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__ __ _ ;, . , . , . . _ :: __ - .i {i� ' WORKERS'COMPENSATIONDECLARATION � � 76A663 70/Bt '. . 'CATION FOR�ECTRICAL-PERMIT. � � �� . I hereby aFfirm tha[I have�a certficate�of consent to self insure, CE•6o6o� , ,� � • � �� or a certificate of Warkers'Compensation Insurance,or a certif�ed � C��T�'OF LOS ANGELES BUIL�ING!AND SAFETY 4i�.�. coPY Jhereof(Sec.3800,4ab Q) ' � .���� ��h� U.: L ... ,, . .�. ( ;�:. �-. .�� : . .. �: . . .. .. . .. �::,; ��-'. PoliqfiJo.��� '� f S ComPenY � � f r.... !�,,.�•.:� .. . ,..FAR AO NT.YO FlLl!'IN � � � .I�B � ���C +'" �- I' L tiJ . � pooaESS t�f. �.7J._. ;�.: . / .�❑� Certified toPY�hereby lurnished. � . - - IJew ReS�eM�ar$IdpsZ'8 Is fi3�'Sy lf H. NO. F .. LOCALITY �� �'� A � ., �, �, : . ., _ � � � .Certified copy Is�filed with the�countY building insp� tien � y�t�1 8�24Family:9q�Ft,. $ � -� .:: -.,�� � � '. -.Date !- ��U � �'^ � f� � �i�Fesidential Swimmi Pools.' � .� ._ _ . '� cROssssC, r.t�A.;,_.-. •! �-.'-•.=-.. ,.. . ,. �� department. � � 1 Mulh famil i I. - 1. � .. �D�: � .- f19 . OWNER OR� � X �iti.;V�. . . '. __�.-�--'- ' � . . .. . . FlflM W1ME .� �� . . � �CERTIFICATE OF EXEMPTIO FFT ROM WORKERS � � �- � � M1�a� � � � � � `"� � �'�L�1�: � . . Outlets:Rec—Light'_�Sw.— � � �")� ���,••L.t- (..'�,✓�'. �. � � . ��.��� .. COMPENSATION INSURANCE ...�� � .. . . ; ADDFE55.: . - . 1 ��(Thia oectlon naed not be compleled if tha work Invoived DY the .- , Firs[2D � � CRY•r.,���., y..:....�T�. �f�,.��Tel t�-/�/�.��✓.-17 h• . � permlt Is lor ona hundrad dolWrs(5100)or leas.), ' � .Total No, qddilional - �� � I certify that fn the peAormance�oi lhe work for which this permit - , � Plnra cHECK � � . is issued,I shall not em lo a � � � � �� ��I� � . � .. p y� m/person in any manner so as to . become subject to the Workers'Compensation Laws.� . ., Lighting Fixtures_�� �First 20 � �� � ADDRESS � �' . � �� � � � • Additional �� - ' TeINo. �� � �} . � ; � � .. � � . . .� ..�.-7otal No._ '- � � . , . qTY ' . �- . . �Date `� 'ApWicant Fixed Appliances Not Over 1 NP � pERMi7 � � �.�NOTCE, AFfPLICANT: If, eiter making.this Certifiwte.�ol -'J--^. �-G�i`. +��� '� �i - Eaemption,you should become subiect to the Workeis'f:ompensation � .'Aange_�Heater�D.W. _ . ' ��M � � �-i ���D�sions of the LaDor Cotle,you must Porthwich comDly with such Oven�_ Dryer_-W.M._ �. ADDRESS /� _�:=.� � f,�-�C-- �.� '^rf( `� provisions or this permit shail be deemed revoked.� .- � ' .� Top �—FAU _ W.H.� - � � ,.-- r Te1 No' LI� � �-, - . . . . .: . .. . � CRY��,,r-� � '., '..[' T� Z// -- . � ��LICENSED CONTRACTORS DECLARATION � ,�HooO_�Fan _Other_ sy . i; -I hereby affirm thet 18m liCensetl Under provisions o(Chapter B �� �' � � . � ��. uCENSEOR / `� � :'Clase �•�� } �, ��lcommencing with Section 7000J of Division 3 of ihe Business aM . Disp —.�Room Air Cond. _ pgG.NUMeER�;�-�f-�-�-�/ il. RoFession5 Code and my liC0n5e iS ln lull�Orce 2�d ellEtt. . � :y�. OISlR�C�NO. ' � PRDCESSED BY . O . ; . Power Apparatus d Large Appliancee . i _ i .�� CJ - : ,:..- � � � �� .: /' t ._ �SiEe 8 Type NP,KW,KV0.or KVAR� ! � ��! � f- � � . . .'License Number �t--l ��:�-(��Lic.Class�[ � -� � �. .. ,�1 ' FlNAL�,.' � . .. �_ UP to 1 IncL�` . � ��.I Y., �'Coniraotor �' '��� ,�� �ia�`t^oate � ��... Over 1 to 10 Incl. .I DA�� DAT O ' r ��I� �::y� ' -Over 10 to�501�1 �. 4 FINAL �.. � ' �� i j. �❑ I am exempt uMer Sec. . . .. . OJer 50 to.100 Inc. _ .. . .:I � BY 1 - j� �, � . � �� ( � Over 100.�. .1 ' �� p .i. B.BP.C.for this reason � 1 �� . . . .. � Services.5wbd,�MCC 8 Panelboards . :�� : � � _i � ' - : ,� � � � -' � � Date: � 0-200�AmP.Untler 600 V ' , ' � ; �' i�.., � 'Signature � ` � � :201-7000 Amp.Under 600 V � - 'i� { . ' , � � a:: . .. . - Over 1000 AmD.or Over 800 V .!� I .. � �,❑ Exemptan tor Reg Maint Elect �� � ��.� � �. � ,� tI �..� � ;. � � �. ��� �.�SINGLE FAMILY �� -� ��� Temp.Power Pole d Appurtenances � 'I�� f � `�v,+��t��},� � � HOME OWNER BUILDER DECIARATION - Sign�with One 8rench Circuit� ;/ �„+ . - I ` �; �F���N M t+ Iti � �. ;, 1 hereby eflum that I am exempt from ihe CoMractor s License law � � . •�r�.� � �� � for ihe foliowing reason(Section 7031.5,Business and Prolessions Additional Sign Brench Circuits � ��'I . � .. � � �"���a�• ���; , � ` . ... . : . . . u ��.'O[�8�: . . .' .. .. . . . . . ... ,�..,�.- '"... : . . �,.�: ' ' .�:'� � �[ . t ; � . � . .. � . � ' ....-� Mise.:Conduits d Conduc}ors . � �1 . � �. .{��'��'.7 Q p . ' ❑ I,as owner of the pmperty,wtll do the work and Ihe strucNre I �.� ;,, . r - � Is not intended or.offeretl tor sale(Section 7044,Business Other(Sea Complete Fee Schetlule)_ ' "' � � � I �, I, �� �++o��FA 4,�1�K . . � I ,. � and Professions Code). . �. ' .. � � - • � - � + � . ��-- CONSTRUCTION LENDING AGENCY�� -� . . �i It - ; ��,��t jl�'�t`1�, �� �- � I�hereby effirm ihat there ts a tonstruction lending agency tor the ., � � ' I� . : �, �' � � �� �pertotmance of the work for which this permA is issued(Sec.3097, pEqMR FEE � . (Sub-Total) .�{���'•1 � i �� i, . � I 4 � �Civ.C.).: . . . . , . . . . ' .. i � . � . . PLAN CHECKING FEE "� 7 ' � - - �S . ' I � ' ' � � '� Lendera Name � . .. , � � , PERMR ISSUING FEE �- ' ' i , i � I ��Lender's Add�ess � �� - �� � . � �� .. , � � . �� ��l certify that I have�read this appl�caUon and state that the above TOTAL FEE " '�J!�y" ' � � :' � � . � .�;:information is wrrect.I egree to comply with all Coun ordinances� � � „ �� � � ` � ( ., h . . . .� „ . . .. � i�.and Steta�laws re9uiatirg Electdcal�wirin9,and�ereby euthorize � - . ,. ` ._ :. .; � I r .y . . . . .. ;.represeMeti�,�es of this County lo enter upon the above-mentaned -�� . .� . '� } � � � # `•..pcpp.e{tY�r Ins.pactioq.purposes-.�., � ' ' � � ' y�� � . , �f \' SEE HEVERSE FOR E%PLANATORY�.pypyAG�� • . � ,. . . , ,^.---�__c�'.,�.-4:...�-----• , ;{- r I , 4 �:; �Sgnatumvf Permittee � �.Oate . � • _ � � '� � � . � . . � �. �.. . , � . . � � . , - . � ,�� , . � . � �^r*e:� �l's rtr!�Tr g�'f�, -1 !^r;4� a +'y7 t' r e :,� b^7:� 1 ��� 4 i a :�'� , � � C� . •H${l��r��a �.IA'-i..��J`"i i�..�_,Y-!"�� � E{�..J4�fiy,.�_R � .�� •' � ��.' . . . 1� c'fn � . i-�ii .�r � {i t�Ht n i � �...y i . ..� YT3�ih3 01„^,7NIaJIJ� I 27J3r7L;A 27J�O 1�.'J:]� b. .i»e, i,, r.:��;�m �' � � �•�t r �c ....C, O_�r..J'1�.� �u.Y'. .. ---�-----r-� .. :. .���.�..�...r..,. ' . , . .. .. � E���7��I� � 6 .J O t/la .'.�l.l 1 O �- _ .. _ �E ::7 � � :�.� . � , .�. ;. .. . ^" ..; . .' ' ---J i_ ... _ . . . �, -- .O � i �'' � ` I :�c. .1�. i .t t . r �.. b J � . j � • '�t� �cl � i : a r — � `,._�—�---- i : � _. : � �.,� ,> > _ ,,, _ ., . , ,, t o ___--____ � � .. T �-`. 1� '_ �_� �1 F V '� .. 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