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HomeMy WebLinkAbout1625 BEARS DEN RD (2)b PENSATIOr�€CLARATnse 701e1 APPLICATION FOR ELECTRICAL PERMIT I hereby affirm that I hove a certificate of consent to self CE-BO6 CE-B06G osure, or n certificate of Workers' Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certified copy thereof (sec. 3800, Lob. C_) Policy No. Company FOR A"LICANT TO Mi. IN JOB r ADDRESS J /' Certified copy is hereby furnished. New Residential Slags. & Pools EACH NO. FEE Certified copy is filed with the county building inspec- 1 & 2-Family, Sq. Fl. $ -- E LOCALITY lion department. Multi -family Sq. Ft. — NEAREST ✓f� © Jij f� ✓ CROSS ST. C. llr. Dote Applicant Residential Swimming Pools OWNER OR q FIRM NAME /i 426/ CERTIFICATE OF EXEMPTION FROM WORKERS' J, y/ . MAIL COMPENSATION INSURANCE Outlets: Rec Light_Sw. _, 7V . ADDRESS (This soe/ion rood not be completed if the work involved by /�First 20 ' y CITY r Tel. No. the Pormif is for ono hurrdred dollars ($100) or Ion.) Total No.�tsSL Additional .�� 1 I certify that in the performance of the work for which this issued, i �^ { PLAN CHECK APPLICANT permit is shall not employ any person in any manner so as to become subject to the Workers' Compensation Lighting Fixture First 20 J J ADDRESS r-- 7 7 ! Toml No. Additional CITY �' T.I. No. Owe -2 �1 ✓ Applicant v i NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range_ Heater _D.W. APPLICANT Compensation provisions of the Labor Code, you must forth- Oven _ Dryer _ W.M. ADDRESS with comply with such provisions or this permit shall be Top _ FAU _ W.H. _ deemed revoked. Hood Fon Other— CITY Tel. No. LICENSED CONTRACTORS DECLARATION _ — LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond, REG. NUMBER Class. (commencing with Section 7000) of Division 3 of the Business Power Apparatus & Large Appliances DISTRICT NO. PROCESSED BY and Professions Code, and my license is In full force and effect. Size 8 Type HP, KW, KVA, or KVAR License Number Lic. Class Up to 1 IncL FINAL Over 1 to 10 Incl. DATE /�. r/y VALIDATION Contractor Date Over 10 to 50 Incl. / 0 FINAL ❑ I am exempt under Sec. Over 50 to 100 Inc. BY 0.&P.C. for this reason Over 100 Date: Signature Exemption for Reg. Maint. Elect. SINGLE FAMILY HOME OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ^ProfJefsions Cade): � " os owner of the property, III do the work and the structure is not intended o offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Ci, C.). Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize representatives of this County to enter upon the e above-mntioned pr inspection purposes. G � i�2 /•s of 7 Signature of Permitle , Date Services, Swbd., MCC & Panelb—cis 0 - 200 Amp. Under 600 V 201 - 1000 Amp. Under 600 V Over 1000 Amp. or Over 600 V Temp. Power Pole & Appurtenances Sign with One Branch Circuit Additional Sign Branch Circuits Misc. Conduits & Conductors Other IS.. Complete Fee Schedule)_ PERMIT FEE (Sub -Total) 1 PLAN CHECKING FEE PERMIT ISSUING FEE A)7, TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE OR �597.4A g...e.02 1 • e21,75 • e21.753 o 2.1 3-87 O'Mi'!ER-LLXDVR DECLARATION - _ _ -____ .'.-.._.,. _..�-.m._--� ne:st, a:,:rn, er,�r a:n exm •. o, <cm ,hr Corircrra.'s . - __---- ._._ i _._, _ _._ ,.___ _ _ .�...__._� c=ns. Law fs� + fo'--c i,nq o_r j5oct— 7031.5, '- ( - - !r, r_ ^ t r f.:. fcrt Cods Any city or county which a -r, irnprays. demoffsh. �t orn,iy t u ( .. F to it, lssuunre, also re- Ieaf eru_.tc ;itc--ci,per If to flle a signed a tat. %F --f tf ufi r,:..s i6 t srd pursrran, is tho previsions of the Giceme t— (Chd;3itrr 9 (eemmencing with 76: b a' liv+lion 3 af th,: &us ess dnd Pick,- _ Cc. ) or Ih qt he+^ sxarnp, thra,rom and the hast.s i�-=T' � for th nt>og-,d o- ems7ix+. Any vlolafi !, of S�4ion .. -. 1 7007.5 by cny a+*,t'-rf fe a permit sviy,dCts fhe oppli- .. tP - cisii p y eF nr-1 more than )ive bundro;i wn �.: !- as o -�- es toe fxoperfy mill de ±+ia work, and s r,e 1f ,.Y= i, not ❑'-t4,d or G'ferc if -sole. - (5ss. 70-f->. B-w—c —1 F-fossi— Ccdr: the C—f,—. !or , Lic— Lau✓ doe^ r,,I o" fy to on owner of proper 4y __-....__.__ ._........ _...___.._. vncr b! fl1e c- irnf..—, fheraan, cnd who does -u h work himsrb:'s'' FRC> 4 -: o 0of such imcr vemenfs are not I,;fendr.�{ Or Cr.UFC iR!' S J.- If, fl�'fJTVAr. fh& ii:fllding or impry -cnl it sr,fr' 'r ,ln .— y—, of cnrnFfelicirt, the vn l) f —c !h.- k—dfen of proving fha', he did ncl hell t c,.- lmp— fer tf:, riv,po- of am exern t and _r 5 L p,C. £c- this