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HomeMy WebLinkAbout0970A (5) i f WORKERS'COMPENSAIIONDECLARATION 76A663 t0/87 AppLICATION FOR ELECTRICAL PERMIT [, ' 1� I hereby n�fi�m[hat I have a certificate of consent to self insure, cE-eosG or a eertiticate of Workers'Compensation Insurance,or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY � � � copy thereof(Sec.3800.Lab.C.) 6�� �. U Po�icy No. 10�378��a�y STATE FiJND Fon�w��cnnr To cru nv �1OB ' 24272 BRECKErTItIDGE LOT 29 � ❑ CeRified copy is hereby fumished. . EACN NO. �E ��RESS New ResiOential Bldgs.8 Pools � Certitietl copy is filed wim the counry buia+nq�nspection �$2-Family,Sq.Ft. 263G $.04 — S 105 44 ���A�RY DTAMOA'D BAR TR 42571 NERPEST � rtmenJJ � Multi-family Sq.FL — �' � CROSS S7. � Cp' E & D ELECTRIC INC Resitleniial Swimming Poole ��p oR _oate qpplicant FNiMNAA1E M.J. BROCK& SONS,INC. - �CERTIFlCATE OF EXEMPTION FROM WORKERS' " Outlets:Rec—L'ght—Sw.— � �'v'� P.O. BOX SSO � � . �� CAMPENSATION INSURANCE � � � nDORESS (Thia secUon need not be compietetl N the work imdvetl by the First 20 � parmA h tor a+e Iwndrad ddiars iS100)or bas.) Total No. Addilional c�7v . $REA Te1-�-S2N-8I.J0 ' 1 certity that in the perlormince o�the work for which this permit . ' PLAN CNECK � .is issued,I shall noi emploY arry person in any manner so as to - A�PI.IGM become subiect to ihe Workers'Compensation Wws. Ughting FixNres First 20 ADDRESS �� � � . � �� Additional . ��.�..� � Total No. CRY � � .- � Tel.No. � Applicant � � � Fixed Appliance5 Not Over 1 HP ,�ce ro APPLICANT: If, nfter making this cerercafe or A��"� E & D ELECTIC INC. Exemption,you shoultl become subject to the Nbrkers Compensatbn Range_Heater_D.W. _ . I, proviaions of the Labor Code,you must forthwilh comply wilh such Oven_Drycr_VJ.M._ . ADDFESS 319 PIC ARTHUR WAY �Fl provisions or this permi[shall�e deemed revoked. Top _FAU _ W.H._ . . � CITY �I Te1.No. � . LICENSED GONTpACTORS DECLARATION Hood_Fan _ Other_ — �I hereby nffirm that I am licensed under provisions of Ctk�pter 8 Disp. —Room Air Cond. _ LICENSE OR ��g� � (commencirg with Sec[ion 7000)of Drvisian 3 of Ihe Busine55 and REG.NUMBER 422589 C�1� - Prolessions Code.and my license is in full force and effect. po�p,�p�atus 8 Larpe Appliances. . . _ oiSiA�CT No. aaxessEo Bv Size&Type HP,KW,KVA,or KVAR � O 1'IQ�Q p � license Number 422589 uo.ci�s-C-10 uP to�moi. - � � Fiw�� �� - v �1 Over 1 to 10 Incl. ..VAUOATION /�' ,�� "'� DATE + Contmctor E & D ELEC Date�/�'��� 7 pver t0 to 50�ncl. F��� —�j�j � ❑ I am exempt undcr Sec. Over 50 to t001nc.- gy /7 �i . _. .. . .. . � B&P.C.for this rcason Over 100 ��v L—�J � - �Date: - Services,Swbd.;MGC&Panelboards'" ,� � - - -- � Z 0-200 Amp.Under 6G0 V s�9�ar��e 20�-�000 Amp.under soo v c�O 9 7.0 A ❑ . . . . _ . - . . . - . Over 1000 AmP.or Over 600 V . . .. . � e . Exemp[ion Por qeg.Maint.Elect. � ' '2 ��r�. SINGLE FAMlIY � - Temp.Power Pote 8 Appurtenances �, . �� t.1 5 9 4 - HOME OWNEF-BUILDER DECLARATION Sign with One 8�anch Grcuit � r x hereby affirm that 1 am exempt from the Contractor's License Law p���pnal Sign Branch Circuils • 1 1 a 9 L o for the following reason(Section 7031.5,Busines5 and Pro�essions � ' - coa��: D 8 2 4—8 7 Misa Conduils 8 Conductors " � � ' � - � �- ❑ I,as owner at tho property,will tlo the work antl the structure � is not inte�ed or of�ered(or sale(Section T044,Business� Other(See Complete Fee Schedule)_ . . and Professions Codc�. � CONSTRUCTION LENDING AGENCY �� ' � � � � � hereby alfirm th�it there is a construction lerdirg agency(or ihe , `ormance oF ihe work for which lhis permit is issued(Sec.3097, pERMR FEE � ' (Su6datal)� ]_�5 (yLy � ' � - - '•.1. � PLAN CHECKING FEE� - - - �� � - a Name �PERMIT ISSUING FE[ . . �.O SO , . .. . . HCress a!1 have read ihis application and state that the above TOTAL FEE . . ]_Zrj.9�4 �. _ . _ . . .ewn is correct.I agree to comply wilh All County ord�nances �� , antl State laws re9ulating Electiical winng, antl hereby authorize . . . . . ' .. . . . . _ representatives o�ihis County to eMer upon ihe above-mentianed i inspec�Ion pur0oses. SEE REVERSE FOF EXPLANATONY LANGUAGE � ������ � Si a[re o nrtte� Da�e � � . . _.... .�a-- . . ... . . . . 7.. . � i. . . �. - . ,- . , . � - � ; , ._. . .� . .. , . . _ . . . .. . � . �. . � .. 1 . � .... � , . . . . i� .. . , �. , , . �. .._.._ .� ._.... ---._ _..._._.__..._._._..__. __..._..._._... ... ..� ..._.._ .. .,._. � � - --.__._..-- - ,._..�. .. _,. . . . " ' � iNSNFCrOaS ' -- ' .— AWNER-BUILDERDECLARATION,. � � '. . . �' .�� .. APPRDVALS .-._OATE- �.�.SIG�dhTURE -"-- - --..- .. -.- . � �_.. . __.._ _ ._ . , . . _ .. ' ..ifirm Ihat I pm exem t from the Contracto s . ;,_. .. .� .TEMP.PONJERPOLE � i--�'- � :... �.'.�- �� .,-,,. . � .� . � lawr or.the followin9 reason(Section 7037.5, g�� license _ Y' � � _ _. . _.__.� � •� ., _ . . �- ,. � - � . riess.ana jUN�ERSLAB WORK�� '�_.. .... _..'_� ._... _ _'.__. .__ _ . .., !� �, � �� • ,.'� � Prolessions Code):Arry eity a'County which iequires a permit ' __. . _-_- _ .. . � -���- ROUGH CONDUIT �� ._......-.. - -�� � --.--; '�.'.' . . r:�.,� .�fo consVucl,alter,irnp.�ove,Ucvnolish,o�repair any shucGxe,p�lor � �� •���. ; .�,� _- PJIRING �.,.�. � •�.. ��'�' .- � . ':,, _"' : �����suroice,also rcGuires the qeplicant lor such permit to��r. _ �.. . .._- -. _ _ _ r , - . . A statcmertt fh�i(he is licensetl pursuanl to ihe prwisions � ? . ___ � � - j o!fhe Conhxror's License Lew Chap�er 9(commencing wifh . . . ' FIXTURES ._._._. . � - f . .. ..; .i,� .... ...�.. -��- �- �. �- -.....' .�.�.. : ' ��:Section 7000/o/Divls�on'3 ot fhe Busir�ess any Protcs:.'aas � � �- '---� -��'-------�- POLVER AUTFIOFiIZED ��� �, ��-��� , - - �� � � � - � � Coo'c) o'r���that hc is�exr,mpt thr,efrom and Ihe�Gsis dla�the - �� :. � apeged:exemption..Any ividation o/Section 7031.5'by arry , ;_'-_..__...__._._._.._.__.._..U7ILITY CO.NOTtFlcD..- : � . , . � � . '- � 2pplicant!a a pertnit subjecfs the app7icant fo a eivll penalfy � - _._ .___..__..__.FINAL..__.__.._ ..-_ry�tCY 011 f�T'Oi7I -.... . .�.. �� . ... , � . of not moro t�an five�huntlrcd dollaa($500)r ' . � ��� _NOTEs - -"- ' � � ' � - - � - � �- ❑�,as owner ot thc property viill do the vrork,and the .... -- �--- ---.--- ..---- ---- -.-- _I �. ' � -. '. ._aVucture is not Intended or oifared for.sale. ._ ' . . �. ���-' ��� ' - . .. '� ' ' . � . . .. . . . f5ec.7014,6usiricss and Piofessions Cod¢�7he CMtr�.._.a .,: ! .._.....'__ ____ .: . _.. � . � . , Lkense Lnw does not appry to an owner of prnperty who builtls ' ' � ���� �� ��- � � � ' � � � - ���`�' �- � � - � ' � �or frr�piart:s(he�eon,avd wiro dor.s such work himsell provided ,... _. :_._ ..._.-.. . ___:_ _ _—. ...___; ' I „ , , , i , thst such improvemenls�.re rtot intentletl a o11e�M�for sa;a il, � , -:r;. ,., _ . � _. . � .-_. ...,.'___ __. . ..___.._ '_"'__. .. ' � � . , . . �'. ,.. . . haa.-ever,�hC bufltlin or i � . - . ----- --- g m,orovement is SokJ Within MO ycar ol �. . . .... . ,, . �. .. -. . _ . .-_... ... ._. _ . . _. �. � � eompicticn,Ihc owner-Cuildcr wi7f haw thc burdcn at proving lhat ,._._..._"'_.�..._._........ . . �.:._.__ �...___ ._ , �� . , � '� he did not 6uiitl or improve!or the purpose of sate.7 ' , � ��" . � j � � . . . . .. . . `�� : ,. ;�,..l�:i � __- -J-1- � �. . �. �, �. .,�. . � �, � . ..-. , . .. __. .... . . . ... ...._� ._... .. ., _ .. _ . .._. ........ �.��-�. . .� ...... � � � , , . .. .�,.. . . . . �, ...� .� nder Sec. . .'I t; .._. _.._ . -----,: _I '� ' ' ' � '� ���� .. . ._ �. am exempt u�. ., � _ �� . . . � . .� � , � � , :, -�-_ � __.. ....._... •--� „ , , _ , � .,._... . __ _.,.._. , . . .. .. � ._.--B&P.C_.for this reason . . . ' � � :,.� i-. ._....� .-.� _-__ . . . . �.. . � -�� Date-_..--- . ... . . . . ,. . ; � ' � � . ' Owner - � � ... _J ; , . ,. , i � . � . . , . � , � . : � i .. _ _ ...�.__' . __"_. ': . . . � . - ' ' .. . ' . � �. �.. ' . . .... . . . . . , .__. ._ .__ ... .__. _ � . L . . . ' .� ,,. . _ .. . .. . ... i . , -...._.. ------' �-'---- � . . � f _. ...._._. _. .___ . . . . _ ._. . � 1 . _"._..__ i . . � � '_... ' __. ,_.1. I "._'. I'.' I � ... . . . ..... .. .. ...... .. ... ... :: � ).._"_i ... .._. . . � :i' . f � .._..__.. . . _ '/ , � . , .. .. _ . ..__-_.. L . � ...»._._`_.__"'�_�...�....__....... ......... ._......._.. ._. -._..�....._._. , , . . . : �4S���;�-,��. . . - . . `�pUe7 .. ...... .. . . _. . . �. �. • ... . � . . ,. ^'aa�a' . . . . . ._ ._.. _ ._ ._ . . ���^� , . '+�3tl ��� ��