinkAbout1370 VALLEY VISTA (51) i WORKERS'COMPENSATION DECLARATION 7en663 i0ie� APPLICATION FOR ELECTR�A P R I here6y affirm that 1 have a certiiicate of consent to self insure, ce-aosc � or a certificate of Workers'Compensatbn Insurance,or a certified COUNTY OF LOS ANGELES BUILDING AND SP�Fr`��,! M copy thereopf(Sec.38DO,Lab.C.� l� 4�}�A� �� PdiGy NO.`i,7l�.v�Compgny ""�4�� FOF APPLICAN7 TO RLL iN �ppqESS-� LJ � ❑ Cartified copy is hereby fumished. New Residential 81dgs.8 Pods EACH NQ. FEE_ __ � � Certified aapy is tiied wit he county huildi inspection 1 8 2-Femily,Sq.FL S — 8 LOCALITY ���,Q�� NEAREST depa tmeLM�.'� / Multi-family Sq.Ft. CRoss S7. � �ate ��~ �+ qpp�icant `' Residential Swimming Pools OWNER Oa ^�' ('� � FlRM NAME � 1 ���-' -�CERTIFICATE OF EXEMPTIO M NlORKERS' p (+ COMPENSATION INS E Ou[lets:Rec�Light Sw.� �� oa OHESS l { �] (Thie section need'wt be eat�tad if 3he work involved by the First 20 permit Is Fw one hurWred dulWes!$1Q0)nr lass.� . Total No.� pddrtionat GTY Tel.No. t� 1 Certrfy that ifl the peFformanCe d the work fOr�wh�ch thi5 pefmif PIAN CHEC � r is issued,I shall not empby any person in any manner so as to A�t.IGw7 �r become subjec[to the Workers'Compen5ation I.aws. Lighting Fixtwes First 20 � ADDRESS �� Ur V� Additional � Total No.� CI"fY �, Tef.No. DAtC Applic9nt Fixed Appliances Not Over 1 HP PEFiMIT NOTICE TQ APPLICANT: (f, atte� makin9 this Certificate ot ����T � �� � 7c� Exemption,you should hecome subject fo the Nlorkers'Cornpensation Range_ Heater_ D.W. _ V � pravisions ot the Lebor Code,you must forthwith comply with such Oven_ �ryer_ W.M. ADORES3 �3 Z ����� prwisions or this permit shall be deamed revoksd. Top _._,_ FAU _ W H.� LICENSE�COMAAGTDRS�ECLAFiATION Hood— Fan _ Other ���Y � ���NO� � � � I hereby aftirm that I am licensed under provisions of Chapier g uCENSE OR � Disp..— Room Air Cond. — 1 Z'` Gass t � (comrt�erwirig with Sec�n 7oa01 af Div�siors 3 of the Businsss ar,d HEG.NtirnaeR Professians Gotle,antl my license is in full face ard effect. Power Apparatus&Large Appiiances aSiHtCi NO. PROCESSED Bv � License Number�`��� Lic.Class� Size 8 Type HP.KW,KVA,or KVAfi �� � 4 � r Up to 1 Incl. FINAL � I . U Contracto�F 3.J��F�V.�+�'� Date � � a.O � dver 1 to 10 Incl. DATE � �`y4 YALEDATION � �a r ❑ Over 10 ta 5�IncL FtNAL 1 am exempt under Sec. Over 50 ta 700 Inc. BY �� f W 8.&P.Q for this reason Over 100 ��^-�' �� Services,Swbd.,MCC&PenelboarJs � z ' 0-200 Amp.Under 600 V �" Signatura 20t-1000 Amp.Under 600 V i ❑ Ovef 1000 Amp.or OYer 600 V I Exemption tor Maint.Elect. - - ' SINGLE FAMILY Temp.Power Pole&Appurtenances HOME OWNER-BUIIDER DEGLARATION Sign with One&anch Circuit �_�L� ;�, , 1 hereby a(firm that I am exempt from the Contractor's License Law �, , for the following reason(SeCtion 7037.5,Business and Professions Adtlitional Sign Branch Circuits Code): �� • • . u i � � Misa Conduits 8 Cmxtuctors — - -� ; I,as owner of the property,will do the wwk and the structure � �' •�4����: i is rwt intentled or offered for sale(Section 7044,8usirress Other(See Complete Fee Schedule)_ � and Professions Code). • •�z�� r . � � CONSTRUCTION LENDING AGENCY � O 4.� i.—.. ' . I here6y aftirm that there is a construction lending agency for the performance of the woric Tor which this permit is issued(Sec.3097, pERM1T FEE (Su6-Total) „2� i Civ.C.J. ( PLAN CHECKING FEE LerWer's Name PERMR�SSUING FEE O Le�er's Address �� 1 certity that I have read this application and siate that ihe above , TOTAL FEE informatan is correct.I apree to compy with all County ordinances and State laws regulating Electrical wiring, aM herehy authorize eseMatires of this Counry ro enter upon the a6ove-mentioned rtY for inspect� pases. j /��,1�/J'` . SEE REVERSE FQfl.EXPLANATORY LANGIIAGE �.} ll ./ Si pf Permit�ee py� I f :�, �,: `- " y � �� L � ���O �^ • ' _.,. . � � ' ' ^'4.'t0,.,, U T7 � �w � 's�� � ,� � ' ;��p � y T� " "F .,� '�! � O N � � � a � � ' ' ' , . � yq � � � C � ` .G ? ^ `� � � i, . . . � . M �' � 4 O � . . '� �`a c3 � �� N� •�,. C) �� -- R� ' N yy A7 �" V ? CJ T. E� C OC� . . . ' .. ' 40 •S� 4� E'� p�O N y �� ��' .0 '_" 'f¢U N \ � ....�^� . . �.Q tU`L' ?.�� �� :.�1'� O Y C� 4 a zJ d ...... ti • _ . ' '.. . ln � C (.� � -� � N. �'� CE Q1 , \�, ' '� ���� `�o �o: �.� c�a � � ° .c a Pa .c�..:� sl. -'� :.ti „"� . 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