HomeMy WebLinkAbout12_21_1981 - 20948 MOONLAKE ST (2) WORK&RS'COb1PENSATIONDECLARATION, � �BA663. � .. APPUCATION FOR ELECTRICAL PERMIT {j �
' ' ce$osG iz�sol
-I hereby affirm that I have a certiticate af consent to self. COUNTY OF LOS ANGELES ' BUIIDING AND SAFETY U
insure,or a certiCcate of Wnrkers'Compensation Insurence,or�� - � " .
a certified copy thereof(Sec.3800,Lah.C.) �
� FOR APPLICANT TO FILL IN JOB '
� Polfcy No. Company ADDRESS, �
NeW ReSidential Bidgs.&Pools . EACH NO. FEE • . �
� Certified copy is hereby furn(shed. � ° ' 1&2-Family,5q.Ft. a — $ LOCALITY / � � , �
�. Multi•family Sq.Ft. N ARES
� Certified copy is filed with ihe county building inspection CRO55 ST.� �
Residential Swimming Pool} -
department. ' OWNER OR
�y L/., � FIRM NAME 7�' � [iL O
Date Appiicant Outiets:-Rec.LLight✓Sw.� AODRESS �L�Q �
First 20
CERTIFICATE OF EXE�1P'fION FROM WORKERS' Total No. � Additional CITV � Tel No. — L }
COMPENSATION INSURANCE . �- ,;. ' � . � PLAN CHECK a
_ -(This section need not�6e completed if the w0[k InvOlved � AP�LICANT � � ' � V '_
by fhe permit is for one hundred dollazs (5100)or Iess.) Lighting Fixtures First 20 q RESS . - � �
� Total No. Additional O
I certify thaC in the'performance of the work for�vhich this CI7Y � Tel No.. F
Fixed Appliances Not Over 1 HP . V
permit is issued,[shall not employ any person in any manner . PERMIT W
so as to become subject to Ihe Workers'Compensation Laws. Ra�ge_Heater D.W._ APPLICANT p.
. O�en _Dryer_W,M,_ � A�ORESS � �
Z
Date � Applicant Top _FAU _W.H._ � . . —
Hood_Fan ._Other_ CITY Tel No.
NOTICE TO APPL[CAN7:li,after making this Certifcate of Disp. _Room Air Cond__ LiCENSE oa
lixemption, you should become subjed to ihe Workers' � REG.NUMBER Gass-
Cnmpensatinn provisions of the LaAor Code,you must forth• power Apparatus&Large Appliances � DISTFICT NO. . PROCESSED eY
with comply with such provisions dr this permit shsll be _ � � � �
�deemed revoked. � . Size&Type HP,KW,KVA,or KVAR rn,/A� . ��
� � . UP to 1 incl. J•�/• .
FINAL
Over t to 10 Incl. ' DATE '
��—��'� VAUDATION�
.LICENSED CONTRACTORS OECLARATION - Over 10 to 50 Incl.- .�
1 hereM1y affirm ihat i am licrnsed under pmvisions of Ch�pter Over 50 to 100 Inc.- FINAL - ' �
9 (commencing with Section 7000)of Division 3 of the Busi- Over 100 BV 1
ness and Professions.CoJe,and my license is in tull force and �
effect. ' Services � � - .
License Numbei Lia Class _ 0-200 Amp.Under 600 V � . . .
. 201-1000 Amp.Under 600 V .
Contractor Date � Over 1000 Amp.or Over 600 V - . ;'3�j�;A _
j� e 3 a
HOhtE O�tNER•BUILDER ISCCLARATIOY Temp.Power Pole&Appurtenances � ' '
- Sign with One Branch Cir�vit � - ' . � °••��C�^ -
I hereby affirm that I am exempt from �he ContractoPs qdditional Sign Braneh Circuits . �
License Law for the following reasan (Sectian 7071.5,Husi• - '�r Q(.�� �
ness and Professions Cnde): � � � �
� Misa Conduits&Conductoro � -
� 1, as owner of the property,will do lhe work and the Other(See Complete Fee Schedule)— - . �J�?�� -� �
stmcture is not intended or otfered for sale (Section . � . -
7044,Business and Professions Code). , .
CONSTRUCTfON LGNDiNG A(31iNCY. " � ' .
1 here6y affirm ihat [here is a construction lending aFency � � - - �
Cor the performance of the work for which Ihis Dermit is pERMIT FEE (5ub•Total) � �
issued(Sec.3097,Civ.C.). . � . �
Lender's Name . PLAN CHECKING PEE � (One-Fourth Permit Fee) - � � �
Lender's Addres: pERM1T ISSUING FEE $�L ` �
1 certify ihat I have read thit appiication and state ihet ihe TOTAL FEE. . pZ0 G � ' � � �
above in(ormation is torrect.!agree to comply with all Co�mty _ , - � .
ordinances and State laws regulating Elenrical wiring, and � • � � '
hereAy authorize representatives of this County to enter upon ' • - . � ' �
the abnve-mentioned property for inspection purposes. -SF.F.'RF.VF.RSF.�OR EXPLANATORY LANGUAGE �
�C�'�--�R) ��Dl��..C� i o�/-
Signature of Perm tee Date � - � , �
, - ' . _
� � . _ . . .�. _. . , .. .
` ; ' ' ,
. � , •
� ; � � . • !
! . � ' . + _..
; • � ... .
• z m c v ;, � � c -� ; :
O Z -1 O, X o. Z m
. . . ��,-i D r'� � ..:� �. G O y.
. _ � � � � c z c� m � r
� _ � �v.� �
, o c � � �: ° � ..
-I• • : ZO. p'. m � . . �
. . � p Z . .� O c 37.. 'ry .
, , , � p• � � � r
T �• ' ,:.� � "O N
. . _ _ • � _. m N. � m . ..
1 � � O. .
� . � . _ � - ' . .
. - _ . . . 1- � � � ' I
i i
� �. � � i � j � � 'o . � . . �
�- - � D
. � , �, • � ` .-i ..
I . '� m
. . , i I ' � a ' . I �� . .
i ... . _ � � � _ � . .... �T ,, ...
t'v,
' � � � " � , . NZ .
4 "" 1 _ _ , . . . " _ _ "_'_' _ ' ' L� .•
' � ' I ' • � �Q , •
�p
- - - rt't�
,
� - . - - . _ ,
. . . , - . � O n•Q,q 1.� ��^ �•� � �.W'�•Z '^ n C r S� C" - -
i . ; • ��� � � n O � n� �a�C•�e „�� O O�-' � + =� f, ^ _
i , � - � � - � G�'II.^`` '� O '� ^O.^_...o'�'^` � � c�.�. f' p �-�` 7 �
� C� - C,�. "' c' C 'n � � X � �e .. ` n O'Y r, �'n h i�
' - ' - . .. . ` � G ' " � C� C � �Pi �4 tn'O C� ~�y Y C �^ �� � �n'C: �' � I.. f � O .
I ' � . . � � ' -r' ,,.� ' �.�;:�.Q �'��,-� h L� v n ry�� Q � � A �'c c ° r' � �' �
� -- _ . .. . ' . = � y �'s �. � `-n`'. . p C c t�° 4 p:�,� � `� �• ,�,"',t Z
''� �- - - � � r' `� ��4� c � G�v � o+, e�, C, '� ,� ,o.�� � "`~ „ Cr: .
� ' . � , - . . � - �� � ^n �.�y ^' �, �� - ^� �� �,�,'t'= �' '�'C y,O y ir '
. . . . . � 0 '_'.�. _. ,_.. p "� ._. -�'^ i n`'V�`m ti.�., q.o ��^ ^ � .
^ � o o�;y e-�� •o ti c a c� n^.o �b�=�=. =C
. . . , „ C � - � < Q h -°�` v� J [r C p'C 4 y h r,
. . � ' ✓i C� C��Z � r� ,�,= =ln C'H.C `�' �� C' �,.. r. '.
, _ .� . - _ •-. ' �. O- C,� �R O �. C.` ���o C � y `.q �.n' � � C m C ,
� . _ . . _ . . I �. � '� C� � - ^�'�'��p�p cn C C n � + �' � " ��- hy
� . . '. ' - � v' r�u � fi'� ��� � b p � � �•��` o�� h'� � ��r' `.� ^'
. . - p � fi y o c �� O � C� -�` �e�y.n �� c �� � . � ,.
. - - - � � R` o h� �a ., . �
' ' � � Q a � ^�� � �`� . �� p n� " .� � .
- • • ' �`' ° �b � � _ °.°� �` O � ` `n? ? Y F --� C"
, _ . . - �O ��~'. ��.' � L=C' G� �4 ,,,��'n a.S C.� � C C � Y
� Q. ,�n c n�c o ��q b'�,c Z. •, �•`c ' � "� `
� . �'� �=' = c` � ° �+u r, _ Q:� •; � P���- �''
_ o �o o_� n� ;o � � �`,a o `o'`'.n' ��� o n p
' � _ � ' , �a �o `° � o c �y � . � � ` ti'" n: ~ ' � = � !
� � `� O C C C w ` C M'` .�-
� - .� _ � , .D�i � ti 4 e.n� T .��.,� ' ���` o+,O� � �C � •
� ' _._ . . . • � _. l '" - . _. �o ..`,t0 h h�O G � -. �� � �O� R :' ?��N .