HomeMy WebLinkAbout1307A +* �• . .w r��r` a�r
W�'COMPENSATION DECLARATION ��,�3 ,o;e, APPLICATI4N FOR ELECTRICAL PERMIT �
I hereby oftirm �hat I have a certifimte of mnsent to self CE-806G
insura,or a certificate of Workers'Compensotlon Insurance, COUNTY OF lOS ANGELES BUILDING AND SAFETY
or a certified copy thereof(Sec.3600,Lab,C.)
P�olicy No. Compony fOP APYLICANT i0 flll IN ��g
Certified co s hereb f�mished. EACH NO. FEE ADDRE S� �w �
PY� v New ResideNial Bldgs.&Pools
/ � Ceriified copy is filed with the wunty buildin inspec- 1&2-Family,Sq.Ft. E — S LOCALITV
lion de rfm nt. Multi-family Sq.Ff. -- NEAREST
Residenlial Swimming Poals OWNEROR /.�
Date ppliconf 1
FIRM NAME (f GO NLJ
RTIF A7E OF EXEMPilO FRO ORKERS' p�tlers:Rec_Light�5w._ � �
COMPENSATION WSURANCE "'� nDDkE55
fThi�sa�ion n��d not b�com I�t�d if Th�work lnvolr�d b Firsi 20
ha psrmth is for ane hundred dollars(5100)er I�n.) Y Total No.� Additional ..$Zl � CITY Tel.No.
I certify ihat in the performance of the work for which this qppN�N7K
permit is issued,I sholl not employ any person in any manner
so as lo bemme subject to tFe Workers'Compensation Laws.� lighting Fix�ures First 20 AD�RESS
Tmal No. � Additional �`�
_� CITY I.No.
Date opplicant Fixed Appliances Not Over 1 HP EkmiT
NOTICE TO APPLICANT: If, offer making ihis Certificafe of APPLICANT
Exemplion, you should 6ecome subject to fhe Warkers' Ranga—Heater_D.W.._
Compensation provisions of ihe Lobor Code,you musr forih- Oven _Dryer _W.M.— ADpRE55 0 `
with comply wifh 5uch provisions or this permit sholl be Top _FAU _W.H.�. •
deemed revoked. C�TY Ld0
LICENSED CONiRACTORS DECLARATION Hood �Fan _Other, L
Disp. _Room Air Cond. — UCENSE OR
I hereby affirm lhof I am licensed under provisions of Chapter 9 REG.NUMBER � �!Q ^�_ }
(commencing wilh Section 7000)of Division 3 of�he Business OISTRICT NO. PROCESS BY p,
ond Professions Cvde,and my license is in full force and aKecL Powei Apparatus 8 Large Appliantes /�� � O
Size 8 Type HP,KW,KVA,or KVAR� C.GC/!"Y7Qij�"� U
License Number �c,Closs Up to 1 Incl. FINAL (�
2 Over 1 to 10 Incl. DATE `R 1_ yq��DATION �
Con�ractor Dafe Over 1010 50�ncl. D C �
❑ — FINAL
I am zempt under Sec_ O�er$0 fo 100 Inc BY da d
�/� N
B.&P.C.for this reason �°ef�� z i
. Date: Services,Swbd.,MCC 8 Panelboards ► —
0•200 Amp.Under 600 V �
Signa�ure 201-1000 Amp.Under 600 V �� 3 Q`]a
� Over 1000 Amp.or Over 600 V
Exemp�ion for Reg.Maint.Elect. {�• • • •2
SINGLE FAMILY Tem Power Pole&A urianantes
HOME OWNER-BUILDER DECLARATION P� PP I • •U 3.5 0
Sign with One Branch Circuit
I hereby affirm thot I am exempt from the Controc7or's License qdditionol Sign Branch Cirwils ♦ • .4 3�5 0 c=i
Law for�he following reason(Seclion 7031.5, Business and ,
' Professions Code):
� M;sa Conduits 8 Condudors �2•2 2.�S�
1,as owner of the praperiy,will do ihe work ond the
strucwre is nor inrended or affered for sale (Section Olher�See Compiete Fee Schedule)_ �
7044,Buslness and Professions Code).
CONSTRUC710N LENDING AGENCY �
I hereby affirm thai ihere is a constru<tion lending agency far ��
fhe performance af the work for wbich this permit is iswed PERMIT FEE (Sub-Tofal)
(Sec.3097,Civ.C.).
PLAN CHECKING fEE
Lendei s Nome /v
PERMIT ISSUING FEE
Lender i Address
I cenify thal I hove read fhis applica7ion ond state ihat the TOTAL FEE �„3.
obove infarmofion is mrrect.I agree to comply with all County
ordinances and S�ote lows regula�ing Eledriml w ring,and
heraby a orize representa+ives of fhis County to ente�upon
rhe ab entioned erry f r inspeclion purpases.
SEE REVERSE FOR EXPLANAiORY LANGUAGE
i
nature o erminee Dot �
,►�►� 1'� : R j F f f� � 3 �C`� i't Q', R�� �'4#
` ��� '.'-�RFFROVAls - pa,� � �O'VtrNER-HUIL�ER DECLARATION
.j.,..___ $4Gt�lArURF �
TFA P.tC�V 5 POL(. - � { F I he�raby Hirm toct I om exernpi from ih�Conhoc�or's
.. .`;.�.... .-':.�..�.. ---' .
--�--�-- � License lo � far iho follpv.�ng renson ($ection 7031 5,
UP �E45LA��V��K � . Gvslness anc Prafessitlns Cods} Any city or cpunty wblch
. _... _.. �...�..... __� ._._.�_�.� . ,..'
� . � � ROUGi C JOU' ' . { �. .rr�uire$c pEr '#fo canstruct,offer,Impreve damnlish,
-{ � or repnl�priy sfhect�e,pNor to!ts issuanre,'a�sa�
, �• . . .. !JJIx P�> t.. � . — .. _� . � 9uPres kM oppRmnt/arsuch permlt fe ilfq a algnad stafe- .
��Xfu � , mcnt PF. f he Fs Ikensed��rsuont fo fhe pravizlons o/the
�_ `T__`V��� � , , antrnrtcrs Lleenso lauw(Chapfer 9{cemmenGng with
. . !PL,a'J�R AJ?kdU}�i7g���^ ' Socfien 7004)of pivislan 3 of thc 6os(ness and Prof�-
sia�s Code)or thot hu ts exempt tberefrom and fhe basrs
. . _ . . �iJ71;tTY C{].NQ7iFjE#7 �.�^���- it�r t11u oltaped examr!ian. Any vtolcNan oi SacNon
,FlP�.�hL ---� C{�#,:F,.,� �y��� . .. . 7G3t.5 6y any ap{rlicant for a�perm�f subjects the appfi-
...___�_._____._ canf to a ctvll pcnalty o,'nol mo�o ihnn f7vo hvndred
�.�._._._��....�......... _ ,
� PJc)T[E dr.Harx($50tl).:
r � - � . �f,os awner nf ina preperty will Co tne wcrk,nnd
�`k--s�� ' � �_�_, " ths struGura is not intanded or of#erx+for snle.
`" '� � � . . (Ssc.iUd4,L+usiness ord F�a€r�ssions Code: 7he Canfroo-
`•.'�`. .�::..' ��.� ...�;'�, . . id�s Uc ansc 4aw does not apply to an owner of properfy
'. �� ��� � ^ � ^ . wba boiids or'lmprov�s fBareon, and who does such
��-�' � � ������ ' � � �� � _ ._ iork hlmsslf prov;dnd that such�(mprovements ore no1
.F�. . ... -._ . , . .�„,` . __...__.___.__.. -_..-.._ .._----�------- ir.+unded or oftercd far salc.H,boweve�,the bultdine�or
�_, ,__�.,�____ �,__.�____�_ lmprovemant is sold wilhin ona yeor nf tompfetivn,}fio
, - � ow�a<-but(dnr wJlt havs thr burden of proving thvt he d�d
-� � � � nn+6uttd or i�nprova tor ihe pvrpese of sals.) �
��__.,..._...__..� __.�_..__T�..__—�....._....-��__ � __. �, I am..exempt und�'Sec.�.. . -�- -'
.. ., . . .. . .,.
__��.____.._._._.- ---......� _�___ __.. ._...... . 8��3 F.C.�for this reason�_.____.�._..._,-,_�
, __.___......._._..._____._._.,...�-----`.._.m.—�.---.��..-�...._._.-.��---_.__..
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. . . - Date�.,,�_.._.._._._ _......_.__.__
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