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HomeMy WebLinkAbout0783A . ---- - r /� �/ . � __ ._.._. _. �K��OMP�SATION DECL�TIqp 76A663 APPLICATION F�R ELECTRICAL PERMIT v CE�808G 12�80) � , I hereby atfirm that � have a certiPicate of consent to se�t COUNTY OF LOS ANGELES ✓/1///,�/BUILOING AND SAFETY�^ insure,or a certiticate ol Workers'Compensetion Insurance,or ��24( ' � c.J � a cer�'ed copy thereof( ec.3Sio0, eb.C.) / �p�_(�f/�[/f� �j+���,.,7. Q„�� FORAPPLICANTTOFILLIN JOB � PoLcYN vpvouCompany- ""vt�q� ADORESS �� l New Residential Bldgs.&Pools EACH NO. FEE ` � Certifisd copY is hereby furnished. 7$i Z.Family,Sq.Ft. S — S LOCALITY � � � �CertiEied copy is filed with the county building(nspectton Multi•family Sq.Ft. CROSS ST � ' depanment. � � Resideotisl Swimmirg Pools . OWNER OR f'_ �/����G� � /JlFIqM NAME L_�J .. . Date�t.�1_ADPlicant Outlets:Rec�'l.ight �S Sw. /� � t qb�RE6S � / 1,/ First 20 CERTIFICATE OF EXEMPT[ON FROM WORKERS' 7ota1 No.� Additional CI7V � T.i�Io�` _ � � COMPL•'NSATION WSURANCE . . ALAN CHECK C ('i'his section need not 6e compieted if the work imoived ,�p J z APPLICANT - U by the pamit is for one hundled dollars(SI00)o�IesaJ Lighting Fixm,/re,s First 20 AODRE35 - - Totel No..� Additional � 1 ttrtify tha[in the performance of Ihe work for which this fixad Appiiances Not Over 1 HP CITY T�I No. U petmit is issued,1 Shel!ttot employ eny pafson(n ony mannef � PEAMIT � so as to become subject to the Worke�s'Compensation Laws. Ran9e_Heater_O.W._ APP ICANT "�/ / �y � Oven _Oryei_W,M,_ AODRE'S/ ,[� � J � Dece Appiicent Top _FAU W.H._ � ' � — � Hoad_Fan �Other� CITY Tsi No. .NOTICE TO APPLICANT:If,after making this Certificate ot p�sp__q�m Air Cond` �� ' u E SE R / _ � Exemption, you should�become subject to the Workers' REG.N MBER� F7 Cieas � Compensation provisions oT the Labor Code,you must forth- PoWer Appera[us&Large Appliances DISTRICT NO. PR ESS O BY with comply with such provisions o� this permit shall be Size&Type HP,KW,KVA,or KVA /� � - - deemed revoked. �� . � � UP to 7 lntl. OVef 7 t010I�CI. pq EL LICENSED CONTRACTORS DECLARATION � Over 70 ta 50 Incl. �/-�"7—�/ VALIDATION ��. I here6y atfirm that I am�licensed under provisions of Chapter Over 50 to 700 Inc. FINAL Bv ' 9 (commencing wilh Section 7000)of Division 3 of the Busi- Over 700 p'L/'-+�:� � � ': ness and Professions.Code,and my license is in full torce and °i efPect. � Services � 'i ��,� �/ 0-200 Amp.Under 600 V . - . Litense Nump�r� � Lic.Class ���7�`%-' i �, /� 201•T000Amp.Under600V � „ � '� �k:- I�Contractor � � �" �Date ����?if�� Over 1000 Amp.or Over 600 V . �,��,.,�r c,� ��.I NOMG OWNER-BUILDER DECLARATION � ''�' T Temp.Power Pole&Appurtenances . .�. ,.•-�� `� Sign with One Branch Circuit ' '� � � � �1 here6y affirm that I am exempt from the Contracror's Additioaai Sign Braneh Circuite � Q c i.�—��� ���.License Law tor the foilowing reason(Section 7031.5,Busi- . ,�ness and Yrofescions Code): , . � !�y - Misa Conduits&Conductars I,I� 1,as owner ot the property,will do[he work and the Dther(See Complete Fee Schedulel— structure is not {ntended or offered for sale (Section ��� 7044,Business and Professions Code). CONSTiZUCTION LENDING AUENCY �� htreby afiirm that �here is a cons[ruction lending agenty �Ifor the performance of the wock tor which this petmit is pERMIT FEE ISub•7ota71 �7 � � ��.�issued(Sec.3097,Civ,CJ. � � . . h.ender's Name PLAN CHECKING FEE (One-Fourth Permit Fee1 ' � ' 1 ,�,ender's Add�ess PERMIT ISSUING FEE - . s I I �\ '" _."� - . !I cGrtify that 1 have read�,lhis application and state thal the 70TAL FEE ��j , �i Sbove information'7S�correct.I agree to compiy with all Cmm[y ��dinances and Stete laws teguleting Electrical wiring, anJ �iere6y author(ze representetives of this County to enter upon . - � i`e above•mention/e�d property fo�inspection purposes. SEE'REVERSE FOR EXYLANATORY LANGUAG& . �i ��- �1�7L� —�, � � � '�.k Signature ot Perm lee Dete . . I � , ._ ' . � . , . Otif'NER-BUILDEP.DECLARATIOti ,.___.�. ..�...__.__... �. . � � �' ... .. ...... . . . 1 hcrchy nf�rm d�.�t I am exempt from Uic Contnctnr's � APPROVALS - DATE �NSPecron�s � �� - � ���� � � Licenu La��� for tl�e follo�cing reason(Sertion J031.5. , - - sicnfn'suaE - --� � � � -- B�iriners and'Projessioxs Code/: Any cir}��oi rou�it}� �:...._. ._ . _-._.__'_ � � � � . . . . _ -TEhiP.POI^fER POLE - �" � . ' - '. x'Jtidr requireS a pentrif !u corlslRlcf, alter, lnrpro�'e, ' "�— ' - � � .� � - - U�+lDER5�A4wOR�� ' � - � � . � � demolish,orrepcir�an}��srrurnere,prrorlo its iiruancc, � . . also rcquires rlic,applicant Jor such pennit m filc a �. -- ROUGH�CON�UIS,. � - —�� '--��— � � � � �� �� ��� srgned .rta7emen� tlrct !re is lice�rsed pursumtt to tlre � � � � . pror;siau of�he,Contrartor's Liceiue LaK+/Chapter 9 ..- -� ---� . ... .- rnR�N� '� � .- -. (couuncncing �rith Sectiun 7000J of�D�isforr 3 of 1lre . . . ' . . _ . FixTu�tes �- � � � �- �• �� � - 13usines.c an�!'rofes.rions Codc/ or rhar ke is ezempr . , , . _. � � � � • - - -t4ercjrom mrd dre basis far the allegcd ezemption.�1 rry� . . . —. .. . .. PptiveRaUTNoaizE❑ . � ` ' � rrolarionofSecrion 7031.56panyapplicanrJorapernrir - � t7f�L�iv co.NOT�P�ED � . , subjccta the apPl+cmrt to a cR'il pelrally of not�norc tlton : � ____.. _ �. FlnaL_ - ��� �'i:�c-2.nac r�2ci� -.:'..:-',. . � �.. . � ... � , �e Ofl,�as�o�ii�nc�rrofst�Oproperty�uil[do-thc�vork,and J+ � ` � hOTES . � ''� � . �� ,"-��� � the structure is pot intended oc o[lcrcd for salc.. ..---- .. . .. -.__ ... . , , � ,. � � _ . � � (Sec, 7U44, IJu.riiren ond Rajerrioru Cade: The Corr- ' ' . ' . , � - � trcttor's l.iccrr.rc Law,docs not applp.to a�r o�ener oj _ . . . . ➢roperty xdro huildr or irnprores therea��,a�rd wlro does r _-..__ -..��.�� . . -. �.:. �._. ��. i :� � ;' _ . . �- � � sucl: wnrA /tintself prorided tliQt se�ch improvrure�its � . . , . , � ,. . , , : . , are �rot in�e��ded or ojfered jo�rale /j, howe��er, the - , . . - - . - .' . .. " ; ( : . building ar r�nprarenrcnt ic sold ivil4i�r one Tcar oj , . . �- . _. . ' -. �� . , . .. ��canpletio�i. �lhe ox'n:r-huilder. �ci!! Irare ti+e GurJen .'_-. . :..._ . ... ...... , .: ... . .-. . . . � .�oj prorrag.tl:nr de-Ji� not build.or impro��e Jor 7he . . . .. . . . , . , . .. . . , purposenfsafe./ � . � � ` _ ' • I am esemp[under Sec. , — _ . _ B R P.C,for t]iis re5son Da4c . Oicner' �: . ' ., , �