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HomeMy WebLinkAbout1050 GRAND AVE (5) - -- - ---_ _ .... ._ _... ..._ . . _ _.._ . ...... .. , __ ._ _.._. . ___ _ _ _. -- ,-.---. � WORKERS'COMPENSATION DECLARATION Y6A663 �o,e, � APPLICATION FOR ELECTRICAL PERMIT j� - I hereby affirm thal I have a certifimle of mnsent to self CE-806(' '�insure,or a ceriificare of Workers'Compensa�ion Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY L� �. or a ceriified coipy�thereoF($ec.3800,Lab.C.) ' , , Po'[y No.,r.2,CaLs7�GCompany y�It.r�'U� fOR AVVtICANT TO FlLL IN - lOB - ADDRE55 �I.J; � Geniiied copy is hareby f�rnished. �, New Residenliol Bldgs:8 Pools� . EACH NO. � FEE 1 8 2-Famil q. LOCAUTY� Cartifiad copy Is filed with iFe county 6uilding inspec- Y•5 F�� S — s �� L NEAREST lion depar enL �/�� � Multi-family Sq.Ft. CRO55 ST. L � 1�_ y/�/� t�A1r�Ge� ResideMial Swimming Pools OWNER OR , - Daie Applicont 5.�r�� ' - FIRM NAME ) � CERTIFICATE OF ExEMPTION FROM WORKERS'� � � Mqii � Outle�s:Rx_Light Sw._ y. � ' - COMPENSATION INSURANCE� � ��First 40 � (/7) AOORE55 I D ' � (Thh��etien nNd nof b�compl�t�d if 1h��work imolwd by Total No. CIiY , tho parmlt is for on�hundnd do�lan(5100)or bss.) Addiiional - D��� °' � I certify thai in the performonce of�he-work for which this � ' v�nnl CHKK �, permit is iuued,I shall not empioy any person in any manner - APPl�G4M �• -ti> � So as to become subjact to Ihe Workers'Compensation Laws. Lighling Fixtures First 40 � ADDRES$�� � ; � - � � � Tolat No._� Additiooal �, Dote. epplican� � CITV r (�Tel.No. � c � �. NOTICE TO APPLICANT: If, ofter making �his Cenificote of Fiaed Appl�ances Not Over 1 HP vERmii �^ '�� Exemption, you should become su6jacl to the Workers' Range_Heater_D,W._ ' APPIICANT V ....' . Compensation p�ovisions of Ihe Labor Code,you must forth- Oven _�ryer _W.M.— ADDRE55 � � � � �wiih comply wi�h such provisions or ihis permit shall be 7op _FAU —W.H._ � -deemed ravoked. - � � Hood _Fa� �_O�her_ QTY �, Tel.No. � �, LICENSED CONTRACTORS DECLARATION LICENSE OR , I here6y oHirm that I am licensed under provisions of Chapix9 Disp. _Room Air Cond. — REG.NUMBER � -Clau. (commenting wilh Sectio�7000)of Division 3 of the Business power Apporotus 6 Large Applionces ' DISTRICT NO. PROCESSED BY �, ' and ProFessions Code,ond my license is in Full force ond effecc � 4 : /`Q �.�� �� � Stze 8 Type HP,KW,KVA,or KVAR� �. Ia i O license Number '�7' — lic.Closs � Up fo 1 IncL F�NA� (f� V . � Contractor��•��^�-" �i / . . Over 1 to 10 Ind. DATE 1 d' VAIIDATION Q �l�late Over 10 10 50 Ind. ►- ❑ FINAI I am exempt�nder Sec. Ova�50 to 100 Inc. BY �� W , B.BP.C.for this reason Over 100 � _ � �� Servicas,Swbd.,MCC 6 Panelboords 5- ► � � � - Date: 0-Z00 Amp.Under 6W V � '. Signature � '101-1000 Amp.Uoder 6W V '. - � - �- ❑ . Ovar 1000 Amp.or Over 600 V �, . Exempnon for Reg.Moint.Elect. � SINGLE FAMILY � Temp.Power Pole 8 Appurtenances � �8� �J�A HOME OWNER-BUILDER DECLARATION Sign with Ona Bronch Circuit - I here6y affirm that 1 am exempr from the Conlraclor's License� qdd�lional$ign Bronch Circoits #_� � � � �z , Law for 1he following�eason(Secfion 7031.5.Bosiness and �- ' - - � � ' � �, Professions Code): � ' � • •�j Q Q Q � Misc.Conduits 8 Conducfori , •J Q O O U I,as owner of the property,will do the work and the , � � � _ �� strutNre is not imended or afferod for sole(Sacfion Other(Sea Comp�ete Fee Schedule)_ ; . �. 7044,Business and Professions Code). ' . �2 1 9_a Jr CONSTRUCT�ON LENDING AGENCY � , - � .. . � I hereby affirm fhol ihere is a constrodion lending ogency for � the performonce of the work for whith this pe�mit is issued PERMIT FEE � �-� (Sob-To�al) �� ,1 - '� � - - (Sec.3097,Civ.C.�. . � . � PLAN CHECKING FEE � � � � � .- . . ._ _ Lender's Name � - i � � PERMIT ISSUING FEE . I V Sv � Lender's Addrass � ��1 - I ceriify that I have read fhis applicaiion ond s�afe that the TOTAI fEE . V QOO � . _, ._ . . obove informalion is torretf.I agree lo comply with all Couny . . . ordinances ond$tate I ws regulaling Eladriml wiring,and � .. . ... - � hereby a Whorize r res lalives of fhis County la enfer upon . �� �. � � � - - t bove-menY ned pr pert:or inspec�ion pu oses. ' � /� � �- . SEE REYERSE FOR EXPLANATORY LANGUAGE , � . ..... ._ `✓ iSignalure f Perm tee �a�e � � �, - . . .. .__ _... _. . APPt�OVALS DATE OWNER-BUILDER DECLARATIpN . . _ SIGNATURE -_.. _. ..._ . _._:.. . _ . . _ � - � TEMP.POWER POLE � � ' � , �'� - �� � ' I horoby affirm the�I am exempt from the�Controctor's . � � � . � � . . ' .. liccnse Law 4or tho following reason (Soctlon 403L5, UNDERSLP,B WORK. . . _ � � ' � Buslness ondProlesslons Code):Any dly or rounty whlch ROUGH CONDUIT . � � � � - �^ . rnquiros u permlf ta consirucl,altor,Improve,demollsh, . � � �-��or�repolr any s}ructvro,�prlor fa Ifs Iseuance, oleo re- - ' � , VlIRING - ,- . qulresfheapplfcaniforsuthparmfttofileaslgnodstafa- . � -- � � - FIXTURES -_ � _._. . _ ; menf ihat he ls Ifeansedpursuan!fo Ihe provtslons ol the -� � , . , ..�.�,GoMrac�or's Gcense Law,(Chapter 9(commenctng wl�h -' � -� POWERAUTHORRED - "- �� � � - � � Secflon 7000)of DJvlsion J ol Ihe Bvs�ness and Profes- . ; - � � � slons Code)or thaf ho Is exemp}fherefrom and fhe basls �— �� � - � - � � UTILITY CO.NOTIFIED- � � for iho alleged oxomptlon. Any vlolafion of SecHon � �-�- � -- FINAL . � 7031.5 by any opplleanf for o parml�sub�ods fhc oppli- � �nlc�on �ronl ' � tonf/o a tivlf penafty ol not morc lhan ffve hondrod , '� � - -� - � NOTES � . � -- ,} dollars(5500).: . _ . . . . . � , �� �'��� -' "' ! , ❑,I,os owner af Ihc property will do tha work,and -� � � ' � � � . 1he strudoro Is not inlonded or offered for sale. . - � i � -�- � � -�� � . � - ��(Sec.7041,6uslness andProfesslona Code: T6e Controo- �`. . ._ _.____. . _ .. . _ . . . _ . ', � ' � . ror's llcensc Law does not opply to an owner of property � � ' � � . _ . ..- ,..� I who bullds ar Improves fheroon, and who does such ... ... . . __. . . . � - - . . _.. �. � work hlmsolf provlded}haf such tmprovoments.arc no� , � -�� - � - ��� � � - � inlended or offered(or sale.IL 6owever,fhe 6uilding or � " � � � � ,-- Improvement Is aold wllhfn one yoar o{completion,the �, � . , � ' owner-6ullderivllfbavetho6vrdertofprovingfhathedid � ' � � - �- �� " � ',nol 6utld or Improve for Ihe purpose of sale.) . � . . . . . . . .. . _..._. . -__ . . .._ , �_ . � " � ' � � ' ��.I am exempt under Sec. , , . � B&.RC.foc.this reason � . . . - - � � ' ' � ' � Date . . . .. . , . , � . Owner � �� , . . �. I . ' ^ , . . . ' . ... . � . . . . . . . . , . � . �� � ..� . . • ', ' .. _. _ . . - . _ ., . � . . . : . �. - ; f ' _ ,