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HomeMy WebLinkAbout0785A (4) r - __ __ _._,- - ---_.__-�--___-___._ _.�.._. r�- �i �- . -_.__.. � ���061PENSATION DECLARAT 76A663 APPLICATION FOR ELECTRICAL PERMIT . I ,.., �.. ,_ , I: �` , .,�I , CES06G(2�80I t hereby affum tnat I,have a'.reruticate.of consent to seit COUNTY OF LOS ANGELES BUILDIN AND SAFETI�f . Inture,or e certificate o(Workers'Compensation Irisurance,or ,/ � a certif1��d7 opy thereoP( eC 800, ab.�C.)'� I �I ' � � - ^ L�• + — +�� � ' VV�'�/'!�1�/1/ I d ��'�',�' �� � � FOR APPUCANT TO FILL W� JOB �y�7 � J � VolicyNb.� nn-rr��m�nY ' T 7 P % G EACH NO. � FEE ADDitE55 /oC� �/1/ Ti� � � ; � � � , �, I i - New Residential Bldgs.&Pools � � Certified�copy ii h Ireby furn�shed� , �. ` I�1..i ,' 1&2•Family,Sq.FL $ —' S LOCAUTY y��' '� � � �� ���� il i, � (� �i '� ' i :.I � MWtidamily Sq.Ft. Nea 7 � �Certified copy is fiied with Ihe county�building inspection � CROSS ST " � � . �'� department.' �� �'� ' I; , I! '�� �� Residential Swimming Pools . pWNEq ON '� i�� II� .i - 1 f�r , y� l FIRM NAME r!J � Date �� A�p�cant' � f� • � � ' ,� � � MAIL V Outlets:Rec Light Sw. f '��I I �I ��" II.' , ,': IiI��. I= II �. .� ,�/ First20 O F ' l ADORESS 7�S l �1 � CERTII'ICATE�OF CXEMPTION FROM1f WORKERS' Total No.�LL Additional CITv � � , 7ei No.�jtA � � } , I ICOSIPENSATION INSURANC6 I � PLAN CHECK , a . ' � ��� �� �� , ..: �I�V� I'�� ��i. GI'�APPLICANT � U (This section neeJ lnot c completed�If the work�involved � 3 Lighting Fixtures First 20 A�DFlESS by the permit lis for one hundred�dollars,(5100)'prlessJ [e i i � Additionai 0 ' � !.Ii. ;� �� � .�. �' I��. �'„ ���'� TotalNo. CITv Te1No. U 1 certiry�that'in the periormance'ot�the work for which this Fixed Appliances Not Over 1 HP permit is is3ued�I s6a11 not employ any�person in nny manner PERMiT ' � W sn as tn become subIjectll�he Workers IComPensafion'Laws. Range_Heater_O.W._ APPLICANT �C ..�OA n, I �... I' I ��� I �i, 'i . Oven _DrYer_W.M._ ADDRES�S � . .,c� Z I j ���� ToP —FAU W.H.._ Da� � APPI��in` " '''' . . � � CITY ,f � �Tel No 3 ? I I (I I�I � I I I��� !' �I I '�� Hood_Fan LOcher_ ^�� h c NOTICE��'i0 APPL1CANi ff,after mak�ng this Certificate of _Disp. _Room Air Cond._ J 3 LICE SE O �/ � � ExemPtion,I�oa,shouldll6ecome subject to Ithe I{5'orkers' REG.NUMBEP���/�� Class ^/� Compensationlprovisions of the LSlbor�Code;youlm4st forth• Power Apparatus&Large Apptiances DISTRICT NO. PR ESS D BY with comply�w�th sueh�prov�s�ons or this permrt�shall be � —� deemed revoked ' 1 � . .I � � � Size&Type HP,KW,KVA,or KVAR ��;i I.� I ��. �I f �. „� II I I�.�` II�.�� ��� � UPtailncl. FINAL i ', Ovef 1 to 1 D InCI. DATE _ C�r VALIDATION LICENSED CONT ACTORS DECLARATION�' � G�— , Over 70 to 50 Incl. � •�������-� �i �,I�I I�:1, �j���. Ii (I�� �' . FINAL � 1 hereb affirm that I nm censed Under provlsions o(Cha tet Over 50 to 100 ine. BY 9(commencing ivith Section 700D)'ot�ivisitin 3 of the➢usi- Over 10D ness and Protessions CoAe��and my license�is in full force and effect.. '- .I��I �� 1�� �I �� � ' �' ��i I 'I Services � ,� ���:������ '-�� ,.�. �� ��,,� D-200 Amp.Under 600 V � License Numl{i � ''Ua Clsss ' ' / I 201•1000 Amp.Under 600 V Contractor�' ��;��� � �7Daie�. ��e2C+'�I�� �� Over 1000 Amp.or Over 600 V . ��.����F� � �I�i'� I� IP�i l �� � � �; � 4 � ; . . � •i� HONE'011'NER BUILDEft�DECLARATION I ' �i Temp.Power Pole&APPurtenances '� '����� I ��'� C � ���'��� �� � Signwith One Branch Circuit I .:e Q n q n 1 hereby af[irm�that .1 am�exempt from the Contraaor's Additional Sign Braneh Circuits � ' License Law fotlhe followmg reason (Seclion i7031.5.�Busi- � �.�,���.,•� ness and Profess�ons Code) I '�.j ��� ' � ' � �I� 'i � • '��i: I � Misa Conduits&Conductore �. •l_p 1 � 1,as owler�of the pr Iperty,�,will do Ithe work�Ind the Other(See Complete FeeSchedule)— structureii$'�not interided or,offeredlfoi��sale�,(Section � 9044,f3usidess and Profefslons Code)J � �� � 'I CONSTRUCTIO�1 L'F.NUING!AOENCY -� �� �, . - . . � I hcre6y aifirm�that therei�Is a 4onstrucNbn lending egency . for [he peifoimanee tif tl�e'woik Itor ivhlch',ihislpermit•is pERM1TFEE � lSu6•Total) �Q � issued(Sea13091.�C��.C.). `����' ' � I �� � '� I�i� .�� � Lender'sName'I11�. i. Li', i � :I - ''V',. �i '� ����' I, I�I I' �I �� 'i� � 'I I��, PLAN CHECKING FEE' (One•Fourth Permit Fee) Lender's Address ' � � � � ' , i� 1�,, . . i � I PERMIT ISSUING FEE j � I certify that I.iavl lread this application,ond�state that,th'e TOTAL FEE Z,,� gQ � ebove informallon'is correct.11 ugree to comply with al�County . . ordinances anA State laws lregWbting Electrical w�dng�,and � hereby authorize`representat�ves uf this��County�to entrr upon . � . � � theabove-mendoned;property'for Wpection burposes I '�, � 5EE'REVERSE FOR EXPLANATORY LANGUAGE ' %I.l_:��(.1��7,Q�J II'� I '� `I D�locLi.�l ` ' Signature of Permittee �I,' , '�, � Date; �� . . �n., �I I ���. _ . . . ._ _ -- - -- _ _ _ . . • . . 1 . . . . . .. . . . 01YNF:R•LUILDER DECLARATION ' � � � � 1 hesby affizm Ihat 4nm esemPt fmm the Contrae. .... ._ _...._. ..._. .. ._.:� � .. . ��araova�s ��; �n7e �SIGNGC,TUORE � � • LiCensC L8t5' �or.[ItB follqtVing re�son (Section 703 ' - � . ��- - - � �� Busrrress aad Profesrror�s CodeJ: Any�ciry or co4 ... ' ' � "' ���. � `rennr�.voweR PO�e � . � ' - -� '��� , . ' K•Grcl� �eqerrres a pennit to consrnrct, a7rer, impn -_ , , - � � �--� ���—" ' � � ' - U,�ibeRS�ae�voF�K� � � �� '- '�' . demolrrA,or repair mrl'atnrcfure,priur to!ts isrum -- ' - � -- � - . aiso requires r1�c applrcanr fUr SUCit pellni! ro jrl ��-- �- � -- "ROUG�I cONDUIT_- " - - � � - � - "� -� signed ata�enrcin tlmt Ge is licensed ptrn'tr��tt-to'� � � - � ���-"n�`- -- prorisiona of the Cnntrector's Lirense Law(Chapte A .. _ ..._.. � L'l'IFiI.N�; . .. ' / . , - , _ . (ranmencing wi11r Scction�7000J of..Dirisroit 3 oJ'�. _ . � . . �FIX7u.Fl[5 . - .� - ' � � � - l�iunress mrd ProJrssiwa CodeJ or tltat he is exer � ' �� ' : , �� � � t)rerefrom ar�d die Lesit far 1hc alleged exemptiorr.A '� ..� �. . ._- _ �___ . Pobv[R aUYHORI � � � � �� rioletion of Section 7031.5 by eny�epplicmtt jora pen UTI�IIY co.NO7IFIEU ' � ' . .subiccta tl:e aPplicarrt to a ciril p�rteGy oJnot mose/l, . � .-_.._. _._ . .. - � - . . , . ,. . , , _ ..� . ' � fivc hurrdred dotlarr(SS00J.: � . � _. . .___ . FiNaL. . _ �'�ifc�t.a�a �Zcst�... ' � � � � ❑1,as o«r,cr of Ihc property oill Jo[hc���ork,a � ' . , - � �� � , ❑ie structare is not intend:d or offerod('nr sale. ' _ - _ _. �_ NOTE' ' ' � ' • � ' � � ' � (Sec. 704a, IJurinesi an:l Profca.irons Code: The Cc � . " � _ ' , � � � , . . t�crtnr's Liccrrsr Law docs rtol apply� to m�awnc� . . , � p�opert}�w/to b�dlds or irnprm�es rh.ereo�t,ettd who do .. • � � � ' - � . I � . s�eci+ µ'ork himself prm�ided lliat suclr inrproeemeii � . - , . � � � are r�ot iirterided o�ofjered jor sale. IJ, koweveq N -. . . ...— .. . . - . . . . . . ��. •� � " . : .. . . . buildirig or i�uproner�renr is'rold widiin une pear � , � - . .:. - . . . . - � _ � �- , . . �coiirpfetiat, !!ie owr.er�builder ici!! hci�e tJte burde . . :..- _�.. ... ,�. .. -_...... . ._ ..:. ,". .. � - , � , � � of prori�g�th.nf lie�did not build Or infprore for th ' .. � I -, . � . . . .. . Furposc of safc.J.. � � i... . . , r , I am exempt�mder Sec. . - - , _ B R P.C.for this reason ' ,Datc _. • Owncr; - _ i