HomeMy WebLinkAbout0874A WORKERS'COMPENSATION DECLARA710N 76a663 10/61 qpp��CAT10N �F4R ELECTRICAL PERMIT � ^ I hereby offirm �hat I have a cer�ificate of consen�io self �E'� -�` insore,or a ce�Niicaie of Workeri Compensafion Ins��ance, COUNTY OF LOS ANGELES BUILDING AND SAFETY �� or a certilied copy rhereof(Sec.3800,Lab.C.) �J P❑olicy No. Compony FOR AIPIICANT TO FLLL IN O�RESS S C7�IV Certified copy is hereby furnished. New Residentlal Bldgs.8 Pools EACH n10. FEE � Certified topy is filed with the tounly building inzpec- 1 8 2-Family,Sq.fl. S — _ �����TM wt�'�JV� «$ lion deparlmenl. Multi-tamily Sq.Ft. — NEAREST ,l � Residenlio)5wimming Pools CROSS ST. S Date Applicanl i�IRM N ME �� �--�VL�'r 1 � CERTIFICATE OF EXEMP110N FROM WORKERS' pu�lets:Rec_l�ght_Sw.� '�'A�� $��`�_ COMPENSATION INSURANCE F_s p .4DDRE55 (Thls s.crion n«d�wr b•compl��•d if�h•work t�volvd by To1a1 No. Addifionpl CITY Tel.No. �ho p�rmif i�for o��hundred dollars(5100)er Ia��.) 1 cerli{y�hof in ihe performance of the work for which this . A pNCqM� permit is iss�ed,I shall not employ any person in any manner so as ro bec e suhject ro Ihe Wor n'Com sahon Laws. LigMing Fixtures First 20 ADDRESS To�ol No. Addirional Da�e b ZZ ppiicant CITY Tel.No. NOT�CE O AFPLICaNT: If, of� mak�ng � �s ert� co�e oi Fized Appliances Not Over 1 HP pEgMit �r�' Ezemp�i n, yoo shovld become subject t the orkers' Range_Heater_D.W._ AvctiCnNT��r.bT�'Qi� 'r��/� � Compenso�ion provisions of�he lobor Code,you must for�h- Oven _Dryer _W.M._ ADDRE55�0� (�,� (�� with comply wi�h such provisions or Ihis permif sholl 6e iop _FAU —W.H.� .deemed revoked. � qTY�� Tel.No.��O Y � LICENSED CONTRACTORS DECLARATION Hood _Fan _Othe�_ �-y Disp. _Room Air Cond. _ � LiCENSE OR , �22 J p CIa55.0 �O � I he�eby of(irm fhot I om licensed under provisions of Chapier 9 RFG.NUMBER � (commencing wilh Section 7000J of Division 3 of ihe Business DISTRICT NO. P ED BY 0.' . ond ProFessions Code,and my license is in full force and effecL Power Apporotus B Lorge Applionces O. Y�P ZZ 7 (7 � Size 8 Type HP,KW,KVA,or KVAR � U License Number Lic.Closi FINAL (L^ Up to 1 Incl, I rI . S !O +'� Over t fo IO lnd. DATE !l/d' VAUDATION N Coniroctor�a��,��_��Date� (C _ , ❑ , �_ Over 10 to 50 Incl. FINAL `, W I am exempt un er Set. Over 50 to 100 Inc. BY ��7'Ll A p.; 0.8P.C.for�his reason Over 100 �R• � • • •2 . . Z � Data: $ervices,Swbd.,MCC B Panelboards , � 0-400 Amp,Under 600 V�GL7 � • •�l 3�J�� � � Signo�ure 201-1000 Amp.Under 600 V�� � •43,50� ❑ Over 1000 Amp.or Over 60p V � ° . Exemption for Reg.Maint.Elect. I O.Z 2—8 S SINGLE FAMILY Temp.Power Pole&Appurtenoncas HOME OWNER•BUILDER DECLARATION Sign with One Branch Circuit I heieby of}irm fhot I am ezemp�from the Conlrocror'a Litense Addilionol Sign Bronth Circuifs Law for ihe followin9 reason(Secfion 7031.5, Business and . e� - Professions Code): /J����77r � ❑ I,as owner of Ihe pioperly,will do the work ond the Misa Conduits 8 Conductors �'������ � ,�/ . srructure is not intended or offered for safe(SeUion Olher(See Complere Fee Stheduie)_ � FGC��O 70a4,Business and Professions Code). CONSTRUCTION LENDING AGENCY � I hereby affirm that theie is a constroction lending agency for rhe pertormance af Ihe wark for which this permil is issued pERMIT FEE (Sub-Tolal) � � � (Sec.3097,Civ.C.). � PLAN CHECKING FEE � � Lender's Nome . PERMIT ISSUING PEE � . � Lender's Address I cerlify Ihol I have read this applicalion and stare ihat�he TOTAL FEE �above informat�on is correct.I agree to comply with all Co�nty ordinances ond Siaie laws reguloting Elecniml wiring,ond . hereb oulhorize represenforives of this County to enter u on . the ove-memione �propeny(or inspeuion purposes. SEE REVfRSE FOR EXPLANATORY LANGUAGE �e � ' SignaNre�f dte pat - •-„_ � ; _.. ,.. :r� _,.. ; ; �` -Y � ' LDE C I ,_t . _J_ �. .."c.. �'�P,F�OVALS ,DATE .ci�N'Tl F�-. ' '. .. _ _. _ � t ,. , .t , . __, „ .. . _- .---_ . _ .. _ . ..GWNEP U R D ARAT ON , ... .-,. . �. ��i, .� T�h1P�PO VEP,PC.E,...�- --� _ �..._ _ ..: . _ . � - I herehy affirm fhc;B am emF}`ffom Ihe Conr�ec�cr% '� ���� � i �� �� . . . . _.. .... _. ..._. '. :� ' �: li<enac Lcw fo: Iho Ifollow ng reason (Seclion 7J3L5. �...-_.�. .._ - ,UhDE2SLA�WORK . . ' . .�; _ . � . . , Busl,�ess and Profes;lons Code)�Any dly vr county whicfi -� -� - -'l`"- � RO1]"`H CU�:�UIT �" � r' t' ^i � � . . � . '� requtres apo�mll tc mnstruu,olter,I�iprove,demnli;h. T� ..� j� ': �-�}•;-� �j``?v���� � �G.� � .. . . ..� .� . _ or ropalr any etrutlurc,pNor fo Ils lisuante, also rr- - - - � - - -������NJI�2.hG -� - - � . . �qWro�lheapplfcentforsvchpermn�ofifeas�gnedsrofe- � ; � � -'� --- ���� �� -�- � - � manf thcf be Is(iCensedpUrsuont fe thcFrovislon:o/lhe '__.._ ._._. .._.. .... . -'FIXiU�Es'''., .'_ .: _� � � . „ , . . ,. � __ ._... . ' � , � . ., Conlfector's Ll:enSe lbv�fChapler 9(commencing wlfh � '� � ' --�--��- �' Sedion 70qOJ.of Divlsion 3 ef iho�0�siness dnd Profes- r _ . ,����GV)e:nUTr�i 2=_��-)._. --�_ __ .. . _._ _.._. � � . �� � � � '� ..Flons Code)er lhat he Is exempt therefrom and Ine 6asis _ _ _ _ . UTILITYCO.NOTIFIED ' � ' � �. .far fFe.allogcd exempNon.�Any v7olo��on ol SecNon FINAI ' � .� c7 .- . .. --_ ' . ;' ..- .'' �: . 7031.5 6y,cny c�p!lt�nt for o perm!t subjccis thv oppli- ._.__.. . . .. _. ... _ .. .L�nlcr o Jiokl � � —:-su !fo n�ivlFpetfc�fy of nvf more iFjon��ve hundred . Nores _. . _ �'��!GCs�s� �" , �� �;�j o .. _.� .. .. - - .. ..- � ' � . . . . . . . .. . .. . � ., It aa owner o{1}�o property w I�do Ihe�Wark,and ;ti ' ' " ' �^�" � - � the��!ruct�r(�Is not i�iendud o:offc�ed fo�sple! . . .-('. �.- ;`� � ' , . � ., � . . .(Soc:bi4,Hu�InessanCProf�ssiomCode:� 7heCantrac- , � � � -'•' . .�_.}.; - _-. -_ �"� V � -�--- ` � ' � itor'S Gltenac!aw does nof opp(y fo on ownor ol properly �-�''�� ^�''�"� ��� � -:-. '•� '� , _.,�, �. who 6ulfds or�fmprovas Ihoreon, and who does such � �� � ` � �-� �- - �- - - - - - � �� -� - - � work h!msvlf p:ovfdAd}fiv�auch Improvemenfs ore nof � .'-' � —• � -: • �:1 :. . - . ,----� — -...----�-- -._- . . � � ' . .��inlenAcd or.o(ferrd for se/e.!(,however,the 6udd�ng or � ��-�-' � ���� � � � - - � � ' � lmprovemcnt is scld within'one yecr ci tomplefion.�16c . . � � � � � � � � ' ��ow^ar-boflderv+tflhovetheburdenofprovingthcf6edid r., .'.f . �. .. r>o,�6WId or Improve��r7n2,pvrpDY�`ol sale.) . �.. .. .. . . . . . Y'_a . . . ' ' "..... .. . " �� ..' !"..\ .`._` \.", '•. ..._. . . . ____ . .... \\� . E' -1 I I.�m e.�n�try�t under 5 c_�_.;� �- �, � �,. � . �:�. ..� .. _'.. ._. . .�.... -- B.Z P.C.}or.lh�,rc�son; �4 (-�`� -` . . .... . .... ... . .. 1 Y .� � . , -.,. -. . , _, .. : .•.. �.�,., � , , . .. � i I . ..� �..�. _.�� �� �'•�\. .. �-'.' .�• .. .. . � ; '_-" _ __. .... . . .... . ... _.._. . . . . .� .. .,. , . . .� . .r.,,. . . . , . _. . __._- - � ---- ' ., . , . .�.�. , -'--Dnte- --- .- ... _._..._.. � .. . . .. , . _. . ' - , _ Owner ,. . , ., , .. .. . . . . , .. . .5. .. _ _...._._. -.---... ... _ . � , . - �. . _ . ,. . , . _ .. ,. . -- --._.._— . . �.. .. . _ ... ..,J � � . .. � .. . .'.. __. C__!_' ' _ , . . • . ... . . . ., . , • � _. ' `` .* . .. �. .. . . ..... . 1 � — . . ... .. . . .. ..... .�'L�\��� �,\) J� � � ' . _r•^- �4 �_�� .. �, �\ ^�vj` � ,