Loading...
HomeMy WebLinkAbout12_13_1982 - 1817 PEACEFUL HILLS RD WORKERS'COMFENSATIONDECLARATION � 76A663 APPLICATION FOR ELECTRICAL PERMIT � � � CE-806G(2�601 � 1 hereby a[firm thet [ have a certiticete of consent to sel£ COUNTY OF LOS ANGELES BUILDING AND SAFETY insure,or a certlflcate of Workers'Compensatlon Insurence,or � . a cerNfied coDY thereof(Sec.3800,Lab�.C.) �� � - ' � � FOR APPLICANT TO FILL IN JOB Poli Company EACH NO. FEE ADDRESS - �]_1S � �� . New Residential Bldgs.&Poots � Certified copy is hereby furnished. � 1&2-Family,sq.Fc. 2393 s — a LOCALITY TR#35742-4001 Diamond rrd. Multi•tamily Sq.Ft. — A � . � � Cerlified copy Ls filed with the county 6uitding inspectlon Residential Swimming Pools CRO35 ST . department. � , . _, _ OWNEROR - - . FIRMNAME O �C. S SOTLS TAC. Date 1�-1�-A�plicent ��'-�����FIP�'-t'r'i G.TPI Ou�lets:Rec.^Light Sw._ � ' � ' MAIL ����t zo Aooaess k698 Greenbriar Lane - CL•'RTIFICA7E OF EXEMPTION FROM WORKERS�� Total No.�_� Additional CI7Y � - Tel No. - COMPENSATION INSURANCE � � l 529-81 O O . - � . PLAN CHECK _ ('fhis sec[ion need not be compkted if the work involved APPLICANT V _ by the permit iS fOr one hundred d011us (5100)or less.) Lighting Fixtures � First 20 A�DRESS� . - Q� . Additional � � Total No. CITY �- �7el No. I— I artify that In the pedormance at the work for whieh this Fixed Appliences Not Over 1 HP � U� permit is iuued,(shill not employ any person in any manner PERMIT �� � W` — — --co as'to become subject to the 14'orkers'Compensation Laws. Range_Heater D,W._ � AVP ICANT C ��� E��-'�IIC ��TIC N " }�:�_ . .. Oven _DtYer_W.M._. . � � ADDRESS- �Q.O. �$�]{ 2886 � 2 � YDa. �. .. ADplicant� ToP —FAU _W.H.._ . — - Hood_Fan _Other_ , ��T CA..91769 Te1 N°. 627-0936 , �NOTICE TO APPLICANT:If,aHer�making this CertiFicete oL Disp. _Room Air Cond._ LICENSE O 1,53378 � - � C 1� •Exemption, you should'become subject to the Workers' REG.NUMBER Clns CompensaHon Drovisions of the Labor Code,you must forth- power Apparatus&Large Applientes - � �ISTRICT NO. PROCESSED�BY , with comply with such provlsions or this permit shall be Size&Type HP,KW,KVA,or KVA � " � ' � -�4 O n 6{� deemed tevoked. � - � ' S .. . . UP to i�ncl. " . , - . � - FINAL �� '— � Over 1 ta 10 Incl. DATE ,z���--�� VALIDATION ���- LICENSED CONTRACTORS DECLARATION ' � � Over 10 to 50 IncL � . FINAL I hereby aff'vm that 1 am licensed under provitions of Chapter Over 50 to 100 Inc._ . gY • • � O Q.?7� . 9 (commencing wilh Section 7000)of Division 3 of the Bust• Over 100 � � � ness and Professions.Code,and my license is in full torce and . . � ��7� 5_S 7 . � �effecL Services- License Number�S��'�R'�� �Lia Class�'�l O � . 0-200�Amp.Under 600 V � S e��x�C� 201•t000 Amp.Under 600 V �Contractor Date 12�13�H2 . . Over1000Amp.orOver600.V . , HOME OWNER-BUILDER DECLARATION Temp.Power Pote&Appurtenanees �b-he•pby affitm that T am exempt from the Contractor i Sig�with One Branth Circuit , � ' !:a-Law for the toliowing reason (Section 9031.5,Busi• Additional Sign Branch Circuits - . � � - ���._� �ofessions Code): . � . � _ . . - Misc,Conduits&Conductors . � 1,as owner ot the property,wiil do the work and the Other(See Comptete Fee Schedule)— � � � � structure is not tntended or oftered for sale (Section _ � . - � . � 7044,Bustness and Professlons Code). � . � , � CONSTRUCTION LIiND[NG AOI>NCY � - ' I�hereby afflrm thet there is a construction lending agency � � � � . � , - for ihe performance of the work for which this permit is pERMIT FEE (Sub-Tota�J . � � � � � issued(Sec.J097,Civ.C.). �. � " ' . 98.72 �' � ' LendePs Name PLAN CHECKING FEE -(One-Fourth Permit Fee) � � . . . Lender's Address � PERMIT ISSUING FEE � 10.5� • � � . 1 cerHty that I have read ihis appllcation and state-that the TOTAL FEE � 10 �22 � � � above information is correct.1 agree to comply with atl County � � � � . ordinances and State laws regulating Ekndcat wiring, and , � � here6y authorize representetives o[this Caunty to enter upon - � � , � � �_,- _ � - the�above-mentloned property for inspection purposes. - ,SEE'REVERSE FOR EXPLANATORY LANCUAGE . � . . ' � � � 1 2-1't—R2 � ignatur Permittee Date � . . . . � . . . . - . . . . , . ( , i - - _ - - . -- ____ - __ -- - - . . . �� � . . � ; ._ _, , - . � : . i _ , , � : , . i , i . , ' � ' I i'� . . .. , , �. ,� ; - ' � ; �: i _ , �i , ' �.; ;� . _ . _ i ' , �, , � �, • i { , . . i � �IJ � ' � �. �, ' p T -i O T �� O Z r' ~ ` � � -i Z r t � � C O. ; �. . � ' _ D � m D � � r '� � c: � �' • - x � �o , � c,_ �,. � � - ' n D m - n r. O .� ' � C N ' O p ..� p ' � ' . i . '� Z � ZO W , � � - ... ' � , .�� .O . C � .9 D ' s � ' I ; 'T �7 �{ � p'. vri • C;; - m N � m�, - . - � �� . � � � �� . . . � ' - � . . ". - ' ' �� . , _ _ _ . -.. . _ .. � ..' '. "_ _ �. ._'_. ' _ "". ' _ _ _ '. ; � � � �� .. . r; �. , , , ' _, _._ , .. . ._ _ __ _- - - - _ ' I' i i � � � , m - ' ( -� -' - - - - .._ . __ , � � � , _. . . ; , , . �� ,. y .. - - • - - -- - - - , 2 m = I �. -Di� -. . � ' � �� - _ _ - - - - my _ _ j � , - � i . -. I ', , � ' , ,. , � - - , ! ,. ' . _ , . , , , . � . ; � _ . _ -. � i . ' � . � i � � . ' . . - � . ' . I � . � � ' I - i � �.. .� - ' . . ' � � ' � i - � y - .. . � . - i , i .. � _ � .. ... . . . � �,- . _. ! �,� . � ._ .. _ _ _ . . .._.. ._.. . . .... .. . . . ._ - • _ , :. : i ; �. . . � ` . ' I . . � - k 1 ' . . . _ . .. ' .. .. - ' . .. ' ._ . : . • . . _ . ' ... , ',:` • T _c:n...o-q �C �yC ��.`..•:� � �b�U `^ �CF Q�t' . , _ _ ' ' • . _ � ;�,o-�,�0 n O ,9, m i: �_,y O.O m ,,�, � O�_p � � ,,�, Fi.. - � . - � �. _ . ' . _ �(� .. �_ U'L`y�:4.� �'O :� ���,ra'4� C .r`.. • 'o p �C•} m - _ . I�-1 � -- ° � 4�; Y a � � o;h� h'�� A . , � ' . � �� . " . � :Q , V . _; f9 � 4C <it h'O f)�� N 3 O h ��� y�--0 �..t N '� q'. ..Q O .�' �, . - � ,- '. _ .. . ' . � -. � �'�' ._ _ rV � `"oc � � �'>�1-F t��t�•� H ��'' �a ti o Q � h q � C � � .P'.n+ -t � � � . _ �� I X � -. ~ ;: �-i� . .l�'� 0.C q y� ���'� � �t ti ��,..�,� .� . . , � . - � � . .: _ " , -� - '' - .. n J ;'� �,L C�� ��b v,• �o C � 4 -. m ... � ti `�n+ � ' ' - .-�, �s �a ' '� �Q' ��.- a a :, -: -- --v �o.3 77 . . 0 � . = ? q.� c �. ,o � o�o;� o�:�o � �o o.c � � r .._CO . I . ! , ' . ' ^ io 0 � O`,4�'h. .p �, 0 3 A �n:Q �`b n.�^i ,� , _ � -• . - _ ..r c �.y . . o � h5 �; ��h �o ^a� c � y .� • - .� � . ' . - �.. ;n• - 4,�' o? ., c � c c., o .o'� �c. c'-;-� -�" .. p- ii� '��+o ...a. �.00 wh � � �� o d t7 - - , • - _ . . 1 � '�'i ���'.�' � �'�O y 4-Q� '`o. � t"� f�o p � : �.c �y'� . •� � _ ' � � � , . - �� ' o � ��C,��A'C o ���p b � y� o �� �-�y �•Y.�. .. Cl. h' C4., A 1. , _ ' ' . _ . . � fi'i o o��o �N O n �.b 4 m`a h,�� e o`o° -' _� . . _ . . . ' - .. . . ' ` � 4 1 p .. o �".io'�� �:`< �. � •n " .`� C '' �o�-.'. �C� _ - d- n .m� � � �. o.b� � c'� � naj �.� � C" , - � . . - O �`� ;o � �,c`^ 0.,r ,�.b m .. ,`"h y- p.n � O . ��y . . . - - - , � �. .. � . . �� � - - �•o`��° nMa . c :i°,QO�ba ~�•',`^�� r_y _ � O Q C� .ti O k "' ':'h r �O � ti� . . , ... __ . . . _ . ... 'a � y �„�Q q �0 � .^� � : � ��"'�:-M � �� � �"� � '.. ' " . . ' -' - � C;+.0 p.0 �Y�, _o c ��� O� ;Q "•,�,�i� `p'C� 0 � o y - 3 � N n � ; � ^ z � . I� . . ' . ^ _ �1 .. �. ' 'c ro �0 Ri�F . . ' � `^tr*~'� ' F m C `�a ` k c U��" C e�� �•v w " . ._ .. _ . '� - - ' - � O D �� � O T, � O C n . . . . _' . . . - .. . �.�.�.'. '�:t - �.�. �ti� o � y-` � ' - � _ - . � .. - � , � -_ . . - _ . .. � . .".4� ��/�-,�j O � .c 3� � ~ �� n O � � �. . ' � _ , ._. � . . . . . ' , t0 ��1�O � T``: C -. •�..'\C �O `O�C A � ��C��tn' � s .«...�."h^�•�� ———— —