Loading...
HomeMy WebLinkAbout0981A WORKERS'COMPENSATION OECLARATION 76A683 70/B7 � � CE-006G APPLICATION FOR ELECTRICAL PERMIT I hereby attirm that I have e certificate ol consent to self insure, or a certi�icate ot Vlorkers'Compensatmn Insurance,or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY eopy thereo�(Sec.3800,Lab.C.) 5�� 1003782 STATE FUND FOR ADPLICANT TO FlLL IN .roe Policy No. Company � ❑ Certifietl copy is hereby furnished. . New ResiAential 61dgs.&Pools � encrt NO. FEE poo�ess 24269 BRECKENRIDGE LOT 40 rf.,� Cedifetl co y ng 1&2-Famit 3291 s. — s LOCALITY 7QS py is filed with 1hZ count buildi Inspection y,Sq.Ft. — department. � Multi-family Sq.Ft. r�naEsr �^�-_^./)� CROSS ST. Date �ri �%� qpplicant E & D ELECTRIC I . ResidentialSwimmingPools ' M.J. BROCK & SONS�INC. OWNEfi OR . � FIRM NAME � � CEFfTIFICCOMPENSAT ON NSURO�WORKER5 � putlets:Rec�Light_Sw.— --���� � � � ,� qDDRESS �P.O. BOX 3SD .-�Thie sactlon neetl not be complNed H ths work Involved by tha First 20 Total No. Additional CITY_ . Tel.No. �parmit le for one hurWrsd doilara(5100)a lesa.) � p�aN cr�CK� 'I certify that in the performance of the work fof which this pefmit , ' � APPLICANT ' -� �is issued,I shall not employ any person in eny manner so as to ' become subiect to ihe Workers'Compensation Lavrs. Lighling Fixtures First 20 � ADDRESS � � Additional � � � Tolal No. CI7Y �� Tel.No. � �•e Applicant Fized Appfances Not Over 1 HP PERMIT � . .JTICE-TO�APPUCANT: If, after making this Certificate of nPaucnrrr �.E & D ELECTRIC INC. Exemption,you should become subject to the Wakers'Compensation � Range_Heater_�.6V. ,_, provisions of the La�or Coda,you must Forihwith compry with such Oven_ Dryer_ W.M._ ADDRESS � provisions or ihis permit shall be deemed rewked. _ Top _FAU-_ W.H.-_ CI7Y � 'ifPLA� Tel.No.9(y(-Z131 � LJCENSED CON7RACTORS OECLARATION . Hood_ Fan _ Othei_ �I hereby aflirm that 1 am licensetl under provisions of Chaptcr 9 _ UCENseOa , - �commencing with Section 7000)of Division 3 ot the Business and Disp. —Room Air Cond. _ REG.NUMeEa� Class. _ Professions Code,antl my license is in tull force and effect . pp�.�r Apparatus 8 Large Appliances . oiSTRICT NO. ' PROCESSED BY Size&Type HP,KW,KVA,or KVAq , �(/ m Q 10 b License Number 422589 u�.ci�ss C-10 _ . . uo io i inc�. . � . . . FiNn� , C� E & D ELEC /�� i (�J Over 1 to 101nc1. �ATE y VALIDATION � Contractor Date7?'-1��T:.��� Over 10 to 501nc1. � FINAL ❑ .I am exempt under Sec. - Over 50 to 100 Inc.- gy W B%P.C.for this reason Over 100 � . _ Serv�ces,Swbd.,MCC 8 Panelboards " ' ,� � ' � �� Z . Date; 0-200 Amp.Under 600 V �. Signature 207-1000 Amp.Under 600 V� � � � � � ` ❑ � � � �� - Over 1000 Amp.or Over 600 V �� Exemption for Refl�Maint Elect. �-^ � SINGLE FAMILY -� Temp.Power Polc 8 Appurtenances HOME OLYNER-BUILOEF DECLARATION Sign wi�h One e�anch Circuit , `4 9�.� A I hereby affirm that I am exempt from the Contractor's License Law �� e for the following mason(Section 7031.5,Business and Pmfessions- ���tional Sign Branch Circuits - � � � ° -• • •2 Code): � Misc.Conduits&�Conductors� � � � ' � -� - � • � 4�.2� �` I,as owner of the property,will do the work and ihe s[ruclure is not interded ar offered lor sale(Section 7044,Business . Other(See Camplete Fee Schedule)_ , • • 1 4?.1 4� pnd Pmfessions Cotle). � oa�u-a� CONSTRUCTION LENDING AGENCY ��" ' - � � I hereby affi�m that[here is a construction lending agency 1or the ' performance ol the work tor which this permit is issuetl(Sec.3097, pERMR FEE � � � (Sub•Totall - � � Civ.GI. PLAN CHECHING FEE � -- � - Lender's Name �� PERM7T ISSUING FEE . � �� �ZO O � - � Lender's Address I cer[ify that I have reatl this application and state that the abovo TOTAL FEE . . � 1[aZ,1(y _ . - . . . . . informa[ion is correct.I agre�to comply with ell County ordinances and State laws regulating Electrical wiring, and herehy authorize . . . . .. . . . . . .. . �epresenlati�es af Ihis County to ente�upon ihe above-mentianed . rt o inspection purposes. SEE REVERSE FOR E%PLANATORY LANGUAGE ' ' ' P- 0��¢�-��- Si e oi e � � Dale �. ._. .. .,. ...r. ; . ,. ... . . ,.. . . _... . . , , .. � . . � . . . (` ,'�. �., r.� . ., , i . '.'_ . . . . ,�. .. � . t_S1 , ,. '... ' , ,. .. ..... , „ ' 'JJ L.I;..... . . . ."._'.. ..._.__ . .._..—. .�_'._..__. ...".,.. . _._.._.,- " . SIG^IATURE .�_.-._ .,.___..._ _....I �. ...�,.�.. .. .� irisaec,lor�'s� ___._' . .'.OWN' ,,._ �,��. � ��r � .� � ,�.- �� - ��qpaROvn�S � -on7E - � . ..- ER-BUIL�ER.DECCARATION_ . _� -- -��-..----`''� �' , ; ' ; � . �. TEMP.POYJER POLE� ��- �� -� . .��- � - - ;.�i,-�� �'����� ��'� ''�' '� ; I hereby affirm that I am exempt from the Cor,!ractor'a License . �. .---...'�-.�.� ..-:'-..--...�.. � '' �:- = .. . . ' � : ,��� Law for�,ihc lollowing reason(Section 703T.5,6usinass and �, UN�ERSLAB WORK ;__. . . ._.._� - .__.._.'—_ ..___._ . +�, �, '. , � '.', : Rn/essions CodeJ:�ny eity or eounty which iequires a pem�it � .._-___'_ '_. ..___ . - _....___ _. _ ..__._.: -'���-•, � - � � � .. -I�i:�fo canstrucf.�2!fe�,fmP�c,ticmofish.a icFa�irarry�stn,efwe,prior ,J . - . � , .ROUGH CON�UIT - � � � ---to Its lssu�nCc,a!so�equires ihe Applieant�or St�ch permit f0 lile ' ___'_ . __.'. _.___ � ; �, NlIRING �, �i .�g f �i � � �� a signetl statement th.1 he is ficenSM p(csuanf to the provis;ons , _ ' -�-�- ��� �-��� - FlXTLIRES� - �- - �� - �� � ; o/the CoMrocfa`s Lxense Low(Cha,ter 97canmencing with : ., .,,,..���,-,.,�.1 � .�.. . .. ._.. .. ...._..�'��--- , , . . . . ; �-� 7�Scetron 70001 ol��Div�ion 3 ot thc F?us.'nrss�and Profcssicns - � .� .:..._ ___,...... __.___. .POtYERAU7HORIZE�. . .. ... ... .. . .. .--... ...._. � Codel a�that he�is�exempf there/rom 2nd 1hc A�sis�ku�l,7c � �. � . ; : � alleged exemption.�A�y�viot�tion o! Section 7031.5 by aay � ..- - -�--..-. -.-- . UTILITV CO.NOTIFIcD�-� � . � . : � �� � � , , ., � ' �'appliCyat!or a pemnit Suty'ects the applieant fo a civif penalty ' .------ ----._ FINAL. --.--�- [_'nICY D3l�Y0171 - -..._._.- � ��� . . � � �� ' I o1 rrot moie than�ivc h�ndred dolfars(5500): '� . . i -�� . , , , _ � � ' ❑I,as owner oF ihe property�will do the vrork.and tL•e !___._.__._ ".__'_'_ _ __"NOT[5 �.. r � -----�-�� -� - ,.�.,. � ---structure is.no[intenCetl or otfered far sale. _ ... ' ---- . . i � ... .. , .� _. . � -'�� �,�� ,� " , � � � - '(Sec:7044,Qusiness anrl Prolessions Cotle: 7he Contrx�.... - � . , i �� License Law�does not apply ro an owner of property who buirds ' � � � ' �' , , � - � . . � � ' ���- � ' - 'or lmproves thercon,�a�tl who does such wak himseli provitleatl _.__...___ _ ... . _...... _.. ._._..__. ._.. . . i , , , . , tha:such irirprovemen:s ure nof infenCed w o!lcied/w sale.��lf, ,, . .�.��_.. '.�. . _ . . ._. _. t :�'..'__ . . � � � . . . . . hwmvcr,��the bm7din or i... . �� � -- -- g mprovement is sold wifhin one yca.'of � , . . - � . _. _- .______-______ . , . , '� ' canpletion,the owner•buifdcr wif!havc the burcien o�proving Ihat {....',.:--.. ..._....._,...._. .._. .:�_..... � ,. � �-"-��- '"-�� � � 'y ' he did not buil0 or Gnprovo/a Ihc pufi0.sc o!sale.) ' ' � - n. � � _ '�. . . . ..,., . � , . _. . ..,._ .. _. ..._ _ .... ._. � - -. ... . '., _ '. .i..___ ...._. ...__.... .. ....� . .... �.__..,� ` . . . . � _ . . ... � . � " j ` ' ` . j , I am exemPt under Sec. �' _ _, . _. i - ' -� ',.! ... .' , . '��� . � .... . .. . ; ._.B.&P.C._for this reason � ' -- . .. � . .. . ... . ., � ' .. . . ._ . . � ,,_ , ... . . � . , , ---�----- - � , � .._ ._. _. ..,,: .. ... . , . , -.`.-Date-- - -- - . . . . . -- - - � . . _ �-, �_� Owner _ � , i , i , . . � � .. ' . . . � . . .. . � , �. . __.___ .__ _.._. . , . . .. . .: . r r. � .�.. . t . . - �� - --- _ -,. _. � ;. ,. . .. . : � . _ . � ., � . . � ;_ . . . � .�.. ;.... . � .. �. `--------- ---�---. __�.._. .. _.-----'- - ----.__. ..._....." . . ,., _., , - , . :� � . i . . . . _ ., � , .. . . .� . , � . . . . . �. .... .--._...� - � �. � ,..:. , � . .._.....__.._.._--__ ._. .. . ...____._. . �_. -_______, . i . � , ..� � ..., ,_. _ , , , , , ; .