Loading...
HomeMy WebLinkAbout0967A � � WORKERS'COMPENSATIONDECLARATION 76A663 ,�,e, APPLICATION FOR ELECTRICAL PERMIT � CE•806G . I hereby aflirm that I have a certificate of consent fo selF insure, or a certlticate ot Workers'Campensation Insurance,or z certilied COUNTY OF LOS ANGELES 5Qp BU�LDING AND SAFETY � Copy thereof(Sec.3900.La6.C.) � PolicyNo.-� ln(S37Rxompany 4TATF FiTNT) FORAPPLICANTNFILLIN .ios � ❑ Cerfilied copy is hereby furnished. ,, New Residential Bldgs.8 Pool EACH NO. FEE nooaess� Z4254 BRECKENRIDGE LOT 26 . '-�Certlfietl copy Is (iled with the count buildi 1&2-Famil S F �291 S • — � LOCALITY DI6IMOND SAR TR 42571 y ng inspedion 1'• a� i. dEp 2�Im � . MUHi-�Hmily Sq.F!. — NEAREST /i.��•� � Residential Swimming Pools � cAoss Sr. ;C te Applicant E �F T1 FT.ECTP.TC T�T� o'r+NEROR � .. �� . � � . FIRh1NAME M.J. BROCKi'&..SONS -�3�C. � �� V CERTIFlCA7E OF EXEMPTION FFOM 1^lORKERS' � Outlets:Fec_Light_Sw._ �� p�poAE55 P.O, $�$� Q COMPENSATION INSUFANCE� � �. ; � ��7his seclion need not be complsled li the work fnvoired 6y the .First 20 � permit Is lor one hundred tlollers($100)or'le6s.) Total No. Additional cirv .BREA Tel.No.S29—HZ�O I certify that in the performance of the work lor which this Dermit � qPp���M K - ' Is i5sued,1 Shall not employ any Derson in 8ny manner 50 ps to � become subject to tho�Workers'.Compensation Laws. L'phting Fixt�res First 20 � ADDRESS ��-- - � � Atlditional � . �� � Total No. � CITY - � 7e1.No. f� AppliGant Fixetl Appliances Not Over 1 HP ,ICE 70 APPLICANT: It, after making this Certificare of P�RwT E & D �LECTRIC INC. Exemption,you should beceme subjeet to the Workers'Compensation Range_Heater D.W. _ APP���M � provisions af ihe Labor Cotle,you must forthvrith camD�Y��ilh such Oven_Dryer_W.M._ ADDRESS 319 fIC�ARTHUR WAY �Rl �provisions or this permit shall be tleemed revoked. _ � � Tap _FAU _�W.H._ . . CiTv UPALND Te�.No. UCEPJSED CONiRA,CTOFS DECLARATION � Hood— Fan _Other_ — I hereby�attirm that I am licensed under piovisions of Chapter 9 , Dis —Room Air GoM. _ UCENSE OR 422589 Gass. C-1� (commencing with Section 7000)of Divisfon 3 of the Basiness and p' ReG.NuideEa Pfo(eSSiOnS COdE,and ifly IiCCnSC iS In fU�l(Or�e�nd Cf(CCt. O�STRICT ND. PROCESSED 9Y . Power Apparatus&Large Appliances � �) . Size d Tyve HP,KW,KUA,or KVAR V � License Number422589 Lia Class C—�� Up to 1 Incl. FINAL E &D E ELC /' '[�— � over 1 to 101nd. DATE y� �. Con[ractor �Date\?'��� . - .VAUDATION . O ❑ Over 10 to 50 Incl. Fl A� U I am exempt under See. Ovcr 50 to 100 Inc. gy W • B.&P.C.for this reason Over 100 � Services,Swbd.,MCC 8 Panalboards - � �� - � -�- - � Z � ��Date: D-200 Amp.Under 600 V ^ Signature 201-1000 Amp.Under 600 V � � - � -- -� . ove��o0o nmP.o.ove.soo v -^p 9 6 7{� Exemption for Reg.Maint.Elect. �• • �G � ' SINGLE FM.1ILY �-� - Temp.Power Pole&Appurtenances � • �4��p� � HOME OWNEF-BUIL�ER OECLARATION Sign with One Branch Circuit 0 gi,��2'�7�' I hereby effirm ihat I am exempt irom the Contractor's License Lnw AtlCilional Sign Branch Circuits for the following reason{Section 7031,5.8usiness ofxl Prolessions , � --- Cade1: ❑ I,as owner of the property,will do ihe work and the stmr,ture Misc.Conduits 8 Contluctors - - � - - � � � is not intended or offered for sale(Section 7044,Bus�ness Other�See Complete Fee Schedule)_ ► , � and Professions Code). � CONSTRUCTION LENDING AGENCY � �� ��� � � I hereby affirm that there is a construction lending agency 1or ihe � performance of t�e work for which this pe�mit is issued(Sec.3097, pERM1T FEE � (Subdotap 131 �i4 -- � Civ.C.). PLAN CHECKING FEE � � �� �� � � � Lender's Name . . PERMIT ISSUING FEE . ZO SO ' , _ . . Lender's Address ' 1 certiry that 1 have reatl this application r,nd state lhat the a6we TOTAL FEE ],Lt2.1Q .. . . . . information is correcL 1 a9rec to comply with ali COunty o�dinan:es . and State laws regulaling Electrical wiring,pnd hemby authorize . . . . _ represen[atives ot this CouMy to enter upon the above-mentionetl proper�y r in5pec�ion OurpoSes. , 7 ^� SEE HEVENSE FOR EXPLAN4TOAY LANGUAGE S' atuYe ol' it.ee Date - . .,. .... . _ ... -r.� . � . . , . . . . . � o � ,. . I . . . .�. , .. , ' � :��: .. C�'.',1. . . _ ,... .� . _ .. ..... .. ..... .... - . . . . . ,. �� . . .. � , . . . r_,____...,......._.._.____..___..---�----'--•-_.._�.....__. .__..�._...,.___....._._._ .._.._--.___.._.... .._.._..._---��--'-- . � � �: � ' �� � ' � :-`��%��� � �'�' '. .. .OWNER-BUILDER DECLARATION�'� ( ^.,�,, '.r..�...'�i._' ' '�APPROVALS -. _�_DATE. .. ifJ5PEC10RB^.". .. .� ..... . . � . __. .. _ � SIGNATl1RE ... .._ _.. „ . ... . . : "' �"; � 7EMP.�AQINGR POLE � -�t;, � � � I hereby afllrm�ha!I am exempt irom the Contractars Lirensc . - � �--� --�----- _ - -- �- � Law tor the followin9 reason(Sectian 7031.5,Business�;ind j UNDEflSLA�NlORK� - ...... ... ...:....____-.'.._... ___ .__.. . :� .� .. ' Pro/cssions Codel'Any Gty or counly which requircs a�pe�mit � .__..— .___- .-.___.. �.� -,-� �.� � - .. .. {20UGH CONDUIT-' .. �.- .. _� . -...��---�i . ' . . ' ... i....�•� .-..to ConsLuct,alter,irqorwe,Cemolish,'or rcpair arry sfructiue,A�iw � .__�•__ • .. _� " __ .. .. 1 - �to it issuance;also rcquires hc app,'icant for such permit t�yi'c_� s t � W���NG � 1� }�`' -� _ � . , � a sic�ned sta!emenl that he is licensetl pursuant to fhe pronsrons ��. ------ �- �- -� -� � � �-- . � � o!the Crnhacta's Llcense Law(Chapler�9�(commencmg with � FIXTURES, '-�-- - -��� ' ' ' , �.�,..,��,._.n� �- ;:. �,� . . - .-.-�. ...._� ., , � .,',Sectian 7000)ol Division�3 of the Business antl Pro/sssirns � . .__ ... _____-. �t �- ---��- -��- POWER AUTHORIZEO�,-� , � , �� � � i Code)orthaf�he is exempt�tnerelrom�ond the basis fN the i ' ' -�-�- ��------�---UTILITY CO:NO7IFlED � � � , � � ' alleged exempGon. Any violafion o/Seefion 703 f.5 by any �, . � ., .. - . .. ` ry�pliCant hr�a permit su6lects tlre epPlicanl fo a clNl penalty � FINAI-- --�-----j%1tICY QYt f'YOlil �i � �-� � o�not mae than fivc huntlmtl tlotlars($S00): - � ' -'_. __,_ _NOTES . .._._. _ ,� � � , , :. . , . . .. ,, � -.. sifuctu�relisarwt i lendetltoeOifePedtforVsaeo Ihc v.br.an _ k dJne i � ti . ��... . ; . . � . . .. ' �(See.�044.Business tvid Prolessions Codc: 7he Contra.wr's �' ., . . �-�� ��� . - � �Lieensc Lav�tloes rrot a� I�ro a�wmer cf y � �':.' , : �, ,,� .. .. , ; . . . , '�PY P�Aert who buik's ,--��-�- � � ' ' ` ' �� � " "-- ��� ' or 7�rwes thaeon,ar,d who Uoes sueh vraic himsc;/prwided -__ ._ .... ._._' . . _ _'_._ , � . �� . . � . . , . , lhat such hnprovemen!S am not intentled a otle�ed for safe.If, �+ � '."�-�� . .. � ��' ... ; ' � � �,, � howe�er,ihe b✓iltling oa ilnrywemr,nt is sold within one year ot !. .. ... - . ,�, �. . . .. _. � . .. . . . . . , . canplelion,1he Wme�-Cul,'dc�will ItT e the bwdcn of provin9 thal . .__._.__... .,."'__, . . _._..... .._�"'_"_.___.. � . � � . he tlid not build or imp�rnc for 1hc u . .. , p rpose of sa�eJ , . � � , -� :..�. ... . . ' . ..: : . � _. _.. ,.l') _.'_ __ E-------� , i , , _ .. � �- ����"� , . , ::< ..�_,�._.�... .�.. • . .. _�� .� . . � '��IamexemPtunderSec.���� � - --.. ..__ .._ . , , . , , ,. _�: , . ,. . . _._. ._ ....__-- -� - . . . � . . . _- - -- .___ . . . .._. - � t' . , --- -�B&P.C.for ihis reason �- - i . . � . _. ._... __ _ . ._.._.. . . � . , ,:. . . . �__.Date..____. . .-- --- - - � . � . �_ .. _. .: ._.._...._ . .... . .,� , .: : � �. . . ' ' � �.� . Owner , . ._----._._. ._--.. .. . .. . , , . .. �� , I" . ' � , . . , . , . . . , _ . . . i_..; .._ �-. . . . . ---...__ _ ... � . � - � . , � : .. . -