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HomeMy WebLinkAbout1288A ..._ _ . _ , WORKERS'COMPENSATIONDECLARATION 76A66� 10i81 APPLIC�4TION FOR ELECTRICAL PERMIT � I hereby affirm 7hot I have a certificote of tonieM to self CE-806G insme,or a ce�t+fcate of wo�ke�s'Compensaron Insurante, COUNTY OF LOS ANGELES BUILDING AND SAPETY or o cer7ified copy thereof(Sec.3800,Lab.C.) r P❑olfcy No. Compony FOR A►FUCAN�TO FILI�N ADDRESS � S(,17�7'�� �fied copy is hereby turnished. New Residential Bldgs.8 Pools EACH NO. FEE � Certified copy is filed wilh the counry buildin nspec- 1 8 2-Family,Sq.Ft, S — S LOCAIITY �5�� C� y' '�`�'� lion deparimenL s'�yq✓37"Tf � Mul�i-family Sq.F�. NEnREST O�! ,r ��� �� ResideMiol Swimming Paols CROSS ST. l� T`d'c'L� �ale ApplimM �r ''J F�IRMNAME N • / • S17 CO� � CERTIFICATE OF ExEMPTION FROM WORKERS' Outlets:ReclZligh��Sw..(_ /s ��� _ y p- COMPENSATION INSURANCE - ADDRESS . �S �.QvfJ CA C�11 F�. Thls s�chon n��d nol b�com I�f�d if fh�work involv�d b Firsl 20 �y � P Y Total No. �� Addiiionol � CITY('�/F}j yG7 Tel.�y�J�ry- 1h�p�rmit h Far on�hundr�d doflors(5100)or I�t�.) PLAN CHECK _ I certi(y Iho1 fn Ihe periormonce of the work for which lhis A7PlIG1M permit is iss�ed,I shotl not employ any person in any monner so os to become subject to the Workeri Compensa�ion laws. l�ghfing Fixtures Firsl 20 �� ADDRESS Total No.� Addilionol CITY Tel.No. Dote eppliconl Fiaed P.ppliances No1 O�er 1 HP PERMIi NOTICE TO APPLICANT: If, afler making this Certifica�e of AVPUCAN7...S ' $- � Exemption, you should become subjecf io Ihe Workeri Range_Heoter_D.W._ Compenwrion provisions of�he Labor Code,yob mus�forth• Oven �Dryer _W.M.— ADDRE55 ,�j�2p� C�( O� �p� with comply wNh such provisions o� this permif shall be Top _FAU —W.H.— � r deemed revoked. Hood _Fan _O�her_ CITY ` Tal.IVo. fi' �3 UCENSED CONTRACTORS DECLARATION uCENSE OR �1 hereby affirm ihot I pm licenied u�der p�ovisions of Chapfer 9 Disp. _Room Air Cond. _ REG.NUMBFR a3 Q'�IO Clou.�i'��� } (commencing wiih Section 7000)of Division 3 of the Busines5 power Apparofus 8 large Appliances DISTRICT NO. E55 BY O and Professions Code,and my licenze is in full force ond affect. V Size 8 Type HP,KW,KVA,or KVAR 0 license Number a���S�� lit.Closs ���� /-/fL FINAL �`'I • � f Up l0 1 Ind. DATE �T..!'"YC �1 2 t��A p (� y)f.G D/ �'. Over 7�0 10 Incl.� 1 ALI1� DArpN, }= ConfrattAv���� Date� Over 10 l0 50 Ind. „ 2 U ❑ FINAL w I om exempt under Sec. Over W l0 100 Inc. 61' � o •(7�O� �" 6.8P.C.for this reason Over 100 ��—�� Z Dote: Services,Sw6d.,MCC 8 Panelboards /S- O , • • •��j.��� ��/�200 Amp.Under 600 V / Signatore 201•1000 Amp.Under 600 V Q� �Q.� �-�7 aOver 1000 Amp.or Over 600 V � Eaemption for Reg.Moim.Elect. SINGLE FAMIIY Temp.Vower Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One 8mnch Circuit � I hereby offirm thaf I om exempt fram fhe Controctor's License qddilional Sign Bronch Cir[uits law for Ihe following reoson(Sectian 7031.5,Business and Proiessions CodeJ: ❑ 1,as owner of the property,wili do�he work ond�he Misc.Conduirs&Condvclors slructure is not in�ended or offered for sole(Seclion O7her(See Complele Fee Schadule�_ , 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby offirm Iha��here is a mnstruction lending aqency ior � the performonce of the work for which this permil is issued PERMIT FEE �Sub-Total) � (Sec.3097,Civ.C.). . .q �����,� PLAN CHECKING FEE lender's Name�//� PERMIT ISSUING FEE lende(s Address Q I certify thai I have read this applicotion and s�ole thot the TOTAI FEE above information is correc�.I a9ree�o Comply wilh oll Counly ordinances and Stale laws regularing Electrital w�ring,and hereby authorize represeNolives ollhis Cov��y 10 enter upon Ihe above-menlioned p�operty for inspeclion purposes. � SEE REVERSE FOR EXPLANATORY LANGUAC.E � //>�c',�7 ' g�awre of Pe�teer.✓ Dale � � lrKGr`'�/�, �i��� . •�r ._ j _ _ f:' ^ ` . - , ..... ... _ . ._ ... � `.-:= �r� K . - ...;.. .. . .-.-.----��, OWNE^n-6UIl�ER OECLAP,ATION . ..�-F.FFROVA,S OATE 57GNAT1IRF-- . .-.. ' .. � . _ ... ._ ._. _.__ .. . .. . .� . .�� �� -�- TEMP.�FOWEF PO.E. ,� �-'----_ ��'. .' �: �. � . .���. . I hereby affir.m tha`�am ezempi from the Conrractor'a � � � __ - ��';; � Licer.so low for the.fnqawing ren:on (Secfion 7071.3, -___._ ._._.... .._ .. ._.". .. ; �� -�- -�- - - U�JD�RSLAIINlORK � ' �, � , ;.; ., . ., .. . ,-,-�CwinessandFrofesslonsCoCe):.4nycityormuntywhich . ._.- - -- -- - �-- ROUGHCONDUI7 . - -__. � . _._.._._ _..�__...___., •,, . .. . - requlrosapermBlomnslrucf.aker.lmprove:demolish. . - ,o�repclr any siru[luro,prfor!o ils Issuanca,-afso re- i -- -- -� - --"� -� WIRING� -�- � '� �' •, . . � qulrog iho oppflmnt for sucb permH ta flle a s/gnrdsta/o� � - ��� -�� ��� � � `��� ��- men'fnol he 7s I/cCnsed pursuonl to thc prov7slons o/}ho ' � � �.� FIXTU�.ES � �-- - � ' �4 Canlrpttofi LJcense Law(Chapler 9.(commendng wHh �_. �,��`�.� � . ::_ :._. .. . POVJER AUTHORIZED �- -�� ��--���'��'�-� � - ` - - �' � � Section:000)ef;ptv/ston 3 oi the Business c�nd Profes� � ' � � � slons Coda)or fh�/h^l;oxempt therc/rom cnd the basis UTI:fTYCO.I�OTIFIED � , ��� � � ..�or.nc� plfegod exempfion.�Any_vlolallon oF SecNon . .. _ .. . _ _. . � _.- �- � : FINAL ��� �-� ` ' . ..c .-.... �.�.� � . . � � .� ' ..TC31.5 by any oppllcoot lar a permlf subf?[ts�hA appli� . . n(e�on rdrt( � . � �, � � , � �a•�f to a cl�fl penclly o{rtaf moro Ihon live hundred __ NO7ES .� � ��� �-� --`.`. � doflars(5500).: . . . -. .. _ . . , ._. .. ..... . _ _. . . . .._. ._ _.. . - - . �� . � . � � �� " �� � .. I]I,m awncr of ine propeny�will do ihe work,and - !he s�ructuro is�not inier.dad or of(erod far soie. . �.. �. -. �.,. � - . . � - � � . ..._. �� . .. �- �;__ �� ' _. .(Soc.703-S.Buslnes;andProlessioneCode: TBeConfroc- � � � � ' Ior s Uconeo Lew dces nof opply to an owner oi property � � . � . �-� , �� , who Evi:ds or'lmprovos !horeon, end who does such -" " " - - ' � " - work bl,r.selF provided 1F.at s�zh�Improvrmenh are oof . ... � . .. .� -. --..-- ..��-. ',-.-...-_._...; . . , '.. ...� . ... �. ,.� �intended or oflarvd Jor sale 1/,hawuvnr.�tbe building or - �rmpteveme;;f!s sold withfn one yoor ol comyl�fion.Ihe . . � �. � � ��- ��'�ownar-bu;tdc�wlfl fiave 1he 6urden u!proving�hat he d�d " - � � �-.nol bWfd or Improvo for iho porpose o(sofo.) . . ' , , � . . � ., . .. . ..._'._._..__.. _ . � . . _ . .. . _...__ .: . .. _ .. -. � .�I am exempt u�der Soc. �� , . ' . ... . _ .. . _ . . . � j _. .___r .__.. . . � . �._ .. . . � „ _ , .. _.� . . � .... -.. _ � . .. _ . . .. �.... � __..6.&P.C.for_this reoson � � � � � � ' : . � � . � � .. . . .. . �•- � � � . __.__---. . . . _. _ . , . , , . , .. .. - � . __. .. . . . ... .. ��- . ... . __..Q.:te _ . . . . ' Owner_ . . . .. . .