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HomeMy WebLinkAbout1295A �. _ . . . ,. _, ....... _ ._. _ : ..... � "'°RKERS-`°"`PE"S''r'°"°E""R"T'°" '�� '°'8' APPLICATION ��DR ELECTRICAL PERMIT ' � ' , I hereby aHirm thai 1 have o certificate of consenf ro self . ��� � i�. insure,o�a 2ertifimte of Workers'Compensation Insurante, COUNTY OF LOS ANGELE$ BUILDING AND SAFETY ' i.. or a certified copy thereof(Sec.3800,Lab_.C:) -. �. � � . � . , - , . - , . . � . . -;P❑olicy No. ' Zompany � � ,:� � � fOR APPLIGNT TO PILL IN �. - � �. � J06. .. . . �p ,v v.a . Certified copy is fierebyfumtshed. .. � . New Residenlial Bldgs.'&.Pools �-�EACH.- NO. FEE.. �ADDRE55 Ci � - ❑ _.. � � �� .:. � � , . ' � .. . LOCALITY � � . . . . Certified topy�is filed with tfie.to�nty building inspec- 1&2-Family,Sq.�Ft.� S '^' _ (i"�� � �. - lion depprtment � . � � - � � Multi-family Sq.FL � �� �'NEAREST � . . .. . ` . .. . . � � �. � ' Residential Swimmiag Poois ��5 ST. /r � � Date � ..� APPlicont �� .� . . OWNEROR �. . ��n��. . � - � � ���_g � �� - . F RM NAME ; CERTIPICATE OF�XEMPTION FROM WORKERS' � O�tleh:Rec Li ht Sw. ' ' � �'� ' � � COMPENSATIONINSURANCE .���� • . . _��f� . :��� S' ADDRESS � � i' �' {This�secfion�nead nof ba eomplated H tho work'involvod by Totol No�"� Addit�nal� �. ' � CtTY . . . . � 7� ��T� � fhe permif Is for one Aundrad dollnrs(5100)or less.) I�certify ihpt in the performonce of�the�wark for whlch this � � � � � - � � 7LAN CHEdC � � . `permit is issued,I�ahall nOf emp�oy any persan in any mtlnner � ' 2 PP���T . �� Y � � -so os fo become subied to�the Workere'Compensation Lows.� UBhting Flxtures - First 20 � v' ADORESS -� yjy�� � �. � . � �. . . .� .�.�..� . �... , .'. �. `..� � ���Toral No.�_ Additiondl . . .Date � opplimnt - . � . . . � CI7Y • � Tel.No..�� .. ��NOTICE TO APPLICANT: If,-pfter making this Cerfificate of� fixed AppliancesNot Over�l HP . . PERMiT� . . , ��Ezemption,�you ehould 6ecome subjecf�fo�ihe�Workers' �. Range.,,.,Heofer.._p.W..,,._ A��� /� ; 'Compensation provl3ions of the LaboF Code,you must forrh= .� � Oven:_,.,Dryer� _,W.M._ - - .� -���� ADDRESS ��- ������ ��-��� - ' "��-�� � --� f � �wlth�comply wifh such.provisions ar this permtt shall be Top�,_,,;..,,,FAU .—`.W.H.— � . � . y � C deemed revoked. . ..� �-. �.- . ,., ,. .,�� .. . . ' � .��:�:ZItY ._. . .._ -Tel.Na� . . ' � - LICENSED CONTRMCTORS DECtARATION'-,� � � Hood T Fan-� T Other_ . � � � ���� � i� �' " . . .� � . �...Disp:-_�Room�AirCond.�.� � 410ENSEOR . . . � lass.� � �. . I here6y affirm}ha1 f om�lidensed vnder provisions of Chapier 9 � , -. . . REG:NIJMBER " �� �- . � . i (commencing with Section 700D)of Division 3 of��he Bosiness pawer A ratus&Lar e A liances ' � DISTRICT NO. � ROCE BY and Professions Code,and my license is in full force and effect. � PPO 9 .PP � ,�� �� ' -� . .._ . ,.. 1. � 0. .. . . . . . , .. � . Size&Type HP,KW,KVA,or KVAR . � � � . �. . p � . ': license Number�.: �. �:lic.Class ��� � . � . ..Up to 1 IncL .. � . . . . : FINAL.. ` . . . .. - .... . . � . �� � - -� �'� � . �-.4ver7to�l0lnel, DATE<����,, .�.. VALIDAtION e , Q �. � � Commcto� - - Oate - .Over 10 fo 50 Incl, . � fINAI�- .�.. �j , '� � ❑ I am exempf unde[.Sec.� � . -�- ��Ovar 50 to 100 inc. � � BY�... , ..�. � ' � 8.8P.C.for this reason � - : . �Over�100. � . .. � .. . 6 . Z . . . .- . . ... �Services,Sw6d.,:MCC.B-Pa�el6oards .. �. .. . ►. ... .. .. . .. ... -- . . . -.-.-�.j +. .. � D°�e: � �0.200 Amp.Under 600 V � . . � � . ; -Signoture� . .� . . . ,� 201�-1000 Amp.Under 60q V .. . . ._ , . ....- - . . � . - �y : ' ❑ '� � � � Over 1000 Amp.or Over�60p V ' . ... . ��� 2 9,S A � : '�` - �Exemption for Reg.Moint;EIec4..� . . - .....- ...-.... . , . , _ .,._ � � � I _ , #• • • ���2 . ... �. SINGLE FAMILY� ' � . . � . j . � � � Temp.Powe+Role�8 Appunenancas � � � � �� - � HOME QWNER-$UILDER DECLARATION- � - � Slgn with One Branch Circult �' � � �� � . �:�v jJ.�3,']rj. ; � � �, I heroby affirm�hat I am exempt from the Controctoi s license � . Additional Sign Branch-Circuita �� � _4�,1��., -. � Law for Ih�e following reason(Secfion 7031.5,Business ond �- . . . . . '� � � -� � �;,�� ; � �PioyfessionsCode): . . . . � .� �. . �. . '.� . .. . '. .. � . � .� - �. ' � � P p Y � � � Misf:��Conduits 8 Cond�ato�x '� �" . .. � � .�-�.. ...Q.&'�-C�_-a 3 + , . ' � I,as owner of the ro ert,.will do the work and the ��� � � �. structure is nof iroended.or offered for sple(Section�� f)iher(See Complete,Pee.Schedule)_- ► � ; - � � � � . 7044;Business bnd Arofess'rons CodeJ.. � , � � � � � � � - � � , � �� �� � .-� �' ��� - � CONSTRUCTION tENDING AGENCY'� � � � �" � " . � � �3 . . °' + � . . I here6y affirm tha�there is a construuion tending agency for� - � � � � i ! ihe performance of the work�for which this permif�is issoed - PERMITFEE �� ---` - �� ($ob-Tordl) �- -����.- �� � .�,..,. ,...„;. � �(Sec.3097,Civ.C.). . . . � . �. . . . . . - � -. . �. � � �O YL�Z�� ..' PLAN CMECKING 6EE -_.,.. ... .. . .- _�. . . .... . � � . .. .._ ... ...�_. . . . ... ;�_ , � � Lender's Name � . . .. .. . . /O , . . '. . . .' -. . . . . . PERMIT ISSUING fEE . �.� .. � .. ..i . i �Lender's Address � . ' � � -- . � ` .:. -� . ' . . ' � 1 certify that!hpve read this applicaHon ana s�ate thW the ��• �TOTALFEE �. . '. - f � � � �above information is correct.I agree to comp�y with pIl.County �� . , � �� � � -���� �- �,-��"� .� �. . � ordinonces and State laws regulating Electrieal wiring,and � . ��` � � � � . . 5 , �� hereby ou�horize represeprotives of ihis Covnty ro enter upon � .'�. ' � " �� , � ��" � ;,,�� � � � � � - ��� �.� -� . -� � � � � .-. �, � ` - . ihe abo meMioned pr perty for inspection purposes. .�� � ��-- � � � � �� . . . - . ��/���� - SEE�REYERSE FOR EXPtANATORY tANGUAGE 1 " - .Si aiure of P e. . � Dote . . . - . '. � � . , � , � . '# , _ �'-��.�� ����� ,� .. _ . �,a. :•'V+�,:..r +�r�.e�► ++��w. � . . � �'�"�� � 'il i�'ll�! ; r :���� . : ..,. .- � . +.�..+�� -..,r as .r ._ e . . . , �. . .....+� _ - 4-`.,,. . :�,., , �.,�.,ApPROVALS .. ... DATB._. _ . . � . . . . ... , . $�^�{ ' OWNER-BUILDER DECLARATIQN � SIGNATURE - � ��"� ' - �� `- . ' � � �� �"' � .TEfyIP.POWER POLE � � - �' ��� ���� �� �� "� � � � � � I hereby affiim thar l dm axempt from the�Conhactor's �. ' ." ."` ,.. � �� � �� .. .' - . . ....Utensa Lqva for ihe�following.reawn (SecNan 7031.5; , ,{�_.� � ,. UNDERSLAB WORK �� � � _ . . . . , � . �� . . Bmsiness.md Professions Code):Any c��y or counfy whfch � � �� � �� � �` � ��ROUGH CANDUIT � - - -- - . ��� ���'��•� regvlres a permM to consfruct,alfer,improve,demo0sh. i � ..:�� ..-i. � . . - -., ,.- , �� ...; or-repolr�any�alruclare.�prlofto!fs lssuance,�olso"re- '.� .� ..-��-��'� - . . . .WIRING�.: . . .�. w� ",� a;' . � . . .qu6'as The appllconf forsu�h-permH M flle o stgned sfa�e- ' . . � �-: .,. � . : . . � �. ; �- .�`"`.� -...� �. . � ment thaf hv Is flesnsad pursvanf to fbe provlslons of the � --- ,,_.,.. --'FIX'1'URES.�..�. ... . . .�. _;. ._� `.,.e, � -y�,�� ,,�-- � ,- : -�- ....._ ' . Coqtraefori 4cansv Low(Chopfe{,9(eommanNng w�th � ' - ."` '-..y...� .. "......-... . POtNER AUTHORIZED� '. `. : - � ., � . . . � . ' , . � SeNlon�700QJ of Dlvislon 3 of.the Businese ond Profes- � � - - -`�`��' UTill�'�COrNOTIPIED� � � '. . �. `� - - � sions Code)or Ihat hels examp��here/rom and ihe bosis . � . . -foc fhe alleged�exemptfon..Any,vlolotlon of�Seetlon ' ... :-.--.� � �INAL.`- ... f� c� .. .., � . ��� . . '� ,.. ��1.5 by.any opp7foant for a permit su6jects�he appU- . . ,,___ .. � .C�rtf¢r oa .Jrrorst . . . , � .,. . . ' . ��� . �.. . ,: - , edn!ia n Uvi1 penvlfy of not more ihan flve hundred +�oTes • daoan�asoo�.: � .. �.. , �'` �..-.,.. - ., - � � . . . . . .. ..0 I,as�owner of the properry.will do the�work,and � � �:.��� �.:;.1: ,., .,,. .',:. . ' . . . � .. �� " ' -`-�'�`" ` � � � ' � The shuct�re Ia nqt(ntended or oiferod for sale.,,�. . - � � .- - � � ' ��' . � . --:�.. - � - -� . . '-�,�(3ec..704/,Buslness and Profasslons�ode: The Controo- . ...._.. ...� ......� _.. . _.. � � � � � � "��� � � � � �. �for's ticensa Low does not apply fo on ownar.of property _ .__„__., '� ,_ � ,_ �. ,.,___,_ ;. � .. , . _�. �.,. :,,,� , � whe bullds or Improves fhereon,.and wbo.does soc6 � � . - � work K1msaH provtd�d thaf such improwmentz ore not . ' ��...�..._.. _ . . .�:.... . ...... . . . „.. . � �... .. , .. .. . ��� � . . •. .. tntended or offerod forsale.��lf;'.hawtreer,the bullding or . � � � �� � ' � � impravemenf Js sold wltbin one year of�complelion,the ' � . -_ . ' . � , � -"ownor.bulfder wtlf hava fhe bui�den otprov7ng Thot he d�d �� . ------ -' � ' � ��� " � � ' � ' - �not 6ulld or improve for Ihe purpose of sale.) - . . . . .., .... .� . . . . ,. .._. ._. , ... . . .. . . , ,. ... . . .. . . . - I am exempt under Sec. ; . , _ ° B&P.G for this reason :. . ._ , ,.. - � . -_._._.... . �.,,� � . ,� . �_ .,Date... �.. d Owner . . . c ._ . . . � . . � _. ... .... f'.. . . . , ., i . ` . . . .. . .. . . . . ... . . , I�. , . . '_". . . , . . . t. � .�, �� � ,n ,.� ��_ �.� , � - . I. . . ".. ., .,- ,.. . . ..._. .. . . . .' ., .._.. . . .. . . . � . . ... . . .. .... . . ... . .r. , � � , . . . , � -�y . �.