HomeMy WebLinkAbout1366A +�� a'" "��'."'—__� � +���' . _.. . . . _ . . .
a�s►�+ NSA7PE ION DECLARATION �aA�3 �o�e� ,APPUCATfON ftJR EL�CTRICAL PERMI'f �
I hereby offirm thaf I have o ceitifimte of mnsent 10 self GE-806G
insure,or o ce�tificme ot Wo�ke�s'Compensation Insuronce, COUNTY OF LOS ANGELES BUILDING ANO SAFETY
or a certit"ied copy thereof(Sec.38D0,tab.C.) .
P❑ollcy No.C 5$�ompany 7NE1 FOR A►PLICANT TO FILL IN J08 ��
Cerilfied mpy is here6y f�rnished. New Residential Bldgs.&Pools EAGH NO. fEE AD�R
� Cerlified copy is filed with 1he munty building inspac- 1 8 2-Family,Sq.Fr. 7 SF,'1 b — S LOCA ITY
tion department. Multi-family Sq.H. NEARES
�� �� Residential Swimming Pools cROS55i.
Dafe�_Applicant T me�('.aa F.lortr C OWNEFOR
FIRM NAh1E
CERT�fiCATE OF EXEMPTtON FROM WORKERS' O�tlets:Rec_Liqhl�Sw.� � � ' MAIL
COMPENSATION INSURANCE Firit 2D A�DRE55 V ew Dr.
(This s�tf{on neod nW br tomp{elod li fhc work inrolvod by To�ol No. Additional CITY Covfna, C.B. Tei.No.967-9541
}he p�rmi}y for one hundnd dolYan(SI00)er I�ss.)
� I car�if thaf in the erformance of Ihe work for which ihis PLAN CHECK
Y P A7PLICANT
� permit is Issued,I sholl not employ any person in any monner
so os io 6ecoma subject 10 the Workers'Compensation Laws. ligMing Fixlures Pirst 40 ADDRESS
Total No. pdditional
/^ CITY Tei,No.
f a�p�i�ant Fixad Applionces Noi Over t HP PERMI7 n u
N��ICE TO APPLICANT: if, ofter moking this Certifimte of APVUCANT T McGee Electric, YIIC.
- Exemption, you shauld become subjed lo ihe Workers' Range_Heater�D.W.,
Compensa�ion provisions of�he Labor Code,you musf forfh- Oven _Dryer _W.M._ AO�RESS 1 1111
with comply with such provisions vr Ihis permit shall he Top _.FAU �W.H._
deemed revoked. CITY 7e1.No.
LICENSED CONTRACiORS DECLARATION Hood _Fan _Other� O 1��$ 591-6461
Disp. �Room Aii Cond. _ UCENSf OR Closs.
I,heraby affirm ihat I am licensed under provisions of Chaprer 9 REG.NUM6ER Q$ C—IQ
, (commencing wilh Secfion 7DOp)of Diviaion 3 of thg Business power Apporatus 6 La*ge Appliantes DIS7RIGT NO. PROCESSED BY p�
and Professians Code,and my license is in full force and effecl. U
Size&Type HP,KW,KVA,or KVAR Q
Licanse Number 4'4��a3 Lic.Class C'�0 Up to 1 I�cl. FINAI �
Over 1 fo 10 Ind. DATf r � `� �
co�o-o�,o� Electrical po�e 8/20/86 � � VALIDATION �
❑ Over 10 to 50 Mcl. FINAL J
1 om exempt�nder Sec. Over 50 70 100 Inc. BV s} �[�; �
B.BP.C.for this reosan Over 100 + """tT�y Z
Dote: Servicas,Sw6d.,MCC 8 Panelboards _ ►
0-200 Amp.Under 6W V
SignoWre 201-1000 Amp,Under 600 V
QOver 1000 Amp.or Over 60p V
Exemption for Reg.Maint.Elect �� ��6 p
���' SINGLE fAMtLY Temp.Power Po�e&Appuiienonce6 �2
- HOME OWNER-BUILDER DECLARATION �• • e c
I hereby offirm iho�I am exempt from�he Controttor's License Sign with One Bronch Circuit
Law for the following ieason(Secfion 7031.5, Business and Addilional Sign Branch CircuRs ��o �'7'J,Q�
Professions Code): �
❑ I,as owner of�he properfy,will do�he wo�k and}ha Misc.Conduits 8 Conducron d `'-° ��'.L��
sfrocNre is nof intended or offerad for sale (Section Other(See Complele Fee Sthedule)_ � ��?.�E�„b,6
7044,Busineu ond Professions Code)_
CONSLRUCTION LENDING AGENCY
�here6y affirm fhaf fhere is a wnsfrucfion lending agency for
Ihe performance of the work for which ihis permi�is issued PERMIT FEE (Sub-To�al) (Z $2
(Sec.3D97,Cir.C.).
PIAN CHECKING FEE
Lender's Name 1� 5�
PERMIT ISSUING FEE �
lender's Address
i certi4y thoi 1 have read�his application and siate ihai the TOTAL FEE �3.�2
above information is correci.I agree to comply with oll County
ordinances and Slate laws reguloling Elechiml wiring, ond
hereby a��harize represenratives of this Co�ny ro eNer upon
the ove-menrioned p(operty for inspecrion purposes. SEE REVERSE POR EXfIANATORY LANGUAGE
' „� � 8120186
Signafure af PermiHee Dpre
- A�� �� ;A � � , � '� '��-, � ��lT ��� f�i►,
:ONJN[R-BUIL�ER 6E�I.ARA'RON
3 h, FrVAtS DAT'c 5?GR1AtU9?€ . . . ... . _....
. . . ,._ . . . . �_-_._._.._.,�-�_.._.�.
., •. , . ,___ exem t �
7��p p,,�y�R c,;-+�� � � 1 hereby affirm that I om p trom the Controc!or's
, � �� -^�------ . � � liconse f.nw fo� ?he fo��owing reason (SeNion 7A9i.5,
��� JiVDERaLS C 4�C>fiK f Bustrtess andPro(cssions tode) Any clty o�touniy wAlcb
___�.�_..�
�p{jrH 7 p:�;7 ~-� ~� i � requl;es o permit to cansirucf,olfer,trnprove,demolfsh.
_-----t � - • �'or Rei�Yaf��cny�kMuoture,pr'ror#o Its i$suarice, atse re-
� ".Y1�Rih�G -� �p,.,�..�` qutraslheap�ficar.tforsuehpermltfaftleasignedstote�
� �� ' �'���F7�7J �5� �� � W� mant ihat he Is ilrensedpursuant to fheprovlsions of the
- � Contractor'e Llcense Law(Chopfer 4(commencing w��h .
�_____..��..�.�
-� � ' F6`dL12 RUTHOFIZ"b Sochien 7000)07 DWlston 3 of the @�sirsess dnd Profra-
---"�-`�-�---'� -- sians Code)cr thal he Is azsmpt fherelrom and tho bo5is
U7!'f�YCO.N�JT�F'Ifi�3 !or rhe alleged exemptlon. Any wolarion of See+�an
p�h�; �4� �» 7031.5 by any applt�onJ f(rr a perm�t subjeeea tha appli�
�� v_.� _. nfn,-on. �rna9 _ _ cart To a clvil penalty of not more�hon iive n�„�ad
u07E�5 � dolfors{S5Q0).: �
..,. .�......... : . „� � -(]I,as owmer of ihe property will do the wors„�nd
��� ����- ���- - � � rhe struefura is not intended or oHerad foF eale�.
� (Sac.7P44,8uslnsxsondProfess�onsGodr: ihsConkoc-
� � � _�;.._ ' _____ - -ier i Licsnsa Law doss not cppfy ro on ownx of proparry
_, . _. � � , , „ , who bul(ds or�fmprovss�hareon, and who does suci�
_._ ____r��.__�.,_...�__.�.___________._. _. � work hlmsetf prov�ded thof such-Improvemerots are ncr
�-� - . � � , Intended or offersd for sale.If,howevec the budding or
_ �. .__�..___._...��_..�._..�._....�.,....�._.____. � improvemen}Is sold withirt one yeor ol complef7on.IFw �
. � owner-6uildsr wifl have fFe burdon of proving that he drd
� ry, ,� � - nat b�Nd or improva for ihe gurposR ot safe.)
. _._� _.. ��.. .._. I am-exPmpr�nder Sec. _,
_.____.__._____ �.____.w___.____..._.,__________.._ _ . . B&P.G,fcr this r�;asan
_..____.' --..�,.,.�._._. p ____. . - � . . bate,� _ .
__.._� _. �.. ._.._.�_.___.._._� � Owner_ � , -,_
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