Loading...
HomeMy WebLinkAbout0979A (5) WORKERS'COMPENSATION�ECLAflAT10N ��63 ���87 APPLICATION FOR ELECTR(CAL PERMtT {� I hereby affirm that I have a certificale of Consen[to 5elf insure, G6806G or a certil�cate of ZNorkcrs'Gompensation lnsura�e,or a certified COUNTY OF LOS AMGELES �O BUILD�NG AND SAFETY L� copy ihereof(SeD 3IIOO,Lab.C.) Porcy wo. 1003782 �mpa� STATE FUND Fon avrucuur ro fl��x� ,roe ❑ Certitietl copy is hereby Furnished. EACH NO. FEE AD°�Ess � 24283 BRECKENRIDGE I.OT 38 � Nevi Residential Bldgs.8 Pool t s 2-Famil �291 y _. s LOCALRY eena�ee�ovv �s f�iea w��n me county building inspection x sa.F�. AIAMOND �art;+�nt „ -� MuNi-family Sq.FL � -- NEAREst ��d^�•f E & D ELECTRIC I C. ResidentialSwimmingPoois �+osssT Dale Applicant � OWntER o�+ ' cx��eNnMe M.J. BROCK & SONS IN � CERTIFICATE OF E7(EMPTION FROM WORKERS' OuUets:Rec_Li9ht_Sw._ ` - �� MA�� P.O. BOX 3SO - COPdPENSATION INSUflANCE � - �nooqess (Thia aectbn nead not 6e completetl H the work Irnolwd by tM1e Firs!20 pqmit Is Ior one hundretl dolian(5700)or kss.{ Total No. Additional ��TY - - BREA Te1.�'10.529_gl 0 I,Certily tha[in the performanCO Of thr.Wofk fOf Which fhis permit � . . FLAN CHECK - Es issued,I shall not employ any person in arry manner so as to p�f11�M become subject to Me YVorkers'Gompensailon Laws. Lighling Fix[ures . Firs!20 � AODRESS � Total No. Additional , ,/'�. � � - CfTY .. . . Tel.No. e App!,cant � � Fixed Appi�ances Not Over t HP ..JTICE TO APPLICANT:�II, afler making ihis Ceridicato ot PEhnnir E & D ELECTRIC INC. E:emption,you should become subject�o the Workers'Compensation . Range�Healer_DVl. _ . ����NT prpvisions of the Labor Code,you must torttrwith comply with wch Oven,�ryer_VJ.M._ qDDRESS 319 M � provisions ar tnis perm�t shan Ce deemed revoked. Tov .—FAU _W.H._ C1Tv UPLAND icl tso.446-2I31 LIGENSE�CAN7RACTOFiS�ECLARATION . - Hood—Fan _Other� I here6y alfirm that I am licensed uncler provisions ot Chapter 9 Disp. ._._.Room Air Cond. _ uCENse oq (commencing with Section 7000)of Division 3 0l the Business and REG.IJVMBER 422589 � c��s. Professions Code,and my license is in full fOrce and effect. power Apparatus 8 Large Appl'�ances -- . DiS7Ric7 No. 1 pROCESSED BY Size 8 Type HP,KW,KV�,ot KVAR 1 O 0. O ucense Numher 42Z589 �c.C�ass C�lO Up to 7 Incl. FINAL U DATE �7 �Contractor E & D ELEC• p����j�-Cg�- . . o����o�o�^��. . / VALIDATION 0 ❑ 6.�cr 10 ta 50 Incl. F�Nq� �J U 1 am exempt under Sec. Over 50 to 1001nc. gy �,�! � Over tU0 V B.EP.C.br this reaSon N - Date: Services,Swbd..MCC 8 Panelboards � � ' � � z 0-200 Amp.Under 600 V Signaturc 201-1000 Amp.llnrkr 600 V � � ❑ Exemption for Reg.Maint.Elect. Over t000 Amp.a Over 600 V ; ¢=O Q 7.9 A �o • < • +'� �'�^ SIf1GLE FAMi�Y Temp.Power Pole d ApOurtenance5 � . - HOME OWNER�BUILDER DECLRRATION � I e � C1 Z.��A 1 hereby al(irm lhat 1 am exempt frar.�the Con!racter's License l.aw Sign with One Hranch Circuit �. for the following reason(Section 7031.5,Business and Professions Addilional Siqn&aoch Circuits .. _ <. i U C.� �� codel: 0u24�-S7 ❑ I,as ovrner of the propery,will do lhe work and ihe struclure Misa Conduits d Canductor5 - � � � � -� is not in!r.nCed or cfferetl for Gate(Seetion 7044,8usiness . Other(See Complete Fee Schetlule)_ � antl Prolessions Code). ► � � � � CONSTRUGTION LENOWG AGENCY . _ . 1 hereby afiirm Ihat lhere is a Construction tentling agency tor the � performance ot the wwk for which fhis Cermit is issued(Sec.3097, p`RM7T FEE � {Su6-Total) 13�. /� -� -- �� � ' Civ.GI. . PLAN CHECKING PEE �- � � � �� - . Lender's Name - PERMIT ISSUING FEF � . �LO O . - �endcr's Adaress 142.14 I certiy that I have read this applicalion end state that the above TOTAL PEE . , ' � inlormation is cOrrect.i agre=to Camply with ati County ordinances �� � and State laws re9ulating Electrical wiring,and here6y outYrorize . representatives o!ihis County lo enler upon the ebovc-msntioned � ' - �- � - r inspection//pIIarposes e�/ .SEE REVERSE FOR E%PLANATORY LANpl14GE Si aWr a c ����� ��t��T . . . . . ... Date � ..-� .�..,,.. .Y � .. _.... ... :-_ , . . . �, � . . , .. , • � , '.: . � � .. -,.... . �' � . .. . ., -. ,... , . , . . . � ... .. . ... . ... .. .. _.. .. ..,�. .. . . " , ' .... .. . � _ . , . .. � .. . _ .,C?:., . .,. .. . c,.., _ . . . . _. , i.. . . . . . .. . .. . .. . . ,. � � '� . -.. ._._+. . .. _ ___,_'--•' ' .'-'.. ..._'-' '•" '-.. ...__...._ _._._ .__" .. .. __._._....� _�._ .. . . .. . I � ..,. . .. .. i.. . .. . ... INSPkCTOR'S� . ,.. :� APaROvuS ; -- Dn7E '� ��" � - - --` �---�-�OWNER•BUILDER DECLARATION.��� ,�,' � '- . .. SIGNATUR[- - - �.. . . .� . . ���, - 7EMP.POWER POLE - ..i�l�i�� � - - � ��'�.`� � � �� I hereby affirm that I am exempt from tlie Contractofs License < <� . �. .. _ '.'_. . ' ' '--- • ' _ � - - . . �: � � Law lor.the lallo•.ving reasonlSeetion 7037.5,Susiness'and __'__ � UNDEASLAB NlOfiK '� ' _ . �..- _..�.___ ______ _. � � � . : Prolessirns Code):A cily a counfy which�equires a pomiif �-""-"'- '"...'-'� - -- � ' . . '' . "' � .;i;.'t�COR;i2Cf,81fel,Yi/In/OVe,dMil07'Sh,of fCp�i!��ry StlLC:NC.AliO/ �oucH coraouir - - - ' j � 5 r�,,�� ;�' ' � � � -�� to Its7ssua�ce,afso icquims he npplica�rt fa�such pcimit ta file [ � � � ,VlIAING , ' Q�' -� � i . . � . ' a signCd sta!emenf 7haChe is licensed p�.rsuont to.fhe p.rovlslons �, . . �. ...' �. ... , . ' i -----" -�-'--'------�----FlXTURES---"�� � �� , o�f�c Crnhxror'c�Ckense Law(Chap!cr 9 feommencing with �� :-r;�_..<-;� .'.: . � �. . - - . .._ . ..-. .-- . .. � ., ! =���.Section 7000J o/Dtvision'3�.of.(hc Qusiness and Professrrns ' � ' -"-" �� "---��- �-���- - � " -�-" - � � � Codcl a-thal he'is exempt-lherelrom�and!ho Wsis/a^�fhc -��` ---� `-----.... . ._.. .f'0�7ER AUTHOF71ZE0,. � , � , ' �� allegd c.mmption. Any vlol�Npo ol Sectipn 7031,5 by cvY i--.--------------- -UTIUTY CO.�NOTIFIED �i . � { �.. � . � ��.n6canf fa a permit sublecfs 1he appNeanf Io a'ciN!penalv ' .._..._' _ FWAL -_._ ./;y(j('1'p11�YD)It._ . . . ._. , ., . � � d of rtof mare than five hundred dollars(55001.'�� � � � '�-, ; ,,i � � � , � "� _. ,.�, ' ❑I,as owner of the properfy will do the vrork,and jhe ;_ „___ NOT[s __ __._.. � �• � � � .structure is nOt iniCntled or offered for sale. .. . ... . _ _ .._ ..._ . � . . . . - ,',�f �...... ' . . ., - ' .. - - , � ,, � ��, . .- -(See.704a,f3usiness aad An�essions Code.�'7he Con✓aa....., L_�_----�-�'-� - `- �_. _� .,. , , ' - liCens^Law docs nOf a,opty fa an ownCr o1 prcperYy wDo bui�tls ' ^� � f�.-.' -�'_`!:� ' � ' � � � �- � - - � � ` � a impiwes lhcreon,,i�tl who does sueh wcrk himse(1 prwided . _1., .u..,. ..... � _.�.. .. . �., � f .. .. , . ... � (hat sUch'vnprOvenrents arc not inf^ntled or ollcred lor S�le.Il, t. �-- - . � , ..., . � . ; bowever,�the bul7drng w impro✓emeM is-sbld witnin one year ol � , � � ... �� '��eanple�ion,fhe a•mer-bui�dcr r�il7 ha�fne burcicn of proving lhat , � � ... � . ., - _.._._..... ...__ .. . : �_...::J._.._._.- � _.... . . .. , ..............__.�..""'�'""'" "... .. - � . . �- . . � �� he drd not bu.Hd or lmprove Por the pu�pose of sale.l � �1.// i}j � „ � „ ' �� . — --- _ _. - , . i , ._ .� i ` ,, _. _ _ _ _ _ � _ - . ,.I am exempt under Sec. , •-�� '---- ---_.-_.__�_.._.. �. � � . _. _ � _ . _ .. _ _..__ . . . . �.. . .,�. .,.... , . , �, . . .` -. _. .. •... ._ _.i ' -- -_..... ; , _ . i . __6&P.C.for this rea;on :: , . . .. . ,�_ . ,,. .. • • � ._. ___ _�' _.__ ._ r..�� . � .__. .. _ .. � �. "---�-- � . . � ,.:. .. , : .. .Date - . . . . { i . ' , . �. , ' ' - � � - � Owner _ . ___. .. . . ___. :. . „ . ,.�, . . _i.. . . . .. . . . , . �i- - --- � - - . ' . .. . . , � � � ..,: �r �. . . , . . .. , . , ' ` _' . .. . .. . . .. _ ;� �� �`�' .