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HomeMy WebLinkAbout1007A _ . � , _ .. . _ .. .,�._:.._._._ _. _. . . �_ _. _ _. __ ..� `1. �.�!j . Y:_��R.�.�, �.-�� . . ..,.�: . � � b.. �.. . .. ._t ,�. . �.. . �. .._� ... " ' ,�COMPENSATION DECLARATION � �� 18A963 10/8t /�R � � M �E-BOBG /�41"PLICATION FOR E�ECTRICAL PERMIT � - I hei@oy aHirm that I have a certiflcate W consent to aelf.insute, �. �� .. � . w a certificate ot Workers'Compensatbn Insuran ,or certit' . � � COUNTY�dF tOS ANGELES � '� -$UILDING AND SAFETY � �PY reof(Sec.3800,Lab C.) . � � � . � P011�' � ariy�' � � FOR APPLICAFtT"7'0 flLLiN':...., .�... . -J08 � . ADDRESS . ,❑ . rtifie c py,re hery6y,furnished ;,,; �` � New Residential Bldgs.&Pools E�ACH�.. HD. _ FEE . _. . . � �' .,� � .... . . ... �� � 1 8 2-FamIIY.Sp.Ft. � �... $ — S !LOCAtITY -. Certliled�copy t��Aled'with!he unty Iwilding inspectfon �. NEAaES7 de e . ..,.c.. .�-.� - ., �Multi-famlly S4.Ft. ��� - 'caoss S'i .` .. .. ` . �� Residential Swimming Pools .,..�. . -..—._ .., .._._ _. , ...bate �..APPlicant �� . , OINNfR OR �. � . , . . . . . ,�._ -.-.: � ERTIF TEOF'•£XEMPTION��F WOFiKERS • � �.. . .� � � ...__. _ , .�. ._.,_ � �. FlRMNAME � � , � ,-. C9MPENS,4TION WS NCE>� .� " �Ourets:Rec—Light,_,.Sw .._.._. � ... Mal� .;� . . . ,. ..,:_ , .y� - . . _ ..,_.. , .1.� ..... ADORES ' . . � :..('Ihls sectfon.need nOt 6e.compteted if the xark�Ipvolvetl by the �� � � ��First 2D � � - , . � "�Total No: �Additional�-..�.. -_ . .... _.._ :CI . .. . �.. ��... , � el.Na � ,,,,� . ���permtt ia for ona Nundred dollars($700)or kss.!. ...r �� �, . . � �� :p N eCK ' ��Lcertify that in the�.PerformanCe.ef.the wwk,for which thls PermN �. . ..._... ..,._ ._. . ...._ APFLiiCAN7 .._ _ �.__..; . � � � ��. - �become su6ect to the�.NJorkers'Compensation�.manrvec so,as to ���. �. � , : ` � � F . . . � R issued f.sball rWt emPbY�1Y-Person Gtalaws. . . U8hdn8Fixtures � .�First20-.._. . ...'_... ..... ��. . �'�AODRESS ..� , , -� �' �'�.. j _ . � - � ,. . � � � Total Na�� AddiNonal . . . ...�. , `�`. CITY __..:..�. .. ,....; . Tel.Na � Data '"..� . .,ApplicaM ��. ..�.. .. . . ..._ _.. .. � - ' . . �NQ71GE,TO APPLICAN7: tt,,attar-.,making this 4;ertificate of ��xed Appliances Not Ovpr 1�HP p�qMiT ��� -^— , ,�.Exemption,ryou xhould become Bu6jeGt to the Wo�kers Gompe�sation ,.. �Range_�Fleater_��D.W � - � APauCANT � � ... . ._...__ .. —._ . . . � ,Rrovisions of tha La6or,Gode,Yqu must farthwith,coinRly,with such � � Oven__,_.Oryer ���W.M._ ..... __... __-.ADDRE.9 . .. . _. �... __.. _..._. . _._. i .�..promsions or this Pemiit.ahall'�e deemed rewked.�� .,.,' .._.TOP--—...EAU.�W.H.".._. � � . ..,.. _ .. ..._�. �_:- CITY.. _.___..._ .... __ 7..Na. � � ,.,, ..�,.LICENSED�CONT9ACTQRS pECLARATION . .c � � Hood_.Fan _.Other_ �� �,.1 persby affirm thai I.am ticensed.under,provis,ions of�`hapter 9_ �� � �� � � ucEN oR � � � ._�..LNSP.-�•..Room�Afr.Cqntl. I. ��Ycommendrig with Sectiqn 70001 of DMsbn 3�oi the Buairieas erM �� ""`" �� ��� ��� � AEQ:NUMaER-`����� ��--��`--� . ProteS810n3 CtlUe 8ntl`my IiCensB is in�fuil force end effect.'' �01STRIG7 NO. � ��� pCESSED BY ��' : . ; . .. -. ..PDwer NPDardtus 81,a�ge Mvliances .__. . ... . .._ . .�..._ ._.... ��__. .... ..._ _ . �.,�7 � . . - 4��L� . Size 8 Type MP,KW,KVA,ar KVAR �. � � � y o� . L Ntimbei����lic.Class T T�^. .. �. .. -..UP�Y InCC�.. . ._ . ..�.... _._ . . . FlNAL . _.... . .. . __ .. . ...._ . _._. �,4TE � � {. 'oate , :�°��� �. . . __ ,Y951P9A�SJ. , a ��� .. Over t�to SO lncl. � FINAL � � � . ❑ _lam xemPturxier ea : '.. . . � - _ ,_..._ .... OverSO,to.t001na....,..... � - BY........._. .._ �:._�..___. .OS�_ _. _. . .. __ .. _. .__. ____. .. . �" .�' - . ' B P.C.for this reason � . .�. Over 100. � � . . . . . � _... ..Services,�Swbd.r�MCC�&Panelboartis�...'•- .. ._..__... � ..... � . � . ._.. .___ Date:�- . _ ....._.. _.:�.. .............�. . - .___ ._.... .� . _�...... . �.. .._ . � 0•200 Amp.Under 800 V ' - � �+ 6ignature . . . . . _: ....:..20t-1000 Amp.Urn�er 800 V � � � - � ; : .... .. .___., ,...._.. ._ .. ._... ._ . ......___. ... .. ._.__._... __ .......:.. .. ..._.... .. . _....._.. �:..,.: . _ Over 1000 Amp,or Over 600 V . ._ .,... ... . ._ � ❑. .ExemPhon fo�Reg.MaiM.Ekct. . � � ..,. __... ._.__. _:_ �..... ,__..._. _. ...... ._.: . , ..�..�. .�..._.... .. ..�_...,.... . ...�...._., ...�__.� .. ..�� . .. .��_...-�SWGLEfAMILY . _.�.... � .' . TemP Power Fole&Appurtenances � � � � � . . .:....HOME OWNER-BUILDER DECLARATION � Sign with Ona&anch Cfroult �� .�_�...-. � .. .:.. . .... .....-... �,.... c Y O..Q�A..-� � � � I hereby affirm that I am exempt.from the Contrector's License Law � � � - - � � -�� � � for ttte tolbwirg reason(Section 7031.5,Busfnesa and Professions ��-- �Additiopal$19n.Branch.GirGuikB �.. .._ � . , ,. -. . . :_.,.�,.. _ ,, .,..,.#� •��..�^.1.�..,,., ;� - Code1: � - �. .. . . � ; . .. . .. . � .. � .. _Misc.Conduits d Contiuctoro .' - _ . ..,. .._.. � � f i i� ��rJ Q .. '❑ �.as avner o1 4he . .. ~.,.. ,. ._.. . - :��.�. ..__. . , property,will do Me work anQ the structure ' �' . � i�not intended or offered for.�sale tSectb�7044,Business ��r(See Complete Fee Schedule)_ � �• i •� 7,rj�� '. i . and Profassions Code). �� . ...- . _.... . ._..._. ... . .. .. . ,..-.._. .. . ._. _.. � ._. ,._. . . : oa�u�a�i ; _ �CONSTflUCTION LENDING AGENCY ..- . . ._.. . ..,. ... . .. . ._ . ..... . .�... ._....... .... ....�.'._. . ...:..�, ....._' � . 'I hereby�affirtn thaY Nere i8 a Construction lending egefx:y Mr}he .� .- .. . �.. . .. . � . � .performance of the�wark for whicfi this permit is issued(3ec.3087, . �..-pgqp4fT fEH��-� � � � � Civ.C.. . .. ' _�_.'-- _.,,._.. _.(Suti•7otap ...7 I�..,.� . . . .. . �. .. .. . . . � �, ���_ -PLAN CHECKING FEE .�.,... :..._ ..��,.... , � � � � �- . ; . , lender's Nama� � . . . ._... . .._..: _ __._ .,._._ ..._..... . . , � . . , ..._.. _._.. . � " . . . . , . PERMR ISSINNG FEE ,.�.; ,_.:.. � .,�� � � � � . .�' . � - � � .._ ...:. . ..... . ....._ . . .. _. . - _' Lender's.Atltlress� � . . . .. - � . . . {. .I certify that I have read fhis applkztion and atate that the�atiove TOTAL FEE� �- � �'�. t`�, , � � . . ...... ._..__.. .._ �._.. . ...�, . ..:: ..._.._ .� . .:... . .._.. ..,.. , _�.__. .,_ .. -�intormation is correct.1 ag[0e to Comply with all Counry ordinenCes . . - antl-State laws regulatinQ Electdcal wirin9.aM heiebY authodze � � .. . ' � � � . � � � -,.., � ' �rePresentaUveS of ihis Coun to e ter u . ...... ..:...�.. ...._:._: ,..,,._ . . ..__. __.._. ..:.., ._;......_ . .-..�,. ...._._.. ..___, .. tY pon ihe�above-mentioned ""._..-". � � ,Propertv P 'n DurPoses. , .� , .:... _.__ ..�SEEREYERSE FQR EXPLpNATORY LANfil1AGE.,...__. �� � . . .. . .1 / .. . . ,_...- —... . .. _. _.�.., w ,.._.� . , �BiCnature o ee . . te G . � . .. , . ..� . .. ' . .. � � .. � � ),� f r� .. ..7"� ..t/�7s.>,'AC'� � .r�.,,.,.., 9�t � `:�� �r 3�l�a11�. a�s� Y `)':, ,.i��zn li c, . I �i 'tk�al I t ri�i�.. ±�.�...1� .. � YT3 . C.�k F.)Yh.�ai°ti7 �3J `kn �, I�O'�'� Z j. r „ � .ie ia � �� �r � v�o� �-^� � :,` h„�,,.�_1 �.�. ,.._._...,..._._..___. ..�..,_,...��._._..w ,.... ,...� t ��^�(�,y� , . E�"{ f �� `ht, (�}ALS a -flAT� I R' 'r -- --� �,y;� .^��1,\ "O.NYMEC'�WiLC1ER CyL�1R�lOM1� <� � c�`.t����...��.� S` �p�� i __ .a � �1���i1�t�riE� ` '_ _ �,n d � ' , � � „ �-� y� ���.,, ''',� .� _.,..�.,t T€€ARF'��WER Pl�LE��� '� �j - -( ��� . .._ .",, j ,,r +I hereby afflrm that f am exempt'from thB�Gbn4'ractor's lker�e ,".Y�,:'-.��s b,�S,� ? . UN �.. fJOijK ,,:, .�-_.- i.. .�_ . _ ._ �"' �,..�.� '%�±�te�for theCode).'�9.teas�a c�amtf�W�ich.ro4u+�shlessr�d � ``�` �L� RQUGy �DUIT �._r...._____ . t . r.�. - ,.� 'o",s� � � � i_� , � _-� ,;;__ � _,��.�� „ ��.�+�x:� i � �e���iemeM`t�s V�c9n�s��t.ra me�1 ro)ire __� '��O ��`� �XT E$,. -�J� . _-_f - -..; �. ,,..-.,. . 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