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HomeMy WebLinkAbout1625 BEARS DEN RD (6)b PENSATIOr�€CLARATnse 701e1 I hereby affirm that I hove a certificate of consent to self CE-BO6 CE-B06G APPLICATION FOR ELECTRICAL PERMIT 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 see/ion treed not be completed if the work involved by /�First 20 Total No.�tsSL Additional ' y CITY r .�� 1 Tel. No. the F rmif is for one hurrdred dollars ($100) or Itt".) I certify that in the performance of the work for which this issued, i �^ { PLAN CHECK APPLICANT permit is shall net 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 ��jj,, �s�./- Exemption, you should become subject to the Workers' Range_ Heater _D.W. APPLICANT (/�(.vf r�-3 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 Services Swbd MCC & Panelboards 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 or offered for sole (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 above -mentioned prr inspection purposes. Signature of Permitle , Date 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 PLAN CHECKING FEE PERMIT ISSUING FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE �597.4A g..•e.02 1 • •21,75 • •21.755 o 2.1 3-87 J _ i O'Mi'IEP WIMP DECLARATION .nT 17", - _ _ -____ .'.-.._.,. _..�..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 j5—t— 7031.5, '- ( - - !r, r_ ^ t r f.:.7crt Cods Any city or county which a -r, irnprays. demoffsh. �t cr n,iy t u ( .. P to it, lssuunre, also re- I e f e f4 - -ci, perm If to flle a slgned atot. n,¢at if fi .s i6t srd an. to the ev;s;ons of fh. p r r.• pr (eemmencing with Srrt'c 76": 0, a, liv+slon 3 af th,: busies, dnd Pick,- _sxarnp, t� ra,rorc, and the hast.s i�-=T' � for ph aI>og-,d o- ems7ix+. Any vlolafi !, of S�4ioe .. -. I 7007.5 by cny a+*,t'-rf fe a permit sviy,dCts fhe oppli- .. tP - cisii F y of nr-1 more than )ive bundro;i wn property mill de f+ia work, and s 1,© 1f ,.Y= i, not ❑'-t4,d or G'ferc if -sole. - (5ss. 70-f->. FJ-w—c —1 F-fossi— Ccdr: the C—f,—. !or , Lic— Lau✓ doe^ rof o" fy to on owner of Prop.rly __-....__.__ ._........ _...___.._. vncr b! tl1e c- Irnp..—, fheraan, cnd who does -u h work himsrb:'s'' FRC> 4 -: n 0of such imcr vemenfs are not I,;fendr.�{ Or Cr.UFC iR!' S J.- If, h�'fJTVAr. fh& ii:fllding or impr.� -cnl zC sr,f'' 'r ,ln .— y—, of cnrnFfeficirt, the vn l) f —c !h.- k—dfen of proving fha', he did ncf hc.lt t c,., imp— fer tf:, riv,po- of am exern t and _r 5 L p,C. £c- this